Compulsory Drug Detention Centers Research Articles

Relationship between psychological factors and perceived stigma of addiction among women with substance use disorders, Thailand.

BACKGROUND:Substance use disorders (SUDs) are one of the most stigmatized health conditions that impact drug user's treatment engagement. However, to date, little is known about perceived stigma and its correlates with psychological factors among high-risk groups such as people with SUDs in the criminal justice system. This study aimed to determine the association of psychological factors and perceived stigma of addiction among women with SUDs.MATERIALS AND METHODS:This cross-sectional design was conducted on 652 women with SUDs who were treated in all 7 compulsory drug detention centers in Thailand with consecutive sampling technique. The data were collected by standardized interviewers with interviewing questionnaire. Multiple logistic regression was applied to examine the effect of psychological factors and perceived stigma.RESULTS:More than half of SUD patients (57.2%) were methamphetamine abuse or dependence, approximately 69.9% reported high level of perceived stigma, 56.7% had mild depression, 34.8% had low level of perceived social support, and the average perceived stress score was 19.2 (standard deviation, 7.5). The perceived stigma was positively related to depressive symptom and perceived stress while was inversely related to perceived social support.CONCLUSION:The psychological factors were strongly associated with perceived stigma of addiction. Thus, the detection of psychological problems among SUD patients may be benefit clinicians for identifying which patients are most at risk of perceived stigma and are the potential targets of intervention to reduce stigma in clinical practice.

End compulsory drug treatment in the Asia-Pacific region

In March, 2012, 12 UN entities called on governments worldwide to close compulsory drug detention and rehabilitation centres for people “suspected of using drugs or dependent on drugs, people who have engaged in sex work, and children who have been victims of sexual exploitation” because of health and human rights concerns.1 In 2020, 13 UN agencies reiterated that statement, focused on centres in Asia and the Asia-Pacific region, citing continued human rights violations, including lack of due process, forced labour, inadequate nutrition, physical and sexual violence toward detainees, and denial of evidence-based drug dependence treatment and basic health-care services in these facilities.

The Perceived Stigma of Addiction and Treatment Utilization among Cannabis Addicts in Thailand.

Context:A major social problem among clients with substance use disorders is stigmatization related to health conditions, which contributes to poor mental and physical health circumstances and becomes hazardous to substance abuse treatment. Meanwhile, decreased stigmatization among cannabis users might occur because some people use cannabis without experiencing harm or believe it to be a harmless substance and might not be receiving treatment. Several studies have investigated stigma toward substance use disorder and treatment. However, less is known about how stigmatization influences treatment.Aims:To investigate the association between the perceived stigma of addiction and treatment utilization among cannabis addicts.Materials and Methods:A cross-sectional design was conducted with consecutive sampling techniques among 977 cannabis users recruited from all 7 compulsory drug detention centers in Thailand. The data were collected by standardized interviewers with a structured interviewing questionnaire. Binary logistic regression was applied to determine the effect of perceived stigma of treatment utilization.Results:Most clients were male (84.5%), had a family history of drug problems (54.5%), and had a history of mental health problems (5.1%). Most of them reported moderate-to-high levels of perceived stigma (87.2%) and received treatment (28.9%). Greater perceived stigma was associated with decreased treatment for cannabis abuse.Conclusions:The perceived stigma of addiction is a barrier to cannabis abuse treatment utilization. Thus, a better understanding of stigma could reduce its negative impact on seeking and engaging in treatment.

