Evaluation of a needle social marketing strategy to control HIV among injecting drug users in China

Wu, Zunyou; Luo, Wei; Sullivan, Sheena G.; Rou, Keming; Lin, Peng; Liu, Wei; Ming, Zhongqiang

doi:10.1097/01.aids.0000304706.79541.ef

Cited by 54 publications

(39 citation statements)

References 20 publications

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“…Social marketing of needles in Guangdong and Guangxi has been demonstrated to increase access to clean needles and safe injection practices [25]. HIV prevalence along the China-Vietnam border declined in the context of peer outreach and distribution of safe injection equipment [26].…”

Section: Resultsmentioning

confidence: 99%

Do community-based strategies reduce HIV risk among people who inject drugs in China? A quasi-experimental study in Yunnan and Guangxi provinces

Wang¹,

Fu²,

Longfield

et al. 2014

Harm Reduction Journal

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BackgroundHIV transmission among people who inject drugs (PWID) is high in Yunnan and Guangxi provinces in southwest China. To address this epidemic, Population Services International (PSI) and four cooperating agencies implemented a comprehensive harm reduction model delivered through community-based drop-incenters (DiC) and peer-led outreach to reduce HIV risk among PWID.MethodsWe used 2012 behavioral survey data to evaluate the effectiveness of this model for achieving changes in HIV risk, including never sharing needles or syringes, always keeping a clean needle on hand, HIV testing and counseling (HTC), and consistent condom use. We used respondent-driven sampling to recruit respondents. We then used coarsened exact matching (CEM) to match respondents during analysis to improve estimation of the effects of exposure to both DiC and outreach, only DiC, and only outreach, modeled using multivariable logistic regression.ResultsWe found a significant relationship between participating in both peer-led DiC-based activities and outreach and having a new needle on hand (odds ratio (OR) 1.53, p < .05) and consistent condom use (OR 3.31, p < .001). We also found a significant relationship between exposure to DiC activities and outreach and HIV testing in Kunming (OR 2.92, p < .01) and exposure to peer-led outreach and HIV testing through referrals in Gejiu, Nanning, and Luzhai (OR 3.63, p < .05).ConclusionsA comprehensive harm reduction model delivered through peer-led and community-based strategies reduced HIV risk among PWID in China. Both DiC activities and outreach were effective in providing PWID behavior change communications (BCC) and HTC. HTC is best offered in settings like DiCs, where there is privacy for testing and receiving results. Outreach coverage was low, especially in Guangxi province where the implementation model required building the technical capacity of government partners and grassroot organizations. Outreach appears to be most effective for referring PWID into HTC, especially when DiC-based HTC is not available and increasing awareness of DiCs where PWID can receive more intensive BCC interventions.

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Section: Resultsmentioning

confidence: 99%

Do community-based strategies reduce HIV risk among people who inject drugs in China? A quasi-experimental study in Yunnan and Guangxi provinces

Wang¹,

Fu²,

Longfield

et al. 2014

Harm Reduction Journal

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“…10 35.3% in an intervention study after a 12-month follow-up. 83 Another recent large-scale distribution of sterile injection equipment and peer educator outreach intervention project in China and Vietnam showed significant decline of HIV incidence among new IDUs, and there was no indication that the project led to any increase in IDUs. 84 However, under Chinese culture, NSPs are regarded more as condoning and even encouraging drug use and do not have as many benefits for society as a whole.…”

Section: High Risk Behaviors and Hiv=aids Epidemic Call For Improvemementioning

confidence: 99%

Consequences of Drug Abuse and HIV/AIDS in China: Recommendations for Integrated Care of HIV-Infected Drug Users

Wang

et al. 2009

AIDS Patient Care and STDs

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Drug abuse is a complicated social phenomenon rather than a neural disease. It especially fuels the HIV/AIDS epidemic. Researchers have shown interest in HIV-infected drug users as the socially and medically marginalized population, but they did not provide good enough care. Based on published English and Chinese journal articles and official reports, this integrated literature review summarizes the epidemic of drug abuse and HIV/AIDS, and comments on the clinical and psychosocial consequences, and harm reduction measures in China. Officially registered drug users have reached more than 1 million recently. A little under half of the people living with HIV/AIDS are injection drug users, as they transmit the disease through needle sharing and unprotected sexual behavior. The main consequences of drug abuse and HIV/AIDS included high prevalence of hepatitis viruses and tuberculosis co-infections, severe mental problems and extreme poverty. Even health professionals hold discriminative attitude toward drug users because of condemnation of drug abuse behavior and fear of HIV infection. Although interventions for drug addiction and harm reduction have been scaled up quickly, such as methadone maintenance treatment and needle syringe programs, the measures should be further revised, and the effectiveness needs to be evaluated appropriately. To enhance HIV-infected drug users' quality of life and the utility of medical services, improving health care providers' attitude is the first step. Then securing good quality of integrated medical care services with multidisciplinary cooperation will be essential.

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“…Responding to the growing IDU HIV epidemic in China, domestic and international programs launched harm reduction programs in 2003 [17,18,19]. A major component of harm reduction is methadone maintenance treatment (MMT), a substitution program known to reduce morbidity, a mortality [20,21] and risk of HIV infection in drug users [22].…”

Section: Introductionmentioning

confidence: 99%

Methadone Maintenance Treatment Participant Retention and Behavioural Effectiveness in China: A Systematic Review and Meta-Analysis

et al. 2013

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BackgroundMethadone maintenance treatment (MMT) has been scaled up by the Chinese government alongside persistent compulsory drug user detention, but the extent to which detention interferes with MMT is unknown. The study systematically reviews Chinese MMT retention rates, reasons for drop out, and behavioural changes.MethodChinese and English databases of literature are searched for studies reporting retention rates, drug use and sexual behaviours among MMT participants in China between 2004 and 2013. The estimates are summarized through a systematic review and meta-analysis.ResultsA total of 74 studies representing 43,263 individuals are included in this analysis. About a third of MMT participants drop out during the first three months of treatment (retention rate 69.0% (95% CI 57.7-78.4%)). Police arrest and detention in compulsory rehabilitation was the most common cause of drop out, accounting for 22.2% of all those not retained. Among retained participants, changing unsafe drug use behaviours was more effective than changing unsafe sexual behaviours. At 12 months following MMT initiation, 24.6% (15.7-33.5%) of MMT participants had a positive urine test, 9.3% (4.7-17.8%) injected drugs and only 1.1% (0.4-3.0%) sold sex for drugs. These correspond to 0.002 (<0.001-0.011), 0.045 (0.004-0.114) and 0.209 (0.076-0.580) times lower odds than baseline. However, MMT participants did not have substantial changes in condom use rates.ConclusionMMT is effective in drug users in China but participant retention is poor, substantially related to compulsory detention. Reforming the compulsory drug user detention system may improve MMT retention and effectiveness.

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Evaluation of a needle social marketing strategy to control HIV among injecting drug users in China

Abstract: Needle social marketing can reduce risky injecting behaviour and HIV/HCV transmission among injecting drug users in China and should be expanded.

Cited by 54 publications

References 20 publications

Do community-based strategies reduce HIV risk among people who inject drugs in China? A quasi-experimental study in Yunnan and Guangxi provinces

Do community-based strategies reduce HIV risk among people who inject drugs in China? A quasi-experimental study in Yunnan and Guangxi provinces

Consequences of Drug Abuse and HIV/AIDS in China: Recommendations for Integrated Care of HIV-Infected Drug Users

Methadone Maintenance Treatment Participant Retention and Behavioural Effectiveness in China: A Systematic Review and Meta-Analysis

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