Bio-behavioral Survey of HIV, Syphilis, HBV, and HCV Prevalence, Drug Use, Sexual Behavior, Knowledge, and Stigma among People who Inject Drugs in Thailand: A Respondent-driven Sampling, November 2022 to March 2023
DOI:
https://doi.org/10.59096/osir.v19i2.279142Keywords:
people who inject drugs, sexually transmitted infections, bloodborne diseases, respondent-driven sampling, ThailandAbstract
Objectives: People who inject drugs (PWIDs) are a vulnerable population facing multiple public health challenges. We aimed to estimate the prevalence of sexually transmitted infections (STIs) and bloodborne diseases, and assess drug behavior, sexual behavior, knowledge of STIs, and stigma among PWIDs.
Methods: A cross-sectional survey using respondent-driven sampling was conducted in three regions of Thailand from November 2022 to March 2023. We collected data on HIV, syphilis, hepatitis B virus (HBV), and hepatitis C virus (HCV) testing, drug use and injection practices, sexual behavior, knowledge of STIs, and stigma.
Results: Among 1,015 PWIDs, the prevalence of HIV, syphilis, HBV, and HCV was 8.2%, 3.3%, 6.4%, and 34.8%, respectively. Heroin was the most commonly injected drug, and the age of heroin initiation was 14 years or below. Over 70% reported using a new needle at each use; however, in Chiang Mai Province the rate was 46.0%. Treatment was sought and received by 69.2% of respondents. While 77.3% reported being sexually active, only 32.6% consistently used condoms, and 48.4% reported using drugs before having sex. Screening for HIV and other STIs were 59.9% and 37.3%, respectively. HIV knowledge was low at 44.0%, and less than 10% were aware of pre- and post-exposure prophylaxis. Stigmatization within the family was reported by 33.2% and 14.8% avoided accessing healthcare.
Public Health Recommendations: Our findings indicate that STIs remain a significant issue in Thailand. PWIDs demonstrated suboptimal rates of using clean needles, seeking treatment, and knowledge about prevention practices. Recommendations include strengthening harm reduction, expanding screening, improving prevention education, and enhancing healthcare access.
References
Office of the narcotics control board Ministry of Justice. Thailand Narcotics Control annual report 2022 [Internet]. Bangkok; Ministry of Justice: [cited 2025 Dec 1]. 101 p. <https://aseannarco.oncb.go.th/uploads/Ebook/pdf/1811339084713505.pdf>
Proute M, Le Coeur S, Tiv MH, Dub T, Jongpaijitsakul P, Ratnamhin A, et al. Risky injection practices and HCV awareness in Chiang Mai Province, Thailand: a respondent-driven sampling study of people who inject drugs. BMC Public Health. 2020 Dec 24;20(1):1450. doi:10.1186/s12889-020-09549-w.
Prybylski D, Manopaiboon C, Visavakum P, Yongvanitjit K, Aramrattana A, Manomaipiboon P, et al. Diverse HIV epidemics among people who inject drugs in Thailand: Evidence from respondent-driven sampling surveys in Bangkok and Chiang Mai. Drug Alcohol Depend. 2015 Mar;148:126–35. doi:10.1016/j.drugalcdep.2014.12.034.
Talek M, Saingam D, Wichaidit W. HIV testing and HIV positivity among people who inject drugs (PWIDs) with and without history of high-risk behaviors: findings from a respondent-driven sampling (RDS) survey in Southern Thailand. Sage Open. 2023 Jul 6;13(3):1–9. doi:10.1177/21582440231196725.
Jackson JB, Wei L, Liping F, Aramrattana A, Celentano DD, Walshe L, et al. Prevalence and seroincidence of hepatitis B and hepatitis C infection in high risk people who inject drugs in China and Thailand. Hepat Res Treat. 2014 Mar 27;2014:1–5. doi:10.1155/2014/296958.
Martin M, Vanichseni S, Leelawiwat W, Anekvorapong R, Raengsakulrach B, Cherdtrakulkiat T, et al. Hepatitis C virus infection among people who inject drugs in Bangkok, Thailand, 2005–2010. WHO South-East Asia J Public Heal. 2019;8(1):50. doi:10.4103/2224-3151.255350.
Erickson BH. Some problems of inference from chain data. Sociol Methodol. 1979;10:276. doi:10.2307/270774.
Heckathorn DD. Respondent-driven sampling II: deriving valid population estimates from chain-referral samples of hidden populations. Soc Probl. 2002 Feb;49(1):11–34. doi:10.1525/sp.2002.49.1.11.
Semaan S, Lauby J, Liebman J. Street and network sampling in evaluation studies of HIV risk-reduction interventions. AIDS Rev. 2002;4(4):213–23.
