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Thailand is located at the Golden Triangle: Population: 65 millions

Current Status of Drug Use and HIV in Thailand Apinun Aramrattana, MD, PhD Faculty of Medicine & Research Institute for Health Sciences Chiang Mai University, Chiang Mai. Thailand is located at the Golden Triangle: Population: 65 millions. Thailand.

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Thailand is located at the Golden Triangle: Population: 65 millions

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  1. Current Status of Drug Use and HIV in Thailand Apinun Aramrattana, MD, PhD Faculty of Medicine & Research Institute for Health Sciences Chiang Mai University, Chiang Mai Thailand is located at the Golden Triangle: Population: 65 millions Thailand International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  2. 0.4 0.6 1 1.1 1.7 2.6 100% 10.6 5.3 7.7 12.8 80% 34.1 19.3 16.5 13.8 5.3 53.7 57.4 60.3 60% 6.3 84.9 83.4 40% 78.2 76 73.7 72.5 71.1 5.7 6.6 6 47.8 20% 32.1 24.1 19.6 0% 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Heroin Opium Ganja Inhalant Alcohol ATS Others Transitional patterns of drug users :10 years ago 19117 38582 21894 27995 27082 27155 13946 29403 30129 29167 NUMBER 18353 Methamphetamine epidemics has been predominated since 1996 Vichai Poshyachinda: MOPH Drug treatment statistics International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  3. Understand young ATS users:- Age at first use of methamphetamine 91% International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  4. Duration of MA use (yrs) and frequency of alcohol use in last 30 days), Chiang Mai, Thailand, 2005 High prevalence of depression (CES-D score >=22) Male = 31% Female = 45% P < .0001 Celentano D D, Aramrattana A, Sutcliffe CG, et.al. (2008) Journal of Adolescent Medicine. 2(2):66-73. International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  5. Youth drug related HIV/STD risk in Thailand Prevalence rates C. trachomatis and N. gonorrhoeae infections, methamphetamine users, Chiangmai, Thailand, 2005 Substance abuse was associated with sexual behavioral risks but not with prevalent STI. Chlamydia trachomatis Neisseria gonorrhea Celentano D, Sirirojn B, Sutcliffe C, et.al. (2008) Sexually Transmitted Diseases 35,400-5. International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  6. Alcohol and Substance Use Patients at OPDSuan Prung Psychiatric Hospital 1995-2006 Rehabilitation law War on drugs Short-term impacts of the ‘War on Drug’ 9% mortality in 5 years among MA psychotic patients. Main causes were suicide, accidents & AIDS Source: Kittiratanapaiboon, P.,Suan Prung Hospital, MOPH, Thailand International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  7. 3rd National Household Survey Retrospective trends of new users 2007 Trends towards polydrugs use. Meth. tab. decreased. Ecstacy increased. Ice was introduced recently and increased. War on drug 2003 YA Ba (Meth. tab.) Cigarettes บุหรี่ ICE (MA crystal) Ecstacy International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  8. War on drug effects: Overcrowded prisons • In 2012, 141 prisons (1 hospital) in Thailand contains around 215,000 prisoners. • About 60% related to drugs, use or trafficking • 86% related to ATS • Overcrowded • Delay diagnosis and treatment International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  9. Household Survey Trends: Ever users: 2001-2011 Estimated Numbers ( x 1,000) Source: ACSAN, ONCB, 2012 Marihuana is re-emerging. Ya Ba are increasing again with Ice emerges on top. International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  10. Estimated number of ATS users in northern Thailand, 2011: 311,600 Research Institute for Health Sciences, Chiang Mai University, 2011 1.4 % >26 12.0 % 4-26 86.6 % 0-3 WHO-ASSIST Score among ATS ever users, Household Survey, 2011. International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  11. HIV prevalence among Injection Drug Users: Trends from HIV Sero-Sentinel Surveillance (HSS) Source: 1989-2011 HSS, Bureau of Epidemiology (BoE), Thailand (2012) International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  12. Source: 1989-2011 HIV