Incarceration Experiences among aIncarceration Experiences among aIncarceration Experiences among a Incarceration Experiences among a CommunityCommunity--Recruited Sample of Injection Recruited Sample of Injection

Drug Users in Bangkok ThailandDrug Users in Bangkok ThailandDrug Users in Bangkok, Thailand Drug Users in Bangkok, Thailand

Kanna HayashiKanna Hayashi11Kanna HayashiKanna HayashiNadia FairbairnNadia Fairbairn11

Karyn KaplanKaryn Kaplan22

Nawarit RuttanussonNawarit Ruttanusson22

Calvin LaiCalvin Lai11Evan WoodEvan Wood11, , 33

Thomas KerrThomas Kerr11, , 33

1 1 British Columbia Centre for Excellence in HIV/AIDSBritish Columbia Centre for Excellence in HIV/AIDS2 2 Thai AIDS Treatment Action Group / Mit Sampan Harm Reduction CenterThai AIDS Treatment Action Group / Mit Sampan Harm Reduction Center

33 F lt f M di i U i it f B iti h C l biF lt f M di i U i it f B iti h C l bi3 3 Faculty of Medicine, University of British ColumbiaFaculty of Medicine, University of British Columbia

BackgroundBackgroundBackgroundBackground

Mit Sampan Community Research ProjectMit Sampan Community Research ProjectMit Sampan Community Research ProjectMit Sampan Community Research Project

•• AA collaborative research effort involving: collaborative research effort involving:

Thai AIDS Treatment Action GroupThai AIDS Treatment Action GroupMit Sampan Harm Reduction CenterMit Sampan Harm Reduction Center

ChulalongkornChulalongkornUniversityUniversity

•• 12 12 former/active drug users former/active drug users trained as peer researcherstrained as peer researchers

P h i l d iP h i l d i•• Peer researchers involved inPeer researchers involved inall stages of the projectall stages of the project

Summer Summer 20082008, Bangkok, Thailand, Bangkok, Thailand

ObjectiveObjectiveObjectiveObjective

•• To examine the prevalence and correlates of incarcerationTo examine the prevalence and correlates of incarcerationTo examine the prevalence and correlates of incarceration To examine the prevalence and correlates of incarceration experiences among a communityexperiences among a community--recruited sample of IDU recruited sample of IDU in Bangkokin Bangkokin Bangkokin Bangkok

•• To examine the prevalence of syringe sharing within prisonTo examine the prevalence of syringe sharing within prison

MethodsMethodsMethodsMethods

•• A crossA cross--sectional survey administered by peer researcherssectional survey administered by peer researchers•• A crossA cross--sectional survey administered by peer researcherssectional survey administered by peer researchers

•• Data collected in August Data collected in August 20082008

•• 252 252 IDU in Bangkok recruited through peerIDU in Bangkok recruited through peer--based outreach based outreach and wordand word--ofof--mouthmouthand wordand word ofof mouthmouth

•• Univariate statistics and multivariate logistic regressionUnivariate statistics and multivariate logistic regression

•• Variables:Variables:SocioSocio--demographic characteristicsdemographic characteristicsDrug use patternsDrug use patternsHIV risk behaviorsHIV risk behaviorsInteractions with drugInteractions with drug--law enforcementlaw enforcement

ResultsResultsResultsResults

•• Sample characteristics:Sample characteristics:Sa p e c a acte st csSa p e c a acte st cs66 66 ((2626..22%) female respondents%) female respondentsMedian age = Median age = 3636..5 5 yearsyears

58. Have you ever been in prison overnight or longer?

•• Primary outcome of interest:Primary outcome of interest:

y p g gYesNo

MSCRP Cohort (n=252)No

78% of the study participantsreported a historyof incarceration.

MaMaResultsResultsMaMa•• Multivariate logistic regression analysesMultivariate logistic regression analyses

Adjusted Odds RatioAdjusted Odds Ratio((9595%CIs)%CIs)

4 934 93

u t a ate og st c eg ess o a a ysesu t a ate og st c eg ess o a a yses

Ever in Compulsory TreatmentEver in Compulsory Treatment 4.934.93((1.95 1.95 –– 12.48 )12.48 )

Ever in PrisonEver in PrisonEver OverdosedEver Overdosed 33..6969

((11..45 45 –– 99..39 39 ))

22..2020((11..12 12 –– 44..32 32 ) )

Ever Shared SyringesEver Shared Syringes

Female GenderFemale Gender 00..4141((00..20 20 –– 00..82 82 ) ) (( ))

All variables presented above achieved the significance level of All variables presented above achieved the significance level of pp < < 00..0505. .

