Abstract
BackgroundHIV transmission among people who inject drugs (PWID) is high in Yunnan and Guangxi provinces in southwest China. To address this epidemic, Population Services International (PSI) and four cooperating agencies implemented a comprehensive harm reduction model delivered through community-based drop-incenters (DiC) and peer-led outreach to reduce HIV risk among PWID.MethodsWe used 2012 behavioral survey data to evaluate the effectiveness of this model for achieving changes in HIV risk, including never sharing needles or syringes, always keeping a clean needle on hand, HIV testing and counseling (HTC), and consistent condom use. We used respondent-driven sampling to recruit respondents. We then used coarsened exact matching (CEM) to match respondents during analysis to improve estimation of the effects of exposure to both DiC and outreach, only DiC, and only outreach, modeled using multivariable logistic regression.ResultsWe found a significant relationship between participating in both peer-led DiC-based activities and outreach and having a new needle on hand (odds ratio (OR) 1.53, p < .05) and consistent condom use (OR 3.31, p < .001). We also found a significant relationship between exposure to DiC activities and outreach and HIV testing in Kunming (OR 2.92, p < .01) and exposure to peer-led outreach and HIV testing through referrals in Gejiu, Nanning, and Luzhai (OR 3.63, p < .05).ConclusionsA comprehensive harm reduction model delivered through peer-led and community-based strategies reduced HIV risk among PWID in China. Both DiC activities and outreach were effective in providing PWID behavior change communications (BCC) and HTC. HTC is best offered in settings like DiCs, where there is privacy for testing and receiving results. Outreach coverage was low, especially in Guangxi province where the implementation model required building the technical capacity of government partners and grassroot organizations. Outreach appears to be most effective for referring PWID into HTC, especially when DiC-based HTC is not available and increasing awareness of DiCs where PWID can receive more intensive BCC interventions.
Highlights
HIV transmission among people who inject drugs (PWID) is high in Yunnan and Guangxi provinces in southwest China
According to an assessment by the World Health Organization, Joint United Nations Programme on HIV/ AIDS, and the Chinese Ministry of Health, China's overall HIV prevalence has remained relatively low between 0.5%–0.6% in 2011 [3,4]
Following several years of program implementation, we aimed to evaluate the effectiveness of this comprehensive harm reduction model delivered through participation in community-based DiCs and interpersonal outreach for improving HIV risk behavior among PWID in southwestern China
Summary
HIV transmission among people who inject drugs (PWID) is high in Yunnan and Guangxi provinces in southwest China. To address this epidemic, Population Services International (PSI) and four cooperating agencies implemented a comprehensive harm reduction model delivered through community-based drop-incenters (DiC) and peer-led outreach to reduce HIV risk among PWID. In 1989, China reported its first cases of HIV among 146 heroin users in Yunnan Province, along China's southwest border [1]. The provinces of Yunnan and Guangxi have two of the highest concentrations of HIV cases, as well as registered drug users in China. In Guangxi, there are approximately 50,000 registered PWID, with injecting drug use accounting for over 69% of the cumulative reported cases of HIV in the province [6]
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