Contextual Factors Associated with Rushed Injecting Among People Who Inject Drugs in Thailand

Ti, Lianping; Hayashi, Kanna; Kaplan, Karyn; Suwannawong, Paisan; Wood, Evan

doi:10.1007/s11121-014-0477-z

Cited by 19 publications

(10 citation statements)

References 34 publications

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“…132 In a number of countries, even if syringe possession is legal, police routinely seize injection equipment that they find, further undermining protection of health. 75 Police presence was associated with unsafe rushed injection among PWID in Bangkok in a multivariate analysis, 133 and a small sample of PWID in Hai Phong, Vietnam, reported greater likelihood of needle sharing and other risky practices when police were present or their presence was feared. 134 …”

Section: Drug Policy and Infectious Diseasesmentioning

confidence: 99%

Public health and international drug policy

et al. 2016

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Executive summary In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. The “war on drugs” and “zero-tolerance” policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights, and development impact. The Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of the 2016 UNGASS on drugs. The Johns Hopkins-Lancet Commission is concerned that drug policies are often colored by ideas about drug use and drug dependence that are not scientifically grounded. The 1998 UNGASS declaration, for example, like the UN drug conventions and many national drug laws, does not distinguish between drug use and drug abuse. A 2015 report by the UN High Commissioner for Human Rights, by contrast, found it important to emphasize that “[d]rug use is neither a medical condition nor does it necessarily lead to drug dependence.” The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol for which the goal of social policy is to reduce potential harms. Health impact of drug policy based on enforcement of prohibition The pursuit of drug prohibition has generated a parallel economy run by criminal networks. Both these networks, which resort to violence to protect their markets, and the police and sometimes military ...

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Section: Drug Policy and Infectious Diseasesmentioning

confidence: 99%

Public health and international drug policy

et al. 2016

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“…Despite reductions in HIV incidence, morbidity and mortality (Joint United Nations Programme on HIV/AIDS (UNAIDS) 2014), such advances have not occurred similarly in PWID despite numerous evidence-based HIV prevention recommendations (Dutta et al 2012; Joint United Nations Programme on HIV/AIDS (UNAIDS) 2014). It is increasingly recognized that law enforcement strategies have failed to curb drug use (Irwanto et al 2015) and contribute greatly to the risk of injection-related HIV infection (Booth et al 2013; Ti et al 2014). Punitive drug policies including compulsory drug detention for PWID and the death penalty for drug trafficking, continue to be a direct barrier to evidence-based HIV prevention services for PWIDs in Southeast Asia, including access to needle and syringe programs (NSPs) and opioid agonist therapies (OAT) like methadone or buprenorphine (Irwanto et al 2015; United Nations Office on Drugs and Crime 2014).…”

Section: Introductionmentioning

confidence: 99%

Confronting the HIV, Tuberculosis, Addiction, and Incarceration Syndemic in Southeast Asia: Lessons Learned from Malaysia

Culbert

Pillai

Bick

et al. 2016

J Neuroimmune Pharmacol

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Throughout Southeast Asia, repressive drug laws have resulted in high rates of imprisonment in people who inject drugs and people living with HIV (PLH), greatly magnifying the harm associated with HIV, tuberculosis, and addiction. We review findings from Malaysia's largest prison to describe the synergistic effects of HIV, tuberculosis, addiction, and incarceration that contribute to a‘perfect storm’of events challenging public and personal health and offer insights into innovative strategies to control these converging epidemics. The majority of PLH who are imprisoned in Malaysia are opioid dependent. Although promoted by official policy, evidence-based drug treatment is largely unavailable, contributing to rapid relapse and/or overdose after release. Similarly, HIV treatment in prisons and compulsory drug treatment centers is sometimes inadequate or absent. The prevalence of active tuberculosis is high, particularly in PLH, and over 80% of prisoners and prison personnel are latently infected. Mandatory HIV testing and subsequent segregation of HIV-infected prisoners increases the likelihood of tuberculosis acquisition and progression to active disease, enlarging the reservoir of infection for other prisoners. We discuss strategies to control these intersecting epidemics including screening linked to standardized treatment protocols for all three conditions, and effective transitional programs for released prisoners. For example, recently introduced evidence-based interventions in prisons like antiretroviral therapy (ART) to treat HIV, isoniazid preventive therapy to treat latent tuberculosis infection, and methadone maintenance to treat opioid dependence, have markedly improved clinical care and reduced mortality. Since introduction of these interventions in September 2012, all-cause and HIV-related mortality have decreased by 50.0% and 75.7% respectively. We discuss the further deployment of these interventions in Malaysian prisons.

