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In February 2003, the Thai Government enacted a 'war on drugs' to reduce supply and demand for illicit drugs. This study aimed to examine the impact of this policy on injection drug users (IDUs) drug utilisation patterns and to explore IDU attitudes toward and experiences with the policy in Chiang Mai province. In April 2003, 263 IDU who participated in a study in the preceding year were followed up and 165 IDUs (63%) were available and consented to participate in a cross-sectional survey. Of these 85% had ceased injecting and 70% had done so since the implementation of the policy, with a higher percentage of rural compared to urban IDUs ceasing injection (78% versus 55%, p < 0.001). One-third of those who had ceased drug injection reported smoking opium or methamphetamine, with a lower percentage of urban compared to rural dwellers (24% versus 36%, p < 0.01). Paradoxically, 88% of participants reported that government policy was 'good,' ostensibly because it might reduce the temptation to use drugs among the non-initiated by reducing the supply. The majority of study participants reported ceasing injection, often transitioning to other substance use. Differences in drug utilisation patterns were found between urban and rural dwellers. The fear produced by the policy probably led to an underreporting of injection practices and could lead to increased risky syringe behaviours. Continued research is needed to monitor the effects of the policy on patterns of drug use, routes of administration, and HIV risk behaviours. [ABSTRACT FROM AUTHOR]

Objectives: : To measure mortality rates and assess predictors of all-cause mortality in a cohort of Thai injection drug users (IDUs) who were enrolled and followed up from 2004 through 2006., Methods: : In this prospective cohort study, we enrolled 314 community-dwelling IDUs (95% being men; 42% of ethnic minority; median age, 29 years [range, 18-69 years]) and followed up them at 6-month intervals. Mortality rates were calculated based on person-years of follow-up. Marginal Cox proportional hazards models for clustered data were constructed to determine the factors associated with all-cause mortality., Findings: : During 445.7 person-years of follow-up, 17 of 314 (5.4%) IDUs died. The all-cause mortality rate was 3.8 per 100 person-years (95% confidence interval [CI] = 2.2-6.1). The standardized mortality ratio was 5.8 (95% CI = 3.5-9.1). The mortality rate among HIV-positive IDUs was 13.4 per 100 person-years (95% CI = 5.4-27.6). In a marginal Cox proportional-hazards model for clustered data, the excess mortality was associated with HIV-positivity (hazard ratio [HR] = 7.0, 95% CI = 2.8-17.6), benzodiazepine use (HR = 3.1, 95% CI = 1.1-9.4), and excessive alcohol consumption at enrollment (HR = 3.5, 95% CI = 1.3-9.1)., Conclusions: : The all-cause mortality among the drug injectors is high. The increased mortality was associated with HIV infection, benzodiazepine use, and excessive alcohol consumption.

Objective: Social norms have been associated with a wide range of health behaviors. In this study, the authors examined whether the social norms of HIV risk behaviors are clustered within social networks and whether the norms of network members are linked to the risk behaviors of their social network members., Design: Data were collected from the baseline assessment of 354 networks with 933 participants in a network-oriented HIV prevention intervention targeting injection drug users in Philadelphia, United States, and Chiang Mai, Thailand., Main Outcome Measures: Four descriptive HIV risk norms of sharing needles, cookers, and cotton and front- or back-loading among friends who inject were assessed., Results: Three of 4 injection risk norms (sharing needle, cookers, and cotton) were found to be significantly clustered. In Philadelphia, 1 network member's (the index participant) norms of sharing needles and front- or back-loading were found to be significantly associated with the network members' risk behaviors, and the norm of sharing cotton was marginally associated., Conclusion: The results of this study suggest that among injection drug users, social norms are clustered within networks; social networks are a meaningful level of analyses for understanding how social norms lead to risk behaviors, providing important data for intervening to reduce injection-related HIV risks.

Aims: To estimate mortality rates among HIV-negative injecting drug users (IDUs) and non-injecting drug users (non-IDUs), and to assess predictors for mortality among the IDUs., Design: Prospective cohort study in northern Thailand with 2-year follow-up., Setting: IDUs and non-IDUs who were admitted for detoxification treatment for opiate or amphetamine dependence in a regional drug treatment center were screened. After discharge, HIV-negative individuals were followed-up in the community., Participants: A total of 821 HIV-negative drug users [346 IDUs (42%) and 475 non-IDUs, median age = 32; 51% were ethnic minorities]., Measurements: All-cause mortality., Findings: There were 33 deaths over 1360 person-years of follow-up. The all-cause mortality rate was 39 per 1000 person-years among IDUs [standardized mortality ratio (SMR) = 13.9], and was 14 per 1000 person-years among non-IDUs (SMR = 4.4). Among male IDUs, the hazards for all-cause deaths were ethnic minority status [adjusted hazard ratio (HR) = 2.9, 95% CI = 1.2-7.2], incident HIV infection (HR = 2.8, 95% CI = 1.1-7.7) and longer duration of drug injection (HR = 1.07, 95% CI = 1.01-1.14)., Conclusions: The mortality among IDUs is high. Being from an ethnic minority, recent HIV acquisition, and a greater number of years of drug injection are predictors of mortality among the IDUs in this region.