Risk factors for HIV infection among drug injectors in southern Thailand

Background: To determine HIV sero-prevalence and risk factors for HIV infection among injecting drug users (IDU) in southern Thailand. Methods: Using a cross-sectional HIV sero-prevalence and behavioral survey, 272 active IDU were interviewed about background, life-style, drug use patterns, and sexual behaviors at six drug-treatment clinics in southern Thailand. Results: Ninety-one percent reported lifetime needle sharing; 96% had tried HIV risk-reduction by either stopping/decreasing visits to sex workers and/or stopping/decreasing needle sharing. Only 5% knew that bleaching needles could reduce transmission risks. Overall, 51% tested HIV-positive (43% ethnic Thai vs. 64% ethnic Malay). HIV seropositivity among ethnic Thai was independently correlated with past history of needle sharing (OR 6.95; 1.89-25.58), injecting immediately at drug onset (OR 2.53; 1.25-5.13), and starting first injection at younger age (OR 2,61; 1.31-5.22). Injecting immediately at drug onset (OR 4.32; 1.23-15.14) and not carrying new needles (OR 4.47; 1.27-15.69) were risk factors among minority ethnic Malay. Conclusion: A high rate of HIV infection persists among southern-Thai IDU. HIV-infected individuals may act as a bridge of HIV transmission to their sex partners. AIDS prevention efforts should more intensely focus on minority ethnic Malays, discouraging needle sharing and increasing protected sex with regular sexual partners. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.