Patterns of HIV prevalence among injecting drug users in the cross-border area of Lang Son Province, Vietnam, and Ning Ming County, Guangxi Province, China

Jarlais, Don C. Des; Johnston, Patrick; Friedmann, Patricia; Kling, Ryan; Ngu, Doan; Chen, Yi; Hoang, Tran Vu; Donghua, Meng; Van, Ly Kieu; Tung, Nguyen Hoang; Binh, Kieu Thanh; Hammett, Theodore M.

doi:10.1186/1471-2458-5-89

Cited by 25 publications

(19 citation statements)

References 8 publications

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“…Friedman and Des Jarlais 11 showed this for a wide range of European cities as well as American and South Asian cities. Further, support for this is evident from the history of epidemics in places like New York City in the mid-1970s, 12,13 Southeast Asia in the late 1980s and early 1990s, 14 Vancouver in the 1990s, 15,16 and, more recently, China, Vietnam, 17,18 Iran, 19 and Russia. 20 We have nonetheless been hampered in our ability to understand the spread and prevalence of HIV among IDUs by the lack of comparable interurban data over time and space.…”

Section: Introductionmentioning

confidence: 88%

HIV Prevalence Rates among Injection Drug Users in 96 Large US Metropolitan Areas, 1992–2002

et al. 2008

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This research presents estimates of HIV prevalence rates among injection drug users (IDUs) in large US metropolitan statistical areas (MSAs) during 1992-2002. Trend data on HIV prevalence rates in geographic areas over time are important for research on determinants of changes in HIV among IDUs. Such data also provide a foundation for the design and implementation of structural interventions for preventing the spread of HIV among IDUs. Our estimates of HIV prevalence rates among IDUs in 96 US MSAs during 1992-2002 are derived from four independent sets of data: (1) research-based HIV prevalence rate estimates; (2) Centers for Disease Control and Prevention Voluntary HIV Counseling and Testing data (CDC CTS); (3) data on the number of people living with AIDS compiled by the CDC (PLWAs); and (4) estimates of HIV prevalence in the US. From these, we calculated two independent sets of estimates: (1) calculating CTS-based Method (CBM) using regression adjustments to CDC CTS; and (2) calculating the PLWA-based Method (PBM) by taking the ratio of the number of injectors living with HIV to the numbers of injectors living in the MSA. We take the mean of CBM and PBM to calculate over all HIV prevalence rates for 1992-2002. We evaluated trends in IDU HIV prevalence rates by calculating estimated annual percentage changes (EAPCs) for each MSA. During 1992-2002, HIV prevalence rates declined in 85 (88.5%) of the 96 MSAs, with EAPCs ranging from -12.9% to -2.1% (mean EAPC=-6.5%; p<0.01). Across the 96 MSAs, collectively, the annual mean HIV prevalence rate declined from 11.2% in 1992 to 6.2 in 2002 (EAPC, -6.4%; p<0.01). Similarly, the median HIV prevalence rate declined from 8.1% to 4.4% (EAPC, -6.5%; p<0.01). The maximum HIV prevalence rate across the 11 years declined from 43.5% to 22.8% (EAPC, -6.7%; p<0.01). Declining HIV prevalence rates may reflect high continuing mortality among infected IDUs, as well as primary HIV prevention for non-infected IDUs and self-protection efforts by them. These results warrant further research into the population dynamics of disease progression, access to health services, and the effects of HIV prevention interventions for IDUs.

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Section: Introductionmentioning

confidence: 88%

HIV Prevalence Rates among Injection Drug Users in 96 Large US Metropolitan Areas, 1992–2002

et al. 2008

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“…As we have reported elsewhere (Des Jarlais, Johnston et al, 2005), at baseline there was a negative gradient of HIV prevalence by site running from the sites farthest from the border in Vietnam to those farthest from the border in China. Similar negative gradients were observed at baseline (odds ratio = .97, p = < .0001) and 12-months (odds ratio 0.97, p < .001).…”

Section: Discussionmentioning

confidence: 52%

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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“…In addition, we identified a gradient of HIV prevalence generally descending from the site farthest from the border in Vietnam (Lang Son City) to the site farthest from the border in China (Ning Ming City), and a similar gradient of average length of drug injection history in the sites (Des Jarlais et al 2005a). These patterns are consistent with the spread of heroin injection and HIV from south to north along a major heroin trans-shipment route (Beyrer et al 2000), although in fact transmission may have been bi-directional.…”

Section: Hiv Prevalencementioning

confidence: 97%

“…Such interventions can also help to reduce HIV prevalence and incidence in more mature HIV epidemics among IDUs (Des Jarlais et al 2005b). Ecological studies of multiple cities suggest that those with needle/syringe exchange programmes see declining HIV prevalence among IDUs while prevalence tends to increase in those without such programmes (Hurley et al 1997).…”

Section: Evidence Of the Effectiveness Of Harm Reduction Programmesmentioning

confidence: 99%

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

Hammett

Jarlais

Johnston

et al. 2007

Global Public Health

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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.

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Patterns of HIV prevalence among injecting drug users in the cross-border area of Lang Son Province, Vietnam, and Ning Ming County, Guangxi Province, China

Abstract: Background: To assess patterns of injecting drug use and HIV prevalence among injecting drug users (IDUs) in an international border area along a major heroin trans-shipment route.

Cited by 25 publications

References 8 publications

HIV Prevalence Rates among Injection Drug Users in 96 Large US Metropolitan Areas, 1992–2002

HIV Prevalence Rates among Injection Drug Users in 96 Large US Metropolitan Areas, 1992–2002

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

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

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