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“…27/2009), make little distinction between drug users and traffickers (Nasir, 2011), and have generally proved counterproductive to HIV control (Joint United Nations Programme on HIV/AIDS, 2013). Drug enforcement has spawned police brutality against PWID (Davis et al, 2009), itself a social determinant of unsafe injection among PWID in the community (Hayashi et al, 2013; Ti et al, 2014), and increased criminal convictions and incarceration rates among PWID (HIV Cooperation Program for Indonesia, 2013; Morineau et al, 2012). Conservatively, 8-13% of Indonesian prisoners are PWID and official estimates of HIV prevalence among prisoners range from 1.1-13.9% (Directorate of Corrections, 2010a, 2012; Nelwan et al, 2010), with the highest prevalence being in specialized narcotics prisons which house inmates sentenced for drug-related crimes (including drug possession), although prisoners with substance use disorders (SUDs) are detained throughout the prison system (National AIDS Commission, 2010).…”

Section: Introductionmentioning

confidence: 99%

Within-prison drug injection among HIV-infected male prisoners in Indonesia: A highly constrained choice

Culbert¹,

Waluyo²,

Iriyanti³

et al. 2015

Drug and Alcohol Dependence

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Background In Indonesia, incarceration of people who inject drugs (PWID) and access to drugs in prison potentiate within-prison drug injection (WP-DI), a preventable and extremely high-risk behavior that may contribute substantially to HIV transmission in prison and communities to which prisoners are released. Aims This mixed method study examined the prevalence, correlates, and social context of WP-DI among HIV-infected male prisoners in Indonesia. Methods 102 randomly selected HIV-infected male prisoners completed semi-structured voice-recorded interviews about drug use changes after arrest, drug use cues within prison, and impact of WP-DI on HIV and addiction treatment. Logistic regression identified multivariate correlates of WP-DI and thematic analysis of interview transcripts used grounded-theory. Results Over half (56%) of participants reported previous WP-DI. Of those, 93% shared injection equipment in prison, and 78.6% estimated sharing needles with ≥10 other prisoners. Multivariate analyses independently correlated WP-DI with being incarcerated for drug offenses (AOR=3.29, 95%CI=1.30–8.31, p=0.011) and daily drug injection before arrest (AOR=5.23, 95%CI=1.42–19.25, p=0.013). Drug availability and proximity to drug users while incarcerated were associated with frequent drug craving and escalating drug use risk behaviors after arrest. Energetic heroin marketing and stigmatizing attitudes toward methadone contribute to WP-DI and impede addiction and HIV treatment. Conclusions Frequent WP-DI and needle sharing among these HIV-infected Indonesian prison inmates indicate the need for structural interventions that reduce overcrowding, drug supply, and needle sharing, and improve detection and treatment of substance use disorders upon incarceration to minimize WP-DI and associated harm.

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Contextual Factors Associated with Rushed Injecting Among People Who Inject Drugs in Thailand

Cited by 19 publications

References 34 publications

Public health and international drug policy

Public health and international drug policy

Confronting the HIV, Tuberculosis, Addiction, and Incarceration Syndemic in Southeast Asia: Lessons Learned from Malaysia

Within-prison drug injection among HIV-infected male prisoners in Indonesia: A highly constrained choice

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