Abstract
BackgroundNeedle-syringe exchange programs (NSPs) have been substantially rolled-out in China since 2002. Limited studies reported effectiveness of NSPs in a Chinese setting. This study aimed to assess the association between accessibility to NSPs and drug-use risk behaviors of IDUs by investigating primary (self-reported) data of IDUs recruited from NSP sites, community settings and mandatory detoxification centers (MDCs) in Hunan province, China.MethodsA cross-sectional survey was conducted in Hunan province in 2010. IDU recruits participated in a face-to-face interview to provide information related to their ability to access NSPs, demographic characteristics, and injecting behaviors in the past 30 days.ResultsOf the total 402 participants, 35%, 14% and 51% participants indicated low, medium and high ability to access NSPs in the past 30 days, respectively. A significantly higher proportion of IDUs (77.3%) from the high-access group reported ≤2 injecting episodes per day compared with medium- (46.3%) and low-access (58.8%) groups. Only 29.0% of high-access IDUs re-used syringes before disposal in the past 30 days, significantly lower than those in the medium- (43.1%) and low-access (41.3%) groups. Reported levels of needle/syringe sharing decreased significantly as the ability to access NSPs increased (16.3%, 12.7% and 2.5% in the low, medium and high access groups, respectively). Ninety percent of IDUs recruited from MDCs had low ability to access NSPs.ConclusionsIncreased NSP accessibility is associated with decreased levels of injecting frequency, repetitive use and sharing of injecting equipment among Chinese IDUs. Mandatory detention of IDUs remains as a major barrier for IDUs to access NSPs in China.
Highlights
HIV epidemics usually first emerge in China among people who inject drugs
Needle-syringe exchange programs (NSPs) have been implemented for almost a decade in China, only limited studies evaluate the effectiveness of NSPs in alleviating risk behaviors among Chinese injecting drug users (IDUs) and all have been conducted in high-HIV transmission provinces (Sichuan [21], Guangxi [21,22] and Guangdong [22,23])
Community IDUs were recruited by outreach and peer-referral, whereas IDUs from NSP sites and mandatory detoxification centers (MDCs) were recruited at venues
Summary
HIV epidemics usually first emerge in China among people who inject drugs. HIV prevalence among injecting drug users (IDUs) in southwest and northwest China has stabilized at ~20% in the past decade [1,2,3,4], with infection spreading across to in other at-risk populations and the general population [5,6]. NSPs have been implemented for almost a decade in China, only limited studies evaluate the effectiveness of NSPs in alleviating risk behaviors among Chinese IDUs and all have been conducted in high-HIV transmission provinces (Sichuan [21], Guangxi [21,22] and Guangdong [22,23]). Based on a cross-sectional study design, this study further investigates (1) the association between the ability to access NSPs and injecting behaviors in a low-HIV transmission setting; and (2) the impact of mandatory detention on IDUs’ ability to access NSPs. Needle-syringe exchange programs (NSPs) have been substantially rolled-out in China since 2002. This study aimed to assess the association between accessibility to NSPs and drug-use risk behaviors of IDUs by investigating primary (self-reported) data of IDUs recruited from NSP sites, community settings and mandatory detoxification centers (MDCs) in Hunan province, China
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