Health and safety risks associated with public injecting among people who inject drugs in Bangkok, Thailand

Abstract

The injection of illicit drugs in public spaces is known to pose significant health risks to people who inject drugs (IDU). However, to our knowledge this practice has not been explored in the Asian context. Therefore, we sought to characterise the prevalence of and factors associated with public injecting among a community-recruited sample of IDU in Bangkok, Thailand. Data were derived from the Mitsampan Community Research Project between July and October 2011. Using multivariate logistic regression, this cross-sectional study examined the prevalence and correlates of public injecting within the past six months among 437 IDU participants. In total, 121 (27.7%) participants reported injecting drugs in a public space within the past six months. In multivariate analyses, public drug injection was independently associated with male gender [adjusted odds ratio (AOR) 2.51, 95% confidence interval (CI)) 1.29-5.22], weekly heroin injection (AOR 2.19, 95% CI 1.27-3.77), assisted injection (AOR 1.93, 95% CI 1.06-3.49), rushed injection (AOR 4.36, 95% CI 2.65-7.24), incarceration (AOR 2.27, 95% CI 1.01-5.04) and noticing police presence where drugs are bought or used (AOR 1.83, 95% CI 1.06-3.19). A substantial proportion of Thai IDU in our sample reported recent public drug injection. This behaviour was independently associated with a wide range of individual and contextual factors that pose significant health and safety risks to the IDU. These findings highlight the importance of addressing the broader social and physical risk environment surrounding IDU as a means of preventing negative health outcomes among this population.