Factors associated with incarceration and incident human immunodeficiency virus (HIV) infection among injection drug users participating in an HIV vaccine trial in Bangkok, Thailand, 1999–2003

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Abstract:

ABSTRACT Aims 

To determine if incarceration was associated with human immunodeficiency virus (HIV) infection and identify risk factors for incarceration among injection drug users (IDUs) participating in an HIV vaccine trial in Bangkok. Design 

The AIDSVAX B/E HIV vaccine trial was a randomized, double-blind, placebo-controlled study. A proportional hazards model was used to evaluate demographic characteristics, risk behavior and incarceration as predictors of HIV infection and generalized estimation equation logistic regression analysis to investigate demographic characteristics and risk behaviors for predictors of incarceration. Setting 

The trial was conducted in Bangkok Metropolitan Administration drug-treatment clinics, 1999–2003. Participants 

A total of 2546 HIV-uninfected IDUs enrolled in the trial. Measurements 

HIV testing was performed and an interviewer-administered questionnaire was used to assess risk behavior and incarceration at baseline and every 6 months for a total of 36 months. Findings 

HIV incidence was 3.4 per 100 person-years [95% confidence interval (CI), 3.0–3.9] and did not differ among vaccine and placebo recipients. In multivariable analysis, being in jail (P < 0.04), injecting (P < 0.0001), injecting daily (P < 0.0001) and sharing needles (P = 0.02) were associated with HIV infection and methadone maintenance was protective (P = 0.0006). Predictors of incarceration in multivariable analysis included: male sex (P = 0.04), younger age (P < 0.0001), less education (P = 0.001) and being in jail (P < 0.0001) or prison (P < 0.0001) before enrollment. Conclusions 

Among IDUs in the AIDSVAX B/E trial, incarceration in jail was associated with incident HIV infection. IDUs in Thailand remain at high risk of HIV infection and additional prevention tools are needed urgently. HIV prevention services, including methadone, should be made available to IDUs.

Keywords: HIV infection; HIV vaccine trial; Thailand; incarceration; injection drug users; jail; prison

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1360-0443.2008.02436.x

Affiliations: 1: Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, 2: Bangkok Vaccine Evaluation Group, Bangkok, Thailand, 3: Thailand Ministry of Public Health—US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand, 4: Bangkok Metropolitan Administration, Bangkok, Thailand, 5: VaxGen, Inc., Brisbane, CA, USA

Publication date: February 1, 2009

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