Injection prevalence and risks among male ethnic minority drug users in Northern Thailand.

Thailand's rate of HIV due to drug use is increasing, and nearly one-half of clients at a drug treatment centre in the north are from marginalized ethnic minority groups. We describe and compare socio-demographics, drug use, and sexual practices across ethnic minority people presenting for treatment at the Northern Drug Treatment Center, Mae Rim, Thailand. A prevalence study was conducted between February 1999 and January 2000. Trained interviewers administered a baseline questionnaire to 1,865 people admitted to the Northern Drug Dependence Treatment Center. Ethnic minority (Karen, Akha, Hmong, Lisu, and Lahu) males were included in this analysis (n = 629). Between 7% and 28% of each minority group had ever injected drugs (p = 0.002). Ninety-five per cent of men ever injecting had used heroin. Younger age, speaking Thai language, having a job with higher contact with Thais, and prior drug detoxification were significantly associated with injection in multivariate analysis, while Hmong and Lisu ethnicity were protective. Using occupation and language as proxies, contact with Thais and concomitant acculturation may be a risk for injection among this population. The inadvertent consequences of acculturation as it relates to injection and HIV risk must be addressed.

Methamphetamine users in northern Thailand: changing demographics and risks for HIV and STD among treatment-seeking substance abusers.

Our objective was to determine sociodemographic, sexual and drug-use-related risk factors among methamphetamine (MA) users presenting for drug treatment in northern Thailand. Patients admitted for drug detoxification for MA and other drugs were studied cross-sectionally for risk factors associated with substance abuse and blood-borne and sexually transmitted pathogens. In all, 1865 (200 women) patients treated for MA, opiate, and mixed substance abuse between 1 February 1999 and 31 January 2000 completed all study procedures. Among 1865 participants, 750 (40.2%) were admitted for MA detoxification and 1115 (59.8%) for opiate (heroin, opium, or both) treatment. MA users were significantly younger, better educated, more likely to be Thai than highland ethnic minorities, and had significantly different sexual risks and sexually transmitted disease rates, including lower syphilis seropositivity and higher chlamydial prevalence, than persons admitted for opiate or mixed drug treatment. For those who reported MA use only, use by injection was rare and HIV infections significantly less common than among all other drug users. Thailand is undergoing an epidemic of MA use. These young users are a strikingly different population from opiate/heroin users in northern Thailand. MA users had higher rates of chlamydia infection than opiate users, reflecting their young age, and HIV rates in this population were lower than injecting drug users, but still elevated. MA use is a serious public health problem in Thailand and both improved prevention and treatment methodologies are urgently needed.

The effect of oral contraceptives on protein metabolism.

The effect on protein and amino acid metabolism of combined oral contraceptives (OC) containing 150 micrograms of laevonorgestrel and 30 micrograms of ethinyl oestradiol was studied in a group of 34 healthy non-lactating women. This was compared to an identical study conducted in another group of 19 subjects who used IUCDs for contraception, and also in two other groups of subjects who were given an additional multivitamin preparation on a daily basis (29 subjects) and on the days when OC was not taken (29 subjects). Assessments were made prior to, and during the third week of the 4th, 7th, and the 13th cycles of OC treatment. Results indicated that the ceruloplasmin and retinol binding protein underwent significant increases with OC usage, while sex hormone binding globulin concentration, on the other hand, remained unaffected. At the same time, a significant reduction of several of the plasma amino acid and plasma albumin concentrations was observed, suggesting that the increase in the visceral and other types of protein concentrations previously noted was due to increased hepatic protein synthesis rather than increased breakdown or excretion as result of OC intake. Interesting biochemical alterations and metabolic effects previously observed may well be related to this altered synthesis and release of proteins and/or protein binders as well as induction of certain metabolic enzymes from the liver.

PIP: To assess the effects of combined oral contraceptive (OC) use on protein and amino acid metabolism, measurements were obtained from four groups of women: Group 1 (29 women who took OCs for 21 days followed by 7 days of multivitamin administration); Group 2 (29 women who took OCs and multivitamins concurrently for 21 days); Group 3 (34 women who took OCs and a placebo for 21 days); and Group 4 (19 IUD users). The OC used in this study contained 30 mcg of ethinyl estradiol and 150 mcg of levonorgestrel; 13 cycles were evaluated in the one-year study period. The fasting concentrations of ceruloplasmin and retinol binding protein increased by an average of 155% and 178%, respectively, above baseline in OC users but not in IUD controls. Fasting plasma concentrations of sex hormone binding globulin showed no changes over baseline in any of the four groups. Free amino acid concentrations were depressed in OC users by 13-33%, with the largest decreases occurring for tyrosine, glycine, ornithine, and proline. Finally, mean concentrations of alpha-1 and beta-globulins increased in OC users, while albumin and total protein decreased significantly. Overall, there was a trend toward increased hepatic protein synthesis with a resultant reduction in concentrations of plasma amino acids and albumin. Multivitamin supplementation did not alter any of these patterns.

The incidence of HIV-1 infections in village populations of northern Thailand.

OBJECTIVES: To determine the age- and sex-specific prevalence of HIV-1 infection in a general ambulatory population in northern Thailand in 1990 and 1992, and the incidence of HIV-1 infections between 1990 and 1992. DESIGN: Health fairs were held in five villages in Chiang Mai province in northern Thailand between December 1989 and January 1990 and again in January 1992. Participation of all village residents was encouraged. Villagers were offered testing for serological markers of hepatitis B virus (HBV) infection and free HBV vaccine was made available to susceptible individuals. METHODS: Sera from the two surveys were linked and coded by demographic characteristics (age group and sex). Individual identifiers were removed and the sera tested for HIV-1 antibodies by enzyme-linked immunosorbent assay with Western blot confirmation. RESULTS: In 1990, 21 out of 1161 (1.8%) individuals were HIV-1-seropositive; the infection rates were 3.3% in men and 0.5% in women. In 1992, 44 out of 956 (4.6%) individuals were HIV-1-seropositive. Among people included in both surveys the 2-year incidence was 2.0% in women and 4.1% in men (annual incidence, 1.0 and 2.05%, respectively); however, among men over the age of 14 years the 2-year incidence was 6.3%, whereas among women of this age the 2-year incidence was 1.8% (annual incidence, 3.15 and 0.9%, respectively). Among men, incident HIV-1 infections were common, even among those aged 50 years or more. CONCLUSIONS: Infections with HIV-1 are disturbingly frequent and increasing among adult populations in semi-rural areas of northern Thailand. In order to contain further spread of the epidemic public-health strategies targeted to the general public, including those in rural areas, will be needed.