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Yang H, Li Y, Xu M, Hu Y, Yuan F, Liu L, Li L, Yuan D, Ye L, Zhou C, Zhang Y, Su L, Liang S. The Update of HIV-1 Prevalence and Incidence and Spatio-Temporal Analyses of HIV Recent Infection Among Four Sub-Groups in Sichuan, China During Surveillance Period Between 2016 and 2022. Infect Drug Resist 2023; 16:6535-6548. [PMID: 37814665 PMCID: PMC10560476 DOI: 10.2147/idr.s428744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/27/2023] [Indexed: 10/11/2023] Open
Abstract
Background Sichuan Province has gradually become a hot-spot for HIV/AIDS. Little is known about the HIV-1 incidence and prevalence among four sub-groups since 2015. Meanwhile, the distributions of hot-spot areas related to recent infection cases that indicate current transmission among the four subgroups are also rare. Objective The main purpose of this study was to assess the HIV-1 prevalence and incidence and to visualize the distributions of hot-spot areas of current transmission among four subgroups (people who inject drugs, male STD clinic attendees, female sex workers and men who had sex with men) during the surveillance period in Sichuan province between 2016 and 2022. Results Of the 267,617 individuals, 2158 HIV-positive samples were tested with Lag-Avidity EIA, among which 493 samples were identified as recent infections. Among people who inject drugs (PWID), both HIV-1 prevalence (from 1.41% to 0.34%) and incidence (from 0.03% to 0.140%) showed a significant decreasing trend. Among men who had sex with men (MSM), female sex workers (FSWs), and male STD clinic attendees, HIV-1 prevalence indicated significant decreasing trends, whereas HIV-1 incidence showed no significant changes. Spatial analysis demonstrated the formation of hot-spots and clusters of current transmissions sharing regional differences, mainly concentrated in the southeast, and most of these were consecutive hot-spots. Conclusion The prevention and control were efficacious and persistent. However, among the other three subgroups, there is a need for a regional cooperative in prevention and control approaches and collaborative research in many aspects.
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Affiliation(s)
- Hong Yang
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Yiping Li
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Mengjiao Xu
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Ying Hu
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Fengshun Yuan
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Lunhao Liu
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Ling Li
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Dan Yuan
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Li Ye
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Chang Zhou
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Yan Zhang
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Ling Su
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Shu Liang
- Center for AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
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Wang J, Zhao P, Xu W, Wang C. Sexual uses of drug and alcohol among men who have sex with men in China: implications for HIV prevention. BMC Infect Dis 2022; 22:895. [PMID: 36447161 PMCID: PMC9710115 DOI: 10.1186/s12879-022-07880-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Sexual uses of alcohol and drugs are pervasive among men who have sex with men (MSM) and associated with increased risk of HIV infection. However, there are limited studies related to sexual uses of alcohol and drugs among MSM in China. This study aims to describe the pattern of alcohol use, drug use, and multi-drug use during sex among Chinese MSM and to examine the association between condomless anal intercourse, group sex, commercial sex and HIV infection. METHODS We conducted an online cross-sectional survey in China. Characteristics on social-demographic, sexual behaviors, and sexual uses of alcohol and drugs were collected. The associations with high-risk sexual behaviors and HIV infection were analyzed with multivariable logistic regression. RESULTS A total of 699 MSM were included in this study. About 39.5% (230/582) of men reported sexual alcohol use in the past three months and 50.8% (355/699) reported sexual drug use. Of those reporting sexual drug use, around 10.7% (38/355) reported having multi-drug use. Factors associated with both sexual uses of alcohol and drugs included: reporting more male sexual partners (alcohol: adjusted odds ratio [aOR] = 1.77; drug: aOR = 2.12), reporting condomless anal intercourse in the past three months (alcohol: aOR = 2.08; drug: aOR = 2.08), having ever engaged in group sex (alcohol: aOR = 2.04; drug: aOR = 5.22; multi-drug: aOR = 3.52) and commercial sex (alcohol: aOR = 4.43; drug: aOR = 4.22 multi-drug: aOR = 5.07). Sexual drug use was also correlated with reported HIV-positive status (drug: aOR = 2.53, 95% CI:1.31-4.90). CONCLUSION Sexual uses of alcohol and drugs are prevalent among Chinese MSM. Interventions to reduce the sexual use of alcohol and other drugs may be warranted among MSM in China.
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Affiliation(s)
- Jinshen Wang
- grid.284723.80000 0000 8877 7471Present Address: Dermatology Hospital, Southern Medical University, 510095 Guangzhou, China ,grid.284723.80000 0000 8877 7471School of Public Health, Southern Medical University, 510515 Guangzhou, China ,grid.284723.80000 0000 8877 7471Southern Medical University Institute for Global Health, 510095 Guangzhou, China
| | - Peizhen Zhao
- grid.284723.80000 0000 8877 7471Present Address: Dermatology Hospital, Southern Medical University, 510095 Guangzhou, China ,grid.284723.80000 0000 8877 7471Southern Medical University Institute for Global Health, 510095 Guangzhou, China
| | - Wenqian Xu
- grid.284723.80000 0000 8877 7471Present Address: Dermatology Hospital, Southern Medical University, 510095 Guangzhou, China ,grid.284723.80000 0000 8877 7471School of Public Health, Southern Medical University, 510515 Guangzhou, China ,grid.284723.80000 0000 8877 7471Southern Medical University Institute for Global Health, 510095 Guangzhou, China
| | - Cheng Wang
- grid.284723.80000 0000 8877 7471Present Address: Dermatology Hospital, Southern Medical University, 510095 Guangzhou, China ,grid.284723.80000 0000 8877 7471Southern Medical University Institute for Global Health, 510095 Guangzhou, China
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Jia D, Xu Y. Effects of an 8-week Baduanjin intervention combined with low-carbohydrates diet among overweight people who struggle with drug addiction. Front Public Health 2022; 10:989519. [PMID: 36339240 PMCID: PMC9633992 DOI: 10.3389/fpubh.2022.989519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/30/2022] [Indexed: 11/12/2022] Open
Abstract
Background Prior studies have consistently revealed that a combination of physical activity with caloric restriction results in a reduction in body weight in the general population. Both overweight and drug abuse are risk factors for poor physiological health, and poor mental health has been associated with drug abuse and unhealthy body mass index (BMI). However, the effects of low-carbohydrates diet (LC) combined with mind-body exercise intervention on improving anthropometric characteristics, lipid metabolism, quality of life, and craving among overweight people who struggle with drug addiction have yet to be clarified. Methods Fifty-four eligible male patients were randomly assigned to the control group (CON; n = 18), the Baduanjin intervention group (BA, 60 min × 5 times/week, 8 weeks; n = 18), and the Baduanjin combined with LC intervention group (LC; n = 18). We compared the anthropometric characteristics, blood biochemical parameters, quality of life, and drug craving responses between the three groups at baseline (week 0), week 4, and week 8. Results After repeated measurements in the general linear model, both the BA and LC groups exerted significant effects on decreasing waist circumference, BMI, body weight, hip circumference, body fat percentage, total cholesterol level, and triglyceride level (P < 0.05). There was no significant difference in the HDL-C level observed among the BA and LC groups at 8 weeks (P > 0.05); however, there was an overall upwards trend. A significant change in trends in the quality of life scale score was determined in the three groups (P < 0.001). The three groups showed reductions in visual analog scale score distribution over time (P < 0.05). Conclusions Either Baduanjin or an 8-week Baduanjin combined with LC can significantly reduce anthropometric characteristics and body composition, enhance the quality of life, and reduce craving in overweight/obese patients. Baduanjin combined with LC is particularly effective in improving lipid metabolism.
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Affiliation(s)
- Dongming Jia
- School of Public Health, Hangzhou Normal University, Hangzhou, China,Zhejiang Police Vocational College, Hangzhou, China
| | - Yuming Xu
- School of Physical Education, Hangzhou Normal University, Hangzhou, China,*Correspondence: Yuming Xu
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Jiang L, Li Z, Huang J, Liu B, Yang Y, Lin L, Wang C, Xie X, Peng X, Xu W, Li H. Spatiotemporal clusters of HIV/AIDS infections caused by drug use and heterosexual contact in Ruili city, China 1989-2016. BMC Infect Dis 2019; 19:925. [PMID: 31666015 PMCID: PMC6822478 DOI: 10.1186/s12879-019-4568-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 10/16/2019] [Indexed: 11/28/2022] Open
Abstract
Background Ruili is a border city in southwest China along the heroin trafficking route. In recent decades, the city has witnessed increased in HIV transmission. The current study aims to explore the spatiotemporal trends in HIV prevalence identify and map the spatial variation and clustering of factors associated with HIV transmission through drug use and heterosexual contact transmissions at the village level from 1989 through 2016. Methods Geographic information system-based spatiotemporal analyses, including global and local spatial autocorrelation analyses and space-time scanning statistics, were applied to detect the location and extent of HIV/AIDS high-risk areas. Results Drug use and heterosexual contact were identified as the major transmission routes causing infection in Ruili. Results of global spatial analysis showed significant clustering throughout the city caused by transmission via drug use in the early phase of the epidemic and transmission via heterosexual contact in the late phase of the epidemic during the study period. Hotspots of transmission from drug use were randomly distributed throughout the city. However, the hotspots of transmission by heterosexual contact were located in the central area only around the Jiegao China-Myanmar land port. Space-time scanning showed that transmission from drug use clustered in the southwest area between 1989 and 1990, while transmission by heterosexual contact clustered in the central area between 2004 and 2014. Conclusions Heterosexual contact has become the dominant mode of transmission. Interventions should focus on highly clustered area where is around the Jiegao land port.
