Patterns of Risky Behaviors Associated with Methamphetamine Use Among Young Thai Adults: A Latent Class Analysis

PurposeMethamphetamine (MA) is the leading illicit drug in Thailand among youth and young adults. Sexual risk behaviors are associated with methamphetamine use, but few data are available on the daily context of methamphetamine use. We developed an inductive behavioral typology that young Thais engage in while using methamphetamine.MethodsWe conducted a cross-sectional study in Chiang Mai, Thailand, in 2005–2006 among 1,162 street-recruited methamphetamine smokers 18–25 years of age. Data collected included sociodemographic characteristics, sexual behaviors, and drug use patterns. Latent class analysis was used to describe patterns of activities in which participants reported engaging directly after using MA. Logistic regression was used to examine univariate correlates of class membership, separately by gender.ResultsParticipants were 75% male with a median age of 19 years. More than half of participants reported frequent alcohol use (≥4 days/week) and half of the sample reported smoking MA ≥2 days/ week. Three classes of activities emerged for male participants (n = 863): “work” (job related); “high-risk behaviors” (motorcycle riding, fighting, sex); and “combined” (all activities). Two classes emerged for the women (n = 299): “work” (housework) and “high-risk behaviors.” “High-risk behaviors” and “combined” (men only) classes were associated with more frequent alcohol and methamphetamine use compared with the “work” class.ConclusionsOur study found a distinct typology of behaviors associated with substance abuse among young adults in Thailand. Behavioral typologies allow a better understanding of the nuances of “risky” behaviors and might prove useful in targeting interventions.     

The efficacy of a network intervention to reduce HIV risk behaviors among drug users and risk partners in Chiang Mai,Thailand and Philadelphia,USA

This HIV Prevention Trials Network study assessed the efficacy of a network-oriented peer education intervention promoting HIV risk reduction among injection drug users and their drug and sexual network members in Chiang Mai, Thailand and Philadelphia, USA. The study was designed to test impact on HIV infection, but the infection rate was low and the study was terminated early. This paper reports efficacy on outcomes of self-reported HIV risk behaviors. We enrolled 414 networks with 1123 participants. The experimental intervention consisted of six small group peer educator training sessions and two booster sessions delivered to the network index only. All participants in both arms received individual HIV counseling and testing. Follow-up visits occurred every six months for up to 30 months. There were 10 HIV seroconversions, 5 in each arm. The number of participants reporting injection risk behaviors dropped dramatically between baseline and follow-up in both arms at both sites. Index members in the intervention arm engaged in more conversations about HIV risk following the intervention compared to control indexes. There was no evidence of change in sexual risk as a result of the intervention. Reductions in injection risk behaviors were observed: 37%, 20%, and 26% reduction in odds of sharing cottons, rinse water and cookers, respectively, and 24% reduction in using a syringe after someone else. Analysis of the individual sites suggested a pattern of reductions in injection risk behaviors in the Philadelphia site. In both sites, the intervention resulted in index injection drug users engaging in the community role of discussing reduction in HIV injection risk behaviors. The intervention did not result in overall reductions in self-reported sexual risk behaviors, and although reductions in injection risk behaviors were observed, the overall efficacy in reducing risk was not established.     

UNANTICIPATED EFFECT OF A RANDOMIZED PEER NETWORK INTERVENTION ON DEPRESSIVE SYMPTOMS AMONG YOUNG METHAMPHETAMINE USERS IN THAILAND

We examined the effect on depressive symptoms of a peer network‐oriented intervention effective in reducing sexual risk behavior and methamphetamine (MA) use. Current Thai MA users aged 18‐25 years and their drug and/or sex network members enrolled in a randomized controlled trial with 4 follow‐ups over 12 months. A total of 415 index participants recruited 568 network members. Linear repeated measures models were fit with depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES‐D]) as the outcome. Among indexes in the intervention condition, mean CES‐D decreased from 20.0 to 15.7 (p < 0.0001) over follow‐up. Controlling for covariates and changes in MA and alcohol use, CES‐D in this group decreased by 0.35 points per month (95% confidence interval, 0.45, ‐0.25). All other groups showed minimal changes in CES‐D score. The peer‐oriented, community‐based intervention designed to reduce MA use and sexual risk behavior also resulted in substantial reduction in depressive symptoms, independent of changes in MA use.     

