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Willard N, Srirojn B, Thomson N, Aramrattana A, Sherman S, Galai N, Celentano DD, Ellen JM. Coalition formation to address structural determinants of methamphetamine use in Thailand. Health Promot Int 2014; 30:782-92. [PMID: 24493782 DOI: 10.1093/heapro/dau001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Despite two recent government-sponsored 'wars on drugs', methamphetamine use continues to be a pervasive problem in Thailand. Out of concern for reported human rights abuses, there has been a call from the international community to take a different approach from the government's 'zero tolerance'. This paper describes the adaptation of the Connect to Protect® coalition formation process from urban U.S. cities to three districts in northern Thailand's Chiang Mai province, aimed to reduce methamphetamine use by altering the risk environment. Project materials, including manuals and materials (e.g. key actor maps and research staff memos), were reviewed to describe partnering procedures and selection criteria. Potential community partners were identified from various government and community sectors with a focus on including representatives from health, police, district and sub-district government officials. Of the 64 potential partners approached, 59 agreed to join one of three district-level coalitions. Partner makeup included 25% from the health sector, 22% who were sub-district government officials and 10% were representatives from the police sector. Key partners necessary for endorsement of and commitment to the coalition work included district-level governors, police chiefs and hospital directors for each district. Initial coalition strategic planning has resulted in policies and programs to address school retention, youth development initiatives and establishment of a new drug treatment and rehabilitation clinic in addition to other developing interventions. Similarities in building coalitions, such as the need to strategically develop buy-in with key constituencies, as well as differences of whom and how partners were identified are explored.
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Affiliation(s)
- Nancy Willard
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA Johns Hopkins Bayview Medical Center, Mason F. Lord Building, Center Tower Suite 4200, 5200 Eastern Avenue, Baltimore, MD 21224-2780, USA
| | - Bangorn Srirojn
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mia, Thailand
| | - Nicholas Thomson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Apinun Aramrattana
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mia, Thailand
| | - Susan Sherman
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Noya Galai
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - David D Celentano
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jonathan M Ellen
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Csete J, Kaplan K, Hayashi K, Fairbairn N, Suwannawong P, Zhang R, Wood E, Kerr T. Compulsory drug detention center experiences among a community-based sample of injection drug users in Bangkok, Thailand. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2011; 11:12. [PMID: 22014093 PMCID: PMC3217860 DOI: 10.1186/1472-698x-11-12] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 10/20/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Despite Thailand's official reclassification of drug users as "patients" deserving care and not "criminals," the Thai government has continued to rely heavily on punitive responses to drug use such as "boot camp"-style compulsory "treatment" centers. There is very little research on experiences with compulsory treatment centers among people who use drugs. The work reported here is a first step toward filling that gap. METHODS We examined experiences of compulsory drug treatment among 252 Thai people who inject drugs (IDU) participating in the Mitsampan Community Research Project in Bangkok. Multivariate logistic regression was used to identify factors independently associated with a history of compulsory treatment experience. RESULTS In total, 80 (31.7%) participants reported a history of compulsory treatment. In multivariate analyses, compulsory drug detention experience was positively associated with current spending on drugs per day (adjusted odds ratio [AOR] = 1.86; 95%CI: 1.07 - 3.22) and reporting drug planting by police (AOR = 1.81; 95%CI: 1.04 - 3.15). Among those with compulsory treatment experience, 77 (96.3%) reported injecting in the past week, and no difference in intensity of drug use was observed between those with and without a history of compulsory detention. CONCLUSION These findings raise concerns about the current approach to compulsory drug detention in Thailand. Exposure to compulsory drug detention was associated with police abuse and high rates of relapse into drug use, although additional research is needed to determine the precise impact of exposure to this form of detention on future drug use. More broadly, compulsory "treatment" based on a penal approach is not consistent with scientific evidence on addressing drug addiction and should be phased out in favor of evidence-based interventions.