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Affiliation(s)
- Li Jiang
- The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, People's Republic of China
| | - Zhoulin Li
- Ruili City Center for Disease Control and Prevention, Ruili, Yunnan, People's Republic of China
| | - Jin Huang
- University of Kunming Medical Science, Kunming, Yunnan, People's Republic of China
| | - Bang Liu
- Ruili City Center for Disease Control and Prevention, Ruili, Yunnan, People's Republic of China
| | - Yingbo Yang
- Ruili City Center for Disease Control and Prevention, Ruili, Yunnan, People's Republic of China
| | - Lanzhu Lin
- Ruili City Center for Disease Control and Prevention, Ruili, Yunnan, People's Republic of China
| | - Chengbo Wang
- Ruili City Center for Disease Control and Prevention, Ruili, Yunnan, People's Republic of China
| | - Ximei Xie
- Ruili City Center for Disease Control and Prevention, Ruili, Yunnan, People's Republic of China
| | - Xia Peng
- Yunnan Provincial Center for Disease Control and Prevention, 158 Dongsi street, Kunming, Yunnan, 650022, People's Republic of China
| | - Wen Xu
- Yunnan Provincial Center for Disease Control and Prevention, 158 Dongsi street, Kunming, Yunnan, 650022, People's Republic of China
| | - Hong Li
- Yunnan Provincial Center for Disease Control and Prevention, 158 Dongsi street, Kunming, Yunnan, 650022, People's Republic of China.
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Shava E, Lipira LE, Beauchamp GG, Donnell DJ, Lockman S, Ruan Y, Shao Y. Risky Sexual Behavior Among Individuals Receiving Buprenorphine/Naloxone Opiate Dependency Treatment: HIV Prevention Trials Network (HPTN) 058. J Acquir Immune Defic Syndr 2019; 78:300-307. [PMID: 29557855 PMCID: PMC5997518 DOI: 10.1097/qai.0000000000001683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Understanding the role of opiate dependency treatment in risky sexual behavior could help optimize interventions for people who inject drugs (PWID). OBJECTIVES We evaluated whether long-term medication-assisted treatment (LT-MAT) of opiate dependency with buprenorphine/naloxone influenced risky sexual behavior among HIV-uninfected PWID and identified predictors of risky sexual behavior. METHODS We used data from HPTN 058, a randomized controlled trial of LT-MAT vs. short-term medication-assisted treatment among PWID in China and Thailand. We evaluated associations between randomized opiate dependency treatment group and self-reported risky sexual behaviors within the past month: condomless sex with primary partner, condomless sex with nonprimary partner, multiple partners, and more than 3 sexual acts. We used generalized estimating equations to conduct intention-to-treat, as-treated, and exploratory analyses of these associations. RESULTS Of 1250 participants included in the analysis, 92% were male, with median age of 34 years (interquartile range 28-39). At baseline, referring to the past month, 36% of participants reported condomless sex with primary partner, 4% reported condomless sex with nonprimary partner, 6% reported multiple sex partners, and 30% reported more than 3 sexual acts. Risky sexual behaviors did not differ significantly between treatment groups at any point. Significant predictors (P < 0.05) of condomless sex with nonprimary partner were history of incarceration and noninjection drug use. Number of needle-sharing partners, noninjection drug use, and higher income were predictors for multiple sexual partners. CONCLUSIONS LT-MAT did not significantly modify risky sexual behavior among HIV-uninfected PWID. Interventions that reduce sexual risk should target PWID with history of incarceration, alcohol use, and needle sharing.
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Affiliation(s)
- Emily Shava
- Botswana Harvard AIDS Institute Partnership, Harvard T.H. Chan School of Public Health, Gaborone, Botswana
| | - Lauren E Lipira
- HIV Prevention Trials Network, Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA.,Department of Health Services, University of Washington, Seattle, WA
| | - Geetha G Beauchamp
- HIV Prevention Trials Network, Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Vaccine and Infectious Disease Division (VIDD), Seattle, WA
| | - Deborah J Donnell
- HIV Prevention Trials Network, Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Shahin Lockman
- Botswana Harvard AIDS Initiative Partnership, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Gaborone, Botswana
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
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Mehrolhassani MH, Yazdi-Feyzabadi V, Hajebi A, Mirzaei S. Cross-country Comparison of Treatment Policies Facing the Drug Abuse in Five Selected Countries. ADDICTION & HEALTH 2019; 11:81-92. [PMID: 31321005 PMCID: PMC6633066 DOI: 10.22122/ahj.v11i2.233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/06/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Drug abuse is one of the main problems of human's life; thus communities have been thinking about the solution of this problem. The present study aimed to compare the general features of drug abuse treatment policies, war on drugs (WOD), and harm reduction (HR), in the selected countries. METHODS The present study was a comparative and desk research that sought to compare context, stewardship, financing, type of substance abuse treatment services, reasons of paradigm shift, and executive challenges of treatment policies in the selected countries (China, Malaysia, Germany, Netherland, and Iran). The necessary data for comparison of the countries were collected through valid databases, review of documents, and reports of international organizations. FINDINGS Context conditions were better in the HR countries. In most countries, the central government played a key role in the stewardship, financing, and service providing. In WOD countries, the presence of judicial structure was higher in the treatment of drug abuse. The policy-making approach was ideological in WOD countries, but evidence-based in HR countries. CONCLUSION It seems that performance of HR countries is better than WOD countries.
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Affiliation(s)
| | - Vahid Yazdi-Feyzabadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmad Hajebi
- Research Center for Addiction and Risky Behavior, Psychiatric Department, Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Mirzaei
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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Chen SJ, Liao DL, Chen CH, Wang TY, Chen KC. Construction and Analysis of Protein-Protein Interaction Network of Heroin Use Disorder. Sci Rep 2019; 9:4980. [PMID: 30899073 PMCID: PMC6428805 DOI: 10.1038/s41598-019-41552-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/11/2019] [Indexed: 12/17/2022] Open
Abstract
Heroin use disorder (HUD) is a complex disease resulting from interactions among genetic and other factors (e.g., environmental factors). The mechanism of HUD development remains unknown. Newly developed network medicine tools provide a platform for exploring complex diseases at the system level. This study proposes that protein–protein interactions (PPIs), particularly those among proteins encoded by casual or susceptibility genes, are extremely crucial for HUD development. The giant component of our constructed PPI network comprised 111 nodes with 553 edges, including 16 proteins with large degree (k) or high betweenness centrality (BC), which were further identified as the backbone of the network. JUN with the largest degree was suggested to be central to the PPI network associated with HUD. Moreover, PCK1 with the highest BC and MAPK14 with the secondary largest degree and 9th highest BC might be involved in the development HUD and other substance diseases.
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Affiliation(s)
- Shaw-Ji Chen
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Department of Psychiatry, Mackay Memorial Hospital, Taitung Branch, Taiwan
| | - Ding-Lieh Liao
- Bali Psychiatric Center, Department of Health, Executive Yuan, New Taipei, Taiwan
| | - Chia-Hsiang Chen
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou and Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Tse-Yi Wang
- Department of Medical Informatics, Tzu Chi University, Hualien, Taiwan
| | - Kuang-Chi Chen
- Department of Medical Informatics, Tzu Chi University, Hualien, Taiwan.
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Zhu D, Dai G, Xu D, Xu X, Geng J, Zhu W, Jiang X, Theeboom M. Long-Term Effects of Tai Chi Intervention on Sleep and Mental Health of Female Individuals With Dependence on Amphetamine-Type Stimulants. Front Psychol 2018; 9:1476. [PMID: 30177899 PMCID: PMC6110176 DOI: 10.3389/fpsyg.2018.01476] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 07/26/2018] [Indexed: 12/19/2022] Open
Abstract
Previous studies provide evidence that Tai Chi (TC) can reduce the symptoms of sleep problems and be of benefit for the rehabilitation of substance abusers. In this study, we investigated if TC practice can improve sleep quality and mood of females who are dependent on amphetamine-type stimulant (ATS). Eighty subjects were randomly assigned to TC intervention and standard care (SC) for 6 months. We applied analysis of variance on repeated-measure with the year of drug dependence as the covariate to test the changes of the self-rated Pittsburg Sleep Quality Index (PSQI), Self-Rating Depression Scale (SDS), as well as fitness after 3 and 6 months. Relapse investigation was conducted by checking the database of China's National Surveillance System on Drug Abuse and that of the Shanghai Drug Control Committee's illicit drug dependents. Our investigation focused on the relapse of participants who had undergone and completed treatment in the Shanghai Mandatory Detoxification and Rehabilitation Center in 2015. The result showed that the PSQI scores of sleep duration [F(2, 92) = 9.86], need for sleep medications [F(2, 92) = 36.44] and daytime dysfunction [F(2, 92) = 5.15] were found to have a significant difference by time × group interaction after 6 months. SDS showed no significant difference between the two groups; however, the score of SDS in TC decreased after 6-month intervention, and no changes were observed in SC. Pulse rate had significantly decreased in the TC group compared with the SC group after 6 months. 9.5% (4) ATS dependents in TC and 26.3% (10) ATS dependents in SC were found to have relapsed. Our result suggested that TC had positive effects on sleep quality, depression and fitness. Long-term study demonstrated that TC may be a cheap and potential supplementary treatment for ATS-dependent individuals. TC may also be considered as an alternative exercise to escalate abstinence for ATS-dependent females. CLINICAL TRIAL REGISTRATION ChiCTR-IPR-14005343 chictr. org.cn.
