Thailand is well known on the international public health platform for its extensive and successful prevention programs in HIV/AIDS. It became one of the earliest countries to control this epidemic. Although these programs reached many different population groups in Thailand, one group was left behind: drug users. The government has had a history of refusing to implement prevention and treatment programs for IDUs. Instead, they have largely criminalized drug use, which have resulted in tremendous increases in incarceration rates and over-crowded prisons. Because HIV prevention and treatment programs in prison are limited, incarceration has become a huge risk factor in HIV infection.
Although data is sparse, one study found that 25% of prisoners were HIV positive, as opposed to the 1.5% prevalence in the general population. Another study found that those with a history of prison were twice as likely to be HIV-positive than those who had never been jailed. These statistics are alarming, given the limited existence of prevention and treatment programs and the growing number of prisoners.
Many factors contribute to this problem. One of them is the budget constraints. Out of the $150million spent on prison health care annually in 2000, less than $25,000 was spent on HIV/AIDS treatment. This restricting budget works out to an annual budget of $3.50 per prisoner, resulting in limited access to much needed healthcare, especially for HIV-positive prisoners. Without treatment, infected prisoners pose the possibility of infecting other inmates through risky behavior, which comprise most of the other contributing factors. For instance, tattooing with shared equipment is common in Thailand prisons. The use of unsterilized tattooing equipment translates to an increased risk of HIV infection. The largest contributing factor is unprotected (consensual and non-consensual) sex between inmates. Condom availability is extremely limited in the prisons. Even with available condoms, prison guards are often reluctant to distribute them and prisoners do not use them. Some prisoners lack awareness of the association between unprotected sex and HIV risk, while others simply refuse to use them because of the stigma associated with condom usage.
When I wrote my policy memo on HIV/AIDS among IDUs in Thailand, I wanted to include this epidemic that was affecting Thailand prisons. However, this issue is far too complex to simply mention it in the memo, so that is why I’m blogging about the issue instead. I think that the government needs to refocus their drug policies and work on expanding health access to prisoners instead of simply incarcerating more people than the prisons can house. Harm reduction policies such as sterile equipment, education, and condom distribution is paramount in reducing HIV rates. Programs that involve counseling and treatment need to be implemented to curb this epidemic.