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Affiliation(s)
- Joanne Csete
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 50 Haven Avenue, New York, NY 10032 USA
| | - Karyn Kaplan
- Thai AIDS Treatment Action Group, 18/89 Vipawadee Road, soi 40 Chatuchak, Bangkok 10900 Thailand
| | - Kanna Hayashi
- Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, British Columbia V5Z 1M9, Canada
- British Columbia Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Nadia Fairbairn
- Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, British Columbia V5Z 1M9, Canada
| | - Paisan Suwannawong
- Thai AIDS Treatment Action Group, 18/89 Vipawadee Road, soi 40 Chatuchak, Bangkok 10900 Thailand
| | - Ruth Zhang
- Provincial Health Services Authority, 700 - 1380 Burrard Street, Vancouver, British Columbia V6Z 2H3, Canada
| | - Evan Wood
- Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, British Columbia V5Z 1M9, Canada
- British Columbia Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Thomas Kerr
- Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, British Columbia V5Z 1M9, Canada
- British Columbia Centre for Excellence in HIV/AIDS, 608 - 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
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Kerr T, Fairbairn N, Hayashi K, Suwannawong P, Kaplan K, Zhang R, Wood E. Difficulty accessing syringes and syringe borrowing among injection drug users in Bangkok, Thailand. Drug Alcohol Rev 2010; 29:157-61. [PMID: 20447223 DOI: 10.1111/j.1465-3362.2009.00093.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Thailand's longstanding HIV epidemic among injection drug users (IDU) has been attributed, in part, to the Thai government's unwillingness to implement evidence-based HIV prevention interventions. This study was undertaken to examine risk factors for syringe borrowing among a community-recruited sample of Thai IDU. DESIGN AND METHODS We examined the prevalence of syringe borrowing among 238 IDU participating in the Mit Sampan Community Research Project, Bangkok. Multivariate logistic regression was used to identify independent predictors of syringe borrowing in the past 6 months. RESULTS A total of 238 IDU participated in this study; 66 (26.2%) were female, and the median age was 36.5 years. In total, 72 (30.3%) participants reported borrowing a used syringe in the past 6 months, with 47 (65.3%) of these individuals reporting multiple borrowing events. In multivariate analyses, syringe borrowing was positively associated with difficulty accessing syringes [adjusted odds ratio (AOR) = 2.46; 95% confidence interval (CI): 1.08-5.60] and injecting with other people on a frequent basis (AOR = 3.17; 95% CI: 1.73-5.83). Primary reasons offered for experiencing difficulty accessing syringes included being too far from syringe outlets (34.1%), pharmacies being closed (13.6%) and being refused syringes at pharmacies (9.1%). DISCUSSION AND CONCLUSIONS We observed an alarmingly high rate of syringe borrowing among a community-recruited sample of Thai IDU. Various lines of evidence indicate that poor access to sterile syringes is driving the high rate of syringe borrowing observed in this study. Immediate action should be taken to increase access to sterile syringes among Thai IDU.
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Affiliation(s)
- Thomas Kerr
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.
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Milloy MJ, Fairbairn N, Hayashi K, Suwannawong P, Kaplan K, Wood E, Kerr T. Overdose experiences among injection drug users in Bangkok, Thailand. Harm Reduct J 2010; 7:9. [PMID: 20465842 PMCID: PMC2880311 DOI: 10.1186/1477-7517-7-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 05/13/2010] [Indexed: 12/02/2022] Open
Abstract
Background Although previous studies have identified high levels of drug-related harm in Thailand, little is known about illicit drug overdose experiences among Thai drug users. We sought to investigate non-fatal overdose experiences and responses to overdose among a community-recruited sample of injection drug users (IDU) in Bangkok, Thailand. Methods Data for these analyses came from IDU participating in the Mit Sampan Community Research Project. The primary outcome of interest was a self-reported history of non-fatal overdose. We calculated the prevalence of past overdose and estimated its relationship with individual, drug-using, social, and structural factors using multivariate logistic regression. We also assessed the prevalence of ever witnessing an overdose and patterns of response to overdose. Results These analyses included 252 individuals; their median age was 36.5 years (IQR: 29.0 - 44.0) and 66 (26.2%) were female. A history of non-fatal overdose was reported by 75 (29.8%) participants. In a multivariate model, reporting a history of overdose was independently associated with a history of incarceration (Adjusted Odds Ratio [AOR] = 3.83, 95% Confidence Interval [CI]: 1.52 - 9.65, p = 0.004) and reporting use of drugs in combination (AOR = 2.48, 95% CI: 1.16 - 5.33, p = 0.019). A majority (67.9%) reported a history of witnessing an overdose; most reported responding to the most recent overdose using first aid (79.5%). Conclusions Experiencing and witnessing an overdose were common in this sample of Thai IDU. These findings support the need for increased provision of evidence-based responses to overdose including peer-based overdose interventions.
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Affiliation(s)
- M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St, Paul's Hospital, 667-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
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Sutcliffe CG, Aramrattana A, Sherman SG, Sirirojn B, German D, Wongworapat K, Quan VM, Keawvichit R, Celentano DD. Incidence of HIV and sexually transmitted infections and risk factors for acquisition among young methamphetamine users in northern Thailand. Sex Transm Dis 2009; 36:284-9. [PMID: 19295472 PMCID: PMC3682416 DOI: 10.1097/olq.0b013e318191ba17] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Southeast Asia is experiencing an epidemic of methamphetamine use, a drug associated with risky sexual behaviors, putting a large segment of the population at increased risk for sexually transmitted infections (STIs) and HIV and in need of prevention efforts. Incidence estimates of STIs are rare in Southeast Asia, especially among newer risk groups. STUDY DESIGN We enrolled methamphetamine users aged 18 to 25 years in a 12-month randomized behavioral intervention trial in Chiang Mai, Thailand in 2005. Behavioral questionnaires were administered at visits every 3 months, and biologic specimens were collected at baseline and 12 months to test for common STIs (chlamydia, gonorrhea, HSV-2, and HIV). Poisson regression with robust variance was used to determine risk factors for incident STIs. RESULTS Overall, 12.7% of 519 participants acquired at least 1 STI. Chlamydia was the most common (10.6%), followed by HSV-2 (4.0%), gonorrhea (2.9%), and HIV (0.6%). Risk factors for both men and women included self-reported incarceration and having a casual sex partner during follow-up, and having a prevalent STI at baseline. Additionally, among women, having 2 or more heterosexual partners, and among men, having a greater frequency of drunkenness were risk factors for STI acquisition. CONCLUSIONS Although HIV incidence is low in this population, incidence of other STIs is high compared with previous studies of young Thai adults. Risk factors for acquisition emphasize the need for new prevention strategies targeted toward current populations at risk.