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Affiliation(s)
- Dong Zhu
- School of International Education and College of Wushu, Shanghai University of Sport, Shanghai, China
| | - Guobin Dai
- College of Wushu, Shanghai University of Sport, Shanghai, China
| | - Ding Xu
- Health and Rehabilitation Department, Shanghai Drug Administration, Shanghai, China
| | - Xin Xu
- College of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Jingjing Geng
- College of Wushu, Shanghai University of Sport, Shanghai, China
| | - Weimo Zhu
- Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Xi Jiang
- Sports Law Center, Shanghai University of Political Science and Law, Shanghai, China
| | - Marc Theeboom
- Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
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Wu Q, Kamphuis C, Duo L, Luo J, Chen Y, Richardus JH. Coverage of harm reduction services and HIV infection: a multilevel analysis of five Chinese cities. Harm Reduct J 2017; 14:10. [PMID: 28193236 PMCID: PMC5307648 DOI: 10.1186/s12954-017-0137-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/02/2017] [Indexed: 02/04/2023] Open
Abstract
Background Since 2003, a harm reduction program for injecting drug users has been rolled out countrywide in China. It entails services for condom promotion, a needle and syringe program (NSP), and methadone maintenance treatment (MMT). However, it remains unknown if and to what extent the coverage of these services at city level is related to a reduced risk of HIV infection among drug users. Methods We wished to quantify the extent to which city-level characteristics (such as NSP and MMT service coverage) and individual-level determinants (e.g., self-reported exposure to NSP and MMT services, knowledge, motivation, and skills) were associated with the risk of HIV infection among drug users. In 2006, we conducted an integrated serological and behavioral survey among drug users in five cities of Yunnan Province, China (N = 685), constructing a multilevel logistic regression model with drug users clustered within these cities. Results Drug users who reported having received NSP or MMT services were about 50% less likely to be infected with HIV than those who reported not having received them (OR 0.45, 95% CI, 0.26–0.83 for NSP and 0.48, 95% CI, 0.31–0.73 for MMT). Despite a between-city variation of HIV infection risk (ICC 0.24, 95% CI 0.08–0.54), none of the city-level factors could explain this difference. Individual-level determinants such as perceived risk of infection and use of condoms were not associated with HIV infection. Conclusions Although people who had used NSP or MMT services were less likely to be HIV infected, this study found no relationship between city-level coverage of HIV prevention programs and variations in HIV infection between cities. This may have been due to the low number of cities in the analysis. Future research should include the analysis of data from a larger number of cities, which are collected widely in China through integrated behavioral and serological surveys. Electronic supplementary material The online version of this article (doi:10.1186/s12954-017-0137-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Qing Wu
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,School of Public Health, Kunming Medical University, Yunnan, People's Republic of China.
| | - Carlijn Kamphuis
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Lin Duo
- Department of Research and Development, Yunnan Provincial Red Cross Hospital, Kunming, People's Republic of China
| | - Jiahong Luo
- School of Public Health, Kunming Medical University, Yunnan, People's Republic of China
| | - Ying Chen
- School of Public Health, Kunming Medical University, Yunnan, People's Republic of China
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Zhu D, Xu D, Dai G, Wang F, Xu X, Zhou D. Beneficial effects of Tai Chi for amphetamine-type stimulant dependence: a pilot study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:469-78. [PMID: 27211290 DOI: 10.3109/00952990.2016.1153646] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Tai Chi is a traditional Chinese sport that is classified as a moderate exercise. Recent studies have evaluated the effectiveness of Tai Chi in substance abuse rehabilitation. OBJECTIVES The aim of this study was to assess the quality of life and physical effects of a Tai Chi intervention on individuals with amphetamine-type stimulant (stimulant) dependence. METHODS Sixty male subjects with stimulant dependence from a Shanghai Mandatory Detoxification and Rehabilitation Center participated in a 12-week trial. Tai Chi was used as an intervention in the experimental group (n = 30). The control group (n = 29) underwent standard care, which included recreation activity, gesture language exercise, and self-education. Outcome measures included the quality of life for drug addiction (QOL-DA) questionnaire [four scales consisting of physiology (e.g., energy level), psychology (e.g., depression), symptoms (e.g., physical symptoms), society (e.g., interpersonal) and fitness evaluations (assessed by body mass index, body fat, hand-grip, flexibility, balance)]. Repeated measures were used to analyze the changes over time. RESULTS Test scores of the QOL-DA in the Tai Chi group significantly increased after 12 weeks in the following areas: physiology, 8.71 (p = 0.005), symptoms, 4.34 (p = 0.042), society, 15.79 (p < 0.001), and total score, 10.60 (p = 0.002). A post hoc test further revealed that quality of life improved in the Tai Chi group but not in the standard care group. Physical results showed a significant interaction with balance(F(1,56) = 6.92, p = 0.011); participants in the Tai Chi group improved by 10 s while there was no change in the standard care group. Although there were no significant interactions in the fitness outcomes (i.e., hand-grip and sit-and-reach tests), the within-group factor displayed significant changes in body fat (F(1,56) = 27.79, p < 0.001) in both groups. CONCLUSION This study demonstrates that Tai Chi is a promising exercise that improves quality of life for individuals with stimulant dependence.
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Affiliation(s)
- Dong Zhu
- a Chinese Wushu Research Center, Shanghai University of Sport , Shanghai , China
| | - Ding Xu
- b Shanghai Drug Administration , Shanghai , China
| | - Guobin Dai
- a Chinese Wushu Research Center, Shanghai University of Sport , Shanghai , China
| | - Fei Wang
- a Chinese Wushu Research Center, Shanghai University of Sport , Shanghai , China
| | - Xin Xu
- c Anti-Doping Research Laboratory , Shanghai University of Sport , Shanghai , China
| | - Daoxin Zhou
- a Chinese Wushu Research Center, Shanghai University of Sport , Shanghai , China
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Chen B, Zhu Y, Guo R, Ding S, Zhang Z, Cai H, Zhu H, Wen Y. HIV/AIDS-related knowledge awareness and risk behaviors among injection drug users in Maanshan, China: a cross-sectional study. BMC Public Health 2016; 16:97. [PMID: 26831139 PMCID: PMC4736619 DOI: 10.1186/s12889-016-2786-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/26/2016] [Indexed: 02/03/2023] Open
Abstract
Background Unsafe injection practices significantly increase the risk of human immunodeficiency virus (HIV) infection among injection drug users (IDUs). Little is known about how demographic characteristics of IDUs are linked to HIV-related risk behaviors in the central regions of China. Methods A cross-sectional survey was conducted at Mandatory Detoxification Centers (MDCs) and the community in Maanshan, China. Results Of the 916 IDUs, 96.4 % reported a history of heroin use during the past year, 93.4 % had HIV/AIDS knowledge, 16.8 % reported receptive syringe sharing and 12.2 % reported inconsistent condom use in commercial sex in the past year. Unsafe injection practice was associated with increased odds of minority ethnicity, lower level of education, and no peer education in the past year. Unsafe sex practice was associated with increased odds of being single, 18–30 years of age, non-local residence, and history of methamphetamine use in the past year. Conclusions Integrated interventions to promote safe injection and protected commercial sex practices targeting IDUs must also consider individual and socio-environmental factors.
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Affiliation(s)
- Baifeng Chen
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, Anhui Province, 241002, China.
| | - Yu Zhu
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, Anhui Province, 241002, China.
| | - Rui Guo
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, Anhui Province, 241002, China.
| | - Shushu Ding
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, Anhui Province, 241002, China.
| | - Zhen Zhang
- Centre for Disease Control of Maanshan City, 849 Jiangdong Dadao, Maanshan, Anhui Province, 241000, China.
| | - Huaying Cai
- Centre for Disease Control of Maanshan City, 849 Jiangdong Dadao, Maanshan, Anhui Province, 241000, China.
| | - Hongbin Zhu
- Centre for Disease Control of Maanshan City, 849 Jiangdong Dadao, Maanshan, Anhui Province, 241000, China.
| | - Yufeng Wen
- School of Public Health, Wannan Medical College, 22 West Wenchang Road, Wuhu, Anhui Province, 241002, China.
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Zhang XD, Kelly-Hanku A, Chai JJ, Luo J, Temmerman M, Luchters S. Sexual and reproductive health risks amongst female adolescents who use amphetamine-type stimulants and sell sex: a qualitative inquiry in Yunnan, China. Harm Reduct J 2015; 12:34. [PMID: 26472221 PMCID: PMC4608054 DOI: 10.1186/s12954-015-0065-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 09/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China, as other Southeast Asian countries, has witnessed an increased use in amphetamine-type stimulants (ATS) amongst urban youth. Amongst female adolescents who both sell sex and use ATS, risk behaviours are compounded resulting in even poorer health outcomes. However, limited knowledge exists on ATS use patterns and ATS-related risk behaviours, particularly in this context. This research aimed to improve the understanding of these issues amongst female adolescents who use ATS and sell sex, and to inform future programming. METHOD This study utilised monthly focus group discussions (four in total) with the same study participants in Yunnan, China. From within a drug-treatment programme, female adolescents who reported both a history of drug use and selling sex were purposively enrolled in the study. RESULTS Participating adolescent females were aged 17-19 years and were all internal-migrants with low literacy. All reported polydrug use (mainly methamphetamine and heroin, whereas ecstasy and ketamine have been infrequently employed). Being less informed about risks of drug use and lack of sexual and reproductive health knowledge seemed to contribute to problematic drug use, rough and prolonged sexual intercourse, inconsistent condom use and ineffective contraceptive practice. For their income, participants largely relied on selling sex, which was frequently coupled with drug sharing services to clients. However, despite the practices, women did not self-identify as sex workers, and therefore did not think that existing intervention services targeting female sex workers were relevant to them. Moreover, criminalization and stigmatisation of drug use and selling sex impeded their access to care services. CONCLUSION Current harm reduction and HIV/sexually transmitted infection (STI) prevention services are unlikely to address the demand of female adolescents engaged in drug use and commercial sex. Our findings highlight that a comprehensive and coordinated harm reduction and sexual and reproductive health response should be conducted involving these most vulnerable adolescents.
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Affiliation(s)
- Xu-Dong Zhang
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185, UZP114, 9000, Ghent, Belgium.
- Centre for International Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.
| | - Angela Kelly-Hanku
- International HIV Research Group, School of Public Health and Community Medicine, UNSW, Sydney, 2052, Australia.
- Sexual & Reproductive Health Unit, Institute of Medical Research, PO Box 60, Goroka, EHP, Papua New Guinea.
| | - Jia-Jia Chai
- City College, Kunming University of Science and Technology, East Ring Road 50, 650051, Kunming, China.
| | - Jian Luo
- Department of Prevention and Education, Yunnan Institute for Drug Abuse, Xi Hu Lu 300, 650228, Kunming, China.
| | - Marleen Temmerman
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185, UZP114, 9000, Ghent, Belgium.
| | - Stanley Luchters
- International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, De Pintelaan 185, UZP114, 9000, Ghent, Belgium.
- Centre for International Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Rd, Melbourne, Victoria, 3004, Australia.
