Development and implementation of a cross-border HIV prevention intervention for injection drug users in Ning Ming County (Guangxi Province), China and Lang Son Province, Vietnam

Hammett, Theodore M.; Jarlais, Don C. Des; Ngu, Doan; Tung, Nguyen Hoang; Hoang, Tran Vu; Van, Ly Kieu; Donghua, Meng

doi:10.1016/j.drugpo.2003.07.003

Cited by 23 publications

(16 citation statements)

References 12 publications

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“…Specific numbers of arrests are difficult to determine, but reports suggest that 10Á30% of IDUs spend time in a detoxification center each year (Reid & Costigan, 2002). Though syringe possession is legal in China and country-wide guidelines regulate when an IDU can be arrested, in practice, the distinction between illegal and legal activities can become blurred and the laws on the books do not always reflect day-to-day enforcement (Hammett et al, 2005a;Hammett et al, 2003). For example, there is ambiguity regarding whether drug residue in a syringe should be considered illegal possession, or if known IDUs can carry syringes (Hammett et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

“…Though syringe possession is legal in China and country-wide guidelines regulate when an IDU can be arrested, in practice, the distinction between illegal and legal activities can become blurred and the laws on the books do not always reflect day-to-day enforcement (Hammett et al, 2005a;Hammett et al, 2003). For example, there is ambiguity regarding whether drug residue in a syringe should be considered illegal possession, or if known IDUs can carry syringes (Hammett et al, 2003). Studies in the USA have reported similar barriers to MMT: views that it substitutes one drug for another, punitive eligibility requirements, fear attendance will reveal ones IDU status, and that MMT clinics may lead to increased loitering and the creation of heroin markets near clinics (Des Jarlais, Paone, Friedman, Peyser, & Newman, 1995;Sullivan, Metzger, Fudala, & Fiellin, 2005).…”

Section: Discussionmentioning

confidence: 99%

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Exploring stakeholder perceptions of facilitators and barriers to accessing methadone maintenance clinics in Yunnan Province, China

Philbin

Zhang²

2010

AIDS Care

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Injection drug use is an ongoing public health crisis in China and one of the largest contributors to the transmission of HIV/AIDS. Though the government has rapidly scaled up methadone maintenance treatment clinics, they have not been extensively evaluated to analyze factors influencing rates of attendance. We explored the facilitators and barriers to accessing methadone maintenance clinics in Kunming City, Yunnan Province, China. Using in-depth qualitative interviews conducted from February 2008 to June 2008 with 35 informants - injection drug users (IDUs) and key stakeholders - we explored factors that determine whether drug users decide to present at methadone clinics. Interviews were digitally recorded with consent, transcribed verbatim, and translated. Content analysis was conducted to identify themes which included general attitudes toward methadone treatment, barriers and challenges to access, and suggestions for improvement. Within these, topics included responses to methadone, its side effects, and fear of discrimination, loss of privacy, and police interference. Respondents also listed numerous suggestions for improvement including raising awareness of harm reduction both among drug users and the community, providing additional support in the form of psychological counseling, job training and behavioral therapy, and increasing communication between police, government, and public health officials. High rates of HIV infection among IDUs in China have prompted public health responses including the scale up of methadone maintenance clinics. Our results may inform policy strategists in implementing social-structural changes to create enabling environments that facilitate an increase in access to methadone clinics among IDUs in Kunming.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Exploring stakeholder perceptions of facilitators and barriers to accessing methadone maintenance clinics in Yunnan Province, China

Philbin

Zhang²

2010

AIDS Care

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“…However, rates of illicit drug use, particularly intravenous drug use, was low among this population. Although drug use was locally prevalent in Guangxi (Hammett et al, 2003), very few women reported exchanging sex for drugs. One of the reasons for this low rate of drug use among FSWs may be because they were relatively new to sex work.…”

Section: Discussionmentioning

confidence: 99%

Can Variation in HIV/STD-Related Risk be Explained by Individual SES? Findings from Female Sex Workers in a Rural Chinese County

