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Chris Beyrer

Publications and source records attributed to Chris Beyrer.

24 records · Page 2Linked to original sources
PubMed2003

AIDS and public policy: the lessons and challenges of "success" in Thailand.

Thailand's public policy on AIDS is widely cited as one of the few examples of an effective national AIDS prevention program anywhere in the world. The Thai experience shows that a national response that mobilized key government and NGO partners and targeted the highest-risk transmission can be effective in reducing the scope of the epidemic, even when action is delayed. Based on interviews with policymakers, AIDS program managers, technical specialists, donors, and NGOs and on a review of the data, we highlight the lessons from public policy on AIDS in Thailand for other developing countries, review the state of the Thai epidemic and public policy in 2000, and identify three strategic priorities for the next phase of the response.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Drug use, increasing incarceration rates, and prison-associated HIV risks in Thailand.

BACKGROUND: Incarceration is a known risk for HIV infection in Thai drug users. Through the 1990s, incarceration rates for drug-related offenses rose sharply, whereas HIV prevention and drug treatment in prisons remained limited. METHODS: We assessed HIV and incarceration risks for injection drug users (IDU) and non-IDU in a large treatment center cohort in northern Thailand to investigate HIV and prison risks in this period. We used Thai Bureau of Corrections data to assess incarceration and prevention funds in prisons, 1992-2000. RESULTS: Among 1,865 drug user in the treatment cohort, 503 (27.0%) had ever been jailed. Men (OR 3.3, 95% CI 2.1, 5.2), IDU (OR 6.3, 95% CI 5.1, 7.9), and men who have sex with men (MSM) (OR 3.4, 95% CI 1.8, 6.3) were more likely to have been jailed. Among male IDU who had ever been jailed (N = 272), 15.8% had used drugs in prison. In a multivariate model, incarceration and ever IDU remained independently associated with HIV infection; IDU, MSM behaviors, and harmful traditional practices remained independently associated with having been jailed. From 1992 to 2000, overall alleged narcotics offenses increased from 117,000 to 276,000/year. The number of persons incarcerated for narcotics offenses increased fivefold from 1992 to 1999, from 12,860 to 67,440. For FY 2000, narcotics treatment accounted for 0.06% of the Thai corrections budget, whereas HIV programs in prisons were 0.017%. CONCLUSIONS: Incarceration rates for narcotics offenses have increased sharply in Thailand, whereas prevention has lagged. Having been jailed is an important independent risk for HIV infection among Thai male drug users, especially IDU and MSM. HIV prevention and drug treatment are urgently needed in Thai prisons.

Adult↗
PubMed2003

A new circulating recombinant form, CRF15_01B, reinforces the linkage between IDU and heterosexual epidemics in Thailand.

HIV-1 subtype B and CRF01_AE have been in circulation in Thailand and Southeast Asia for more than a decade. Initially separated by risk group, the two strains are increasingly intermixed, and two recombinant strains of essentially reciprocal structure have been recently reported. Here we identify additional CRF_01B recombinants and provide the evidence that HIV-1 strains now pass freely between the two high-risk populations. HIV isolates that showed discordance between CRF01_AE and subtype B in multi-region genotyping assays were selected for the study. They were drawn from 3 different cohorts in Thailand representing different risk behaviors and demographic characteristics: a drug user cohort in the north, a family planning clinic attendee cohort in the southeast, and a cohort study of the mucosal virology and immunology of HIV-1 infection in Thailand. The DNA from these isolates was PCR amplified to recover the full HIV-1 genome and subjected to sequencing and phylogenetic analysis. We establish that one particular CRF_01B recombinant, with the external envelope of subtype B and the rest of the genome from CRF01_AE, is circulating widely in Thailand. Termed CRF15_01B (also referred to as CRF15), the strain was primarily heterosexually transmitted, although injecting drug use (IDU) also played a role. In aggregate data from the studies, CRF15 constituted 1.7% of all HIV-1 infections (95% confidence interval 0.5-4.4%) and was dispersed widely in the country. The previously separate heterosexual and IDU epidemics have apparently been bridged by a new CRF. The entry of CRF15 into the mainstream of the epidemic signals new complexity in the long stable molecular picture in Thailand. These recombinants must be considered in ongoing or projected efficacy evaluations of HIV-1 vaccines and antiviral therapies.

Adult↗
PubMed2002

Human rights, politics, and reviews of research ethics.

Although the human rights movement and the sphere of research ethics have overlapping principles and goals, there has been little attempt to incorporate external political and human rights contexts into research ethics codes or ethics reviews. Every element of a research ethics review--the balance of risks and benefits, the assurance of rights for individual participants, and the fair selection of research populations--can be affected by the political and human rights background in which a study is done. Research that at first seems to be low in risk may become high in risk if implemented in a country where the government might breach the confidentiality of study results or where results might be used to deport a refugee group. Researchers should determine whether research could or should be done by consulting human rights organisations and, when possible, a trusted colleague, to learn the background political context and human rights conditions of the settings in which they propose to do research.

Ethics↗
PubMed2002

HIV infection in young men in northern Thailand, 1991-1998: increasing role of injection drug use.

Epidemic HIV-1 infections were first recognized in Thailand in 1988 but increased dramatically in the 1990s primarily as a result of sexual transmission. The Ministry of Public Health instituted programs, including condom promotion during commercial sex, and health education to prevent HIV transmission. We assessed the HIV infection prevalence and risk behaviors among eight cohorts of 21-year-old randomly selected male military conscripts in northern Thailand between 1991 and 1998 to evaluate temporal trends in HIV infection and risk behavior. The prevalence of HIV was 11.4% to 11.9% in 1991 through 1993 and progressively fell to 2.4% in 1998. The men reported progressive decreases in commercial sex from 80% in 1991 to 38% in 1998, increases in condom use for commercial sex to greater than 95% in 1998, and decreases in lifetime history of a sexually transmitted infection from 42% in 1991 to 4.4% in 1997. There was an increasing proportion of men who reported a history of injecting illicit drugs, however, which involved 1.0% of the men in 1991 but 4.2% in 1997. The population attributable risk of drug use for HIV infection increased in recent years; the proportion of HIV-positive men with a history of drug use increased from 1.0% in 1991 to 25.8% in 1998. The public health program to prevent the sexual transmission of HIV in Thailand continues to be highly successful. Nevertheless, injection drug use has emerged as an important risk behavior and is maintaining endemic HIV transmission in Thailand.

Adult↗