Transcript Powerpoint

The Impact of Police Violence on
HIV Risks among People Who Inject
Drugs in Thailand
Kanna Hayashi1, 2
Lianping Ti1
Karyn Kaplan3
Paisan Suwannawong3
Kate Shannon1, 4
Evan Wood1, 4
Thomas Kerr1, 4
1British
Columbia Centre for Excellence in HIV/AIDS
Studies Graduate Program, the University of British Columbia
3Thai AIDS Treatment Action Group/Mitsampan Harm Reduction Center
4Department of Medicine, the University of British Columbia
2Interdisciplinary
HIV Epidemic among Thai IDU
Source: Thailand Bureau of Epidemiology, HIV Total Sentinel Survellance, Ministry of Public Health (2012)
Thai Drug Policy
Intensified police crackdowns in recent years
Kingdom's Unity
Warfor
onVictory
drugs in
over
2003
Drugs strategy in 2011
Targeting
2,800
400,000
extrajudicial
drug users
killings
into drug treatment
Photo from : Mahitthirook, A., Laohong, K.-O., 2012. Phones, CDs seized at prison. Bangkok Post, May 18.
Study Objectives
• To identify the prevalence and correlates of
experiencing police violence among IDU in
Bangkok
• To describe circumstances of police violence
Police violence:
Ever beaten by police
Photo by Rico Gustav
Methods
Mitsampan Community Research Project
• A collaborative research effort involving:
Thai AIDS Treatment Action Group
Mitsampan Harm Reduction Center
Chulalongkorn
University
• Serial cross-sectional
mixed-methods study
• 32 former/active drug users
trained as peer researchers
• Peer researchers involved in
all stages of the project
June 2008, Bangkok, Thailand
Data & Study Sample
• Cross-sectional data collected through intervieweradministered questionnaires
• Adult IDU in Bangkok or in adjacent provinces
• Recruited through peer outreach and word-of-mouth
307 IDU
(June-July 2009)
332 IDU
(July-October 2011)
639 unique participants
Statistical Analyses
• Univariate statistics & multivariate logistic regression
• Variables:
o
o
o
o
o
o
o
Sociodemographic information
Drug use patterns
HIV risk behaviour
Experiences with drug law enforcement
Experiences with accessing healthcare
Health problems
Calendar year of study enrolment
Results
Descriptive Statistics
“Have you ever been beaten by police?”
Yes
38%
No
62%
A community-recruited sample of
IDU in Bangkok, June 2009 October 2011 (n=639)
Participants in 2011 (n=144) most
commonly experienced police
violence while:
1.
2.
3.
4.
Being interrogated (68.1%)
Being arrested (43.1%)
Being searched (22.9%)
In police holding cells
(22.9%)
Multivariate Analyses
Table 2: Multivariate logistic regression analysis of factors associated with reports of police beatings
among a community-recruited sample of IDU in Bangkok, Thailand (n=639)
Variable
Younger age
(< 37 years vs. ≥ 37 years old)
Gender
(Male vs. Female)
Income from drug dealing*
(Yes vs. No)
Study enrolment
(2011 vs. 2009)
Ever in prison
(Yes vs. No)
Barrier to healthcare (long wait time)
(Yes vs. No)
Syringe sharing ever
(Yes vs. No)
Non-fatal overdose ever
(Yes vs. No)
IDU: people who inject drugs; CI: Confidence Interval.
*denotes events/activities in the previous six months.
Adjusted Odds
Ratio
95% CI
1.67
(1.15 – 2.43)
0.008
8.61
(4.58 – 16.21)
<0.001
1.75
(0.87 – 3.52)
0.118
1.66
(1.12 – 2.44)
0.011
4.76
(2.73 – 8.30)
<0.001
1.51
(1.02 – 2.23)
0.039
1.82
(1.23 – 2.70)
0.003
1.67
(1.08 – 2.57)
0.021
p - value
Interpretations
• A high proportion of community-recruited IDU in
Bangkok reported being beaten by police.
• Police violence appears to have increased in recent
years.
• Experiencing police violence was independently
associated with indicators of drug-related harm.
Limitations
• Unable to infer causation from this observational
study
• Self-reported data may be affected affected by
socially desirable responding or recall bias
• Sample not randomly selected, findings may not be
generalizable to Thai IDU at large
Conclusions
• The emphasis on law enforcement-based approaches
may be contributing to:
o Ongoing human rights violations at the hands of police
o The perpetuation of the HIV epidemic among Thai IDU
• A need for:
o Greater police oversight
o A shift toward the implementation of evidence-based policies
and programs specific to HIV/AIDS and illicit drug use
Acknowledgments
 MSCRP participants
 Staff & volunteers at TTAG, Mitsampan Harm Reduction
Center & O-Zone House: Jirasak Sripramong, Kamon
Uppakaew, Amnat Chamchern, Vipawan Suwannawong, Wiwat
Chotichatmala, and Prapatsara Kaewkoon
 Chulalongkorn University: Dr. Niyada Kiatying-Angsulee
 BC CfE staff: Tricia Collingham, Cameron Dilworth, Deborah
Graham, Caitlin Johnston, Daniel Miles Kane, Calvin Lai, Cristy
Power, and Peter Vann
 Research assistants: Prempreeda Pramoj Na Ayutthaya,
Arphatsaporn Chaimongkon, Sattara Hattirat, and Puripakorn
Pakdirat