Fang

Yang

et al. 2008

Health Care for Women International

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Low socioeconomic status (SES) has been linked to HIV and sexually transmitted disease (STD) at a macro level because the majority of new cases of HIV infection in the world have been reported in underdeveloped or developing countries. However, empirical data on the relationship between individual SES and HIV/STD related risk have been mixed. Employing quantitative data from 454 female sex workers (FSWs), this study was designed to examine the profile of the study sample in terms of their individual SES, HIV/STD-related sexual risk across work locations with different social, cultural, and economic conditions; and to examine the relationship between work location and HIV-related risk behaviors, controlling for individual SES. We have shown in the current study that both SES and HIV/STD-related risk behaviors significantly differed by work location. However, the difference in individual SES was not sufficient to explain the difference of HIV/STD-related risk across the work locations. The findings underscore the need for effective prevention intervention efforts targeting FSWs in rural areas. Based on the findings, we also suggest that HIV/STD intervention efforts among FSWs should take the social and cultural contextual factors of their working environment (and sexual risks) into consideration.

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“…With support from the National Institute on Drug Abuse (NIDA) and the Ford Foundation, we are carrying out a 4-year HIV prevention intervention for IDUs in five sites in Lang Son Province, Vietnam and four sites in Ning Ming County, Guangxi Province, China (Cohen, 2003(Cohen, , 2004Hammett, 2003). Full implementation began in the Vietnamese sites in July 2002 and in the Chinese sites in October 2002.…”

Section: Methodsmentioning

confidence: 99%

Patterns of HIV Prevalence and HIV Risk Behaviors Among Injection Drug Users Prior to and 24 Months Following Implementation of Cross-Border HIV Prevention Interventions in Northern Vietnam and Southern China

Hammett

Kling

Johnston

et al. 2006

AIDS Education and Prevention

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In 2002, we implemented a 4-year HIV prevention intervention for injection drug users (IDUs) in Lang Son Province, Vietnam, and Ning Ming County, Guangxi Province, China, a cross-border region seriously affected by inter-twined epidemics of heroin injection and HIV infection. The interventions involve peer education on HIV risk reduction and provision of new needles/syringes through direct distribution and pharmacy vouchers. We consider this to be a structural intervention in which risk reduction information and sterile injection equipment are diffused through the IDU populations and not limited to those who actually interact with peer educators. The evaluation of structural interventions poses complex methodological challenges. The evaluation of our interventions relies primarily on cross-sectional surveys (interviews and HIV testing) of samples of IDUs selected using a combination of targeted cluster and snowball methods. We consider this to be an appropriate, albeit imperfect, design given the study context. This paper presents analyses of data from the IDU surveys conducted just prior to implementation of the interventions and 24 months thereafter. The cross-border interventions have reached large proportions of the IDUs in the project sites, drug-related HIV risk behaviors have declined in frequency, and HIV prevalence among IDUs has been stable in China and declined in Vietnam over the 24 months since the interventions were implemented. Attribution of these positive trends to the interventions must be qualified in light of possible sampling biases and the absence of control groups. However, we believe that the structural interventions implemented by the cross-border project have played a role in stabilizing HIV prevalence among IDUs two years after they were initiated. Evidence of further diffusion of the interventions among IDUs and continued stability or decline of HIV prevalence would strengthen this case.

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Development and implementation of a cross-border HIV prevention intervention for injection drug users in Ning Ming County (Guangxi Province), China and Lang Son Province, Vietnam

Cited by 23 publications

References 12 publications

Exploring stakeholder perceptions of facilitators and barriers to accessing methadone maintenance clinics in Yunnan Province, China

Exploring stakeholder perceptions of facilitators and barriers to accessing methadone maintenance clinics in Yunnan Province, China

Can Variation in HIV/STD-Related Risk be Explained by Individual SES? Findings from Female Sex Workers in a Rural Chinese County

Patterns of HIV Prevalence and HIV Risk Behaviors Among Injection Drug Users Prior to and 24 Months Following Implementation of Cross-Border HIV Prevention Interventions in Northern Vietnam and Southern China

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