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13
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Li J, Luo J, Li J, Liu H. Disassortative mixing patterns of drug-using and sex networks on HIV risk behaviour among young drug users in Yunnan, China. Public Health 2015; 129:1237-43. [PMID: 26298584 DOI: 10.1016/j.puhe.2015.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 03/06/2015] [Accepted: 07/13/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The dominant mode of HIV transmission in China has changed from injection drug use to sexual contact. The objectives of this study were to describe the disassortative and assortative mixing patterns of drug-using and sex networks among young drug users in China. STUDY DESIGN Cross-sectional study. METHODS Respondent-driven sampling (RDS) was used to recruit young drug users in an egocentric network study in Yunnan, China. Egos were categorized as having disassortative mixing network patterns if they reported both sex and drug-using networks. Egos who only had a sex network (no drug-using network), or only a drug-using network (no sex network) were categorized as having assortative mixing network patterns. Multiple logistic regression was performed to analyze the relationships between disassortative patterns with risky sexual behaviour and drug-using practices. RESULTS A total of 426 participants were recruited into the study. Two hundred forty-two egos reported disassortative mixing patterns and 139 egos had assortative patterns. The RDS-adjusted proportion of having a disassortative pattern was 53.2%. Participants with disassortative patterns were more likely to engage in HIV risk behaviour compared to those with assortative patterns. Specifically, drug users with disassortative patterns reported more multiple sex partners (31.4% vs 19.6%), concurrent partnerships (52.1% vs 39.0%), non-regular sex partners (12.0% vs 4.3%), and sex partners who were IDUs (24.9% vs 12.5%). Consistent condom use with regular or non-regular partners was low (between 18.9% and 47.2%) regardless of the mixing pattern. However, parenteral risk for HIV transmission was relatively low in both groups. CONCLUSIONS The transition of the HIV epidemic in China from injection drug use to sexual contact may be attributed to disassortative mixing in drug-use and sexual networks. HIV programs should consider disassortative mixing patterns when designing new behavioural interventions.
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Affiliation(s)
- J Li
- School of Public Health, University of Maryland, College Park, MD, USA; National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - J Luo
- Yunnan Institute for Drug Abuse, Kunming, Yunnan, China
| | - J Li
- Yunnan Institute for Drug Abuse, Kunming, Yunnan, China.
| | - H Liu
- School of Public Health, University of Maryland, College Park, MD, USA.
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14
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Pan S, Jiang H, Du J, Chen H, Li Z, Ling W, Zhao M. Efficacy of Cognitive Behavioral Therapy on Opiate Use and Retention in Methadone Maintenance Treatment in China: A Randomised Trial. PLoS One 2015; 10:e0127598. [PMID: 26107818 PMCID: PMC4479610 DOI: 10.1371/journal.pone.0127598] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/30/2015] [Indexed: 12/12/2022] Open
Abstract
Aims Methadone maintenance treatment (MMT) is widely available in China; but, high rates of illicit opiate use and dropout are problematic. The aim of this study was to test whether cognitive behavioral therapy (CBT) in conjunction with MMT can improve treatment retention and reduce opiate use. Method A total of 240 opiate-dependent patients in community-based MMT clinics were randomly assigned to either weekly CBT plus standard MMT (CBT group, n=120) or standard MMT (control group, n=120) for 26 weeks. The primary outcomes were treatment retention and opiate-negative urine test results at 12 weeks and 26 weeks. The secondary outcomes were composite scores on the Addiction Severity Index (ASI) and total scores on the Perceived Stress Scale (PSS) at 12 weeks and 26 weeks. Results Compared to the control group in standard MMT, the CBT group had higher proportion of opiate-negative urine tests at both 12 weeks (59% vs. 69%, p<0.05) and 26 weeks (63% vs. 73%, p<0.05); however, the retention rates at 12 weeks (73.3% vs. 74.2%, p=0.88) and 26 weeks were not different (55.8% vs. 64.2%, p=0.19) between the two groups. At both 12 and 26 weeks, all of the ASI component scores and PSS total scores in the CBT group and control group decreased from baseline; but the CBT group exhibited more decreases in ASI employment scores at week 26 and more decrease in the PSS total score at week 12 and week 26. Conclusions CBT counselling is effective in reducing opiate use and improving employment function and in decreasing stress level for opiate-dependent patients in MMT in China. Trial Registration ClinicalTrials.gov NCT01144390
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Affiliation(s)
- Shujun Pan
- Shanghai Mental Health Center, Shanghai JiaoTong University School of Medicine, Shanghai, China, 200030
| | - Haifeng Jiang
- Shanghai Mental Health Center, Shanghai JiaoTong University School of Medicine, Shanghai, China, 200030
| | - Jiang Du
- Shanghai Mental Health Center, Shanghai JiaoTong University School of Medicine, Shanghai, China, 200030
| | - Hanhui Chen
- Shanghai Mental Health Center, Shanghai JiaoTong University School of Medicine, Shanghai, China, 200030
| | - Zhibin Li
- Shanghai Mental Health Center, Shanghai JiaoTong University School of Medicine, Shanghai, China, 200030
| | - Walter Ling
- Integrated Substance Abuse Programs, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Min Zhao
- Shanghai Mental Health Center, Shanghai JiaoTong University School of Medicine, Shanghai, China, 200030
- * E-mail:
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15
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Yang M, Mamy J, Gao P, Xiao S. From Abstinence to Relapse: A Preliminary Qualitative Study of Drug Users in a Compulsory Drug Rehabilitation Center in Changsha, China. PLoS One 2015; 10:e0130711. [PMID: 26107639 PMCID: PMC4481107 DOI: 10.1371/journal.pone.0130711] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 05/23/2015] [Indexed: 12/01/2022] Open
Abstract
Background Relapse among abstinent drug users is normal. Several factors are related to relapse, but it remains unclear what individuals’ actual life circumstances are during periods of abstinence, and how these circumstances facilitate or prevent relapse. Objective To illuminate drug users’ experiences during abstinence periods and explore the real-life catalysts and inhibitors contributing to drug use relapse. Method Qualitative in-depth interviews were conducted with 20 drug users recruited from a compulsory isolated drug rehabilitation center in Changsha. The interviews were guided by open-ended questions on individuals’ experiences in drug use initiation, getting addicted, treatment history, social environment, abstinence, and relapse. Participants were also encouraged to share their own stories. Interviews were digitally recorded and fully transcribed. The data of 18 participants who reported abstinence experiences before admission were included in the analyses. The data were analyzed using a thematic analysis with inductive hand coding to derive themes. Results Most drug users were able to successfully abstain from drugs. During abstinence, their lives were congested with challenges, such as adverse socioeconomic conditions, poor family/social support, interpersonal conflicts, and stigma and discrimination, all of which kept them excluded from mainstream society. Furthermore, the police’s system of ID card registration, which identifies individuals as drug users, worsened already grave situations. Relapse triggers reported by the participants focused mainly on negative feelings, interpersonal conflicts, and stressful events. Craving was experienced but not perceived as a relapse trigger by most participants. Conclusions This study of in-depth interview with drug users found evidence of situations and environments they live during abstinence appear rather disadvantaged, making it extremely difficult for them to remain abstinent. Comprehensive programs on relapse prevention that acknowledge these disadvantages are implicated.
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Affiliation(s)
- Mei Yang
- Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, China
- Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Jules Mamy
- Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, China
| | - Pengcheng Gao
- Hunan Judicial Police Vocational College, Changsha, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, China
- * E-mail:
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16
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Yang L, Chen M, Ma Y, Luo H, Yang C, Su Y, Chen H, Shi Y, Mei J, Jia M, Lu L. The changing trends of HIV-1 prevalence and incidence from sentinel surveillance of five sub-populations in Yunnan, China, 2001-2010. BMC Public Health 2015; 15:376. [PMID: 25886791 PMCID: PMC4409774 DOI: 10.1186/s12889-015-1722-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 03/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background Yunnan is one of the provinces hardest-hit by HIV in China. To understand HIV epidemic dynamics and evaluate prevention effectiveness, we studied the changing trends in HIV-1 prevalence and incidence among five sub-populations in Yunnan. Methods Consecutive sentinel surveillances were conducted among people who inject drugs (PWID), male sexually transmitted diseases (STD) clinic attendees, and pregnant women for 2001–2010,female sex workers (FSWs) for 2007–2010, men who have sex with men (MSM) for 2008–2010. For the newly diagnosed HIV-seropositive samples, the recent infections were determined with BED-capture enzyme immunoassay (BED-CEIA), based on which HIV incidence was calculated for each sub-population using McDougal algorithm. Results From 231,117 individuals, 6,107 HIV-positive samples were tested with BED-CEIA, among which 964 samples were identified as recent infections. In PWID, HIV prevalence for 2001–2010 was between 27.16% and 18.35%, while the estimated incidence rate significantly decreased from 11.68% in 2001 to 1.70% in 2010. Among male STD clinic attendees, both the HIV prevalence (from 3.62% in 2001 to 1.73% in 2010) and incidence (from 1.10% in 2001 to 0.40% in 2010) showed a significant decreasing trend. In FSWs, the HIV prevalence for 2007–2010 kept stable (between 2.46% and 1.95%), while the HIV incidence significantly decreased (from 0.71% in 2007 to 0.31% in 2010). In MSM, the HIV prevalence (between 11.78% and 9.42%) and incidence (between 6.01% and 8.38%) remained stable at a relatively high level for 2008–2010. In pregnant women, the HIV prevalence (between 0.44% and 0.30%) and incidence (between 0.15% and 0.08%) remained stable for 2001–2010. Conclusion The HIV incidences in PWID, male STD clinic attendees and FSWs showed the decreasing trend, supporting a positive effect of prevention strategies for these sub-populations. MSM with the highest HIV incidence have become the sub-population most at risk. In most sub-populations, the HIV prevalence did not decline, suggesting the disease burden is still heavy. These findings are valuable for developing HIV prevention strategies in Yunnan.