Compulsory treatment of drug use in Southeast Asian countries

BackgroundSeveral Southeast Asian countries have implemented compulsory drug detention centres in which people who use or are suspected of using drugs, mainly amphetamine-type stimulants, are confined without their consent and in most cases without due process and clinical evaluation of their substance use disorder.Given these facilities’ lack of access to evidence-based drug dependence treatment, and the human rights implications of peoples’ arbitrary detention under the pretext of “treatment”, international organizations have called for their closure. The aim of this study was to estimate recent numbers of compulsory drug treatment centres and of people in these centres in the region. MethodsWe conducted an analysis of cross-sectional governmental data collected from seven countries in the region with compulsory drug detention centres, namely Cambodia, China, Lao PDR, Malaysia, the Philippines, Thailand and Viet Nam. We computed descriptive data provided by government representatives for the period between 2012 and 2014. ResultsThe total number of people in compulsory detention centres overall decreased by only 4% between 2012 and 2014. In 2014, over 450,000 people were detained in 948 facilities in the seven countries. While only two countries decreased the number of compulsory detention centres, most countries increased the number of people detained. ConclusionsIn spite of international calls for the closure of compulsory detention centres, the number of facilities and detained people remained high in the seven countries included in the analysis. These officially reported figures are concerning regarding access to effective drug dependence treatment and given the potential for additional human rights abuses within compulsory detention centers.Further concerted policy and advocacy efforts should support transition of treatment for people with drug dependence towards human rights-based and evidence-based drug dependence treatment. Expansion of existing drug and HIV services in the community rather than compulsory treatment modalities will effectively address the region’s drug and HIV burden.

Associations of the Neighborhood Environment With Substance Use: A Cross-sectional Investigation Among Patients in Compulsory Drug Detention Centers in Thailand.

ObjectivesTo identify the associations of characteristics of the neighborhood environment with substance abuse among clients receiving treatment for drug abuse in Thailand.MethodsA cross-sectional study was conducted of 1128 drug addicts from 28 neighborhoods who were receiving treatment at all 7 compulsory drug detention centers in Thailand. A trained interviewer conducted structured interviews with the subjects about substance use and the perceived neighborhood environment in their community. A multilevel logistic regression model was applied to estimate the effects of the neighborhood environment on substance use.ResultsThe majority of participants, 53.8% only used methamphetamine pills, 31.3% used other illicit drugs as well as methamphetamine pills, and 14.9% used an illicit drug other than methamphetamine. Three neighborhood characteristics were associated with substance use. A 1-unit increase in the perceived neighborhood cohesion score was associated with a 15% reduction in methamphetamine pill use and an 11% reduction of the use of both methamphetamine pills and another illicit drug. Conversely, a 1-unit increase in perceived neighborhood crime predicted 19 and 14% increases in the use of methamphetamine pills and the use of both methamphetamine pills and another illicit drug, respectively. In addition, a 1-unit increase in the scores for stigma surrounding addiction corresponded to a 25% increase of the use of methamphetamine pills and a 12% increase in the use of both methamphetamine pills and another illicit drug.ConclusionsSubstance use among drug addicts was influenced by characteristics of the neighborhood environment. Therefore, prevention and intervention strategies should be designed based on a consideration of the impact of neighborhood context on substance use behaviors.

Experiences with compulsory drug detention among people who inject drugs in Bangkok, Thailand: A qualitative study

Abstract Background Thailand has employed a system of compulsory drug detention centres (CDDCs) where drug users are confined following arrest. Although concerns regarding CDDCs persist, research focused on CDDCs in Thailand is limited. We undertook this study to explore experiences with CDDCs among people who inject drugs (PWID) in Thailand. Methods Data were derived from the Mitsampan Community Research Project, a mixed- methods study involving PWID in Bangkok. Between July 2011 and June 2012, semi-structured, in-depth interviews were conducted with PWID who had been exposed to CDDCs. Interviews explored experiences with CDDCs, including conditions and program structure within CDDCs, and the impacts of CDDCs on on-going patterns of drug use. Audio-recorded interviews were transcribed verbatim, and a thematic analysis was conducted. Results Participants included 27 individuals, including 12 women. Participants indicated that CDDCs varied in their design and structure, although most described the conditions as being poor and unsanitary, with overcrowding and limited access to clean water and adequate nutrition. Most participants were placed in military-operated CDDCs and subjected to long hours of physical exercise and forced labour as punishment, which staff perceived as being essential to attaining a drug-free lifestyle. Many participants also experienced severe verbal abuse and violence by staff. Access to healthcare was limited and often denied, and individuals living with HIV/AIDS were typically unable to access antiretroviral therapy. None of the participants described being exposed to evidence-based addiction treatment, and most participants reported returning to drug use immediately upon release. Conclusion This study raises concerns regarding CDDCs in Thailand, including poor conditions and human rights violations within CDDCs, as well as a lack of access to appropriate healthcare and addiction treatment. CDDCs appear to be contributing to the stigmatization of drug users, while also perpetuating drug use rather meeting the intended objective of facilitating “rehabilitation”.

