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

Abstract

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.

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

“…HIV prevalence across the Lang Son sites was 46% at baseline and 32% at 24 months (p B/0.001). In the Ning Ming County sites, HIV prevalence among IDUs was stable over the period, 16% at baseline and 14% at 24 months (p0/0.069) (Hammett et al 2006).…”

“…At baseline, in Lang Son, 47% of IDUs responding to cross-sectional surveys reported sharing some injection equipment in the past 6 months; this was reduced to 30% at 24 months (p B/0.001). In Ning Ming, the equivalent percentages were 76% and 17% (p B/0.001) (Hammett et al 2006).…”

“…Similarly, self-reported sexual risk factors in the last 6 months were more prevalent among IDUs in Ning Ming (at baseline 16% reported giving money or drugs for sex, 19% reported unprotected sex with a casual partner) than in Lang Son (5% and 2%, respectively). There was some improvement in these measures in Ning Ming by 24 months, down to 10% (p 0/0.575) and 9% (p 0/0.005), respectively, but there remains a need for enhanced sexual risk reduction (Hammett et al 2006). The project is currently distributing 4,000Á6,000 condoms per month.…”

HIV Prevention Interventions for Female Sexual Partners of Injection Drug Users in Hanoi, Vietnam: 24-Month Evaluation Results

“…According to the 2009 IBBS, 51% of IDUs had regular sexual partners and 20% had visited sex workers in the past 12 months [2]. Studies in Bac Ninh, Lang Son, and Ha Giang provinces show that at least 50% of IDUs are sexually active [ [3,4]; Abt Associates, unpublished data, Ha Giang Province].…”

Cross-boundary Substance Uses Among Hong Kong Chinese Young Adults

“…[1][2][3] There are relatively few studies conducted on cross-boundary substance use behaviors, although the spread of disease such as human immunodeficiency virus (HIV) via cross-border injecting drug use or use of psychoactive substances has been a growing concern. [1][2][3][4][5][6] Cross-boundary substance users may have some special characteristics that are relevant to drug prevention. For instance, as compared to their Bstay home^counterparts, traveler abusers were more likely to find drugs less expensive and more readily available; they also tended to be older, became addicted more easily, and were more likely to seek treatments.…”