Sero-Sentinel Surveillance, BOE (2012) International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  13. IDU size estimation: Background • HIV prevalence among IDUs have been 30-50% since 1992. • Little data was available on the size of the IDU population. • The previous estimate of IDU population size for Bangkok in 1991, using capture-recapture method, were 36,600 (Mastro et al, 1994). This was divided by 0.224 (1980-1999 Bangkok/Nationwide IDU-associated AIDS case ratio) to give a national estimate of 160,000 for 1980-1995 (Asian Epidemic Model, 2008). • In 2004 Wattana et al., using RDS and multiplier methods to come up with Bangkok estimate. With the same method and additional assumptions, the national estimate was then calculated to be 38,380 IDUs (Asian Epidemic Model, 2008). International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  14. IDU size estimation: Current status National Household Survey on Substance Abuse, 2011 Method: Ask direct question ‘Have you ever injected drug?’ Results: Ever injected any drugs = 29,300 IDUs Asian Epidemic Model based on RDS study in Bangkok, 2004 Method: Assumptions 1: 30% underestimation Assumption 2: Bangkok/National AIDS case ratio can be a multiplier. Results: Any injections in the past 6 months = 38,300 IDUs Nation-wide Network Scale-Up Survey, 2010 Methods: Known population scale-up & Summation Results: IDUs known in the past 2 years = 40,300 – 97,300 Consensus number (10 Jan. 2012) = 40,300 International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  15. Injection trends among drug dependence patients, 2003-12 Opium Ya-Ba Number Ice • Most common was heroin • Second most common were Ya-Ba and opium %injection among each drug type Source: Office of Narcotics Control Board database, (2012) International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  16. Military conscripts 2nd round, 2011 26,761males • Ever used drug 14,596 (55%) Non-injection 13,519 (50.6%); Injection 1,077( 4.0%) 81% of Non-IDUs used Ya-Ba. Source: Rangsin’s presentation, MOPH workshop, November 2012, Chiang Mai International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  17. Respondent-Driven Survey (RDS) 2009, Thailand (RDS, 2009) BongkokChiang Mai Age < 25 years (%) 3 42 % Male 83 83 % Injection drug experience Heroin 34 34 Methamphetamine 63 32 Midazolam 42 4 Methadone 13 6 OpiumNA 14 %Sharing needle at last injection5 48 % HIV prevalence 24 11 IDUs in Bangkok and Chiang Mai were poly-drug users. International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  18. Response of Thailand to drug use related HIV epidemic • Outreach for education, counseling and engaging • Needle and syringe exchange program (NSP) • - Expanding HIV voluntary counseling and testing • Scale-up methadone maintenance treatment • ARV and related programs • Prison programs These are currently supported by the Global Fund round 8 through CHAMPION IDU program. 1st November 2010, Prime Minister approved National HIV prevention and care plans including NSP. However, current laws still allow polices to arrest people who carrying syringes. International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  19. Available services for drug users (Rapid Assessment and Responses (RAR): Chiang Mai 2010) • Peer group: Thai Drug User Network (TDN) • Population Service International (PSI) • - Drop-in centers and outreach activities by • peers providing education, information and counseling, needle and syringe exchange • GO: Drug Treatment Centers, Hospitals • - HIV voluntary counseling and testing (VCT) • - CD4 test (free) • - Methadone maintenance treatment • - ARV programs through universal coverage • including prison settings • :Prisons - HIV education program, VCT, Tbc • - Methadone program is under planning. International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

  20. Current Status of Drug Use and HIV in Thailand Apinun Aramrattana, MD, PhD Faculty of Medicine & Research Institute for Health Sciences Chiang Mai University, Chiang Mai Thank you very much. Q & A Thailand International Conference on Global Health, National Health Research Institute, Taiwan, 17-9 April 2013

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