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Affiliation(s)
| | - Apinun Aramrattana
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Susan G. Sherman
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Bangorn Sirirojn
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Danielle German
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Kanlaya Wongworapat
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Vu Minh Quan
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Rassamee Keawvichit
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - David D. Celentano
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
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Chan KY, Stoové MA, Reidpath DD. Stigma, social reciprocity and exclusion of HIV/AIDS patients with illicit drug histories: a study of Thai nurses' attitudes. Harm Reduct J 2008; 5:28. [PMID: 18721474 PMCID: PMC2553400 DOI: 10.1186/1477-7517-5-28] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Accepted: 08/23/2008] [Indexed: 11/22/2022] Open
Abstract
Background Stigma is a key barrier for the delivery of care to patients living with HIV/AIDS (PLWHA). In the Asia region, the HIV/AIDS epidemic has disproportionately affected socially marginalised groups, in particular, injecting drug users. The effect of the stigmatising attitudes towards injecting drug users on perceptions of PLWHA within the health care contexts has not been thoroughly explored, and typically neglected in terms of stigma intervention. Methods Semi-structured interviews were conducted with a group of twenty Thai trainee and qualified nurses. Drawing upon the idea of 'social reciprocity', this paper examines the constructions of injecting drug users and PLWHA by a group of Thai nurses. Narratives were explored with a focus on how participants' views concerning the high-risk behaviour of injecting drug use might influence their attitudes towards PLWHA. Results The analysis shows that active efforts were made by participants to separate their views of patients living with HIV/AIDS from injecting drug users. While the former were depicted as patients worthy of social support and inclusion, the latter were excluded on the basis that they were perceived as irresponsible 'social cheaters' who pose severe social and economic harm to the community. Absent in the narratives were references to wider socio-political and epidemiological factors related to drug use and needle sharing that expose injecting drug users to risk; these behaviours were constructed as individual choices, allowing HIV positive drug users to be blamed for their seropositive status. These attitudes could potentially have indirect negative implications on the nurses' opinions of patients living with HIV/AIDS more generally. Conclusion Decreasing the stigma associated with illicit drugs might play crucial role in improving attitudes towards patients living with HIV/AIDS. Providing health workers with a broader understanding of risk behaviours and redirecting government injecting drug policy to harm reduction are discussed as some of the ways for stigma intervention to move forward.
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Affiliation(s)
- Kit Yee Chan
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia.
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Hammett TM, Wu Z, Duc TT, Stephens D, Sullivan S, Liu W, Chen Y, Ngu D, Des Jarlais DC. 'Social evils' and harm reduction: the evolving policy environment for human immunodeficiency virus prevention among injection drug users in China and Vietnam. Addiction 2008; 103:137-45. [PMID: 18028519 DOI: 10.1111/j.1360-0443.2007.02053.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS This paper reviews the evolution of government policies in China and Vietnam regarding harm reduction interventions for human immunodeficiency virus (HIV) prevention, such as needle/syringe provision and opioid substitution treatment. METHODS The work is based upon the authors' experiences in and observations of these policy developments, as well as relevant government policy documents and legislation. RESULTS Both countries are experiencing HIV epidemics driven by injection drug use and have maintained generally severe policies towards injection drug users (IDUs). In recent years, however, they have also officially endorsed harm reduction. We sought to understand how and why this apparently surprising policy evolution took place. Factors associated with growing support for harm reduction were similar but not identical in China and Vietnam. These included the emergence of effective 'champions' for such policies, an ethos of pragmatism and receptivity to evidence, growing collaboration across public health, police and other sectors, the influence of contingent events such as the severe acute respiratory syndrome (SARS) epidemic and pressure from donors and international organizations to adopt best practice in HIV prevention. CONCLUSIONS Ongoing challenges and lessons learned include the persistence of tensions between drug control and harm reduction that may have negative effects on programs until a fully harmonized policy environment is established. Excessive reliance on law enforcement and forced detoxification will not solve the problems of substance abuse or of HIV among drug users. Ongoing evaluation of harm reduction programs, as well as increased levels of multi-sectoral training, collaboration and support are also needed.
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Hammett TM, Des Jarlais D, Johnston P, Kling R, Ngu D, Liu W, Chen Y, Van LK, Donghua M. HIV prevention for injection drug users in China and Vietnam: Policy and research considerations. Glob Public Health 2007; 2:125-39. [DOI: 10.1080/17441690600981806] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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