Abstract
BackgroundInjection drug use remains among the most important HIV transmission risk in China. Representativeness of drug users sampled from detoxification centers is questionable. A respondent driven sampling survey was conducted to compare the results with those from the detoxification center in the same city.MethodsIn 2008, two independent surveys were conducted in Dongguan, China, one for community-based drug users using respondent driven sampling and the other for drug users in a compulsory detoxification center as routine sentinel surveillance. Demographic and behavioral information were collected using the same structured questionnaire. Intravenous blood samples were collected to measure antibodies to HIV-1, and syphilis.ResultsCompared to those 400 drug users recruited from the detoxification center, the 303 community-based drug users had higher HIV prevalence (14.7% versus 4.0%, P = 0.04), lower syphilis prevalence (4.7% versus 10.8%, P = 0.07), higher proportion of injection drug use (83.9% versus 60.2%, P = 0.01) and syringe sharing (47.8% versus 36.3%, P = 0.10), more likely to be separated (12.4% versus 3.8%, P = 0.01) and being migrants from Guangxi province (31.4% versus 18.0%, P = 0.09), more engaging in commercial sex (64.4% versus 52.5%, P = 0.04). HIV prevalence and rate of syringe sharing were consistently higher among drug users from Guangxi.ConclusionsDetoxification center-based sampling missed a subgroup with higher HIV prevalence and higher rate of injection drug use. While detoxification center-based sampled can be used to monitor the trend of HIV prevalence and risk behaviors over time, periodic community-based sampling is still necessary to avoid possible systematic error in detoxification center-based samples.
Highlights
China had the largest estimated number of injection drug users (IDUs) worldwide, with the mid-point estimate of 2.35 million (1.8 to 2.9 million) in 2005 [1]
Injection drug use (IDU) has been the most important risk factor for HIV spread in China since the epidemic was identified in Yunnan in 1989 [2]
From April to June 2008, 400 drug users were recruited at Dongguan Compulsory Detoxification Center, and completed the questionnaire interview and serological tests
Summary
China had the largest estimated number of injection drug users (IDUs) worldwide, with the mid-point estimate of 2.35 million (1.8 to 2.9 million) in 2005 [1]. Injection drug use (IDU) has been the most important risk factor for HIV spread in China since the epidemic was identified in Yunnan in 1989 [2]. By the end of 2009, IDU accounted for 32.2% the total HIV cases in China [3]. Guangdong is a coastal province with its HIV epidemic primarily driven by IDU [4]. Injection drug use remains among the most important HIV transmission risk in China. Representativeness of drug users sampled from detoxification centers is questionable. A respondent driven sampling survey was conducted to compare the results with those from the detoxification center in the same city
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