Was the HIV epidemic among fishermen in Tanintharyi in the 90s due to drug use?

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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0118422

Jamie

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Prevalence and Correlates of HIV and
Hepatitis C Virus Infections and Risk
Behaviors among Malaysian Fishermen

Martin K. K. Choo1*, Nabila El-Bassel2, Philippe C. G. Adam3, Louisa Gilbert2, Elwin Wu2,
Brooke S. West2, Alexander R. Bazazi4, John B. F. De Wit3, Rusli Ismail1,
Adeeba Kamarulzaman1

Abstract

Fishermen in Southeast Asia have been found to be highly vulnerable to HIV, with research
evidence highlighting the role of sexual risk behaviors. This study aims to estimate the rate of
HIV as well as hepatitis C virus (HCV) infections among Malaysian fishermen, and the risky
sexual and injection drug use behaviors that may contribute to these infections. The study
also includes an assessment of socio-demographic, occupational and behavioral correlates
of testing positive for HIV or HCV, and socio-demographic and occupational correlates of risk
behaviors. The study had a cross-sectional design and recruited 406 fishermen through
respondent-driven sampling (RDS). Participants self-completed a questionnaire and provided
biological specimens for HIV and HCV testing.We conducted and compared results of analyses
of both unweighted data and data weighted with the Respondent-Driven Sampling Analysis
Tool (RDSAT). Of the participating fishermen, 12.4%were HIV positive and 48.6%had
HCV infection. Contrary to expectations and findings from previous research, most fishermen
(77.1%) were not sexually active. More than a third had a history of injection drug use, which
often occurred during fishing trips on commercial vessels and during longer stays at sea. Of
the fishermen who injected drugs, 42.5%reported unsafe injection practices in the past
month. Reporting a history of injection drug use increased the odds of testing HIV positive by
more than 6 times (AOR = 6.22, 95%CIs [2.74, 14.13]). Most fishermen who injected drugs
tested positive for HCV. HCV infection was significantly associated with injection drug use,
being older than 25 years, working on a commercial vessel and spending four or more days
at sea per fishing trip. There is an urgent need to strengthen current harm reduction and drug
treatment programs for Malaysian fishermen who inject drugs, especially among fishermen
who work on commercial vessels and engage in deep-sea fishing.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0118422