Sexual Health Exchange 2005-1

According to Xinhua News Agency (17 October 2003), the Chinese Ministry of Public Security has recorded some 600,000 drug users in China, 80% of whom are young people. However, there are estimates that the actual number of drug users may be eight to ten times higher than the registered figure. Even though China has strong anti-drugs policies and the law stipulates that drug users must be rehabilitated, it has increasingly been possible to introduce harm reduction programmes for drug users in the country. The Chinese Plan of Action to Contain, Prevent and Control HIV/AIDS (2001-2005) offered much-needed opportunities for programmes providing syringe and needle exchange, condom distribution and methadone treatment for drug users. One of these programmes is the Xinjiang HIV/AIDS Prevention and Control Project, funded by the Australian Government through the Australian Agency for International Development (AusAID).

Against the major policy changes outlined above, a new initiative based on harm reduction was launched in October 2003 by the Xinjiang HIV/AIDS Prevention and Control Project (XJHAPAC), a bilateral project jointly implemented by the Government of the People's Republic of China and the Government of Australia. Formerly there was a syringe collection programme being implemented by the Xinjiang Red Cross, which began in July 2003. However, the needle and syringe exchange was only established after the changes in the policy were made.

The project covers around 50% of the known IDU population (some 1600 registered IDUs) in Yining City and around 80% of the IDUs in the streets where the project is being implemented. The aim is to prevent the further transmission of HIV and reduce stigma and discrimination directed towards HIV-positive drug users and other people. The majority of this group are young Muslim males.

Since implementation of this project began in late 2003, there have been significant positive changes in community support for IDUs to enable them to access information and needle and syringe exchange. Several key agencies have been involved in this process and have been very supportive, including the local government, police and local community members. Up to February 2005, over 39,000 needle and syringe packages (comprising one single-use syringe and needle, clean water and a cotton swab) have been delivered and over 42,000 used needles and syringes have been collected and disposed of by burning.

Results from a recent evaluation among 130 IDUs indicate that the proportion of those sharing needles among IDUs decreased dramatically, from 63% to 11.5%, over an 18-month period (April 2003-November 2004). Also, condom use increased by 44% for drug-using couples and by 38% in encounters with sex workers. Nearly 90% of IDUs confirmed that they accessed needles and syringes from street patrols and small fixed sites as it was far less intimidating and easier to access than using pharmacies or hospitals.

A number of critical issues underlie developments in this project and these build upon current thinking in terms of strategies to control HIV transmission to and from IDUs.¹ First, clear and explicit requirements have been formulated at the national level and the implications of these changes have flowed down to local policy levels. Second, this project has identified a significant marginalized population whose life-styles and behaviours are typically criminalized and frowned upon, and developed a comprehensive harm reduction approach across sectors and agencies. Thirdly, multiple strategies have been employed to address the issue, including community action, inter-sectoral collaboration and a systematic improvement in IEC (information, education and communication) for IDUs. This represents a ‘combination approach' that includes advocacy, community mobilization, harm reduction relating to safe injecting and safer sex, and care in the community provided by health-care workers allied to community clinics. This includes home-based care and support and the development of skills amongst family members who are the ultimate care givers.

From 2002 onwards, the WBH9 project had focused on raising awareness in communities and during this project the role of the Imam had been recognized and mobilized. In the first months of the current project the challenges included developing support for broader community initiatives and mobilization of street administration levels of government. The focus of this programme was to centre the interventions in the community and therefore community leadership was critical to the success of the project. Muslim clerics are clearly part of the leadership of the community and, while NSEP and pre-marital and extra-marital sex are not supported, the general message conveyed was their role in supporting the community as a whole.

There will undoubtedly be an ongoing requirement to reduce stigma and discrimination towards PLWHA and IDUs, so work with the local community, including government, health services, law enforcement, local community leaders (including Imams), and the general community/women's groups, will continue. However, in addition to specific improvements in the adoption of risk-reduction strategies by IDUs and the reduction in stigma and discrimination, one of the main benefits of the project has been to illustrate the value and power of a comprehensive, carefully planned community-based harm reduction strategy. The current pilot project ended in April 2005; a proposed expansion of the project to be funded through XJHAPAC would extend coverage to 90% of drug users in Yining and Urumqi Cities. At the end of this project (proposed to end March 2007) the governments in each of the areas covered will fund the operational management of the programme. Strategies such as syringe and needle social marketing to support sustainability are being explored.

Ni Mingjian, Director Regional HIV/AIDS Project Executive Office; Caroline Fitzwarryne, Kim Wheeler and Chen Wei, School of International Development, Melbourne University Private; & Don Stewart, Queensland University of Technology, Australia.

Xinjiang HIV/AIDS Prevention and Care Project; 48 Beijing South Road, Urumqi, Xinjiang, PRC, China; tel.: +86-991-366.00.44, e-mail: enquiry@xjhapac.com, web:  www.xjhapac.org

 1. A joint assessment of HIV/AIDS prevention, treatment and care in China. Ministry of Health, China, and UN Theme Group, 2003: www.casy.org/engdocs/new_joint_en.pdf.

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