Injecting drug use
Des Jarlais DC, Kling R, Hammett TM, Ngu D, Liu W, Chen Y, Binh KT, Friedmann P. Reducing HIV infection among new injecting drug users in the China-Vietnam Cross Border Project. AIDS. 2007;21 Suppl 8:S109-14.
Des Jarlais and colleagues aimed to assess an HIV prevention programme for injecting drug users (IDU) in the crossborder area between China and Vietnam. The project included peer educator outreach and the large-scale distribution of sterile injection equipment. Serial cross-sectional surveys with HIV testing of community recruited IDU were conducted at baseline (before implementation) and 6, 12, 18, 24 and 36 months post-baseline. HIV prevalence and estimated HIV incidence among new injectors (individuals injecting drugs for < 3 years) in each survey wave were the primary outcome measures. The percentages of new injectors among all subjects declined across each survey waves in both Ning Ming (China) and Lang Son (Vietnam). HIV prevalence and estimated incidence fell by approximately half at the 24-month survey and by approximately three quarters at the 36-month survey in both areas (all P < 0.01). The authors conclude that implementation of large-scale outreach and syringe access programmes was followed by substantial reductions in HIV infection among new injectors, with no evidence of any increase in individuals beginning to inject drugs. This project may serve as a model for large-scale HIV prevention programming for IDU in China, Vietnam, and other developing/transitional countries.
Editors’ note: Large-scale implementation of harm reduction programmes to reduce the risk of HIV exposure and transmission among injecting drug users (which include community outreach, needle and syringe access, and substitution treatment) have brought HIV epidemics under control in a number of high-income countries. This cross-border programme aimed to achieve public health scale implementation, considered as 7 to 10 syringes per injecting drug user per month, through direct syringe provision and no-cost vouchers to exchange for sterile injecting equipment and condoms in participating local pharmacies. Although the observed dramatic reduction in HIV incidence may be due in part to behaviour change motivated by the large number of AIDS deaths, increased access to sterile injecting equipment helped translate increased motivation into effective risk reduction. This study demonstrates that when harm reduction programmes are implemented at a scale commensurate to the size of the problem, they can turn around an HIV epidemic among injecting drug users in a developing or transitional country.
Booth RE, Lehman WE, Kwiatkowski CF, Brewster JT, Sinitsyna L, Dvoryak S. Stimulant Injectors in Ukraine: The Next Wave of the Epidemic? AIDS Behav. 2008 Feb 9 [Epub ahead of print].
This study was designed to assess differences in drug and sex-related risk behaviours between injectors of opiates only, opiate/sedative mix only and stimulants only. Participants were current out-of-treatment injection drug users (IDUs), unaware of their HIV status, recruited through street outreach in Kiev, Odessa and Makeevka/Donetsk, Ukraine. Overall, 22% tested positive for HIV, including 39% among opiate/sedative injectors, 19% among opiate injectors and 17% among stimulant injectors. Despite these differences, stimulant injectors were at higher risk than other IDUs in sharing a used needle/syringe, always injecting with others, injecting a drug solution drawn from a common container, having an IDU sex partner, not using condoms during vaginal or anal sex and on composite measures of injection and sex risks. After controlling for age differences, stimulant injectors remained at higher risk in their needle and sex risk behaviours. Without intervention, it is likely that HIV will increase among stimulant injectors.
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