ResultsResultsResultsResults

•• Prevalence of syringePrevalence of syringe--sharing in prisonsharing in prisone a e ce o sy gee a e ce o sy ge s a g p sos a g p soMSCRP Cohort (MSCRP Cohort (nn=252)=252)

Ever in prison (Ever in prison (7878%)%)

3030%%

Injected drugs in prisonInjected drugs in prison

8181%% of those who injected drugs in prisonof those who injected drugs in prison8181% % of those who injected drugs in prison of those who injected drugs in prison reported having shared syringes in prison. reported having shared syringes in prison. 8181%%

InterpretationsInterpretationsInterpretationsInterpretations

•• Incarceration is common among Thai IDU especially malesIncarceration is common among Thai IDU especially malesIncarceration is common among Thai IDU, especially males Incarceration is common among Thai IDU, especially males

•• A A 4545--day detention period before being diverted into day detention period before being diverted into y p gy p gcompulsory drug treatment system compulsory drug treatment system

•• An alarmingly high rate of syringeAn alarmingly high rate of syringe--sharing occurring within sharing occurring within prison prison

•• An elevated risk of overdose, perhaps upon release from An elevated risk of overdose, perhaps upon release from iiprisonprison

LimitationsLimitationsLimitationsLimitations

•• No temporal relationships between exposure and outcomeNo temporal relationships between exposure and outcomeNo temporal relationships between exposure and outcomeNo temporal relationships between exposure and outcome

•• Findings likely conservative due to socially desirable Findings likely conservative due to socially desirable g y yg y yreporting reporting

•• Sample not randomly selected, findings may not be Sample not randomly selected, findings may not be generalizable to other Thai IDUgeneralizable to other Thai IDU

•• Incarceration events were not distinguished by type, Incarceration events were not distinguished by type, d ti l ti f i tid ti l ti f i tiduration or location of incarceration. duration or location of incarceration.

ConclusionConclusionConclusionConclusion

•• Incarceration is common among Thai IDU and associated Incarceration is common among Thai IDU and associated ith ele ated health risksith ele ated health riskswith elevated health riskswith elevated health risks

•• Urgent need for harm reduction measures includingUrgent need for harm reduction measures including•• Urgent need for harm reduction measures, including Urgent need for harm reduction measures, including syringe exchange, in Thai prisonssyringe exchange, in Thai prisons

•• Given the harms associated with incarceration, the Thai Given the harms associated with incarceration, the Thai drug policy with intensive focus on drugdrug policy with intensive focus on drug--law enforcement law enforcement g p y gg p y gshould be reshould be re--examined. examined.

"This is a health bomb because of HIV they [inmates] take "This is a health bomb because of HIV they [inmates] take y [ ]y [ ]along and this is a bomb because prisons are universities along and this is a bomb because prisons are universities for criminals.” for criminals.” -- Antonio Maria Costa, UNODCAntonio Maria Costa, UNODC

Reuters, Thursday, April 16, 2009Reuters, Thursday, April 16, 2009

Right to HealthRight to Health

AcknowledgementsAcknowledgementsAcknowledgementsAcknowledgements

MSCRP participantsMSCRP participantsMit Sampan Harm Reduction Center staff:Mit Sampan Harm Reduction Center staff: Jirasak Jirasak Sripramong, Preecha Kanoknan, Sripramong, Preecha Kanoknan, Chuchai WimolchaipornChuchai WimolchaipornTTAG staff:TTAG staff: Vipawan Suwannawong, Wiwat Vipawan Suwannawong, Wiwat ChotichatmalaChotichatmalaChulalongkorn University:Chulalongkorn University: Dr. Niyada KiatyingDr. Niyada Kiatying--Angsulee Angsulee BC CfE staff:BC CfE staff: Daniel Miles Kane, Deborah Graham, Leslie Daniel Miles Kane, Deborah Graham, Leslie Rae, MRae, M--J Milloy, Kora DeBeckJ Milloy, Kora DeBeckMSCRP staff:MSCRP staff: Prempreeda Pramoj Na Ayutthaya, Prempreeda Pramoj Na Ayutthaya, p j y yp j y yDonlachai HawangchuDonlachai Hawangchu