Abstract
BackgroundThailand has experienced a longstanding epidemic of HIV among people who inject drugs (PWID). However, antiretroviral treatment (ART) coverage among HIV-positive PWID has historically remained low. While ongoing drug law enforcement involving periodic police crackdowns is known to increase the risk of HIV transmission among Thai PWID, the impact of such drug policy approaches on the ART uptake has been understudied. Therefore, we sought to identify factors associated with not receiving ART among HIV-positive PWID in Bangkok, Thailand, with a focus on factors pertaining to drug law enforcement.MethodsData were collected from a community-recruited sample of HIV-positive PWID in Bangkok who participated in the Mitsampan Community Research Project between June 2009 and October 2011. We identified factors associated with not receiving ART at the time of interview using multivariate logistic regression.ResultsIn total, 128 HIV-positive PWID participated in this study, with 58 (45.3%) reporting not receiving ART at the time of interview. In multivariate analyses, completing less than secondary education (adjusted odds ratio [AOR]: 3.32 ; 95% confidence interval [CI]: 1.48 – 7.45), daily midazolam injection (AOR: 3.22, 95% CI: 1.45 – 7.15) and exposure to compulsory drug detention (AOR: 3.36, 95% CI: 1.01 – 11.21) were independently and positively associated with not receiving ART. Accessing peer-based healthcare information or support services was independently and positively associated with receiving ART (AOR: 0.21, 95% CI: 0.05 – 0.84).ConclusionsApproximately half of our study group of HIV-positive PWID reported not receiving ART at the time of interview. Daily midazolam injectors, those with lower education attainment, and individuals who had been in compulsory drug detention were more likely to be non-recipients of ART whereas those who accessed peer-based healthcare-related services were more likely to receive ART. These findings suggest a potentially adverse impact of compulsory drug detention and highlight the need to expand interventions to facilitate access to ART among HIV-positive PWID in this setting.
Highlights
Thailand has experienced a longstanding epidemic of Human immunodeficiency virus (HIV) among people who inject drugs (PWID)
Among 128 HIV-positive PWID participated in this study, 25 (19.5%) were women, and the median age was 38 years
We note that evolving antiretroviral treatment (ART) guidelines have dramatically increased the proportion of people living with HIV (PLHIV) in need of ART, among high-risk populations marked with significant comorbidities, including PWID, as the Joint United Nations Programme on HIV/AIDS has recently estimated that approximately 85% of PLHIV are eligible for ART provision under the 2013 World Health Organization criteria [25]
Summary
Thailand has experienced a longstanding epidemic of HIV among people who inject drugs (PWID). We sought to identify factors associated with not receiving ART among HIV-positive PWID in Bangkok, Thailand, with a focus on factors pertaining to drug law enforcement. Injection drug use-driven HIV epidemics are salient in Asia, which accommodates seven of the 15 countries worldwide where >100,000 PWID reside and where an estimated HIV prevalence among PWID is >10% [3]. Recent reviews have suggested various factors constraining access to ART among PWID worldwide, including individual (e.g., ongoing drug use), social (e.g., stigma), and structural factors (e.g., incarceration) [8,9]. Recent international research has elucidated the adverse effects of incarceration on access and adherence to ART [8,10], other impacts associated with the criminalization of drug use have not been fully investigated. In Thailand, the number of people who use drugs detained amounted to more than 102,000 in 2011 [15]
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