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Characterizing and responding to the...

Bazazi, Alexander Reza.

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Characterizing and responding to the epidemics of HIV and injection drug use in Malaysia.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Characterizing and responding to the epidemics of HIV and injection drug use in Malaysia./
作者:	Bazazi, Alexander Reza.
出版者:	Ann Arbor : ProQuest Dissertations & Theses, : 2016,
面頁冊數:	184 p.
附註:	Source: Dissertation Abstracts International, Volume: 78-07(E), Section: B.
Contained By:	Dissertation Abstracts International78-07B(E).
標題:	Epidemiology. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=10583211
ISBN:	9781369619119

Characterizing and responding to the epidemics of HIV and injection drug use in Malaysia.
Bazazi, Alexander Reza.

Characterizing and responding to the epidemics of HIV and injection drug use in Malaysia. - Ann Arbor : ProQuest Dissertations & Theses, 2016 - 184 p.

Source: Dissertation Abstracts International, Volume: 78-07(E), Section: B.

Thesis (Ph.D.)--Yale University, 2016.

The intersecting epidemics of HIV and injection drug use constitute an enormous burden on morbidity and mortality worldwide. Malaysia is thought to be home to roughly 200,000 people who inject drugs (PWID), mostly heroin, and the majority of existing cases of HIV in Malaysia have been attributed to unsafe injection practices. Strict drug laws contribute to the frequent arrest and incarceration of PWID in Malaysia, resulting in large numbers of people living with HIV and opioid dependence in the criminal justice system. Despite the burden of disease in this population, the epidemiology of injection drug use and associated health problems has not been characterized in detail.

ISBN: 9781369619119Subjects--Topical Terms:

568544
Epidemiology.

Characterizing and responding to the epidemics of HIV and injection drug use in Malaysia.
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520 $a The intersecting epidemics of HIV and injection drug use constitute an enormous burden on morbidity and mortality worldwide. Malaysia is thought to be home to roughly 200,000 people who inject drugs (PWID), mostly heroin, and the majority of existing cases of HIV in Malaysia have been attributed to unsafe injection practices. Strict drug laws contribute to the frequent arrest and incarceration of PWID in Malaysia, resulting in large numbers of people living with HIV and opioid dependence in the criminal justice system. Despite the burden of disease in this population, the epidemiology of injection drug use and associated health problems has not been characterized in detail.
520 $a In the first part of this dissertation, I used a cross-sectional respondent-driven sampling study of 461 PWID from 2010 to characterize key aspects of the epidemiology of injection drug use and HIV as well as the prevention and treatment needs of PWID in Malaysia. In Chapter 1, the prevalence of HIV was estimated to be 15.8% (95% CI 12.519.2%), high but within the range of government estimates and estimates from PWID in other countries in the region. Significant geographic heterogeneity in HIV prevalence and risk behaviors was identified that has implications for intervention and surveillance. In an examination of HIV testing in Chapter 2, most people living with HIV were found to be aware of their HIV status despite the fact that PWID infrequently accessed HIV testing services. The primary locations where people reported receiving HIV testing were prison and compulsory drug detention centers, where testing is involuntary and linkage to care limited. In Chapter 3, the prevalence and correlates of recently experiencing an overdose were examined. In the sample, the 6-month period prevalence of non-fatal overdose was 20%. Since non-fatal overdose is strongly predictive of future fatal overdose, this represents a serious and previously undocumented mortality threat to PWID in Malaysia. Several correlates of recent overdose were identified, including reporting rushing an injection from fear of the police, use of alcohol and methamphetamine in addition to opiates, and intermittent but not daily methadone use.
520 $a In the second part of this thesis, one response to the epidemics of HIV and injection drug use is examined: a prison-based drug treatment intervention for people living with HIV and opioid dependence, implemented from 2010 to 2014. Chapter 4 describes this prospective, controlled trial, designed to evaluate the effects within-prison methadone maintenance therapy and a behavioral intervention on post-release health and social outcomes. Implementation challenges and protocol changes are described with a discussion of their implications for analysis. In Chapter 5, data from this trial were linked to government death records to evaluate the impact of within-prison methadone maintenance therapy on survival after release from prison. No effect of within-prison methadone maintenance therapy on survival was detected, but this study revealed extremely high mortality rates after prison release that appeared to be driven by HIV-related deaths.
520 $a This work documents significant threats to the health of PWID in Malaysia, both from overdose and HIV infection, and shows that access to voluntary HIV testing services and to HIV treatment may be limited. Harm reduction and treatment interventions for PWID in the community and criminal justice system are urgently needed to reduce morbidity and mortality in this population. Public health responses at the individual level should simultaneously address multiple comorbidities, such as through the integration of treatment for HIV and opioid dependence. In order to truly improve the health of this population, structural interventions that move beyond the level of the individual also will be needed, such as those that increase access to HIV and opioid dependence treatment in communities and prisons and those that align health and human rights objectives through voluntary HIV testing services and less punitive policing practices.
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