Background. Background

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1 Factors associated with remaining untreated for HIV among people who inject drugs in Bangkok, Thailand Pauline Voon 1 Kanna Hayashi 1,2 Lianping Ti 1,3 Karyn Kaplan 4 Paisan Suwannawong 4 Evan Wood 1,5 Julio Montaner 1,5 Thomas Kerr 1,5 1 British Columbia Centre for Excellence in HIV/AIDS 2 Interdisciplinary Studies Graduate Program, University of British Columbia 3 School of Population and Public Health, University of British Columbia 4 Thai AIDS Treatment Action Group 5 Department of Medicine, University of British Columbia 11 th International Congress on AIDS in Asia and the Pacific November 21, 2013 Page 1 Background Source: Thailand Bureau of Epidemiology, HIV Total Sentinel Surveillance, Ministry of Public Health (2012) Page 2 Background Aggressive drug law enforcement has been the primary response to illicit drug use in Thailand. War on drugs (2003): 2,800 extrajudicial killings Unity for Victory over Drugs (2011): 450,000 drug users forced into drug treatment Page 3 Photo from : Mahitthirook, A., Laohong, K.-O., Phones, CDs seized at prison. Bangkok Post, May 18. Page 4

2 Objective To identify factors associated with untreated HIV infection among people who inject drugs (IDU) in Thailand. Methods Mitsampan Community Research Project Collaborative research effort Community-based research Peer researchers = former/active drug users Involved in all stages Page 5 Page 6 Methods Sample: Adult IDU in Bangkok or neighbouring provinces June 2009 to October 2011 Recruited through peer outreach and word-of-mouth Data collection: o Interviewer-administered questionnaires o Self-reported data (incl. HIV-serostatus) o Variables: Methods o Demographic information o Drug use patterns o Experiences with drug law enforcement o Experiences with accessing healthcare Statistical analysis: o Multivariate logistic regression Photo by Rico Gustav Page 7 Page 8

3 Results Total sample = 757 IDU 128 HIV-positive IDU 19.5% Female Median age: 38 years (IQR: years) Not on ART 45.3% On ART 54.7% Page 9 Page 10 HIV+ IDU not receiving ART more likely to: Have been in compulsory drug detention centres Page 11 Page 12

4 Page 13 Page 14 Page 15 Page 16 Research Centre for Health Economics and Evaluation (ReCHEE)

5 HIV+ IDU not receiving ART more likely to: Have been in compulsory drug detention centres Frequently inject midazolam Page 17 Page 18 HIV+ IDU not receiving ART more likely to: Have been in compulsory drug detention centres Frequently inject midazolam HIV+ IDU receiving ART more likely to: Have received peer-based information/support for accessing health care Page 19 Page 20

6 Limitations Small sample size Unable to infer causation Self-reported data Sample not randomly selected Conclusions and Recommendations Novel efforts are needed to facilitate access to treatment for HIV-positive people who inject drugs in Thailand. 1. Close compulsory drug detention centres 2. Expand peer-based support for HIV+ IDU 3. Focused outreach, education and research efforts Page 21 Page 22 MSCRP participants Acknowledgments Staff & volunteers at TTAG, Mitsampan Harm Reduction Center & O-Zone House: Jirasak Sripramong, Kamon Uppakaew, Amnat Chamchern, Vipawan Suwannawong, Wiwat Chotichatmala, and Prapatsara Kaewkoon, Pascal Tanguay Chulalongkorn University: Dr. Niyada Kiatying-Angsulee BC CfE staff: Tricia Collingham, Cameron Dilworth, Deborah Graham, Caitlin Johnston, Daniel Miles Kane, Calvin Lai, Cristy Power, Guido Thylmann, Peter Vann Research assistants: Prempreeda Pramoj Na Ayutthaya, Arphatsaporn Chaimongkon, Sattara Hattirat, and Puripakorn Pakdirat Page 23