Policing and public health : experiences of people who inject drugs in Bangkok, Thailand

Background: In recent years, Thailand has intensified policing efforts as a strategy to address a continuing epidemic of illicit drug use. Thailand’s “war on drugs” campaign of 2003 received international criticism due to extensive human rights violations. However, few studies have since investigated the impacts of drug policing on people who inject drugs (IDU) in this setting. Drawing on the Risk Environment Framework, this dissertation sought to: explore IDUs’ lived experiences with police; identify the prevalence and correlates of experiencing beatings and drug testing by police; examine the relationship between exposures to policing and syringe sharing; and assess changes in the availability of illicit drugs among IDU in Bangkok, Thailand. Methods: Between June 2009 and June 2012, a community-recruited sample of IDU in Bangkok participated in a serial cross-­sectional mixed-­methods study and completed interviewer-­administered questionnaires and semi-structured in-­depth interviews. Audio-­recorded interviews were transcribed verbatim and a thematic analysis was conducted to document the character of IDUs’ encounters with police. A variety of multivariate regression techniques were used to estimate independent relationships between exposures to specific policing tactics and indicators of drug-­related harm, as well as to examine a temporal trend of street-­level availability of illicit drugs. Results: Respondents’ narratives indicated that drug policing involved numerous forms of human rights infringements and negatively influenced healthcare access among IDU in Bangkok. Reports of beatings and drug testing by police were common (38% and 67%, respectively) and were independently associated with various indicators of drug-­related harm, including syringe sharing and barriers to healthcare. Street-­level availability of illicit drugs increased significantly between 2009 and 2011. Conclusions: The findings indicate that the over-reliance on repressive drug policing is not suppressing the illegal drug market and is instead contributing to police-­perpetrated abuses, the perpetuation of risky injection behaviour, and an impediment to healthcare among IDU in Bangkok. These findings raise concern about the ongoing policing practices and point to the need for providing greater police oversight, as well as a shift toward more balanced approaches to drug control in this setting.Graduate and Postdoctoral StudiesGraduat