HIV This Week

Yang L, Li J, Zhang Y, Li H, Zhang W, Dai F, Ren Z, Qi G, Cheng W. Societal perception and support for methadone maintenance treatment in a Chinese province with high HIV prevalence. Am J Drug Alcohol Abuse. 2008;34(1):5-16.

Methadone maintenance treatment was first piloted in April 2004 in Yunnan, China, to reduce HIV transmission. This study aimed to examine public support for methadone maintenance treatment and was based on cross-sectional data collected in March-April 2006 on a random sample of 411 police staff, medical/health professionals, community members, and drug users. Multivariate logistic regressions were used to analyze the data. The support was the strongest amongst the police and medical professionals but the lowest in drug users. A considerable proportion of the respondents viewed methadone maintenance treatment as contradictory to China's drug control policies and this factor was negatively associated with support for methadone maintenance treatment. Dissemination of more accurate knowledge and the resolution of these conflicts are urgently needed to increase the public support for methadone maintenance treatment.

Editors’ note: This study in Yunnan province underscores the need to discover the reasons that drug users themselves are the people least supportive of methadone maintenance, particularly as China proceeds to scale-up dramatically such programmes. The reason could be as basic as inadequate knowledge about the effectiveness and safety of methadone substitution.

Injecting drug use remains an important risk factor for transmission in Vietnam, with an estimated 50% of the 290 000 people living with HIV reporting injecting drug use as a risk factor. Despite this, effective harm reduction interventions are generally lacking. Walsh and colleagues describe the implementation of peer-based harm reduction programmes in two rural provinces of Vietnam. Peer educators were trained in basic HIV prevention, including harm reduction. After significant preparation work with the Provincial AIDS Committees of Bac Giang and Thanh Hoa and other relevant national, provincial and local authorities, the interventions were commenced. Harm reduction interventions were delivered through outreach as well as on site. These included needle and syringe distribution and collection. Community advocacy occurred throughout the life of the project. Local authorities and peers believed that while there was a general reduction in stigma and discrimination, legal barriers associated particularly with the carrying of injecting equipment remained. This affected the ability of peer educators to work with their clients. Nonetheless, peer-based delivery of harm reduction interventions, including needle and syringe programmes, is feasible and acceptable in these two rural Vietnamese provinces. Community acceptance and uptake of these interventions are key to successful expansion across the region. Active participation by families of drug users seems crucial. This initiative demonstrates that despite a difficult policy environment, peer-delivered needle and syringe programmes are feasible within a rural Asian environment as long as there is adequate local political and community support.

Editors’ note: This local harm reduction programme delivered through peer educators mobilised communities to change attitudes, engaged families, was acceptable to police and other local government officials, and resulted in a large reduction in discarded needles and syringes. Shifts in drug policy with the release of thousands of detainees from drug rehabilitation suggest the potential for scaling–up community-based harm reduction programmes more widely in Vietnam.

There have been concerns that safer injecting facilities may promote initiation into injection drug use. Kerr and colleagues examined length of injecting career and circumstances surrounding initiation into injection drug use among 1065 users of North America’s first safer injecting facility and found that the median years of injection drug use were 15.9 years, and that only 1 individual reported performing a first injection at the safer injecting facility. These findings indicate that the safer injecting facility’s benefits have not been offset by a rise in initiation into injection drug use.

Editors’ note: This supervised injecting facility requires all new visitors to sign a waiver indicating that they have injected previously, a fact that is well known in the community. Deterring people who are insistent on injecting for the first time could be a problem since such individuals tend to use another person’s injecting equipment and are at high risk of overdose. One solution would be for them to be assessed first by an on site addictions counsellor, encouraging consideration of the option of referral for treatment.