HIV Testing and awareness of HIV status among people who inject drugs in greater Kuala Lumpur, Malaysia.

ABSTRACTHIV testing services are the gateway into HIV treatment and are critical for monitoring the epidemic. HIV testing is recommended at least annually in high-risk populations, including people who inject drugs (PWID). In Malaysia, the HIV epidemic is concentrated among PWID, but their adherence to testing recommendations and the proportion of HIV-positive PWID who are aware of their status remain unknown. We recruited 460 PWID in Greater Kuala Lumpur using respondent-driven sampling and conducted HIV testing. We examined past testing behaviors, estimating testing frequency, correlates of testing in the past 12 months, and the proportion of those living with HIV who were aware of their status. Results showed that most PWID living with HIV (90.4%, 95% CI: 83.6%–95.9%) were aware of their status. Among those never previously diagnosed with HIV, few had accessed HIV testing in the past 12 months (14.3%, 95% CI: 11.1%–18.0%). Prison (57.0%) and compulsory drug detention centers (36.1%) were the primary locations where PWID reported ever being HIV tested, and the main correlate of recent testing in regression was recent criminal justice involvement. Although awareness of HIV status may be high among PWID living with HIV in Kuala Lumpur, testing occurs primarily in prisons and compulsory drug detention centers, where it is involuntary and linkage to care is limited. A shift in HIV testing policy is needed to align health and human rights objectives, replacing mandatory testing with voluntary testing in settings where individuals can be rapidly linked to HIV care.

Assessment of an Innovative Voluntary Substance Abuse Treatment Program Designed to Replace Compulsory Drug Detention Centers in Malaysia

ABSTRACTBackground: As part of an ongoing initiative by the Malaysian government to implement alternative approaches to involuntary detention of people who use drugs, the National Anti-Drug Agency has created new voluntary drug treatment programs known as Cure and Care (C&C) Centers that provide free access to addiction treatment services, including methadone maintenance therapy, integrated with social and health services. Objectives: We evaluated early treatment outcomes and client satisfaction among patients accessing C&C treatment and ancillary services at Malaysia's second C&C Center located in Kota Bharu, Kelantan. Methods: In June-July 2012, a cross-sectional convenience survey of 96 C&C inpatients and outpatients who entered treatment >30 days previously was conducted to assess drug use, criminal justice experience, medical co-morbidities, motivation for seeking treatment, and attitudes towards the C&C. Drug use was compared for the 30-day-period before C&C entry and the 30-day-period before the interview. Results: Self-reported drug use levels decreased significantly among both inpatient and outpatient clients after enrolling in C&C treatment. Higher levels of past drug use, lower levels of social support, and more severe mental health issues were reported by participants who were previously imprisoned. Self-reported satisfaction with C&C treatment services was high. Conclusions/Importance: Preliminary evidence of reduced drug use and high levels of client satisfaction among C&C clients provide support for Malaysia's ongoing transition from compulsory drug detention centers (CDDCs) to these voluntary drug treatment centers. If C&C centers are successful, Malaysia plans to gradually transition away from CDDCs entirely.

Compulsory drug detention centres: time to question their continued use?

Compulsory drug detention centres: time to question their continued use?