Lwanga SK, Lemeshow S. Sample size determination in health studies: a practical manual [Internet]. Geneva: World Health Organization; 1991 [cited 2025 Mar 15]. 80 p. <https://tbrieder.org/publications/books_english/lemeshow_samplesize.pdf>
Fleiss JL, Levin B, Paik MC. Statistical Methods for Rates and Proportions [Internet]. 3rd ed. Hoboken (NJ): John Wiley & Sons; 2003 [cited 2025 Mar 15]. <https://content.e-bookshelf.de/media/reading/L-583786-76ad72e5cb.pdf>
Ministry of Public Health, Thailand; Family Health International; United States Agency for International Development. The Asian Epidemic Model (AEM): projections for HIV/AIDS in Thailand: 2005-2025 [Internet]. Nonthaburi; Ministry of Public Health; 2008 [cited 2025 Mar 15]. 65 p. <https://www.aidsdatahub.org/sites/default/files/resource/aem-projections-hiv-aids-thailand-2005-2025.pdf>
World Health Organization. Introduction to HIV/AIDS and sexually transmitted infection surveillance: module 4. Supplement: A guide to using RDS Analyst and NetDraw [Internet]. Cairo: World Health Organization, Regional Office for the Eastern Mediterranean; 2014 [cited 2025 Mar 15]. 65 p. <https://iris.who.int/handle/10665/250535>
Cronin B. Getting started in social network analysis with NETDRAW [Internet]. Greenwich: University of Greenwich; 2015 [cited 2025 Mar 15]. <https://gala.gre.ac.uk/id/eprint/16200/7/16200CRONIN_Getting_Started_in SNA_with_NETDRAW_2015.pdf>
Calvo M, MacFarlane J, Zaccaro H, Curtis M, Caban M, Favaro J, et al. Young people who use drugs engaged in harm reduction programs in New York City: Overdose and other risks. Drug Alcohol Depend. 2017 Sep;178:106–14. doi:10.1016/j.drugalcdep.2017.04.032.
Budambula V, Matoka C, Ouma J, Ahmed AA, Otieno MF, Were T. Socio-demographic and sexual practices associated with HIV infection in Kenyan injection and non-injection drug users. BMC Public Health. 2018 Dec 30;18(1):193. doi:10.1186/s12889-018-5100-y.
Adamson K, Jackson L, Gahagan J. Young people and injection drug use: Is there a need to expand harm reduction services and support? Int J Drug Policy. 2017 Jan;39:14–20. doi:10.1016/j.drugpo.2016.08.016.
Oguya FO, Kenya PR, Ongecha F, Mureithi P, Musyoka H, Muraguri N, et al. Rapid situational assessment of people who inject drugs (PWID) in Nairobi and coastal regions of Kenya: a respondent driven sampling survey. BMC Public Health. 2021 Aug 14;21(1):1549. doi:/10.1186/s12889-021-11373-9.
Mateu-Gelabert P, Guarino H, Quinn K, Meylakhs P, Campos S, Meylakhs A, et al. Young Drug Users: a Vulnerable Population and an Underutilized Resource in HIV/HCV Prevention. Curr HIV/AIDS Rep. 2018 Aug 22;15(4):324–35. doi:10.1007/s11904-018-0406-z.
Des Jarlais DC, Arasteh K, McKnight C, Feelemyer J, Campbell ANC, Tross S, et al. What happened to the HIV epidemic among non‐injecting drug users in New York City? Addiction. 2017 Feb 14;112(2):290–8. doi:10.1111/add.13601.
Gholami J, Rostam‐Abadi Y, Rahimi Y, Fotouhi A, Amin‐Esmaeili M, Rahimi‐Movaghar A. HIV prevalence among non‐injecting people who use drugs and related factors in Iran: A systematic review and meta‐analysis. Drug Alcohol Rev. 2022 Mar 16;41(3):666–76. doi:10.1111/dar.13407.
Gupta A, Shebl FM, Tong Y, Wagner K, Bassett IV, Page K, et al. Association of co-occurring mental health problems with hepatitis C status among young people who inject drugs in rural New Mexico, 2016–2018. Addict Sci Clin Pract. 2022 Oct 20;17(1):58. doi:10.1186/s13722-022-00340-3.
Mateu-Gelabert P, Sabounchi NS, Guarino H, Ciervo C, Joseph K, Eckhardt BJ, et al. Hepatitis C virus risk among young people who inject drugs. Front Public Heal. 2022 Jul 29;10:835836. doi:10.3389/fpubh.2022.835836.
