Page 281 - EPREP book

3.3 PrEP clients in People Who Injecting Drugs (PWID)

Perceived risk of HIV infection among PWIDs
Majority of PWIDs started using drugs from inhaling before switching to injection due to
rapid onset and longer duration of action which resulted to cost saving. Once they became

injection drug users, they would no longer use non-injection administration i.e. inhalation.

Those who were in settings located nearby Drug User Networks were able to access to
free clean needles and syringes while PWIDs in rural settings were more likely to use their

syringes repeatedly due to low socioeconomic status. Majority of PWIDs usually avoided sharing
needles and syringes due to the risk in acquiring HIV and other infections. However, this was

inevitable in case of unavailability of new syringes and they needed the drugs urgently.

PrEP awareness among PWIDs
Among PWIDs who had never heard about PrEP, upon learning about PrEP, most

participants were interested in taking PrEP to reduce their risks of HIV infection and confident
that they would be able to adhere to medications while some participants were concerned
regarding their adherence to therapy.

Among PWIDs who were aware of PrEP, there were those who had previously
discontinued PrEP and current PrEP users. The main reason of PrEP discontinuation was due to

concerns regarding adverse events whereas alarm-clock based reminder was reported to
facilitate good adherence among PWIDs who were current PrEP users.

According to respondents, increased access by expanding PrEP services in various

locations nearby methadone clinics would be essential to improve PrEP uptake among PWIDs
as well as more promotion of PrEP services to improve public understanding and awareness of

PrEP in wider populations.

3.4 PrEP service providers

From quantitative analysis, PrEP service providers in Thailand have positive
attitudes towards PrEP. Majority of participants reported a high level of perceived knowledge in
PrEP and supported PrEP provision in all high-risk groups with residual concern regarding impact

of PrEP on anti-retroviral drug resistance. In terms of service delivery experiences, most
respondents perceived that PrEP would not lead to increase risk behaviors (risk compensation).

Nearly all respondents perceived that PrEP costs less than care for HIV and discerned the
importance of providing PrEP service together with condoms and STIs testing/counselling. PrEP
was perceived to be effective in all risk groups including MSMs, TGW, serodiscordant couples,

PWIDs, and sex workers (Figure 2).

[218] Executive Summary