Pretreatment drug use characteristics and experiences among patients in a voluntary substance abuse treatment center in Malaysia: A mixed-methods approach

ABSTRACTBackground: Drug use in Malaysia remains a significant public health and social problem despite implementation of harsh punitive drug policies such as forcibly placing suspected drug users into compulsory drug detention centers (CDDCs). Following criticism over human right violations in CDDCs, Malaysia has begun to transition towards voluntary drug treatment centers known as Cure & Care (C&C) centers. To best serve the needs of regional C&C centers, data on drug use are essential among patients accessing treatment. Using a mixed-methods approach, the authors examined pretreatment drug use characteristics and experiences with addiction treatment among C&C patients in Kelantan—a religiously conservative state in northeast Malaysia with high prevalence of drug use but where limited data are available on drug use patterns. Methods: A mixed-methods study utilizing surveys (n = 96) and semistructured interviews (n = 20) was conducted among a convenience sample of inpatients and outpatients at the Pengkalan Chepa C&C Center in Kelantan. Results: Survey results showed that 89.6% of participants met screening criteria for moderate to severe addiction severity. Nearly 90% reported lifetime illicit amphetamine (syabu, meth, ice, and pil kuda) use, followed by alcohol (60.4%) and opioids (52.1%). Qualitative results pointed to the powerful influence of peer networks in drug initiation and relapse, and the positive effect of the C&C center on drug rehabilitation. Conclusions: The drug use profile of the Kelantan C&C center enrollees shows extensive pretreatment amphetamine use, polysubstance use, and injection drug use, including high-risk behaviors such as sharing needles, syringes, and containers. Evidence points to the need for integration of social support–oriented practices and behavioral interventions into the rehabilitation of drug users in this region.

Treatment Readiness, Attitudes Toward, and Experiences with Methadone and Buprenorphine Maintenance Therapy Among People Who Inject Drugs in Malaysia

BackgroundLittle is known about attitudes toward and experiences with opioid maintenance therapy (OMT) among people who inject drugs in Malaysia, a country where people who inject drugs comprise 1.3% of the adult population. MethodsIn 2010, 460 people who inject drugs in Greater Kuala Lumpur, Malaysia were surveyed to evaluate attitudes toward and experiences with OMT and treatment readiness. Attitudes towards OMT with both methadone and buprenorphine were assessed using an opinions scale. Multivariable linear regression was used to assess correlates of treatment readiness, measured with the 19-item Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). ResultsAll 460 participants used opioids and nearly all (99.1%) met criteria for opioid dependence. Few had had previous experience with methadone (9.3%) or buprenorphine (12.6%) maintenance therapy, yet many had used methadone (55.2%) or buprenorphine (51.7%) outside of treatment settings. Fifteen percent had injected buprenorphine in the past month, and of the few that were currently receiving buprenorphine maintenance therapy, almost all were injecting it. The majority of subjects exhibited a moderate level of treatment readiness and a preference for methadone over buprenorphine. Those with low treatment readiness scores were more likely to have previous experience with compulsory drug detention centers (p<0.01), needle/syringe exchange programs (p<0.005), or be of Indian ethnicity (p<0.001). Past use of methadone (p<0.01), older age (p<0.001), higher stress symptom severity (p<0.001), and sharing of needles or syringes (p<0.05) were associated with higher treatment readiness scores. ConclusionThere are suboptimal levels of OMT experience among people who inject drugs that may be improved by addressing factors that influence patient attitudes. Those individuals with moderate treatment readiness may be targeted by brief motivational and cognitive interventions in primary care, prisons or OMT clinics aimed at improving entry into and retention in treatment.

Compulsory drug detention centers in East and Southeast Asia

Over the last three decades in response to a rise in substance use in the region, many countries in East and Southeast Asia responded by establishing laws and policies that allowed for compulsory detention in the name of treatment for people who use drugs. These centers have recently come under international scrutiny with a call for their closure in a Joint Statement from United Nations entities in March 2012. The UN's response was a result of concern for human rights violations, including the lack of consent for treatment and due process protections for compulsory detention, the lack of general healthcare and evidence based drug dependency treatment and in some centers, of forced labor and physical and sexual abuse (United Nations, 2012). A few countries have responded to this call with evidence of an evolving response for community-based voluntary treatment; however progress is likely going to be hampered by existing laws and policies, the lack of skilled human resource and infrastructure to rapidly establish evidence based community treatment centers in place of these detention centers, pervasive stigmatization of people who use drugs and the ongoing tensions between the abstinence-based model of treatment as compared to harm reduction approaches in many of these affected countries.

