Expanding the reach of harm reduction in Thailand: experiences with a drug user-run drop-in centre.
BACKGROUND
Despite an ongoing epidemic of HIV among Thai people who inject drugs (IDU), Thailand has failed to implement essential harm reduction programmes. In response, a drug user-led harm reduction centre opened in 2004 in an effort to expand reduction programming in Thailand.


METHODS
We examined experiences with the Mitsampan Harm Reduction Centre (MSHRC) among IDU participating in the Mitsampan Community Research Project (Bangkok). Multivariate logistic regression was used to identify factors associated with MSHRC use. We also examined services used at and barriers to the MSHRC.


RESULTS
252 IDU participated in this study, including 66 (26.2%) females. In total, 74 (29.3%) participants had accessed the MSHRC. In multivariate analyses, MSHRC use was positively associated with difficulty accessing syringes (Adjusted Odds Ratio [AOR]=4.05; 95% Confidence Interval [CI]: 1.67-9.80), midazolam injection (AOR=3.25; 95%CI: 1.58-6.71), having greater than primary school education (AOR=1.88; 95%CI: 1.01-3.52), and was negatively associated with female gender (AOR=0.20; 95%CI: 0.08-0.50). Forms of support most commonly accessed included: syringe distribution (100%), food and a place to rest (83.8%), HIV education (75.7%), and safer injecting education (66.2%). The primary reason given for not having accessed the MSHRC was "didn't know it existed."


CONCLUSIONS
The MSHRC is expanding the scope of harm reduction in Thailand by reaching IDU, including those who report difficulty accessing sterile syringes, and by providing various forms of support. In order to maximise its benefits, efforts should be made to increase awareness of the MSHRC, in particular among women.
Kerr
Thomas
T
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608 - 1081 Burrard Street, Vancouver BC, V6Z 1Y6 Canada. uhri-tk@cfenet.ubc.ca
Hayashi
Kanna
K
Fairbairn
Nadia
N
Kaplan
Karyn
K
Suwannawong
Paisan
P
Zhang
Ruth
R
Wood
Evan
E
D000328:Adult; D055030:Drug Users / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D040261:Harm Reduction; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D003932:Heroin; D006801:Humans; D008297:Male; D008694:Methamphetamine; D008874:Midazolam; D010353:Patient Education as Topic; D015397:Program Evaluation; D012307:Risk Factors; D012737:Sex Factors; D016320:Substance Abuse Treatment Centers / Q000379:methods*; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013785:Thailand
D008694:Methamphetamine; D003932:Heroin; D008874:Midazolam