Despite an ongoing epidemic of HIV among Thai people

Expanding the reach of harm reduction in Thailand: Experiences with a drug user-run drop-in centre.

Despite an ongoing epidemic of HIV among Thai people who inject drugs, Thailand has failed to implement essential harm reduction programmes. In response, a drug user-led harm reduction centre opened in 2004 in an effort to expand reduction programming in Thailand. The authors examined experiences with the Mitsampan Harm Reduction Centre (MSHRC) among injecting drug users participating in the Mitsampan Community Research Project ( Bangkok). Multivariate logistic regression was used to identify factors associated with Mitsampan Harm Reduction Centre use. Kerr et al also examined services used at and barriers to the Mitsampan Harm Reduction Centre. 252 injecting drug users participated in this study, including 66 (26.2%) females. In total, 74 (29.3%) participants had accessed the Mitsampan Harm Reduction Centre. In multivariate analyses, Mitsampan Harm Reduction Centre use was positively associated with difficulty accessing syringes (Adjusted Odds Ratio [AOR]=4.05; 95% Confidence Interval [CI]: 1.67-9.80), midazolam injection (AOR=3.25; 95%CI: 1.58-6.71), having greater than primary school education (AOR=1.88; 95%CI: 1.01-3.52), and was negatively associated with female gender (AOR=0.20; 95%CI: 0.08-0.50). Forms of support most commonly accessed included: syringe distribution (100%), food and a place to rest (83.8%), HIV education (75.7%), and safer injecting education (66.2%). The primary reason given for not having accessed the Mitsampan Harm Reduction Centre was “didn’t know it existed.” The Mitsampan Harm Reduction Centre is expanding the scope of harm reduction in Thailand by reaching injecting drug users, including those who report difficulty accessing sterile syringes, and by providing various forms of support. In order to maximise its benefits, efforts should be made to increase awareness of the Mitsampan Harm Reduction Centre, in particular among women.

Editors’ note: Although drug user-led initiatives to provide harm reduction services have been described in North America, Europe, and Australia, the group of drug users who opened this drug-user-run drop-in centre in Bangkok in 2004 with funding from the Global Fund to fight AIDS, Tuberculosis and Malaria were sailing in un-charted waters for Thailand. The Thai Drug Users Network and the Thai AIDS Treatment Action Group (TTAG) collaborated to start the centre which is open six days a week from 10 am to 7 pm and has 500 to 600 visits per month. At the end of the Global Fund grant in 2008, TTAG assumed oversight of the centre, with drug users continuing to run the centre. It is perhaps not surprising that many drug users interviewed were not aware of the centre given obvious difficulties in advertising its services in a context of documented extreme stigma and discrimination. Expanding the scope of this service and increasing the availability of harm reduction services in general in Thailand will require enlightened leadership in order to reduce the risk of HIV acquisition and transmission among Thais who inject drugs.