Drug use, increasing incarceration rates, and prison-associated HIV risks in Thailand.
BACKGROUND
Incarceration is a known risk for HIV infection in Thai drug users. Through the 1990s, incarceration rates for drug-related offenses rose sharply, whereas HIV prevention and drug treatment in prisons remained limited.


METHODS
We assessed HIV and incarceration risks for injection drug users (IDU) and non-IDU in a large treatment center cohort in northern Thailand to investigate HIV and prison risks in this period. We used Thai Bureau of Corrections data to assess incarceration and prevention funds in prisons, 1992-2000.


RESULTS
Among 1,865 drug user in the treatment cohort, 503 (27.0%) had ever been jailed. Men (OR 3.3, 95% CI 2.1, 5.2), IDU (OR 6.3, 95% CI 5.1, 7.9), and men who have sex with men (MSM) (OR 3.4, 95% CI 1.8, 6.3) were more likely to have been jailed. Among male IDU who had ever been jailed (N = 272), 15.8% had used drugs in prison. In a multivariate model, incarceration and ever IDU remained independently associated with HIV infection; IDU, MSM behaviors, and harmful traditional practices remained independently associated with having been jailed. From 1992 to 2000, overall alleged narcotics offenses increased from 117,000 to 276,000/year. The number of persons incarcerated for narcotics offenses increased fivefold from 1992 to 1999, from 12,860 to 67,440. For FY 2000, narcotics treatment accounted for 0.06% of the Thai corrections budget, whereas HIV programs in prisons were 0.017%.


CONCLUSIONS
Incarceration rates for narcotics offenses have increased sharply in Thailand, whereas prevention has lagged. Having been jailed is an important independent risk for HIV infection among Thai male drug users, especially IDU and MSM. HIV prevention and drug treatment are urgently needed in Thai prisons.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. cbeyrer@jhsph.edu
Chris
C
Beyrer
Jaroon
J
Jittiwutikarn
Waranya
W
Teokul
Myat Htoo
MH
Razak
Vinai
V
Suriyanon
Namtip
N
Srirak
Tasanai
T
Vongchuk
Sodsai
S
Tovanabutra
Teerada
T
Sripaipan
David D
DD
Celentano
D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D011329:Prisoners; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous; D013785:Thailand / Q000453:epidemiology