Social and cultural contexts of HIV risk behaviors among Thai female sex workers in Bangkok, Thailand.

Recently, the number of indirect female sex workers (FSWs) who work at bars/clubs and massage parlors is substantially increasing in Thailand; however, there are huge gaps in knowledge about HIV risk behaviors among indirect FSWs. This study aimed to describe and understand HIV risk behaviors among Thai FSWs in Bangkok in relation to sociocultural factors and work environment (e.g., bars/clubs, massage parlors, brothels, and street). Based on venue-based purposive sampling methods, Thai FSWs were recruited for qualitative interviews (n=50) and survey interviews (n=205). Based on mixed methods, the study revealed that HIV risk and substance use behaviors among FSWs significantly differed depending on work venues, although there were no significant differences between work venues on some key risk behaviors (e.g., inconsistent condom use with primary partners and customers; willingness to engage in unsafe sex with customers). A multiple linear regression analysis revealed that FSWs who had used illicit drugs, were young, had low levels of self-esteem, or reported STIs had frequently engaged in unprotected vaginal sex with customers. Also, FSWs who worked at bars/clubs, were young, had higher income, or reported STIs had frequently engaged in sex with customers under the influence of alcohol. Qualitative interviews illustrated FSWs' alcohol and drug use due to their stressful life (e.g., long working hours and a large number of customers) and easy access to alcohol and drugs. FSWs had shown inaccurate knowledge about HIV prevention methods and engaged in risky behaviors, such as washing vagina with water or toothpaste after having had sex with customers. The HIV prevention strategies in Thailand need to be re-structured through implementing evidence-based HIV prevention intervention programs for FSWs, which must address sociocultural factors (e.g., self-esteem) and alcohol and drug use specific to work venues.

HIV-related risk behaviors among kathoey (male-to-female transgender) sex workers in Bangkok, Thailand.

Based on combined methods, this study investigated substance use and HIV risk behaviors among kathoey sex workers (KSWs) in Bangkok, Thailand. The study found that only half of the KSW participants reported having been tested for HIV, and that except for one participant, all others had not seen health care providers in the past 12 months. About one third of the participants reported having engaged in unprotected anal sex with customers in the past six months. Almost all participants reported alcohol use, as well as having had sex with customers under the influence of alcohol. The prevalence of marijuana and ecstasy use in the past 12 months was high (32 and 36%, respectively); as was for ketamine (20%) and non-injecting methamphetamine (yaba) use (10%). A multiple regression analysis showed that the participants who were post-operative status, had used illicit drugs, or had been abused by their father and brothers were less likely to use condoms for anal sex with customers. Three quarters of the participants sent money to their families and 35% of the participants expressed their willingness to engage in unsafe sex when customers offer extra money. The qualitative interviews revealed that many identified as girl or kathoey in early age and had been exposed to transphobia and violence from father and brothers. Some reported support for gender transition from their mothers. More than half of the participants currently had difficulties in living as kathoey, such as challenges in the job market and relationship with family members. Family obligation for sending money and the Buddhist concept of karma were discussed in relation to risk behaviors among KSWs. The study provided implications for facilitating HIV testing and developing future HIV prevention intervention programs for KSWs in Thailand.

Determinants of waterpipe smoking among high school students in Jakarta, Indonesia.

OBJECTIVES: The study aimed to examine factors associated with past 30 days waterpipe use among high school students in Jakarta, Indonesia. METHODS: We surveyed a multistage cluster random sample of 1,318 students of grade 10th and 11th from 14 schools in Jakarta. Multiple logistic regressions were employed to examine the association between past 30 days waterpipe use with sociodemographic characteristics, cigarettes smoking status, parental and peer use, availability and affordability. RESULTS: Of 1,318 participants, 3.3% of female and 8.4% of male currently smoked waterpipe. Multivariate analysis revealed that current waterpipe use was significantly associated with family use (AOR: 4.844, 95% CI: 1.225-19.151), friend use (AOR: 2.554, 95% CI: 1.424-4.582), and availability (AOR: 2.143, 95% CI: 1.127-4.076). Being current smokers were six times more likely (AOR: 6.055, 95% CI: 3.123-11.739) to use waterpipe in the past 30 days. CONCLUSIONS: The finding suggests that smoking by a family member, friends, use of conventional cigarettes, and availability are significantly associated with increased probability of current waterpipe used among adolescents.

Effectiveness of Positive Deviance, an Asset-Based Behavior Change Approach, to Improve Knowledge, Attitudes, and Practices Regarding Dengue in Low-Income Communities (Slums) of Islamabad, Pakistan: A Mixed-Method Study.