An exploratory qualitative assessment of self-reported treatment outcomes and satisfaction among patients accessing an innovative voluntary drug treatment centre in Malaysia

BackgroundIn Malaysia, compulsory drug detention centres (CDDCs) hold suspected drug users for two years without adjudication. Acute detoxification without healthcare access has been documented. CDDCs are criticized globally due to ineffectiveness in treating addiction and human rights violations. In response, the Malaysian government began transitioning these facilities into voluntary drug treatment centres known as “Cure and Care” (C&C) centres that embrace a holistic treatment-based approach to drug addiction rehabilitation. MethodsAn explorative qualitative study was undertaken to explore patient perspectives and satisfaction regarding treatment and services at the new Cure and Care centre in Kota Bharu, Malaysia. A convenience sample of 20 patients was recruited to participate in semi-structured in-depth interviews. Content analysis was used to identify the salient themes. ResultsPatients identified methadone treatment, psychosocial programs, religious instruction, and recreational activities as important factors contributing to treatment success for addressing both health and addiction needs. Though many had previously been in a CDDC, adherence to treatment in the C&C centre was perceived to be facilitated by the degree of social support, the voluntary nature and the array of new programs available for selection. ConclusionC&Cs represents a dramatic shift in the Malaysian government's approach to drug addiction. Our findings demonstrate positive patient experiences associated with the holistic treatment-based approach of these centres. This exploratory study provides additional evidence to document this ongoing policy transition and may guide continued expansion of new holistic drug treatment programs across the country.

Drug-related harm among people who inject drugs in Thailand: summary findings from the Mitsampan Community Research Project

BackgroundFor decades, Thailand has experienced high rates of illicit drug use and related harms. In response, the Thai government has relied on drug law enforcement to address this problem. Despite these efforts, high rates of drug use persist, and Thailand has been contending with an enduring epidemic of human immunodeficiency virus (HIV) among people who inject drugs (IDU).MethodsIn response to concerns regarding drug-related harm in Thailand and a lack of research focused on the experiences and needs of Thai IDU, the Mitsampan Community Research Project was launched in 2008. The project involved administering surveys capturing a range of behavioral and other data to community-recruited IDU in Bangkok in 2008 and 2009.ResultsIn total, 468 IDU in Bangkok were enrolled in the project. Results revealed high rates of midazolam injection, non-fatal overdose and incarceration. Syringe sharing remained widespread among this population, driven primarily by problems with access to syringes and methamphetamine injection. As well, reports of police abuse were common and found to be associated with high-risk behavior. Problems with access to evidence-based drug treatment and HIV prevention programs were also documented. Although compulsory drug detention centers are widely used in Thailand, data suggested that these centers have little impact on drug use behaviors among IDU in Bangkok.ConclusionsThe findings from this project highlight many ongoing health and social problems related to illicit drug use and drug policies in Bangkok. They also suggest that the emphasis on criminal justice approaches has resulted in human rights violations at the hands of police, and harms associated with compulsory drug detention and incarceration. Collectively, the findings indicate the urgent need for the implementation of evidence-based policies and programs in this setting.

Compulsory drug detention in East and Southeast Asia: Evolving government, UN and donor responses

According to official accounts, more than 235,000 people are detained in over 1000 compulsory drug detention centers in East and South East Asia. Individuals in such centers are held for periods of months to years, and can experience a wide range of human rights abuses, including violation of the rights to freedom from torture and cruel, inhuman and degrading treatment; freedom from arbitrary arrest and detention; a fair trial; privacy; the highest attainable standard of health; and freedom from forced labor. Since 2010, an increasing number of United Nations agencies, human rights experts, and others have expressed concerns about rights abuses associated with compulsory drug detention centers, and since 2012, called for their closure. Although they do not represent a complete break from the past, these calls mark a significant shift from past engagement with drug detention, which included direct and indirect funding of detention centers and activities in detention centers by some donors. However, the lack of transparent governance, restrictions on free speech and prohibitions on monitoring by independent, international human rights organizations make assessing the evolving laws, policies and practices, as well as the attitudes of key governments officials, difficult. Looking specifically at publicly announced reforms and statements by government officials in China, Cambodia, Vietnam and Lao PDR reveals possible improvements in respect for the rights of drug users, and on-going challenges.

