Injecting drug use and HIV infection in southwest China

The HIV/AIDS Epidemic among Drug Injectors in Eastern Europe: Patterns, Trends and Determinants

Our objective is to describe recent patterns and trends in HIV and injecting drug use and to explore possible determinants of the epidemics in eastern Europe. The available data confirm a rapid spread of HIV among injecting drug users (IDUs) in the newly independent states (NIS) and suggest that all successor states of the former Soviet Union are now threatened by such epidemics, while central and southeast Europe have so far been spared from large-scale outbreaks and seem at lower risk. The future course of the epidemic in the NIS will largely depend on trends in drug injecting and on the success of harm reduction programs. Furthermore, there is potential for the further spread of HIV, via heterosexual intercourse, into the general population.

Treatment delay and reliance on private physicians among patients with sexually transmitted diseases in China

We examined health-care seeking practices among patients with sexually transmitted diseases (STDs) in south China. In 1995, we recruited a consecutive sample of 939 STD patients attending the STD clinics of the Municipal STD Control Centers of Guangzhou and Shenzhen, 'special economic zones' near Hong Kong. Attending physicians interviewed patients face-to-face using a standard survey questionnaire. Twenty-seven per cent of all subjects had sought treatment elsewhere for their presenting complaints, before visiting a study clinic. The main sources of prior treatment were private physicians followed by public clinics and drugstores. Women were more likely than men to delay in presenting their current symptoms to a study clinic (32% vs 25%, P=0.046). Factors associated with treatment delay differed by gender. Among men, seeking prior treatment from private physicians (OR=3.31; 95% CI=1.70, 6.43), having no urethral discharge (OR=4.00; 95% CI=2.33, 6.85), having engaged in sex trade (OR=1.64; 95% CI=1.03, 2.63), or being a resident in Shenzhen (OR=1.80; 95% CI=1.12, 2.89) were more likely to delay seeking treatment. Among women, only living in Shenzhen (OR=2.86; 95% CI=1.56, 5.25) was associated with treatment delay. Promotion of appropriate health-seeking behaviours and better management of STDs must be a top priority to slow a rapid spread of STD/HIV in China. Health education, improvement of STD care in the public and private sectors, and regulations of unauthorized private physicians, may help with STD control and HIV prevention.

Risk factors for HIV seropositivity in a sample of drug users in drug treatment in Ho Chi Minh City, Vietnam

The article describes drug use behaviors, AIDS knowledge, risks for HIV infection, and HIV seroprevalence in drug users entering rehabilitation in Ho Chi Minh City, Vietnam. A cross-sectional, descriptive survey of all new entrants to a residential drug treatment center was conducted with linked HIV serology between July 1 and July 14, 1995. A total of 105 subjects participated: 101 men and 4 women. HIV serostatus was available for 88 subjects. Forty-seven percent (41 of 88 subjects) were HIV-positive. Median age of the subjects was 38 years. Mean length of injection drug use was 13.2 years (range, 1-27 years). The primary drug of injection was opium (96%), although 59% of subjects also injected "Western" drugs such as sedatives or tranquilizers. Eighty-two percent (86 of 105 subjects) correctly answered at least 7 of 10 AIDS knowledge questions, and only 28% (27 of 97 subjects) reported any needle sharing in the last 5 years. Seropositivity was associated with a history of previous treatment for drug abuse (p = 0.002), longer history of injecting drugs (p = 0.003), use of Western drugs (p = 0.03), and higher educational level (p = 0.05). Multivariate analysis found that the independent predictors of HIV seropositivity were history of previous treatment for drug abuse (p = 0.06) and longer history of injecting drugs (p = 0.05). Despite low levels of self-reported needle sharing and high levels of AIDS knowledge, HIV seroprevalence was high in this sample. The potential for epidemic spread of HIV in Vietnamese drug users is substantial. Risk-reduction programs and intense AIDS education projects targeting the population of drug users are necessary to control the AIDS epidemic in Vietnam.

No Pain No Gain, Establishing the Kunming, China, Drug Rehabilitation Center

The Yunnan Province in China may be experiencing the highest incidence of heroin use in China, in part because of its proximity to the Golden Triangle. This high incidence, as elsewhere, threatens to increase associated problems in China, including the spread of HIV. Furthermore, the high purity of heroin used in this Province leads to rapid addiction and increased difficulties in treating the symptoms of withdrawal. One response to this epidemic is the development and implementation of the Kunming Drug Rehabilitation Center. The Center, with a capacity for 620 addicts, is grounded in a recovery-oriented perspective that is based on the Therapeutic Community model and modified for the Yunnan Province and China. It is referred to as the Kunming Model and is known for the development of its own medicine for detoxification and its individualized psychological, psychiatric, medical, and biosocial program. Similarities and differences between the Kunming Center and treatment programs in the United States are discussed and implications for universal approaches to drug treatment are addressed.

Risk factors for initiation of drug use among young males in southwest China

To identify risk factors for drug use among young males in southwest China a cross-sectional survey and a non-concurrent cohort study were conducted. Demographic, behavioral and drug-use information was collected from young males aged 18-29 years. The non-concurrent cohort included the period 1 January 1991 to 1 August 1994. A total of 1548 subjects were interviewed. The cumulative incidence increased between 1991 and 1993. Multivariate analysis identified the following significant risk factors for drug use: being divorced/widowed/separated, having been encouraged by friends/others to try drugs, smoking cigarettes, belonging to the Jingpo ethnic group, and having a family member who used drugs in 1991. More than 6 years of education was a protective factor for drug use. Drug use in the community was associated with having been encouraged by friends or others to try drugs (71%), to smoking cigarettes (50%), and to belonging to the Jingpo group (24%). The results are consistent with community based prevention approaches which should be studied carefully because of the unique cultural and epidemiological situation in China.

HIV infection and AIDS in China, 1985 through 1994

OBJECTIVES

This paper analyzes data on the distribution of and risk factors for the acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection in China.

METHODS

Ten years of data on persons tested for HIV infection and AIDS and the proportion who tested positive were analyzed against the background of China's population count. The Chinese- and English-language literature on HIV and AIDS from 1985 through 1995 was also reviewed.

RESULTS

Overall, more males than females had HIV infection. Intravenous drug use was the primary source of transmission, followed by heterosexual contacts. Only a small number of the persons tested were homosexual, but their proportion of HIV seropositivity ranked third to that of drug users; that of general hospital patients ranked fourth.

CONCLUSIONS

HIV infection and AIDS in China began as a highly regionalized and largely rural problem in Yunnan Province. However, HIV infection and AIDS have become an emerging urban problem. HIV seropositivity is low among several groups thought to have an elevated risk.