Dengue is a mosquito-borne, viral disease that has emerged as a global health concern in recent years. In the absence of specific antiviral treatment and vaccines, prevention remains the key strategy for dengue control. Therefore, innovative and community-driven approaches are required to improve the vector control practices. This study applied and evaluated the positive deviance (PD) approach on dengue prevention and control in selected slums of Islamabad during June-October 2020. The two most dengue-affected slums, the Faisal colony and France colony, were purposively selected as intervention and control groups, respectively. A total of 112 participants (56 for the intervention and 56 for the control group) participated in the study. The intervention group was exposed for two months to locally identified role model behaviors through weekly interactive sessions, dengue sketch competitions, and role plays. Another two months enabled the community to practice these behaviors without any external support in order to explore the intervention's sustainability. Three surveys were conducted: before the intervention, after two months, and after four months, to assess any changes in the knowledge, attitudes, and practices of participating communities. Results found that the PD intervention had a significant positive impact on dengue knowledge, attitudes, and practices in the intervention group. PD could offer an empowering and efficient community engagement tool for future dengue prevention and control, both in Pakistan and more globally.

Assessment of pharmacognostic specification of Cannabis sativa leaves in Thailand.

Lack of quality control can affect the safety, efficacy, and acceptability of herbal products that may lead to health problems. Cannabis sativa L. (Cannabaceae) has been widely used as an ethnomedicinal practice for its medicinal values. This study aims to establish pharmacognostic specifications of C. sativa as per standard procedures. Macroscopic-microscopic characteristics, physicochemical parameters, thin-layer chromatography (TLC) fingerprinting, and phytochemical screening of C. sativa leaves collected from various locations throughout Thailand were investigated. Leaves are palmate consists of seven leaflets with green color, margin is serrate with acuminate apex. Anomocytic stomata were found in the upper epidermis while unicellular and glandular trichomes with cystolith were found in the lower epidermis and the epidermis layer covered with cuticle. The physicochemical analysis revealed that the loss on drying (4.068 ± 0.084 %w/w) was within acceptable limits, total ash (14.360 ± 0.084%w/w), acid insoluble ash (2.726 ± 0.080%w/w), ethanol-soluble extractive (11.101 ± 0.223%w/w), water-soluble extractive (23.038 ± 0.306%w/w), and water content (7.523 ± 0.524%w/w). TLC fingerprint showed nine spots with Rf value 0.14, 019, 0.23, 0.29, 0.32, 0.45, 0.58, 0.70, and 0.76. Phytochemical screening of Cannabis leaves indicated the presence of phenolic compounds, flavonoids, alkaloids, diterpenes, triterpenes, and steroids. This study provided referential data for the accurate plant identity, and establishment of cannabis leaves monograph in Thailand.

Methamphetamine dependence treatment rehabilitation in Thailand: a model assessment.

OBJECTIVE: Assess the process and outcome of the treatment rehabilitation program in Thailand by comparing out-patients and in-patients from drug dependent treatment centers (DDTCs) under Matrix and FAST Models. MATERIAL AND METHOD: In the DDTCs, male in-patient and out-patient volunteers aged 15-35 years were randomly selected to assess demographic characteristics, socio-economic status, history of substance use, and other behavior related to their health. Observations of the process of therapy and assessment of patients' improvement were made. After completing the rehabilitation, which lasted four months, trained field workers visited the patients at 1-, 3- and 6-month intervals. Analyses of rehabilitation focused on cognitive and behavioral changes at one and three months. Regarding the follow-up outcomes, comparison of Matrix and FAST Models relapse was analyzed by survival graph and Cox-regression of the days since stopping illegal substance use. RESULTS: Ninety-two in-patients and forty-three out-patients were recruited. No significant difference was found in the characteristics of the patients between the two models or in the treatment centers. After assessing patients at 1-, 3-, and 6-month, more improvement was noted among those in the FAST model than in the Matrix model. CONCLUSION: This research confirmed improvement in attendees at the in-patient treatment model and the effectiveness of rehabilitation.

Effect of "tailored goal oriented community brief intervention model" on AUDIT reduction in Thai communities.