Arguments against the compulsory treatment of opioid dependence

The Asian Network of People Who Use Drugs finds a recent attempt to advocate for compulsory “rehabilitation” centres1 founded on faulty arguments and dubious research that, if heeded, poses a direct threat to the human rights of people who use drugs and the dignity of society at large. Wu’s round table article claims to refute the rationale behind the recent call made by 12 UN agencies “… to close compulsory detention and rehabilitation centres and implement voluntary, evidence-informed and rights-based health and social services in the community”.2 In countries with compulsory centres, the detention of people who use drugs often occurs without sufficient due process, legal safeguards or judicial review, and there are frequent reports of physical and sexual violence, forced labour, sub-standard conditions, denial of health care, and other violations of human rights in such state-sanctioned centres.3 Yet Wu claims “… there is no evidence that people in such centres are at higher risk of opioid-related medical complications, infectious diseases or death, than those not living in compulsory treatment centres”. A 2010 report – one of many exposes – on compulsory drug treatment and forced labour shows that such centres deny access to treatment, put inmates at risk of physical abuse and forced labour.4 To imply that such unacceptable conditions may also exist in the community is the weakest possible defence for favouring compulsory centres. The article suggests that we “… must take into account both the human rights of the opioid-dependent individuals and those of the people who live in their communities”, omitting the fact that deprivation of liberty without due process is always an unacceptable violation of human rights.5 When the rights of drug-using individuals have been compromised for community well-being, these measures have both failed to improve communities and forced people who use drugs further underground, encouraging needle-sharing and other risky behaviours.6,7 State-sanctioned violence always reflects badly on society as a whole, not least in Asian countries that identify as community-oriented. Wu proposes – and the discussants disagree – that compulsory centres make the community safer from violent criminals. Yet studies show that “… many dependent drug users do not commit any crimes other than drug use/possession, where it is criminalized”.8 Evidence also shows that low threshold treatments such as methadone maintenance programmes reduce involvement in crime.9 Wu proposes that: “Compulsory treatment centres should be part of a broader harm reduction strategy.” The UN system has recommended nine essential services for people who inject drugs, all of which have a strong evidence base and none of which sanction compulsory treatment.10 Compulsory drug rehabilitation centres have not shown to be effective in preventing relapse and they pose considerable risks to the well-being of detainees.11,12 The UN Special Rapporteur has reported on abuse, torture, cruel and inhumane treatment and degrading punishment in health-care settings. With regard to mandatory drug treatment, the report states: “… State drug policies intentionally subject large groups of people to severe physical pain, suffering and humiliation, effectively punishing them for using drugs and trying to coerce them into abstinence, in complete disregard of the chronic nature of dependency and of the scientific evidence pointing to the ineffectiveness of punitive measures.”13 The UN office for Drugs and Crime further reminds us that: “Many countries provide long-term residential treatment for drug dependence without the consent of the patient that is in reality a type of low security imprisonment. Evidence of the therapeutic effect of this approach is lacking, compared to traditional imprisonment and community based involuntary drug treatment. It is expensive, not cost-effective, and neither benefits the individual nor the community.”14 We argue that compulsory drug centres fail in their stated aim of achieving abstinence and that the points made in favour of the centres do not amount to any rational excuse for keeping them open. The Asian Network of People who Use Drugs reaffirm our call for relevant states to close down compulsory drug detention centres, and for the UN system to rigorously discourage their continuation. We also offer our network as a resource for governments wishing to implement services that have been proven to reduce crime as well as improving health and human rights for people who use drugs.

