TY - JOUR
T1 - Incarceration and risk for HIV infection among injection drug users in Bangkok
AU - Choopanya, Kachit
AU - Des Jarlais, Don C.
AU - Vanichseni, Suphak
AU - Kitayaporn, Dwip
AU - Mock, Philip A.
AU - Raktham, Suwanee
AU - Hireanras, Krit
AU - Heyward, William L.
AU - Sujarita, Sathit
AU - Mastro, Timothy D.
PY - 2002/1/1
Y1 - 2002/1/1
N2 - Objective: To assess potential multiple relationships between incarceration and HIV infection among injecting drug users (IDUs) in Bangkok. Previous cross-sectional studies have shown strong relationships between incarceration and HIV infection but have not been able to assess potential causal pathways. Methods: Injection drug users seen at methadone treatment programs in Bangkok were screened during 1995 to 1996 for enrollment into the study. With informed consent, 1,209 seronegative IDUs were enrolled in a cohort study to determine HIV incidence and identify factors associated with incident infections. Follow-up visits were conducted every 4 months, with HIV testing and assessment of risk behaviors. Results: Overall incidence rate was 5.8 per 100 person-years (95% confidence interval [CI], 4.8-6.8) of follow-up. A four-step "injection risk" scale was constructed that included less frequent than daily injection, daily injection, daily injection with reported sharing of injection equipment, and injection while incarcerated. This scale was strongly related to HIV incidence, with incidence approximately doubling for each step in the scale. Incidence rate for follow-up periods that contained drug injection while incarcerated was 35/100 person-years at risk. In multivariate analyses, incarceration was related to incident HIV infection in multiple ways: previous incarceration and recent incarceration without drug injection, and the injection risk scale were all independently predictors of incident HIV infection. Conclusions: Incarceration is related to incident HIV infection through multiple pathways. Previous incarcerations are likely to serve as markers for unmeasured highrisk behaviors, and it is also highly likely that HIV is transmitted during periods of incarceration. Programs to reduce HIV transmission in jails and prisons, including drug abuse treatment of inmates and programs to reduce the likelihood of incarceration of IDUs, are needed urgently. Given the current diffusion of injecting drug use, of HIV infection among drug injectors, and of the common policy of incarcerating drug users, it is very likely that the problem of HIV transmission in jails and prisons is increasing in many countries throughout the world.
AB - Objective: To assess potential multiple relationships between incarceration and HIV infection among injecting drug users (IDUs) in Bangkok. Previous cross-sectional studies have shown strong relationships between incarceration and HIV infection but have not been able to assess potential causal pathways. Methods: Injection drug users seen at methadone treatment programs in Bangkok were screened during 1995 to 1996 for enrollment into the study. With informed consent, 1,209 seronegative IDUs were enrolled in a cohort study to determine HIV incidence and identify factors associated with incident infections. Follow-up visits were conducted every 4 months, with HIV testing and assessment of risk behaviors. Results: Overall incidence rate was 5.8 per 100 person-years (95% confidence interval [CI], 4.8-6.8) of follow-up. A four-step "injection risk" scale was constructed that included less frequent than daily injection, daily injection, daily injection with reported sharing of injection equipment, and injection while incarcerated. This scale was strongly related to HIV incidence, with incidence approximately doubling for each step in the scale. Incidence rate for follow-up periods that contained drug injection while incarcerated was 35/100 person-years at risk. In multivariate analyses, incarceration was related to incident HIV infection in multiple ways: previous incarceration and recent incarceration without drug injection, and the injection risk scale were all independently predictors of incident HIV infection. Conclusions: Incarceration is related to incident HIV infection through multiple pathways. Previous incarcerations are likely to serve as markers for unmeasured highrisk behaviors, and it is also highly likely that HIV is transmitted during periods of incarceration. Programs to reduce HIV transmission in jails and prisons, including drug abuse treatment of inmates and programs to reduce the likelihood of incarceration of IDUs, are needed urgently. Given the current diffusion of injecting drug use, of HIV infection among drug injectors, and of the common policy of incarcerating drug users, it is very likely that the problem of HIV transmission in jails and prisons is increasing in many countries throughout the world.
KW - AIDS
KW - HIV
KW - Incarceration
KW - Injecting Drug Users (IDUs)
KW - Thailand
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U2 - 10.1097/00042560-200201010-00012
DO - 10.1097/00042560-200201010-00012
M3 - Article
C2 - 11782595
AN - SCOPUS:0036151270
SN - 1525-4135
VL - 29
SP - 86
EP - 94
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 1
ER -