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Affiliation(s)
- Li Yang
- Institute for STD/AIDS Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, , Yunnan Province, China.
| | - Min Chen
- Institute for STD/AIDS Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, , Yunnan Province, China.
| | - Yanling Ma
- Institute for STD/AIDS Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, , Yunnan Province, China.
| | - Hongbing Luo
- Institute for STD/AIDS Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, , Yunnan Province, China.
| | - Chaojun Yang
- Institute for STD/AIDS Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, , Yunnan Province, China.
| | - Yingzhen Su
- Institute for STD/AIDS Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, , Yunnan Province, China.
| | - Huichao Chen
- Institute for STD/AIDS Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, , Yunnan Province, China.
| | - Yuhua Shi
- Institute for STD/AIDS Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, , Yunnan Province, China.
| | - Jingyuan Mei
- Institute for STD/AIDS Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, , Yunnan Province, China.
| | - Manhong Jia
- Institute for STD/AIDS Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, , Yunnan Province, China.
| | - Lin Lu
- Institute for STD/AIDS Control and Prevention, Yunnan Center for Disease Control and Prevention, No 158, Dongsi Street, Xishan District, Kunming, 650022, , Yunnan Province, China.
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Wang ML. Managing HIV/AIDS: Yunnan's Government-driven, Multi-sector Partnership Model. MANAGEMENT AND ORGANIZATION REVIEW 2015. [DOI: 10.1111/j.1740-8784.2012.00307.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article seeks to unravel the management model used by China's Yunnan Province in its fight against HIV/AIDS. This government-driven, multi-sector partnership model has led to some capacity building and stabilization of HIV transmission among certain at-risk populations. The organizational strategies employed in this model might be useful for resource-poor countries in containing the spread of HIV/AIDS.
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Affiliation(s)
- Shuiyuan Xiao
- Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, China
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Wang L, Guo W, Li D, Ding Z, McGoogan JM, Wang N, Wu Z, Wang L. HIV epidemic among drug users in China: 1995-2011. Addiction 2015; 110 Suppl 1:20-8. [PMID: 25533861 PMCID: PMC4275840 DOI: 10.1111/add.12779] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 01/07/2013] [Accepted: 03/04/2014] [Indexed: 11/26/2022]
Abstract
AIM To describe trends in the HIV epidemic among drug users (DUs) in China from 1995 to 2011. DESIGN, SETTING AND PARTICIPANTS Data sets from China's national HIV/AIDS case reporting and sentinel surveillance systems as of December 2011 were used separately for descriptive analysis. MEASURES Changes in the geographic distribution of the number of HIV cases and HIV prevalence among injecting drug users (IDUs) and non-IDUs were examined. We also analysed changes in HIV prevalence among the broader DU population, and drug use-related behaviours including types of drugs used, recent injecting and recent needle sharing in the context of the rapid scale-up of DU sentinel sites and national harm reduction programmes. FINDINGS The HIV epidemic among China's DUs is still highly concentrated in five provinces. Here, HIV prevalence peaked at 30.3% [95% confidence interval (CI)=28.6, 32.1] among IDUs in 1999, and then gradually decreased to 10.9% (95% CI=10.6, 11.2) by 2011. We observed a rapid increase in the use of 'nightclub drugs' among DUs from 1.3% in 2004 to 24.4% in 2011. A decline in recent needle sharing among current IDU from 19.5% (95% CI=19.4, 19.6) in 2006 to 11.3% (95% CI=11.2, 11.4) in 2011 was found to be correlated with the rapid scale-up of methadone maintenance treatment (MMT; r(4)=-0.94, P=0.003) harm reduction efforts. CONCLUSIONS While HIV prevalence and needle sharing among current injecting drug users in China have declined dramatically and are correlated with the scale-up of national harm reduction efforts, the recent, rapid increased use of 'nightclub drugs' presents a new challenge.
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Affiliation(s)
- Lan Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Abstract
BACKGROUND This study explores patterns of drug use and related correlates among a sample of men who have sex with men (MSM) and men who sell sex to other men (aka "money boys") in China. OBJECTIVES Data were collected from MSM and money boys (MBs) in Shanghai, China using a Community Popular Opinion Leader (CPOL) research design with a self-administered cross-sectional survey to: (1) describe drug use and drug use correlates and (2) examine relationships between drug use and sexual behaviors in general MSM and MBs. METHODS The sample consisted of 402 MSM (203 MBs) who live in Shanghai, China. Descriptive statistics and regression analyses were used to explore associations between drug use and sexual behaviors and make comparisons between MBs and general MSM. RESULTS MBs reported using more drugs in the last week, 3 months and ever; sex after using drugs, and unprotected sex after using drugs more frequently than general MSM. Additionally, many MBs reported receiving free drugs from their clients and those who did receive free drugs were very likely to report having unprotected sex. CONCLUSIONS It is crucial to increase research and include Chinese MSM and their drug use in the Chinese policy conversation. These data suggest that drug use and sexual behaviors after drug use among Chinese MSM differ widely based upon selling sex and separate intervention strategies may be appropriate.
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Affiliation(s)
- Eric J Nehl
- 1Department of Behavioral Sciences & Health Education, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
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21
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Xu JJ, Zhang C, Hu QH, Chu ZX, Zhang J, Li YZ, Lu L, Wang Z, Fu JH, Chen X, Yan HJ, Zhuang MH, Jiang YJ, Geng WQ, Vermund SH, Shang H, Qian HZ. Recreational drug use and risks of HIV and sexually transmitted infections among Chinese men who have sex with men: Mediation through multiple sexual partnerships. BMC Infect Dis 2014; 14:642. [PMID: 25443542 PMCID: PMC4272794 DOI: 10.1186/s12879-014-0642-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/19/2014] [Indexed: 12/04/2022] Open
Abstract
Background Recreational drug use (RDU) may result in sexual disinhibition and higher risk for HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) in China. We assessed whether RDU was associated with HIV, syphilis, and herpes simplex virus type 2 (HSV-2) within the context of multiple sexual partnerships and unprotected sex. Methods We conducted a cross-sectional study among sexually-active MSM in six Chinese cities (Kunming, Jinan, Changsha, Zhengzhou, Nanjing, and Shanghai) in 2012–2013. We interviewed participants regarding RDU and sexual activity and drew blood for HIV, syphilis, and HSV-2. We fit multiple logistic regression models to assess associations of drug use and HIV, syphilis and HSV-2 infections, controlling for number of sexual partners and unprotected sex. Results Of 3830 participants, 28% reported ever using ≥1 of these drugs in the past 6 months: popper (alkyl nitrites), ecstasy, ice (methamphetamine), amphetamine, tramadol, and ketamine. In the past six months, 62% of MSM reported ≥2 sexual partners and 76% did not use condoms at last sexual encounter. HIV, syphilis and HSV-2 prevalences were 9.2%, 12.2%, and 10.3%, respectively.RDU was associated with HIV infection (aOR = 1.67; 95% CI, 1.31-2.13). Men with RDU were more likely to report multiple sexual partners (OR = 1.69; 95% CI, 1.44-1.98) and unprotected sex (aOR = 1.25; 95% CI, 1.05-1.49). The RDU-HIV association persisted (aOR = 1.58; 95% CI = 1.23-2.02) after adjusting for numbers of partners. Conclusions RDU was associated with multiple sexual partnerships, unprotected sex, and HIV among Chinese MSM. It is plausible that RDU is a driver of increased sexual/HIV risk and/or may be an associated behavior with sexually risky lifestyles. Community engagement is needed. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0642-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jun-Jie Xu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Chen Zhang
- Vanderbilt Institute for Global Health and Departments of Pediatrics and Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 750, Nashville, TN, 37203, USA.
| | - Qing-Hai Hu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Zhen-Xing Chu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Jing Zhang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Yong-Ze Li
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Lin Lu
- Yunnan Provincial Centers for Disease Control and Prevention (CDC), Kunming, China.
| | - Zhe Wang
- Henan Provincial CDC, Zhengzhou, China.
| | - Ji-Hua Fu
- Shandong Provincial CDC, Jinan, China.
| | - Xi Chen
- Hunan Provincial CDC, Changsha, China.
| | | | | | - Yong-Jun Jiang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Wen-Qing Geng
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Sten H Vermund
- Vanderbilt Institute for Global Health and Departments of Pediatrics and Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 750, Nashville, TN, 37203, USA.
| | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health and Departments of Pediatrics and Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 750, Nashville, TN, 37203, USA.
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22
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Tang Z, Zhang C, Li X, Liu Y, Su S, Zhou Y, Shen Z. HIV risk among female sex workers with different patterns of drug use behaviors in Southwest China: a cross-sectional study. AIDS Care 2014; 27:293-300. [PMID: 25407357 DOI: 10.1080/09540121.2014.980214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although many researchers found that drug use behaviors significantly increased HIV risk, few of them investigated the association between HIV risk and different drug use behaviors among female sex workers (FSWs) in China. The current study examines demographic and behavioral risk factors as well as the infections of HIV, syphilis, and among a subgroup of FSWs who are injection drug users (IDU) or noninjection drug users (NIDU) in comparison to Hepatitis C Virus (HCV) nondrug users (non-DU). We conducted secondary analysis of the 2010 National Sentinel Surveillance (NSS) data from Guangxi China. A self-administered, standard behavioral surveillance survey was completed by a total of 12,622 FSWs recruited from Guangxi, China. The Guangxi 2010 NSS sample included 2.6% NIDU and 0.5% IDU. Compared to non-DU, IDU were more likely to report no condom use in the last sex act (aOR = 3.25, 95%CI = 1.65, 6.40), inconsistent condom use in the past month (aOR = 4.88, 95%CI = 2.66, 8.96), having an HIV testing (aOR = 2.48, 95%CI = 1.34, 4.58), infections of HIV (aOR = 42.60, 95%CI = 9.45, 192.06), syphilis (aOR = 4.13, 95%CI = 1.86, 9.16), and HCV (aOR = 74.54, 95%CI = 30.26, 183.61). NIDU had 2.89 times higher than non-DU to report a history of sexually transmitted disease and 26% less likely to report inconsistent condom use in the past month (p < 0.05). We called for tailored, accessible, and nonjudgmental drug treatments coupled with effective sexual risk reduction interventions to help FSWs with various drug use problems to reduce their vulnerability and susceptibility of HIV risk in China as well as other cultural settings.
