Healthcare avoidance by people who inject drugs in Bangkok, Thailand.
Although people who inject drugs (IDU) often contend with various health-related harms, timely access to health care among this population remains low. We sought to identify specific individual, social and structural factors constraining healthcare access among IDU in Bangkok, Thailand.



Data were derived from a community-recruited sample of IDU participating in the Mitsampan Community Research Project between July and October 2011. We assessed the prevalence and correlates of healthcare avoidance due to one's drug use using multivariate logistic regression.



Among 437 participants, 112 (25.6%) reported avoiding health care because they were IDU. In multivariate analyses, factors independently associated with avoiding health care included having ever been drug tested by police [adjusted odds ratio (AOR) = 1.80], experienced verbal abuse (AOR = 3.15), been discouraged from engaging in usual family activities (AOR = 3.27), been refused medical care (AOR = 10.90), experienced any barriers to health care (AOR = 4.87) and received healthcare information and support at a drop-in centre (AOR = 1.92) (all P < 0.05).



These findings highlight the need to address the broader policy environment, which perpetuates the criminalization and stigmatization of IDU, and to expand peer-based interventions to facilitate access to health care for IDU in this setting.
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada V6T 1Z3.
A J
AJ
Heath
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6 Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6.
T
T
Kerr
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6 Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6.
L
L
Ti
Treatment Action Group, New York, NH 10016-7701, USA.
K
K
Kaplan
Thai AIDS Treatment Action Group, Bangkok 10900, Thailand.
P
P
Suwannawong
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6 Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6.
E
E
Wood
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6 Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada V6Z 1Y6.
K
K
Hayashi
D000328:Adult; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D015995:Prevalence; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000523:psychology*; D013785:Thailand / Q000453:epidemiology
Thailand; health services utilization; injection drug use; peer-based interventions; stigma and discrimination