Controlling HIV Epidemics among Injection Drug Users: Eight Years of Cross-Border HIV Prevention Interventions in Vietnam and China

Abstract

IntroductionHIV in Vietnam and Southern China is driven by injection drug use. We have implemented HIV prevention interventions for IDUs since 2002–2003 in Lang Son and Ha Giang Provinces, Vietnam and Ning Ming County (Guangxi), China.MethodsInterventions provide peer education and needle/syringe distribution. Evaluation employed serial cross-sectional surveys of IDUs 26 waves from 2002 to 2011, including interviews and HIV testing. Outcomes were HIV risk behaviors, HIV prevalence and incidence. HIV incidence estimation used two methods: 1) among new injectors from prevalence data; and 2) a capture enzyme immunoassay (BED testing) on all HIV+ samples.ResultsWe found significant declines in drug-related risk behaviors and sharp reductions in HIV prevalence among IDUs (Lang Son from 46% to 23% [p<0.001], Ning Ming: from 17% to 11% [p = 0.003], and Ha Giang: from 51% to 18% [p<0.001]), reductions not experienced in other provinces without such interventions. There were significant declines in HIV incidence to low levels among new injectors through 36–48 months, then some rebound, particularly in Ning Ming, but BED-based estimates revealed significant reductions in incidence through 96 months.DiscussionThis is one of the longest studies of HIV prevention among IDUs in Asia. The rebound in incidence among new injectors may reflect sexual transmission. BED-based estimates may overstate incidence (because of false-recent results in patients with long-term infection or on ARV treatment) but adjustment for false-recent results and survey responses on duration of infection generally confirm BED-based incidence trends. Combined trends from the two estimation methods show sharp declines in incidence to low levels. The significant downward trends in all primary outcome measures indicate that the Cross-Border interventions played an important role in bringing HIV epidemics among IDUs under control. The Cross-Border project offers a model of HIV prevention for IDUs that should be considered for large-scale replication.

Intravenous heroin use in Haiphong, Vietnam: Need for comprehensive care including methamphetamine use-related interventions

“…This finding is consistent with previous observations reporting the impact of harm reduction interventions on risk-related behaviours and HIV prevalence/incidence in Vietnam (Hammett et al, 2012). However, the cluster analysis identified two high-risk groups that could represent priority targets for interventions: the first group of participants, reporting high-risk sexual behaviours, included younger, more often female subjects, with more recent, poly-substance use (including methamphetamine and alcohol), and there was an association with sex work.…”

HIV infection among persons who inject drugs

“…There have been many examples of very rapid spread of the virus in PWID populations. HIV incidence rates greater than 10/100 person-years (PY) have been reported in New York [10], Bangkok [11], Manipur India [12], Vancouver Canada [13] and areas in China [14, 15], Estonia [16] and Russia [17]. A number of factors have been associated with very rapid transmission of HIV among PWID (see Table 1).…”

Injection Drug Use Trajectories among Migrant Populations: A Narrative Review

“…Among a sample of recently initiated PWID in Spain, a higher proportion of participants were international migrants than locals (Folch et al, 2016). Along the China–Vietnam and the China–Myanmar borders, mobile drug dealers and migrant PWID populations drive the regional HIV epidemics (Hammett et al, 2012; Rachlis et al, 2007; Williams, Liu, & Levy, 2011). So, although epidemics of blood-borne disease have been identified among PWID over the past three decades, mobility is emerging as a driving factor in syndemics of blood-borne disease and IDU (Beyrer et al, 2000; Folch et al, 2016; Rachlis et al, 2007).…”