OBJECTIVE: The present study aimed to test the result of Tailored Goal oriented Community Brief Intervention Model (TGCBI) the change of Alcohol Use Disorder Identification Test (AUDIT) scores. MATERIAL AND METHOD: A quasi-experimental research comparing between two high drinking prevalence communities in Lop Buri Province, Thailand, an intervention group with TGCBI Model, and a control group without TGCBI. The TGCBI is a treatment that lies on three components. Firstly the TGCBI based on FRAMES consisting of Feedback, Responsibility, Advice, Menu of Option, Empathy, and Self-Efficacy Secondly, drinkers must voluntarily set-up their goal and drinking reduction design suitable for them and their community. Lastly, key informants such as monks, health personnel, family, and friends can be a source to complete the FRAMES. MEASUREMENT: Measurements are done using AUDIT scores. RESULTS: Fifty subjects in control and forty-seven in intervention drinkers completing 1, 3, and 6 monthly intervals were followed-up. The follow-up of the change of AUDIT score after 1, 3, and 6 months of TGCBI in the two communities showed that intervention community, with TGCBI had a decrease in AUDIT score when compared within its community and with a controlled community. CONCLUSION: The results proved TGCBI model is effective in AUDIT reduction.

Alcohol consumption patterns among men who have sex with men in major cities of Myanmar: A cross-sectional study.

Background: Alcohol consumption patterns vary widely across the regions of the world. Although previous studies have focused on the sexual risk behaviours among men who have sex with men (MSM), studies regarding binge alcohol drinking among MSM in Myanmar are scarce. Methods: A cross-sectional study was conducted to identify the alcohol consumption patterns among MSM aged over 18 years in two major cities of Myanmar where the MSM population is higher than other regions. Purposive sampling was applied and sampling was made through Myanmar MSM network. Face-to-face interviews were conducted using a structured questionnaire. Patterns of alcohol consumption were described as frequency/percentage and mean/median as appropriate. Bivariate analysis was also done to find out the association between types of MSM and binge drinking. Results: A total of 256 MSM included in the study (mean age, 27.33±7.7 years). Of 256 participants, 225 MSM had the experience of alcohol consumption in their lifetime (225/256, 87.9%). Among ever drinkers, 152 MSM consumed alcohol within three months (152/225, 67.6%). Regarding beer consumption, the highest proportions of MSM from both groups (42.8%, 36.8%) consumed 1-3 times per week. Overall, 57.2% of young MSM and 41.2% of adult MSM consumed beer together with their friends. Nearly 34% of young MSM and nearly 38% of adult MMS consumed beer at gatherings of friends. At different time periods, higher proportions of Thange (partners of MSM) had experienced of binge drinking than apwint (open) and apone (hidden) (p<0.05). Conclusions: The current study identified the alcohol consumption patterns in terms of type, amount, frequency at different time periods among MSM in major cities of Myanmar. It is suggested to develop and implement alcohol control policy for MSM since the proportion of current drinkers as well as binge drinking higher among these groups.

Current cannabis-related situation in the Asia-Pacific region.

PURPOSE OF REVIEW: We present information on cannabis policy, demand, and supply in the Asia-Pacific region. METHOD: A systematic review of peer-reviewed articles using PubMed, MEDLINE, and reliable sources was conducted. We classified the policy implemented in each country into conducting research, legalization of medical and recreational use, decriminalization, cultivation, and others. RECENT FINDINGS: In Australia, New Zealand, and Thailand, medical use has been approved, whereas it is limited in South Korea and Singapore and illegal in other countries. Except Australia, none of the Asia-Pacific region countries allows recreational use. China and Japan are expected to approve medical use, whereas Australia and New Zealand work on decriminalization. Most cultivation is allowed and regulated for medical use. Cannabis seizures have changed in accordance with these policies. Although the national surveys of four countries, that is, Australia, New Zealand, Japan, and Thailand were conducted in different years, the use of cannabis among the general population has increased. SUMMARY: Any change in the legal status of cannabis must be undertaken with caution and fully evaluated at each stage to determine the extent to which these changes are leading to increased numbers of users, oversupply, and health risks including cannabis-related harm.

Effectiveness of the behavior change intervention to improve harm reduction self-efficacy among people who inject drugs in Thailand.

