Development and implementation of a cross-border HIV prevention intervention for injection drug users in Ning Ming County (Guangxi Province), China and Lang Son Province, Vietnam

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Abstract

This paper describes the background and early implementation of a peer-based HIV prevention intervention involving social marketing of sterile needles and syringes for injection drug users (IDUs) in a border region of northern Vietnam and southern China. Peer educators collect and safely dispose of used needles and syringes and provide IDUs with a choice of new needles/syringes or vouchers redeemable in pharmacies and clinics for new needles/syringes. The project arose from a pattern of changing drug use and increasing HIV infection in the region but its development took 4 years and faced many challenges. Implementation of the intervention posed a new set of challenges for the participating health departments, police, peer educators, pharmacists, injection drug users, and the communities at large. Early implementation of the project has revealed successful multi-sectoral collaboration, and broad acceptance by IDUs of pharmacy vouchers and distribution of new needles/syringes. However, IDUs’ persistent fear of the police, particularly in Vietnam, has required reliance on separate collection by peer educators of used needles/syringes and distribution of pharmacy vouchers and new needles. In China, new needles/syringes and vouchers are largely being provided through exchange. Understanding the development and implementation challenges and the strategies that were successful in overcoming them (including the importance of being flexible and adaptable to contextual factors) may be useful to those interested in launching similar, much-needed interventions in other parts of the world.

Section snippets

Background

The intertwined epidemics of injection drug use and HIV/AIDS are well known and have been documented in more than 100 countries on every continent (Ball, Rana, & Dehne, 1998). However, the problems posed by injection drug use and HIV infection are particularly challenging in border regions where geopolitical sensitivities may exacerbate already difficult issues.

One such region is the border between northern Vietnam and southern China. Fig. 1 shows the location of the cross-border project

Development of the project

This is the first-ever cross-border HIV prevention project targeting IDUs in which the same interventions are being implemented in both countries. The project is opportune in that HIV prevalence has reached a possible “takeoff” point in Ning Ming County, China and risen even higher in Lang Son Province, Vietnam during the time the project was under development.

Despite the need for the project, its development proved extremely challenging and ultimately required 4 years from the germination of

Implementation and evaluation of the interventions

The intervention aims to reduce HIV risk behaviours among IDUs and thereby stabilise HIV prevalence and reduce HIV incidence on both sides of the border, as well as prevent additional cross-border HIV transmission. The project also seeks to benefit the larger public health by collecting and safely disposing of large numbers of discarded needles and syringes that might otherwise put others at risk. The project involves intensive community education and regular meetings with relevant agencies,

Implementation challenges and strategies

Challenges have arisen for all of the key actors and stakeholders in the project: health departments, police, peer educators, pharmacists, IDUs and the community at large.

Conclusions

The development and implementation of cross-border HIV prevention interventions for IDUs pose substantial challenges. These challenges increase in complexity and intensity the more agencies and levels of government are involved. They also increase in relation to the history of police harassment and repression of drug users and to government policies stressing arrest and incarceration of drug users over treatment and support for drug use cessation.

The early implementation experience in this

Acknowledgements

Funding Support was provided by National Institute on Drug Abuse, Grant No. 1 R01 DA-14703, and the Ford Foundation (Beijing and Hanoi offices). The authors gratefully acknowledge all of the health department and clinic staff, other public officials, peer educators, and pharmacists in Ning Ming County and Lang Son Province who are participating in and supporting this project. We would also like to acknowledge the support and encouragement of Joan Kaufman and Eve Lee of the Ford Foundation’s

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