Abstract
BackgroundStudies have suggested that the injection drug use (IDU) was no longer the main transmission route of HIV/AIDS in China. However, there has never been a study to assess the national HIV epidemic among persons who inject drugs (PWIDs) based on a nationwide database.MethodsPWIDs among new entrants in detoxification centers with HIV test results were extracted from the 2008–2016 National Dynamic Management and Control Database for Persons Who Use Drugs (NDMCD). Logistic regressions were used to analyze factors associated with HIV infection, and joinpoint regression were used to examine trends in the HIV prevalence.ResultsA total of 103,619 PWIDs among new entrants tested for HIV in detoxification centers between 2008 and 2016 were included in the analysis. The HIV prevalence was 5.0% (n = 5167) among PWIDs. A U-shaped curve of the HIV prevalence decreased from 4.9% in 2008 to 3.3% in 2010 (Annual Percent Change [APC] − 20.6, 95% CI − 32.5 to − 6.7, p < 0.05) and subsequently increased from 3.3% in 2010 to 8.6% in 2016 (APC 17.9, 95% CI 14.5–21.4, p < 0.05) was observed. The HIV prevalence in west regions in China all presented decreased trends, while central and eastern regions presented increased trends.ConclusionsAlthough the HIV prevalence has been declining in general population, the HIV prevalence among PWIDs has shown an increasing trend since 2010. Current policies on HIV control in PWIDs should be reassessed.
Highlights
Studies have suggested that the injection drug use (IDU) was no longer the main transmission route of HIV/AIDS in China
The HIV prevalence among female persons who inject drugs (PWIDs) was 5.2%, which was higher than 5.0% among male PWIDs (AOR 1.27, 95% confidence intervals (CIs) 1.15–1.39, p < 0.001)
Elder age had a higher risk of HIV infection (HIV prevalence 25–44 vs < 25: 5.2% vs 3.1%, AOR 2.31, 95% CI 2.03–2.64, p < 0.001; ≥ 45 vs < 25: 5.0% vs 3.1%, AOR 2.57, 95% CI 2.20–3.00, p < 0.001). 12.3% of minority PWIDs were HIV positive, and were more likely to be HIV infected compared to 4.1% of Han PWIDs (AOR 2.61, 95% CI 2.43–2.80, p < 0.001)
Summary
Studies have suggested that the injection drug use (IDU) was no longer the main transmission route of HIV/AIDS in China. There has never been a study to assess the national HIV epidemic among persons who inject drugs (PWIDs) based on a nationwide database. Among persons who inject drugs (PWIDs), HIV could be transmitted through sexual contact and injection-related risk behavior, and injection-related transmission is thought to be the dominant route in most settings [2]. Prior to 2007, IDU were predominantly responsible for new HIV/AIDS infections [7, 8]. The proportion of new HIV infections through sexual transmission exceeded IDU and became the primary transmission route in 2007 [8, 9]. Several previous studies using surveillance data indicated that the national HIV prevalence among PWIDs has decreased slightly from 10.6% in
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