Correction: Absence of Antiretroviral Therapy and Other Risk Factors for Morbidity and Mortality in Malaysian Compulsory Drug Detention and Rehabilitation Centers

Correction: Absence of Antiretroviral Therapy and Other Risk Factors for Morbidity and Mortality in Malaysian Compulsory Drug Detention and Rehabilitation Centers

The HIV epidemic and human rights violations in Brazil

Efforts to mitigate stigma and discrimination have been central to the national response to HIV in Brazil, a country historically recognized as a leader in human rights-based HIV prevention, treatment and care. Brazil is credited with avoiding a potentially generalized HIV epidemic by providing universal access to antiretroviral therapy (ART) and associated HIV care since 1996. The Brazilian AIDS policy, although hailed as a model worldwide, has been more difficult to implement among more vulnerable groups of people living with HIV/AIDS, such as drug users, homeless persons, people who use drugs and sex workers, who are often stigmatized as noncompliant or difficult to retain in care. (Published: 12 November 2013) Citation: Malta M and Beyrer C. Journal of the International AIDS Society 2013, 16 :18817 http://www.jiasociety.org/index.php/jias/article/view/18817 | http://dx.doi.org/10.7448/IAS.16.1.18817

Absence of Antiretroviral Therapy and Other Risk Factors for Morbidity and Mortality in Malaysian Compulsory Drug Detention and Rehabilitation Centers

BackgroundThroughout Asia, people who use drugs are confined in facilities referred to as compulsory drug detention and rehabilitation centers. The limited transparency and accessibility of these centers has posed a significant challenge to evaluating detainees and detention conditions directly. Despite HIV being highly prevalent in this type of confined setting, direct evaluation of detainees with HIV and their access to medical care has yet to be reported in the literature.MethodsWe evaluated the health status of 100 adult male detainees with HIV and their access to medical care in the two largest Malaysian compulsory drug detention and rehabilitation centers holding HIV-infected individuals.ResultsApproximately 80% of all detainees with HIV were surveyed in each detention center. Most participants reported multiple untreated medical conditions. None reported being able to access antiretroviral therapy during detention and only 9% reported receiving any HIV-related clinical assessment or care. Nearly a quarter screened positive for symptoms indicative of active tuberculosis, yet none reported having been evaluated for tuberculosis. Although 95% of participants met criteria for opioid dependence prior to detention, none reported being able to access opioid substitution therapy during detention, with 86% reporting current cravings for opioids and 87% anticipating relapsing to drug use after release. Fourteen percent of participants reported suicidal ideation over the previous two weeks.ConclusionWe identified a lack of access to antiretroviral therapy in two of the six compulsory drug detention and rehabilitation centers in Malaysia designated to hold HIV-infected individuals and found significant, unmet health needs among detainees with HIV. Individuals confined under such conditions are placed at considerably high risk for morbidity and mortality. Our findings underscore the urgent need for evidence-based drug policies that respect the rights of people who use drugs and seek to improve, rather than undermine, their health.

The ethics of research in compulsory drug detention centres in Asia.

Throughout China and southeast Asia, people who use drugs are compulsorily detained in government centres in the name of ‘‘treatment’’ or ‘‘rehabilitation’’. These centres are neither prisons nor hospitals: individuals are held without the due process protections common to prisons, such as access to legal counsel, the opportunity to appeal, or judicial oversight of detention. At the same time, they may be detained for years without ever receiving evidence-based drug dependency treatment. Detainees may be held in isolation cells, forced to work, and ill-treated by staff. In some centres, detainees may be tortured with electrical shocks or sexually abused. Individuals are detained without clinical determination of drug dependence, and centres also lock up homeless people, street children, and people with mental illnesses. (Published: 5 December 2012) Pearshouse R and JJ Amon. Journal of the International AIDS Society 2012, 15 :18491 http://www.jiasociety.org/index.php/jias/article/view/18491 | http://dx.doi.org/10.7448/IAS.15.2.18491