Patterns of methamphetamine use and symptoms of depression among young adults in northern Thailand

Introduction

Depression often co-occurs with amphetamine type stimulant use and can negatively impact drug treatment outcomes. Understanding the temporal relationship between depressive symptoms and methamphetamine use can further inform both treatment and mental health options.

Methods

Methamphetamine users aged 18–25 years were enrolled in a 12-month randomized behavioral trial in Thailand. Questionnaires were administered every 3 months and included information on substance use and depressive symptoms. Pattern of methamphetamine use during follow-up was characterized into four groups: early cessation, late cessation, relapse and persistent use. Multinomial logistic regression was used to determine the impact of baseline depressive symptoms (CES-D score and % ≥22) on patterns of methamphetamine use during follow-up. Linear and logistic regression was used to determine the impact of patterns of methamphetamine use on depressive symptoms at the end of the trial.

Results

No association was found between baseline depressive symptoms and subsequent patterns of methamphetamine use. A significant relationship was found between patterns of methamphetamine use and ensuing depressive symptoms, with those achieving cessation experiencing lower levels of depressive symptoms.

Discussion

Many symptoms of depression may resolve with cessation or reduction in methamphetamine use. Clinical and community-based efforts that facilitate drug users’ attempts to stop using drugs should be supported as they may contribute to positive cessation outcomes and help to improve overall mental health.     

Elevated alcohol and sexual risk behaviors among young Thai lesbian/bisexual women

BackgroundLittle empirical data have been published about drinking or sexual behaviors among Thai lesbians. We examine the association of sexual identity with established indicators of alcohol- and sexual-related health behaviors among female bar patrons.MethodsWe conducted a cross-sectional study among women (N = 121) aged 18–24 who frequented popular drinking establishments in Chiang Mai, Thailand. We used general linear modeling techniques to estimate associations between sexual identity and positive alcohol expectancy, harmful drinking, age at sexual debut, and number of lifetime sexual partners.ResultsNearly one-third of women aged 18–24 recruited from Chiang Mai drinking venues identified as lesbian/bisexual. As compared to their heterosexual counterparts, lesbian/bisexuals reported higher positive alcohol expectancy scores, more harmful drinking, earlier age at sexual debut, and higher number of lifetime sexual partners. In adjusted models, lesbian/bisexual identity was associated with higher positive alcohol expectancy (β = 1.94 points; 95% CI: 0.75, 3.13), earlier age at sexual debut (β = ?0.85 years; 95% CI: ?1.46, ?0.23), and higher number of lifetime sexual partners (rate ratio = 1.70; 95% CI: 1.22, 2.37).ConclusionLesbian/bisexual women in this study engaged in multiple behaviors that are potentially harmful to health, which may in turn place this group at heightened risk for alcohol abuse and sexually transmitted infections in Thailand. The clustering of alcohol- and sexual-related risk behaviors, and its consequences for health outcomes in this population, should be explored in future research and may be an important point of intervention.     

Short-term safety of buprenorphine/naloxone in HIV-seronegative opioid-dependent Chinese and Thai drug injectors enrolled in HIV Prevention Trials Network 058

BackgroundBuprenorphine/naloxone (BUP/NX) is not licenced for use in China or Thailand and there was little clinical experience with this drug combination in these countries at the inception of HIV Prevention Trial Network (HPTN) 058, a randomized trial comparing risk reduction counselling combined with either short-term or long-term medication assisted treatment with BUP/NX to prevent HIV infection and death amongst opioid-dependent injectors.MethodsWe conducted a safety phase that included the first 50 subjects enrolled at each of the three initial study sites (N = 150). Clinical and laboratory assessments were conducted at baseline and weekly for the first 4 weeks. Changes in laboratory parameters were estimated with random effects models.ResultsBUP/NX was well tolerated by study subjects and opioid withdrawal scores decreased substantially during the 3-day induction. Two participants experienced grade 3 clinical adverse events, which were categorized as probably not related to the study drug. Grade 2 or 3 increases in alanine aminotransferase (ALT) occurred in 25 (17%) subjects. The magnitude of ALT increase over 4-week follow-up was strongly associated with baseline ALT elevation.ConclusionsIn Chinese and Thai opioid-dependent injectors, we found BUP/NX to be effective in reducing opioid withdrawal symptoms and safe during short-term use. ALT increases were observed over 4-week-follow-up, which are consistent with reports from Western populations. Long-term safety and efficacy evaluations are indicated.