Rogers-Brown J, Sublett F, Canary L, Rein DB, Bhat M, Thompson WW, et al. High-Risk Injection-Related Practices Associated with anti-HCV Positivity among Young Adults Seeking Services in Three Small Cities in Wisconsin. Subst Use Misuse. 2022;57(5):665–73. doi:10.1080/10826084.2022.2026964.
Platt L, Minozzi S, Reed J, Vickerman P, Hagan H, French C, et al. Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs. Cochrane Database Syst Rev. 2017 Sep 18;9(9):CD012021. doi:10.1002/14651858.CD012021.pub2.
Scheibe A, Young K, Versfeld A, Spearman CW, Sonderup MW, Prabdial-Sing N, et al. Hepatitis B, hepatitis C and HIV prevalence and related sexual and substance use risk practices among key populations who access HIV prevention, treatment and related services in South Africa: findings from a seven-city cross-sectional survey (2017). BMC Infect Dis. 2020 Dec 7;20(1):655. doi:10.1186/s12879-020-05359-y.
Ahmed T, Long TN, Huong PT, Stewart DE. Drug injecting and HIV risk among injecting drug users in Hai Phong, Vietnam: a qualitative analysis. BMC Public Health. 2015;15(1):32. doi:10.1186/s12889-015-1404-3.
O’Keefe D, Horyniak D, Dietze P. From initiating injecting drug use to regular injecting: Retrospective survival analysis of injecting progression within a sample of people who inject drugs regularly. Drug Alcohol Depend. 2016 Jan;158:177–80. doi:10.1016/j.drugalcdep.2015.11.022.
Koozegar M, Shahesmaeili A, Noroozi M. Transition from First Drug Use to Regular Injection among People Who Inject Drugs in Iran. Addict Heal. 2018 Jan;10(1):32–40. doi:10.22122/ahj.v10i1.458.
Hayashi K, Ti L, Ayutthaya PPN, Suwannawong P, Kaplan K, Small W, et al. Barriers to retention in methadone maintenance therapy among people who inject drugs in Bangkok, Thailand: a mixed-methods study. Harm Reduct J. 2017 Dec 7;14(1):63. doi:10.1186/s12954-017-0189-3.
Duong HT, Jarlais D Des, Khuat OHT, Arasteh K, Feelemyer J, Khue PM, et al. Risk Behaviors for HIV and HCV Infection Among People Who Inject Drugs in Hai Phong, Viet Nam, 2014. AIDS Behav. 2018 Jul;22(7):2161–71. doi:10.1007/s10461-017-1814-6.
Feelemyer JP, Richard E, Khan MR, Scheidell JD, Caniglia EC, Manandhar-Sasaki P, et al. Does the Association Between Stimulant use and High Risk Sexual Behavior Vary by Injection Drug Use, Sexual Minority Status, or HIV Infection Status? A Meta-analysis. AIDS Behav. 2023 Sep 14;27(9):2883–90. doi:10.1007/s10461-023-04012-4.
Ganapathi L, McFall AM, Srikrishnan AK, Kumar MS, Anand S, Lucas GM, et al. Young people who inject drugs in India have high HIV incidence and behavioural risk: a cross‐sectional study. J Int AIDS Soc. 2019 May;22(5):e25287. doi:10.1002/jia2.25287.
Brookmeyer KA, Haderxhanaj LT, Hogben M, Leichliter J. Sexual risk behaviors and STDs among persons who inject drugs: A national study. Prev Med (Baltim). 2019 Sep;126:105779. doi:10.1016/j.ypmed.2019.105779.
Carter G, Meyerson B, Rivers P, Crosby R, Lawrence C, Cope SD, et al. Living at the confluence of stigmas: PrEP awareness and feasibility among people who inject drugs in two predominantly rural states. AIDS Behav. 2021;25(10):3085–96. doi:10.1007/s10461-021-03304-x.
Jost JJ, Tempalski B, Vera T, Akiyama MJ, Mangalonzo AP, Litwin AH. Gaps in HCV Knowledge and Risk Behaviors among Young Suburban People Who Inject Drugs. Int J Environ Res Public Health. 2019 Jun 2;16(11):1958. doi:10.3390/ijerph16111958.
Borda JP, Arango V, Herrera P, Cabrera O, Castano GA, Tofighi B. HIV knowledge and risk behaviors among people who inject heroin in Colombia. Drugs Educ Prev Policy. 2022;29(5):625–31. doi:10.1080/09687637.2021.1944061.
Vetrova MV, Cheng DM, Bendiks S, Gnatienko N, Lloyd-Travaglini C, Jiang W, et al. HIV and substance use stigma, intersectional stigma and healthcare among HIV-positive PWID in Russia. AIDS Behav. 2021 Sep 28;25(9):2815–26. doi:10.1007/s10461-021-03172-5.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Outbreak, Surveillance, Investigation & Response (OSIR) Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