BACKGROUND: People who inject drugs (PWID) in Thailand reported unsafe injection practices resulting in injection-related health consequences. Harm reduction self-efficacy plays an important role and could be improved to reduce harm associated with injecting drugs. Evidence-based interventions targeting PWID are needed. This study sought to evaluate the effectiveness of the behavior change intervention within the PWID population. METHODS: The behavior change intervention, Triple-S, was designed to improve harm reduction self-efficacy among PWID. This quasi-experimental study was a pre- and post-comparison with a control group design. Participants were PWID, aged 18-45 years, and located in Bangkok. Changes in harm reduction self-efficacy of the intervention group were compared with the control group using paired and independent t-test. RESULTS: Most of PWID were male (84%), had a secondary school and lower education (71%), were single, and had a mean age of 41 years. They had been injecting drugs for an average of 20 years, and the median of drug injections per week was ten times in the past month. Pre- and post-intervention effects were measured and results showed that the intervention group reported improvement in harm reduction self-efficacy in negative emotional conditions (P=0.048). CONCLUSION: Our findings suggest that Triple-S intervention can significantly improve harm reduction self-efficacy in negative emotional conditions. The results may suggest the importance of behavior change intervention, especially when integrated with services provided by drop-in centers. The intervention can be further developed to cover other harm reduction behaviors and improve harm reduction self-efficacy.

Examining the Sociocultural Context of HIV-related Risk Behaviors Among Kathoey (Male-to-female Transgender Women) Sex Workers in Bangkok, Thailand.

Kathoey (male-to-female transgender) sex workers (KSW) in Thailand are at high risk for sexually transmitted infections; however, few qualitative studies have been conducted to understand the sociocultural context of engaging in HIV risk behaviors. A total of 24 participants were purposively sampled in Bangkok based on KSW work venues and substance use. Results revealed the importance of participants' understanding of the self in relation to establishing economic independence through sex work, which could then be used to re-establish support from family, who often have not accepted a son's gender transition. Participants linked being kathoey to a belief in fate but did not view engagement in sex work in the same way. Different sex work venues exposed KSW to different risky situations. HIV prevention programs for kathoey must address the importance of economic security and its relation to social support and gender transition within a cultural- and work-environment-specific framework.

Effectiveness of a Tailored Goal Oriented Community Brief Intervention (TGCBI) in reducing alcohol consumption among risky drinkers in Thailand: a quasi-experimental study.

OBJECTIVE: An intervention to reduce the average alcohol intake and the number of drinking days in risky drinkers was conducted in a quasi-experimental study in two communities (intervention and control communities) in Lop Buri Province, Thailand. METHOD: The participants were risky drinkers (with scores ranging from 8 through 19 on the World Health Organization's Alcohol Use and Disorders Identification Test) ages 19-65 years. In the intervention community, individual participants set their own drinking-reduction goals, and each participant received a Tailored Goal Oriented Community Brief Intervention (TGCBI) administered in four sessions over 2 months. The number of drinking days and the average alcohol intake during the past 30 days were measured before the intervention and at 1, 3, and 6 months after it. Complete data were available from 47 intervention and 50 control participants. Intervention effects at each post-intervention time were assessed with linear mixed models. RESULTS: Baseline sociodemographic characteristics showed no statistically significant differences between the two groups (p > .05). At baseline, M (SD) days of drinking and average daily alcohol intake were 12.9 days (10.5) and 20.4 g (19.2), respectively. The intervention was associated with a substantial reduction in both measures at each post-intervention time, and magnitudes of reduction increased with increasing time. Modeled intervention-related reductions in drinking days at successive post-intervention times were 5.1 (p = .031), 7.4 (p = .001), and 9.0 days (p < .001). Corresponding reductions in daily alcohol intake were 16.5, 17.4, and 25.0 g (p < .001 at 1 month, 3 months, and 6 months, respectively, after the intervention). Adjustment for potential confounders and inclusion in the analysis of participants with missing data made little difference in modeled intervention effects. CONCLUSIONS: TGCBI was associated with a substantial and significant reduction in drinking days and average alcohol intake through 6 months after the intervention. TGCBI could well prove beneficial for risky drinkers both inside and outside Thailand.

Sustainability of Tailored Goal Oriented Community Brief Intervention Model among risky drinkers in community in Thailand.

Tailored Goal Oriented Community Brief Intervention Model (TGCBI), first implemented as culturally secure and acceptable to communities in Thailand, is designed in 2 stages or levels: community level, a culturally secure approach to motivate participants to reconsider their drinking behavior; individual level, involved in the key messages received from the community level together with additional input focused towards individuals. TGCBI's effectiveness was measured by the number of abstinent drinkers and number of alcohol-free months among those who continued to drink at followup in two communities that originally had high prevalence of risky drinking. Multivariate Poisson regression was used to investigate the intervention effect. Results indicated that the number of participants who stopped drinking 6 months later and the number of alcohol-free months during followup were significantly greater (P < 0.05) for 47 participants in the intervention group compared to the control group (n = 50). TGCBI results in sustainable drinking cessation.