Predictors of continued HIV-risk behaviors among drug users in methadone maintenance therapy program in China--a prospective study.

Wen Chen,Yan Hong,Brian J Hall,Yinghua Xia,Li Ling

doi:10.1186/1477-7517-10-23

Abstract

BackgroundTo examine the predictors of continued drug- and sex-related HIV-risk behaviors among drug users in methadone maintenance therapy (MMT) programs in China.MethodsWe followed a sample of 5,035 drug users enrolled for the first time in MMT programs at baseline, 6 months, and 12 months utilizing a longitudinal prospective study design. Drug users’ HIV-risk behaviors, MMT characteristics, and drug use, were assessed at all three waves using a structured interview and HIV/HCV status was assessed at baseline and 12-month follow-up using biological specimens.ResultsThe point prevalence of HIV was 7.6% and 78.4% for HCV at baseline. Results of generalized linear mixed logistic regression models revealed that HIV-positive MMT clients were more likely to engage in drug injection (aOR = 1.70) and syringe sharing (aOR = 4.73). HCV-positive clients were more likely to inject drugs (aOR = 2.58), share syringes (aOR = 1.97), and have multiple sexual partners (aOR = 1.47). Adherence to MMT was the most significant predictor of reduced HIV-risk behaviors.ConclusionsOur data confirmed the positive effects of MMT on HIV prevention and underscored the urgency for programs to reduce HIV risk in HIV- and HCV-positive clients. There is a pressing need to strengthen existing counseling services for HIV-positive drug users to reduce their drug-related risk behaviors and to provide counseling for HCV-positive drug users. Further studies are needed to explore interventions to address high dropout rates and low adherence among MMT clients.

Highlights

To examine the predictors of continued drug- and sex-related HIV-risk behaviors among drug users in methadone maintenance therapy (MMT) programs in China
Guangdong is the frontier of China’s economic reform and forerunner in terms of HIV/AIDS epidemic; the total number of HIV-infected individuals was 37, 723 in 2012 October [31] and 26.6% of HIV infections in Guangdong were transmitted through sharing injection equipment [32]
We identified three treatment characteristics of the participants; first, mean dosage of methadone, the average amount of methadone the client had taken; second, treatment adherence, the number of days the client adhered to the treatment guidelines and took daily dosage of methadone as required; and third, longest duration of abstinence (LDA), defined as the longest duration of negative urine tests for drug use

Summary

Introduction

To examine the predictors of continued drug- and sex-related HIV-risk behaviors among drug users in methadone maintenance therapy (MMT) programs in China. Around 36 million people are addicted to heroin and opium, and many of them are HIV positive or at high risk of becoming infected and transmitting the virus to others [1]. Identified drug users were arrested and sent to detention centers for forced abstinence treatment or “reeducation through labor camps” [14]. Such policies failed to reduce the number of drug users but instead pushed them further underground. The first HIV epidemic broke out among injection drug users (IDU) in Yunnan in 1989 [13,15]. As of 2010, 28.6% of HIV infections in China were attributed to IDU [16]

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Conclusion