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Affiliation(s)
- Zhenzhu Tang
- a Guangxi Center for Disease Control and Prevention , Nanning , China
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23
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Socio-ecological factors associated with depression, suicidal ideation and suicidal attempt among female injection drug users who are sex workers in China. Drug Alcohol Depend 2014; 144:102-10. [PMID: 25236890 PMCID: PMC5581303 DOI: 10.1016/j.drugalcdep.2014.08.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 08/17/2014] [Accepted: 08/17/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Female injection drug users who are also sex workers (FSW-IDUs) occupy a pivotal population in HIV transmission, whereas their mental health problems are largely overlooked. We aimed to investigate prevalence and associated socio-ecological factors of depression, suicidal ideation and suicidal attempts among FSW-IDUs in China. METHODS Using snowball sampling methods, 200 FSW-IDUs were recruited from communities in Liuzhou, China. Anonymous face-to-face interviews were administered by trained doctors. RESULTS Thirty-nine percent of participants had severe or extremely severe depression, 44.7% had suicidal ideation in the last six months and 26.8% had suicidal attempts in the last six months. After adjusting for background variables, self-stigma was significantly associated with severe or extremely severe depression (OR=1.18, 95% CI: 1.07-1.31). Self-stigma (OR=1.08, 95% CI: 1.01-1.15), depression (OR=1.11, 95% CI: 1.05-1.18), having completely broken up with family (OR=2.60, 95% CI: 1.35-5.02) and having been abused by clients or gatekeepers (OR=2.15, 95% CI: 1.32-3.50) were associated with suicidal ideation in the last six months, while self-stigma (OR=1.03, 95% CI: 1.10-1.16), depression (OR=1.12, 95% CI: 1.04-1.20) and being abused by clients or gatekeepers (OR=2.15, 95% CI: 1.09-4.24) were associated with suicidal attempt in the last six months. In mediation analyses, the associations between self-stigma and the two suicidal outcomes were fully mediated by depression. CONCLUSIONS There are unmet mental health needs of FSW-IDUs. Screening of mental health problems should be integrated into current HIV-related services. Psychological intervention efforts should include components such as self-stigma, family support and abuse.
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Li L, Assanangkornchai S, Duo L, McNeil E, Li J. Risk behaviors, prevalence of HIV and hepatitis C virus infection and population size of current injection drug users in a China-Myanmar border city: results from a Respondent-Driven Sampling Survey in 2012. PLoS One 2014; 9:e106899. [PMID: 25203256 PMCID: PMC4159231 DOI: 10.1371/journal.pone.0106899] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 08/10/2014] [Indexed: 02/06/2023] Open
Abstract
Background Injection drug use has been the major cause of HIV/AIDS in China in the past two decades. We measured the prevalences of HIV and hepatitis C virus (HCV) prevalence and their associated risk factors among current injection drug users (IDUs) in Ruili city, a border region connecting China with Myanmar that has been undergoing serious drug use and HIV spread problems. An estimate of the number of current IDUs is also presented. Methods In 2012, Chinese IDUs who had injected within the past six months and aged ≥18 years were recruited using a respondent-driven sampling (RDS) technique. Participants underwent interviews and serological testing for HIV, HBV, HCV and syphilis. Logistic regression indentified factors associated with HIV and HCV infections. Multiplier method was used to obtain an estimate of the size of the current IDU population via combining available service data and findings from our survey. Results Among 370 IDUs recruited, the prevalence of HIV and HCV was 18.3% and 41.5%, respectively. 27.1% of participants had shared a needle/syringe in their lifetime. Consistent condom use rates were low among both regular (6.8%) and non-regular (30.4%) partners. Factors independently associated with being HIV positive included HCV infection, having a longer history of injection drug use and experience of needle/syringe sharing. Participants with HCV infection were more likely to be HIV positive, have injected more types of drugs, have shared other injection equipments and have unprotected sex with regular sex partners. The estimated number of current IDUs in Ruili city was 2,714 (95% CI: 1,617–5,846). Conclusions IDUs may continue to be a critical subpopulation for transmission of HIV and other infections in this region because of the increasing population and persistent high risk of injection and sexual behaviours. Developing innovative strategies that can improve accessibility of current harm reduction services and incorporate more comprehensive contents is urgently needed.
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Affiliation(s)
- Lei Li
- Yunnan Institute of Drug Abuse, Kunming, Yunnan, P.R. China
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
- * E-mail:
| | - Lin Duo
- HIV/AIDS Asia Regional Program Yunnan Management Office, Kunming, Yunnan, P.R. China
| | - Edward McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Jianhua Li
- Yunnan Institute of Drug Abuse, Kunming, Yunnan, P.R. China
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Wang K, Fu H, Longfield K, Modi S, Mundy G, Firestone R. Do community-based strategies reduce HIV risk among people who inject drugs in China? A quasi-experimental study in Yunnan and Guangxi provinces. Harm Reduct J 2014; 11:15. [PMID: 24885778 PMCID: PMC4022425 DOI: 10.1186/1477-7517-11-15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 04/10/2014] [Indexed: 11/26/2022] Open
Abstract
Background 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. Methods We 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. Results We 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). Conclusions A 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.
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Affiliation(s)
- Kai Wang
- PSI/China, 909-9 F, M2 Building, Harmonious Society, Xiaokang Rd, Hongyun Community, Wuhua District, Kunming 650000, China.
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Ding Y, He N, Shoptaw S, Gao M, Detels R. Severity of club drug dependence and perceived need for treatment among a sample of adult club drug users in Shanghai, China. Soc Psychiatry Psychiatr Epidemiol 2014; 49:395-404. [PMID: 23715971 PMCID: PMC3797173 DOI: 10.1007/s00127-013-0713-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 05/15/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Examine the severity of club drug dependence and perceived need for treatment, and further identify their determinants among a sample of club drug users in Shanghai, China. METHODS Two hundred and seventy-six club drug users were recruited using respondent-driven sampling (RDS). Severity of dependence on club drugs was measured using the Severity of Dependence Scale (SDS). RESULTS 69.9% reported dependence on club drugs (i.e., SDS ≥ 4) and 36.6% reported severe dependence (i.e., SDS ≥ 6). One-eighth (12.7%) perceived need for drug treatment. Severe dependence on club drugs was more likely among those who reported recent use of ecstasy and those who had more depressive symptoms, but less likely among those reporting recent use of methamphetamine. Perceived need for treatment was more likely among those who lived with a spouse or boy/girlfriend, but less likely among those had prior drug treatment experience and more severe club drug dependence. CONCLUSIONS Our findings suggest that educational activities should be implemented to raise public awareness about the powerful addictive properties of club drugs, along with efforts to reduce stigma towards drug abuse and psychiatric disorders. Programs to motivate drug users to seek treatment and encourage treatment linkage are urgently needed.
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Affiliation(s)
- Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China,Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Steven Shoptaw
- Department of Family Medicine and Psychiatry, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Meiyang Gao
- Department of Epidemiology, School of Public Health, Fudan University and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Roger Detels
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA,Correspondence to Roger Detels, Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, 90095-1772, USA;
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Chen W, Xia Y, Hong Y, Hall BJ, Ling L. Predictors of continued HIV-risk behaviors among drug users in methadone maintenance therapy program in China--a prospective study. Harm Reduct J 2013; 10:23. [PMID: 24107380 PMCID: PMC3853934 DOI: 10.1186/1477-7517-10-23] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 09/30/2013] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND To examine the predictors of continued drug- and sex-related HIV-risk behaviors among drug users in methadone maintenance therapy (MMT) programs in China. METHODS We 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. RESULTS The 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. CONCLUSIONS Our 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.
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Affiliation(s)
- Wen Chen
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, #74, Zhongshan Road II, Guangzhou 510080, P.R China
- Sun Yat-sen Center for Migrant Health Policy, #74, Zhongshan Road II, Guangzhou 510080, P.R China
| | - Yinghua Xia
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, #74, Zhongshan Road II, Guangzhou 510080, P.R China
- Sun Yat-sen Center for Migrant Health Policy, #74, Zhongshan Road II, Guangzhou 510080, P.R China
| | - Yan Hong
- Department of Social and Behavioral Health School of Rural Public Health Texas A&M University, TAMU 1266, College Station, TX 77843-1266, USA
| | - Brian J Hall
- Sun Yat-sen Center for Migrant Health Policy, #74, Zhongshan Road II, Guangzhou 510080, P.R China
- UNC-Project China, Guangdong STD Control Center, Guangzhou 510095, P.R China
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Li Ling
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, #74, Zhongshan Road II, Guangzhou 510080, P.R China
- Sun Yat-sen Center for Migrant Health Policy, #74, Zhongshan Road II, Guangzhou 510080, P.R China
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Zhang Y, Lu C, Zhang J, Hu L, Song H, Li J, Kang L. Gender differences in abusers of amphetamine-type stimulants and ketamine in southwestern China. Addict Behav 2013; 38:1424-30. [PMID: 23006246 DOI: 10.1016/j.addbeh.2012.06.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 05/21/2012] [Accepted: 06/19/2012] [Indexed: 10/28/2022]
Abstract
The objective of this study was to investigate abuse conditions of new-type drugs for users who are seeking treatment, gender differences, and differences between the amphetamine-type stimulants (ATS) users and mixed amphetamine-type stimulants and ketamine (ATS+K) poly-drug users. A retrospective analysis was conducted of patients with a final diagnosis of the substance use disorder according to the Diagnoses and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) who underwent treatment for exposure to new-type drugs at the mental health center of the West China Hospital from March 2009 to May 2011. A questionnaire was used to collect information about socio-demographics, drug abuse conditions and psychiatric co-morbidities. Male subjects were older (p=0.026), had low level education (p=0.003), were less previously married (p<0.001), were more likely to be employed and to hold higher status jobs (p=0.007); 77.1% of subjects had a psychotic disorder, 28.0% of subjects had a mood disorder, 39.7% had an anxiety disorder, and 45.0% had a cognitive impairment disorder. More men used methamphetamine MA (p<0.001), tobacco (p=0.014) and more than one drug substance (p=0.004) compared to women; women were more vulnerable to mood disorders (p=0.034) than men. For the males, the ATS+K patients were more likely to use 3, 4-methylenedioxymethamphetamine MDMA (p<0.001) and develop more psychotic disorders (p=0.04) than the ATS patients; for females, the ATS+K patients were more likely to use MDMA (p=0.002), alcohol (p=0.014) and develop more cognitive impairment disorder (p=0.034). The present study found that the new-type drug patients have a high degree of psychiatric morbidities; more men were using MA, tobacco and multi-substance and more women patients experience mood disorder in the gender differences. For the males, the ATS+K patients were more likely to use MDMA (3, 4-methylenedioxymethamphetamine) and develop more psychotic disorders than the ATS patients; for females, the ATS+K patients were more likely to use MDMA, alcohol and develop more cognitive impairment disorder. These results suggested that the psychiatrists should focus on the mood disorder among females, psychotic disorders among males who abuse ATS and ketamine, and cognitive impairment disorder for the females who abuse ATS and ketamine.
