|Injecting Drug Users and HIV in Guangxi Province, Southern China (UNAIDS - Best Practice Digest, 2000, 3 p.)|
Extracted from Injecting Drug users and HIV in Guangxi province, Southern China by Dr Chris Beyrer, Director, John Hopkins Fogarty AIDS International Training Programme, in AHRN Newsletter (AHRN: The Asian harm Reduction Network - Targeting HIV/AIDS and Injecting Drug Use in Asia). January - June 1999.
China today is facing an extraordinary re-emerging problem with opiate drug abuse, principally with injecting use of heroin. This has coincided with the introduction of HIV into China where heroin injectors (IDUs) have been the primary risk group affected by HIV-1 infection.
Chinas first HIV epidemic was detected in 1989 among IDUs in Ruili county in Yunnan province which shares a border with Myanmar - the worlds most significant heroin producing country. Until 1994, Yunnan province, with less than 5% of Chinas population, had more than 80% of reported HIV-1 infections in the country. However, HIV-1 infection in drug users outside Yunnan accounted for more than half of all new HIV-1 infections from 1995 to 1997, indicating rapid spread beyond Yunnan.
The first HIV-1 survey in Guangxi province, which borders Yunnan to the west, was conducted in November/December 1993. At that time none of the drug users surveyed were HIV positive. Between July 1996 and July 1997, 227 drug users in detoxification centres in two border towns, Pingziang and Baise, were tested. Some 40.1% were found to be HIV-1 positive. All of them had begun using drugs after 1990, and 52% had a drug use history of only two years or less. Nearly all reported injecting drugs and 70% shared equipment.
A second study among commercial sex workers in Pingxiang also has important implications. Over 800 women participated in this 1997 study; five were found to be HIV infected. All of these five had a history of injecting drug use. No sex workers who were not also drug injectors were HIV infected, which suggests that there was very little sexual spread of HIV at this point in the epidemic in Pingxiang. HIV appears to have spread rapidly since mid-1996, largely due to drug users sharing needles.
Drug treatment and HIV prevention
Because the HIV epidemic is so recent among IDUs in Guangzi province, and sexual spread appears minimal, there is a window of opportunity for prevention. While needle sharing appears to be common, IDUs report that injection equipment is inexpensive and easy to get. For these reasons, our group has focused on peer education for IDUs in Pingxiang. The goal is to train and empower IDUs to work as peer educators within their community, teaching safer injection practices and safer sex, and promoting condom use through their social, sexual and drug using networks.
In January 1998, the first 22 IDU volunteers from Pingxiang city were trained as peer educators in a six month feasibility study. The hope is to expand these activities within the province. The peer educators were an enthusiastic and eager group. The training served to build key bridges of trust between the IDUs and the public health staff. A free condom distribution network has been established, which is a new model for China.
Factors associated with HIV-1 infection were not restricted to injection practices. Unprotected sexual behaviours are likely to increase the probability of HIV transmission beyond this high risk population. Designing and implementing effective intervention strategies targeted towards both injection drug use and sexual risk behaviours are urgently needed to further reduce the spread of HIV in China. Peer education programmes for drug users may prove useful in doing this, empowering addicts to protect themselves and their partners, and building new relationships between drug users and health authorities.