Reducing Youth Drug Related HIV/STD Risk in Thailand

Summary

Principal Investigator: David Celentano
Affiliation: Johns Hopkins Bloomberg School of Public Health
Country: USA
Abstract: Methamphetamine (MA), a central nervous system stimulant, has become the leading drug of abuse in Thailand over the past three years. The United Nations' Drug Control Program reported that the most significant increase of illicit drug use worldwide in the1990s was in the consumption of amphetamine-type stimulants (ATS). The WHO estimates more than 35 million regular users of MA worldwide, making it the second most commonly used illicit drug after marijuana. With recent drought and subsequent reduced poppy production in Burma, the Burmese military junta in power has responded to declining foreign reserves by encouraging the production and shipment of massive quantities of methamphetamine into Thailand during the past two years. These mobile factories are very difficult to locate and the MA tablets are easily concealed and smuggled, resulting in easy access and low price in Thailand. There are a range of social and medical consequences of MA abuse: poor performance in schools among students; anxiety; convulsion; brain damage; MA psychosis, characterized by violent behavior, repetitive activity, memory loss and paranoia; and acquiring HIV and other blood-borne infections from administering MA by injection. In Thailand, youth are the leading age group initiating MA use. A recent Thai national survey estimated that 12.4 percent of students between 12 and 20 years used illicit drugs in 1999, of whom 57 percent reportedly have used MA. Thus, there is a compelling public health need to address the issue of MA abuse among adolescents and young adults in northern Thailand. Preventing escalation of drug use practices, particularly with respect to route of drug administration, may prove effective in preventing the spread of HIV among those who have not yet begun injecting; HIV prevalence among injectors in northern Thailand is currently over 30 percent. In response to this public health emergency, we are proposing a randomized, controlled peer-outreach intervention trial targeting methamphetamine users (n=258) and their drug and sexual networks (n=1032) in northern Thailand. We will adapt Latkin's intervention that has been demonstrated effective in the USA in reducing HIV-related risk behaviors among IDUs. The primary study endpoint would be reduction in transition to injection drug use among MA users who currently deny any history of injection. The primary objective of this RCT is to assess the efficacy of a peer educator intervention versus HIV voluntary counseling and testing (VCT) on transition to injection drug use among MA users and their peer networks. The intervention addresses reduction of HIV risk behaviors. A series of behavioral measures for HIV risk, level of MA abuse (including overdose and psychiatric morbidity) and injection use among the index and network members will be used to evaluate the efficacy of the intervention. Secondary objectives include: (1) To compare the incidence of sexually transmitted infections (C trachomatis, N gonorrhea, and, for women, T vaginalis) and Hepatitis C Virus in each study condition; (2) To compare changes in HIV and sexual risk behaviors in each study condition for index participants and network members; and (3) To compare perceived changes in substance use network norms for drug and sexual risk practices in each study condition. This study builds on an active NIDA study (DA11133) of our Thai collaboration, is an appropriate extension of our work on HIV and drug use epidemiology and is responsive to a public health problem of central concern to our host country.
Funding Period: 2001-09-30 - 2007-09-29
more information: NIH RePORT

Top Publications

  1. ncbi Drug use, street survival, and risk behaviors among street children in Lahore, Pakistan
    Susan S Sherman
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, E6543 Baltimore, MD 21205, USA
    J Urban Health 82:iv113-24. 2005
  2. ncbi Street life and drug risk behaviors associated with exchanging sex among male street children in Lahore, Pakistan
    VIVIAN L TOWE
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland 21205, USA
    J Adolesc Health 44:222-8. 2009
  3. ncbi Patterns of risky behaviors associated with methamphetamine use among young Thai adults: a latent class analysis
    Susan G Sherman
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA
    J Adolesc Health 44:169-75. 2009
  4. ncbi Patterns of methamphetamine use and symptoms of depression among young adults in northern Thailand
    Catherine G Sutcliffe
    Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States
    Drug Alcohol Depend 101:146-51. 2009
  5. ncbi Evaluation of a peer network intervention trial among young methamphetamine users in Chiang Mai, Thailand
    Susan G Sherman
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E6543, Baltimore, MD 21205, USA
    Soc Sci Med 68:69-79. 2009
  6. ncbi Correlates of incarceration among young methamphetamine users in Chiang Mai, Thailand
    Nicholas Thomson
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD 21205, USA
    Am J Public Health 99:1232-8. 2009
  7. ncbi A qualitative study of sexual behaviours among methamphetamine users in Chiang Mai, Thailand: a typology of risk
    Susan G Sherman
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
    Drug Alcohol Rev 27:263-9. 2008
  8. ncbi Sexually transmitted infections and sexual and substance use correlates among young adults in Chiang Mai, Thailand
    David D Celentano
    Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA
    Sex Transm Dis 35:400-5. 2008
  9. ncbi Penile modification in young Thai men: risk environments, procedures and widespread implications for HIV and sexually transmitted infections
    N Thomson
    Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
    Sex Transm Infect 84:195-7. 2008
  10. ncbi Young Thai women who use methamphetamine: intersection of sexual partnerships, drug use, and social networks
    Danielle German
    Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
    Int J Drug Policy 19:122-9. 2008