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Wu F, Peng CY, Jiang H, Zhang R, Zhao M, Li J, Hser YI. Methadone maintenance treatment in China: perceived challenges from the perspectives of service providers and patients. J Public Health (Oxf) 2012; 35:206-12. [PMID: 22997278 DOI: 10.1093/pubmed/fds079] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND China has recently adopted methadone maintenance treatment (MMT) as a national strategy to address the problem of drug abuse and related public health issues such as HIV and HCV infections. However, low enrollment and retention rates suggest that barriers may exist in MMT utilization. This study examined both patients' perceptions and service providers' perceptions of challenges in MMT implementation in China. METHODS Four focus groups were conducted in two Chinese cities, Shanghai and Kunming, to explore the perceived and experienced barriers in MMT participation in China. All focus group discussions with participants were audio taped and transcribed. Atlas.ti 5.1 was used to analyze data. RESULTS Service providers and patient participants reported positive experiences (e.g. effects of MMT in curbing withdrawal symptoms) but also expressed concerns about side effects and continued heroin use during MMT. They also identified barriers in participating and remaining in MMT, including affordability (fee requirement), acceptability (methadone as a substitution, dose, long-term nature), accommodation and accessibility (inconvenient operation hours, lack of transferability to other MMT clinics during travel) and competition between public health and public security. CONCLUSIONS The present findings have implications for reconsidering the current MMT policies and practices in order to improve access, utilization and, ultimately, the effectiveness of MMT in China.
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Affiliation(s)
- Fei Wu
- UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Blvd, Suite 200, University of California, Los Angeles, CA 90025, USA.
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30
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Zhou YH, Yao ZH, Liu FL, Li H, Jiang L, Zhu JW, Zheng YT. High prevalence of HIV, HCV, HBV and co-infection and associated risk factors among injecting drug users in Yunnan province, China. PLoS One 2012; 7:e42937. [PMID: 22916185 PMCID: PMC3420897 DOI: 10.1371/journal.pone.0042937] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Accepted: 07/15/2012] [Indexed: 01/30/2023] Open
Abstract
Objective To estimate the prevalence of HIV, HCV, HBV and co-infection with 2 or 3 viruses and evaluate risk factors among injecting drug users (IDUs) in Yunnan province, China. Methods 2080 IDUs were recruited from 5 regions of Yunnan Province, China to detect the infection status of HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). Statistical analysis was performed to evaluate risk factors related to HIV, HCV and HBV infections. Results The infection rates among all participants were 25.5% for HIV, 77.7% for HCV, 19.2% for HBV, 15% for HIV/HCV, 0.3% for HIV/HBV, 7.8% for HCV/HBV and 7.1% for HIV/HCV/HBV. The prevalence of virus infection varied widely by region in Yunnan of China. Statistical analyses indicated that high prevalence of HIV and HCV among IDUs was positively associated with the duration of drug injection and sharing needles/syringes; besides, HCV infection was associated with the frequency of drug injection. Conclusions HIV, HCV, HBV infections and co-infections were still very prevalent among IDUs in Yunnan province because of drug use behaviors.
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Affiliation(s)
- Yan-Heng Zhou
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
- The Graduate School of the Chinese Academy of Sciences, Beijing, China
| | - Zhi-Hong Yao
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
- The Graduate School of the Chinese Academy of Sciences, Beijing, China
| | - Feng-Liang Liu
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
| | - Hong Li
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Li Jiang
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Jia-Wu Zhu
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
- The Graduate School of the Chinese Academy of Sciences, Beijing, China
| | - Yong-Tang Zheng
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
- * E-mail:
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31
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Ni MJ, Fu LP, Chen XL, Hu XY, Wheeler K. Net financial benefits of averting HIV infections among people who inject drugs in Urumqi, Xinjiang, Peoples Republic of China (2005-2010). BMC Public Health 2012; 12:572. [PMID: 22839738 PMCID: PMC3448504 DOI: 10.1186/1471-2458-12-572] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 07/25/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND To quantify the contribution of locally implemented prevention programmes in contributing to reductions in treatment and care costs by averting HIV infections among those who inject drugs this study calculates net financial benefit of providing harm reduction programmes using information from services being implemented in Urumqi, Xinjiang Uighur Autonomous Region of China ( between 2005 and 2010). METHODS Information was collected to assess cost of providing methadone treatment (MMT) and needle and syringe programmes (NSP). HIV incidence was estimated among people who inject drugs (PWID). HIV infections averted were calculated. Net benefit was assessed by estimating costs of providing prevention programmes and comparing these to the costs of providing care. RESULTS An estimated 5678 (range 3982-7599) HIV infections were averted between 2005 and 2010 and the net financial benefit of providing harm reduction programmes compared to treatment and care costs for HIV infections averted was USD 4.383 million during the same time period. CONCLUSION These results demonstrate the net and accumulating benefit of investing in harm reduction programmes for PWID in Urumqi. The return on investment progressively increased during the time period studied and it is clear that these cost savings will continue to accrue with the continued implementation of HIV prevention interventions in the community that include harm reduction programmes targeted at PWID.
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Affiliation(s)
- Mingjian J Ni
- Xinjiang Uighur Autonomous Regional Centre for Disease Control HIV/AIDS and Sexually Transmitted Infection Prevention and Control Center, 48 Beijing South Road, Urumqi, Xinjiang Uighur Autonomous Region, Peoples’ Republic of China
| | - Li Ping Fu
- Xinjiang Uighur Autonomous Regional Centre for Disease Control HIV/AIDS and Sexually Transmitted Infection Prevention and Control Center, 48 Beijing South Road, Urumqi, Xinjiang Uighur Autonomous Region, Peoples’ Republic of China
| | - Xue Ling Chen
- Xinjiang Uighur Autonomous Regional Centre for Disease Control HIV/AIDS and Sexually Transmitted Infection Prevention and Control Center, 48 Beijing South Road, Urumqi, Xinjiang Uighur Autonomous Region, Peoples’ Republic of China
| | - Xiao Yuan Hu
- Xinjiang Uighur Autonomous Regional Centre for Disease Control HIV/AIDS and Sexually Transmitted Infection Prevention and Control Center, 48 Beijing South Road, Urumqi, Xinjiang Uighur Autonomous Region, Peoples’ Republic of China
| | - Kim Wheeler
- Xinjiang Uighur Autonomous Regional Centre for Disease Control HIV/AIDS and Sexually Transmitted Infection Prevention and Control Center, 48 Beijing South Road, Urumqi, Xinjiang Uighur Autonomous Region, Peoples’ Republic of China
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Role of sexual transmission of HIV among young noninjection and injection opiate users: a respondent-driven sampling study. Sex Transm Dis 2012; 38:1161-6. [PMID: 22082729 DOI: 10.1097/olq.0b013e3182315772] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sexual transmissibility of HIV among young drug users in China has been investigated in few studies. The objective of this study was to examine the role of sexual transmission on HIV infection among injection drug users (IDUs) and noninjection drug users (NIDUs). METHODS Respondent-driven sampling (RDS) was used to recruit 426 young heroin/opium drug users in Yunnan, China. Logistic regression modeling was performed to examine interrelationships among risky sexual behaviors, drug-use modes, and drug-use practices. RESULTS Substantial proportions of NIDUs and IDUs reported engagement in risky sexual behaviors including: (1) multiple sexual partners (42% of NIDUs vs. 37% of IDUs), (2) concurrent sexual partnerships (48% vs. 46%), (3) commercial sex partners (23% vs. 24%), and sex partners who were NIDUs (14% vs. 17%). Both NIDUs and IDUs reported low levels of condom use with nonregular partners (48% vs. 42%) and regular partner (24% vs. 27%), and having a history of recent methamphetamine use (21% vs. 18%). Compared to IDUs, NIDUs reported having had fewer sex partners who were IDUs, fewer IDU network peers, more NIDU network peers, and having lower levels of HIV knowledge and self-perceived HIV risk. CONCLUSIONS Generalization of the HIV epidemic from high-risk groups to the general population may be driven by risky sexual behavior among drug users. Reducing sexual transmission of HIV among both IDUs and NIDUs is the next major challenge for HIV intervention among drug users in China.
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Li J, Liu H, Li J, Luo J, Koram N, Detels R. Sexual transmissibility of HIV among opiate users with concurrent sexual partnerships: an egocentric network study in Yunnan, China. Addiction 2011; 106:1780-7; discussion 1788-9. [PMID: 21457169 PMCID: PMC3142291 DOI: 10.1111/j.1360-0443.2011.03459.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To investigate the patterns of concurrent sexual partnerships among young opiate users and sexual transmissibility of human immunodeficiency virus (HIV) in concurrent sexual partnerships in drug-use and sexual networks. DESIGN Cross-sectional design. PARTICIPANTS A total of 426 young opiate users in Yunnan, China. SETTING Young opiate users recruited from their network ties. MEASUREMENT Respondent-driven sampling (RDS) was used to recruit participants. Multiple logistic regressions were performed to analyze the relationships of concurrent sexual partnerships with egocentric social network components, risky sexual behavior for HIV and drug-use practices. FINDINGS The RDS-adjusted prevalence of concurrent sexual partners was 42.9% among opiate users. Opiate users with concurrent sexual partnerships were more likely to engage in risky HIV-related sexual behavior, compared to those without. Specifically, they were more likely to report having had four or more sexual partners (26.3% versus 2.0%), having had a spouse or boy/girlfriends who also had concurrent sexual partnerships (28.1% versus 8.2%), having exchanged drug for sex (12.4% versus 3.8%), having had sexual partners who were non-injection drug users (22.6% versus 10.1%), having had sexual partners who were injection drug users (25.3% versus 13.5%) and having used club drugs (26.3% versus 13.5%). There were no significant differences in consistent condom use between opiate users with sexual concurrency and those without. The same proportion (25.8%) of opiate users in the two groups reported having consistently used condoms when having sex with regular partners, and 46.3% of opiate users with sexual concurrency and 36.4% of those without such concurrency consistently used condoms with non-regular partners. CONCLUSION The expansion of the human immunodeficiency virus epidemic from high-risk populations to the general population in China may be driven by concurrent sexual partnerships. Behavioral interventions targeting safer sex should be integrated into harm reduction programmes.
