Mahidol University Annual Research Abstracts 2000 565 Incarceration as a Continuing HIV Risk Factor among Injecting Drug Users (IDUs) in Bangkok Suwanee Raktham1, D. Kitayaporn2 , S. Vanichseni1, K. Hiranras1, K. Choopanya1, D.C. Des Jarlais3, W. Subhachaturas1, P. Mock4, T.D. Mastro4 1 Bangkok Metropolitan Administration, 2 Mahidol University, Bangkok, Thailand, 3 Beth Israel Medical Center, NY, USA, 4 The HIV/AIDS Collaboration, Nonthaburi, Thailand Background: Bangkok experienced very rapid spread of HIV among IDUs in 1988, followed by stable seroprevalence at approximately 30-40% with continued high incidence. Estimated incidence from a prospective cohort of IDUs attending 15 Bangkok Metropolitan Administration methadone clinics during 05/95-05/98 was 6.3 per 100 personyears at risk. Previous cross-sectional surveys have shown that having been incarcerated was significantly associated with being HIV seropositive, with odds ratios in the range of 2 to 3. We evaluated risk factors for incarceration among cohort enrollees.
Methods: HIV-negative IDUs were offered enrollment after informed consent; data were obtained from enrollment and follow-up questionnaires. HIV testing and counseling and interviews on demographics, drug use, and sexual behaviors were conducted at enrollment and scheduled every 4 months.
Results: Of 1,209 HIV-negative IDUs enrolled, 133 seroconverted through 12/98. A proportional hazard model demonstrated factors associated (p < 0.01) with HIV infection in Bangkok IDU include: daily injection of heroin (RR=2.4), daily injection of heroin plus sharing of equipment (RR=3.2), being incarcerated since last visit (RR=2.0), drug injection while being incarcerated since last visit (RR=4.5), and having average monthly income of ?5,000 Baht (US$ 140, RR=1.6). Sixtyfive percent of cohort members had been incarcerated prior to enrollment, and 38% of cohort members were incarcerated at least once during followup. Factors associated with being incarcerated, using logistic regression, included: age < 25 years old (RR 2.3, 95% CI = 1.6 - 3.2, referent: age 40+ years), having secondary school education or less (RR = 1.5, 95% CI=1.1 - 2.1, referent: higher education), being in the methadone maintenance program (RR = 0.6, 95% CI = 0.4 - 0.8, referent: 45-day detoxification program), and daily use of heroin plus sharing drugs (RR = 3.1, 95% CI = 2.3 - 4.2, referent: no use).
Conclusions: Drug use while being incarcerated is a strong risk factor for incident HIV infection in Bangkok IDUs. Frequent heroin injection and lower socio-economic status lead to higher probability of being incarcerated. Additional measures are needed to reduce the risk of HIV transmission related to incarceration.
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