Scientific Experts

Detail Information

Publications13

  1. ncbi Drug use, street survival, and risk behaviors among street children in Lahore, Pakistan
    Susan S Sherman
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, E6543 Baltimore, MD 21205, USA
    J Urban Health 82:iv113-24. 2005
    ..3-8.9); and ever having cut themselves (AOR=15.4; 95% CI=3.4-70.7). Drug use is a major coping mechanism among street children in Lahore and is associated with many behaviors. Targeted programs are needed to meet their special needs...
  2. ncbi Street life and drug risk behaviors associated with exchanging sex among male street children in Lahore, Pakistan
    VIVIAN L TOWE
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland 21205, USA
    J Adolesc Health 44:222-8. 2009
    ..Throughout the developing world, children living on urban streets is a byproduct of economic deprivation. In Lahore, Pakistan, there are an estimated 5,000-7,000 street children...
  3. ncbi Patterns of risky behaviors associated with methamphetamine use among young Thai adults: a latent class analysis
    Susan G Sherman
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA
    J Adolesc Health 44:169-75. 2009
    ..Sexual risk behaviors are associated with methamphetamine use, but few data are available on the daily context of methamphetamine use. We developed an inductive behavioral typology that young Thais engage in while using methamphetamine...
  4. ncbi Patterns of methamphetamine use and symptoms of depression among young adults in northern Thailand
    Catherine G Sutcliffe
    Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States
    Drug Alcohol Depend 101:146-51. 2009
    ..Understanding the temporal relationship between depressive symptoms and methamphetamine use can further inform both treatment and mental health options...
  5. ncbi Evaluation of a peer network intervention trial among young methamphetamine users in Chiang Mai, Thailand
    Susan G Sherman
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E6543, Baltimore, MD 21205, USA
    Soc Sci Med 68:69-79. 2009
    ..To our knowledge, this is the first such trial targeting this population. Small group interventions are an effective means of reducing methamphetamine use and sexual risk among Thai youth...
  6. ncbi Correlates of incarceration among young methamphetamine users in Chiang Mai, Thailand
    Nicholas Thomson
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD 21205, USA
    Am J Public Health 99:1232-8. 2009
    ..We examined correlates of incarceration among young methamphetamine users in Chiang Mai, Thailand in 2005 to 2006...
  7. ncbi A qualitative study of sexual behaviours among methamphetamine users in Chiang Mai, Thailand: a typology of risk
    Susan G Sherman
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
    Drug Alcohol Rev 27:263-9. 2008
    ..Methamphetamine (MA) has become the leading drug of abuse in northern Thailand over the past several years, particularly among youth. The current qualitative study explores the relationship between sexual behaviours and MA...
  8. ncbi Sexually transmitted infections and sexual and substance use correlates among young adults in Chiang Mai, Thailand
    David D Celentano
    Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA
    Sex Transm Dis 35:400-5. 2008
    ..Data on the prevalence of and associated behavioral risk factors for sexually transmitted infections (STI) in young adults in Asia have not been widely studied...
  9. ncbi Penile modification in young Thai men: risk environments, procedures and widespread implications for HIV and sexually transmitted infections
    N Thomson
    Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
    Sex Transm Infect 84:195-7. 2008
    ..To determine the prevalence and types of penile modification and describe the circumstances surrounding this practice among a sample of young methamphetamine users in Thailand...
  10. ncbi Young Thai women who use methamphetamine: intersection of sexual partnerships, drug use, and social networks
    Danielle German
    Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21231, USA
    Int J Drug Policy 19:122-9. 2008
    ....
  11. ncbi Initiation of methamphetamine use among young Thai drug users: a qualitative study
    Susan G Sherman
    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA
    J Adolesc Health 42:36-42. 2008
    ..Methamphetamine (MA) has become the leading drug of abuse in northern Thailand over the past several years, particularly among youth. The current qualitative study examines factors associated with initiation of MA use...
  12. ncbi Motivations for methamphetamine cessation among young people in northern Thailand
    Danielle German
    Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
    Addiction 101:1143-52. 2006
    ..To understand factors influencing cessation intentions among young Thai methamphetamine (MA) users, a population with dramatically increasing rates of MA use...
  13. ncbi Incidence of HIV and sexually transmitted infections and risk factors for acquisition among young methamphetamine users in northern Thailand
    Catherine G Sutcliffe
    Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
    Sex Transm Dis 36:284-9. 2009
    ..Incidence estimates of STIs are rare in Southeast Asia, especially among newer risk groups...