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Affiliation(s)
- Jian Li
- Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Hongjie Liu
- Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jianhua Li
- Yunnan Institute for Drug Abuse, Kunming, Yunnan, China
| | - Jian Luo
- Yunnan Institute for Drug Abuse, Kunming, Yunnan, China
| | - Nana Koram
- Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Roger Detels
- Department of Epidemiology, University of California, Los Angeles, California, USA
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Liu Q, Gericke CA. Yulu Shequ - a unique rehabilitation program for illicit drug users in Kaiyuan in southwest China. Harm Reduct J 2011; 8:26. [PMID: 21933384 PMCID: PMC3195714 DOI: 10.1186/1477-7517-8-26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 09/20/2011] [Indexed: 11/21/2022] Open
Abstract
Introduction In China, illicit drug use and addiction have been rapidly increasing over the last two decades. Traditional compulsory rehabilitation models in China are widely considered ineffective. Recently, a new model of drug user rehabilitation called the 'Yulu Shequ Program' has gained a national reputation for successful rehabilitation in the city of Kaiyuan in southwest China. The aim of this study was to describe this program to the international public and to assess the program's effectiveness in terms of relapse rates and costs to participants and public payers. Case description The Yulu Shequ program provides up to one hundred participants at any point in time with the opportunity to live and work in a purpose-built, drug-free community after completing compulsory rehabilitation. The length of stay is not limited. Community members receive medical and psychological treatment and have the option to participate in social activities and highly valued job skills training. The program has very strict policies to prevent illicit drugs entering the community. Evaluation The evaluation was carried out through 1) a review of literature, official documents and websites in Chinese language describing the program and 2) an on-site visit and conduct of semi-structured interviews with key staff members of the Yulu Shequ program. The relapse rate in 2007 was 60% compared to 96% in the compulsory program. Annual costs to public payers of CNY4800 (US$700) were largely offset by income earned through on-site labour by participants totalling CNY4600 (US$670). Conclusions The Yulu Shequ program is an interesting model for drug rehabilitation that could lead the way for a new Chinese national policy away from compulsory rehabilitation towards a more collaborative and effective approach. Caution is needed when interpreting relapse rates as Yulu Shequ participants need to have completed compulsory rehabilitation before entering the program. A more comprehensive evaluation of this program would be desirable before implementation in other parts of China or in other countries facing similar problems.
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Affiliation(s)
- Qinqin Liu
- Professor of Public Health and Deputy Director, Peninsula CLAHRC, National Institute for Health Research, Peninsula College of Medicine and Dentistry, Universities of Exeter and Plymouth, Plymouth, UK.
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Zhao L, Holzemer WL, Johnson M, Tulsky JP, Rose CD. HIV infection as a predictor of methadone maintenance outcomes in Chinese injection drug users. AIDS Care 2011; 24:195-203. [PMID: 21780984 DOI: 10.1080/09540121.2011.596520] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper's design is descriptive and correlational based on retrospective self-report survey data collected in Kunming city, China. The study investigated the difference between a group of Chinese HIV positive (N=36) and negative (N=131) opioid dependent adults maintained on methadone treatment. Comparisons were based on their quality of life (QOL), methadone treatment adherence, adverse symptom occurrence related to methadone treatment, and HIV-related behavior changes. No significant differences were found between the two groups in age, methadone maintenance dose, methadone adherence, sex desire, and drug craving level. Participants who were HIV positive reported significantly lower scores on physical health and total health-related qualify of life. They also reported greater engagement in injection related risk behavior before methadone treatment than those who tested HIV negative. For both groups, sexual and injection risk behavior significantly decreased following initiation of methadone treatment. A regression model revealed that those infected with HIV, associated significantly with higher likelihood of reporting constipation and lack of appetite, and higher frequency of reporting abdominal pain and nausea than HIV negative patients. The primary implication of these findings is that HIV positive persons in methadone treatment may require more focused services to meet their special HIV care and substance treatment needs.
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Affiliation(s)
- Lin Zhao
- Community Health Systems, University of California, San Francisco, CA, USA.
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Dennin RH, Lafrenz M, Sinn A, Li LJ. Dilemma of concepts and strategies for the prevention of spread of HIV in relation to human behavior, law and human rights. J Zhejiang Univ Sci B 2011; 12:591-610. [PMID: 21726067 PMCID: PMC3134848 DOI: 10.1631/jzus.b1000434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 03/23/2011] [Indexed: 12/22/2022]
Abstract
The new prevalence data regarding the estimated global number of human immunodeficiency virus positive (HIV+) cases, i.e., including people who are either aware or unaware of their HIV infection in 2010, lead many to wonder why the increase in incidence has reached today's unprecedented level and escalated within such a short time. This, in spite of prevention campaigns in countries affected by HIV/acquired immune deficiency syndrome (AIDS) with their urgent messages aimed at preventing HIV transmission by promoting changes in individual's behavior. This article analyzes the background of the prevention strategies, in particular their political, social and legal concepts in terms of human rights, and reveals traits of human behavior not considered thus far. A radical reappraisal is necessary, at social and legislative levels, as well as options additional to current concepts. When ethical issues come up, they become blamed for outmoded moralistic positions. However, ignoring the reality has led to dire consequences from prioritizing individual human rights over society's collective need to prevent the spread of HIV.
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Affiliation(s)
- Reinhard H Dennin
- Institute of Medical Microbiology and Hygiene, University of Luebeck, Campus Luebeck, 160 Ratzeburger Allee, Luebeck D-23538, Germany.
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Emerging issues, challenges and aspirations in the HIV/AIDS epidemic in China. Public Health 2011; 125:257-9. [DOI: 10.1016/j.puhe.2011.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 01/20/2011] [Indexed: 11/22/2022]
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Abstract
Research conducted during the first 20 years of the AIDS epidemic provided a solid foundation of data supporting methadone treatment as HIV prevention. Drug users in methadone treatment were consistently found to reduce the frequency of drug use, risk behaviors, and infections. These data have been consistent over time and across cultural settings and have been used to promote the expansion of drug treatment as a prevention intervention. More recently, data have emerged suggesting the prevention potential of medication-assisted treatments other than methadone (buprenorphine/naloxone and naltrexone). Still, with a few notable exceptions, global drug treatment coverage for opiate injectors remains remarkably low and only a few treatment interventions for stimulant use have shown efficacy in reducing HIV risk. Importantly, more recent data provide support for the role of drug treatment programs in improving access and adherence to antiretroviral treatment and that injection drug users in substance abuse treatment are more likely to achieve sustained viral suppression. While important challenges remain in maximizing its impact, the scientific literature provides strong evidence of the efficacy of drug treatment as an HIV prevention strategy.
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Affiliation(s)
- David S Metzger
- HIV/AIDS Prevention Research Division, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA.
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Abstract
Drug use continues to be a major factor fueling the global epidemic of HIV infection. This article reviews the current literature on the ability of drug treatment programs to reduce HIV transmission among injection and noninjection drug users. Most data come from research on the treatment of opiate dependence and provide strong evidence on the effectiveness of medication-assisted treatment for reducing the frequency of drug use, risk behaviors, and HIV infections. This has been a consistent finding since the epidemic began among diverse populations and cultural settings. Use of medications other than methadone (such as buprenorphine/naloxone and naltrexone) has increased in recent years with promising data on their effectiveness as HIV prevention and as new treatment options for communities heavily affected by opiate use and HIV infection. However, few treatment interventions for stimulant abuse and dependence have shown efficacy in reducing HIV risk. The cumulative literature provides strong support of drug treatment programs for improving access and adherence to antiretroviral treatment. Drug users in substance abuse treatment are significantly more likely to achieve sustained viral suppression, making viral transmission less likely. Although there are challenges to implementing drug treatment programs for maximum impact, the scientific literature leaves no doubt about the effectiveness of drug treatment as an HIV prevention strategy.
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Sun K, Zhou S, Chen RY, Cohen MS, Zhang F. Recent key advances in human immunodeficiency virus medicine and implications for China. AIDS Res Ther 2010; 7:12. [PMID: 20500898 PMCID: PMC2890503 DOI: 10.1186/1742-6405-7-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 05/26/2010] [Indexed: 11/24/2022] Open
Abstract
In this article we summarize several recent major developments in human immunodeficiency virus treatment, prevention, outcome, and social policy change. Updated international guidelines endorse more aggressive treatment strategies and safer antiretroviral drugs. New antiretroviral options are being tested. Important lessons were learned in the areas of human immunodeficiency virus vaccines and microbicide gels from clinical studies, and additional trials in prevention, especially pre-exposure prophylaxis, are nearing completion. Insight into the role of the virus in the pathogenesis of diseases traditionally thought to be unrelated to acquired immunodeficiency syndrome has become a driving force for earlier and universal therapy. Lastly, we review important achievements of and future challenges facing China as she steps into her eighth year of the National Free Antiretroviral Treatment Program.
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Affiliation(s)
- Kai Sun
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Washington University in St. Louis, St. Louis, MO, USA
| | - Shuntai Zhou
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing 100050, PR China
| | - Ray Y Chen
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, based at the U.S. Embassy Beijing, No. 55 An Jia Lou Lu, Beijing 100600, PR China
| | - Myron S Cohen
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Fujie Zhang
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing 100050, PR China
- China Medical University, Shengyang, Liaoning, PR China
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