HIV prevention for injection drug users in China and Vietnam: Policy and research considerations

Abstract

A pattern of serious injection drug user (IDU) driven HIV epidemics in Asia, with emerging evidence of generalization through heterosexual transmission, indicates the need for interventions focusing on both drug- and sex-related risk reduction. In a cross-border HIV prevention project for IDUs in northern Vietnam and southern China, peer educators disseminated risk reduction information to IDUs in the community and provided 20,000-25,000 sterile needles/syringes and 4,000-6,000 condoms per month. Since implementation of these interventions, the frequency of both injecting and sexual risk behaviours fell significantly, HIV prevalence among IDUs declined or stabilized, and HIV incidence dropped. There is official support for harm reduction interventions in both countries but this appears precarious in view of persistently powerful political and financial support for a law enforcement approach. Moreover, the simultaneous pursuit of inconsistent policies can have negative effects on the implementation of interventions. A harmonized and consistent policy environment is needed. Most of the evidence for efficacy of community-based HIV prevention comes from the developed world, but well-designed evaluations of such interventions in Asia and elsewhere in the developing world would have a better chance to influence policy decisions there. A synergistic approach to research, policy development, and service delivery is best calculated to achieve positive results in the struggle against HIV/AIDS in developing countries.

Vietnam moves forward with harm reduction: An assessment of progress

“…Police crackdowns on drug users were widespread, resulting in fear among drug users in possession of injecting equipment (Devaney et al 2006, Hammett et al 2007. Despite the suggestion that the HIV Law has the ability to supplant other laws, thereby minimising legal conflicts, rigorous monitoring to ensure that it has the functional capacity to operate unhindered will remain critical.…”

Intravenous heroin use in Haiphong, Vietnam: Need for comprehensive care including methamphetamine use-related interventions

“…Nevertheless, and whatever the profile of risk-related behaviours, many PWID had unprotected sex with their primary sexual partner despite being unaware of their partner’s or their own HIV status. This could constitute a risk for HIV transmission and suggests the need for wider promotion of HIV screening among PWID and their sexual partners, and among the children of women who screen HIV positive (Dao et al, 2013; Hammett et al, 2007). …”

Drug users in Hanoi, Vietnam: factors associated with membership in community-based drug user groups

“…Historically, the government of Vietnam did not support harm reduction initiatives, and oversight of injection drug use policy fell to the Department of Social Evils Prevention in the Ministry of Labor, Invalids, and Social Affairs [14]. Drug users have often been sent to government detoxification centers, called 06 centers, where they could be incarcerated for up to four years at a time [7,15].…”

“…There have been a small number of evaluations of peer-based programming for drug users in Vietnam, but more data about such programs are needed in order to demonstrate the impact of these programs and, if the results are promising, then serve as advocacy in expanding harm reduction and empowerment programs for drug users in Vietnam [3,14,15,18]. This report constitutes one of the first evaluations for such community-based programs in the city of Hanoi, and indeed in all of Vietnam.…”