The Impact of Police Violence on HIV Risks among People Who Inject Drugs in Thailand Kanna Hayashi 1, 2 Lianping Ti 1 Karyn Kaplan 3 Paisan Suwannawong 3 Kate Shannon 1, 4 Evan Wood 1, 4 Thomas Kerr 1, 4 1 British Columbia Centre for Excellence in HIV/AIDS 2 Interdisciplinary Studies Graduate Program, the University of British Columbia 3 Thai AIDS Treatment Action Group/Mitsampan Harm Reduction Center 4 Department of Medicine, the University of British Columbia

HIV Epidemic among Thai IDU Source: Thailand Bureau of Epidemiology, HIV Total Sentinel Survellance, Ministry of Public Health (2012)

Thai Drug Policy War on drugs in ,800 extrajudicial killings Kingdom's Unity for Victory over Drugs strategy in 2011 Targeting 400,000 drug users into drug treatment Photo from : Mahitthirook, A., Laohong, K.-O., Phones, CDs seized at prison. Bangkok Post, May 18. Intensified police crackdowns in recent years

Study Objectives To identify the prevalence and correlates of experiencing police violence among IDU in Bangkok To identify the prevalence and correlates of experiencing police violence among IDU in Bangkok To describe circumstances of police violence To describe circumstances of police violence Police violence: Ever beaten by police Photo by Rico Gustav

Methods

Mitsampan Community Research Project Acollaborative research effort involving:A collaborative research effort involving: Serial cross-sectionalSerial cross-sectional mixed-methods study mixed-methods study 32 former/active drug users32 former/active drug users trained as peer researchers trained as peer researchers Peer researchers involved inPeer researchers involved in all stages of the project Thai AIDS Treatment Action Group Mitsampan Harm Reduction Center ChulalongkornUniversity June 2008, Bangkok, Thailand

Data & Study Sample Cross-sectional data collected through interviewer- administered questionnaires Adult IDU in Bangkok or in adjacent provinces Recruited through peer outreach and word-of-mouth 307 IDU (June-July 2009) 332 IDU (July-October 2011) 639 unique participants

Statistical Analyses Univariate statistics & multivariate logistic regression Variables: o Sociodemographic information o Drug use patterns o HIV risk behaviour o Experiences with drug law enforcement o Experiences with accessing healthcare o Health problems o Calendar year of study enrolment

Results

Descriptive Statistics “Have you ever been beaten by police?” A community-recruited sample of IDU in Bangkok, June October 2011 (n=639) Participants in 2011 (n=144) most commonly experienced police violence while: 1.Being interrogated (68.1%) 2.Being arrested (43.1%) 3.Being searched (22.9%) 4.In police holding cells (22.9%)

Multivariate Analyses

Interpretations A high proportion of community-recruited IDU in Bangkok reported being beaten by police. Police violence appears to have increased in recent years. Experiencing police violence was independently associated with indicators of drug-related harm.

Limitations Unable to infer causation from this observational study Unable to infer causation from this observational study Self-reported data may be affected affected by socially desirable responding or recall bias Self-reported data may be affected affected by socially desirable responding or recall bias Sample not randomly selected, findings may not be generalizable to Thai IDU at large Sample not randomly selected, findings may not be generalizable to Thai IDU at large

Conclusions The emphasis on law enforcement-based approaches may be contributing to: o Ongoing human rights violations at the hands of police o The perpetuation of the HIV epidemic among Thai IDU A need for: o Greater police oversight o A shift toward the implementation of evidence-based policies and programs specific to HIV/AIDS and illicit drug use

Acknowledgments MSCRP participants MSCRP participants Staff & volunteers at TTAG, Mitsampan Harm Reduction Center & O-Zone House: Jirasak Sripramong, Kamon Uppakaew, Amnat Chamchern, Vipawan Suwannawong, Wiwat Chotichatmala, and Prapatsara Kaewkoon Staff & volunteers at TTAG, Mitsampan Harm Reduction Center & O-Zone House: Jirasak Sripramong, Kamon Uppakaew, Amnat Chamchern, Vipawan Suwannawong, Wiwat Chotichatmala, and Prapatsara Kaewkoon Chulalongkorn University: Dr. Niyada Kiatying-Angsulee Chulalongkorn University: Dr. Niyada Kiatying-Angsulee BC CfE staff: Tricia Collingham, Cameron Dilworth, Deborah Graham, Caitlin Johnston, Daniel Miles Kane, Calvin Lai, Cristy Power, and Peter Vann BC CfE staff: Tricia Collingham, Cameron Dilworth, Deborah Graham, Caitlin Johnston, Daniel Miles Kane, Calvin Lai, Cristy Power, and Peter Vann Research assistants: Prempreeda Pramoj Na Ayutthaya, Arphatsaporn Chaimongkon, Sattara Hattirat, and Puripakorn Pakdirat Research assistants: Prempreeda Pramoj Na Ayutthaya, Arphatsaporn Chaimongkon, Sattara Hattirat, and Puripakorn Pakdirat