Demographic characteristics and risk behaviors associated with HIV positive injecting drug users in Xinjiang, China

doi:10.1016/j.jinf.2006.06.001

Journal of Infection

Volume 54, Issue 3, March 2007, Pages 285-290

https://doi.org/10.1016/j.jinf.2006.06.001 Get rights and content

Summary

Objective

To determine the demographic characteristics and risk behaviors associated with HIV positive and negative injection drug users (IDUs) who were screened for inclusion in a prospective cohort study to estimate HIV incidence in Xinjiang, China.

Methods

Data analyses were performed on the demographic and risk assessment data collected at screening from high-risk IDUs, defined as anyone who reported injecting drugs at least three times per week in the last month or injected drugs after sharing equipment on at least three occasions in the last three months.

Results

HIV antibody prevalence among 781 IDUs at baseline survey was 29%. The following factors were significantly associated with an increase in risk for HIV infection: age ≥26 years (OR = 3.16, 95% CI [2.02;4.94]), lack of college education (OR = 2.32, 95% CI [1.02;5.25]), frequency of heroin use (OR = 1.23, 95% CI [1.02;1.47]) and sharing of rinse water (OR = 1.47, 95% CI [1.18;1.84]). Female gender (OR = 0.44, 95% CI [0.22;0.86]), being Han vs Uighur ethnicity (OR = 0.18, 95% CI [0.11;0.27]), and other race vs Uighur ethnicity (OR = 0.23, 95% CI [0.12;0.44]) were significantly associated with a lower risk of HIV infection.

Conclusions

HIV infection among high risk IDUs in Xinjiang, China is high and is associated with older male Uighur IDUs who lack college education, frequently inject heroin, and/or share rinse water. There is a great potential for HIV transmission from IDUs to the general population. Therefore, related risk behaviors in IDUs, especially their sexual behavior, should be closely monitored.

Introduction

The estimated number of HIV infected persons and those with AIDS in China is 650,000 and 75,000, respectively.¹ The adult HIV prevalence rate in China is less than 0.1%, but high risk behaviors associated with HIV transmission such as needle sharing and unprotected sexual intercourse are on the rise.¹ Social norms, practices and attitudes that were once conservative prior to the economic and social reforms of the 1980s and 1990s have become more lax and tolerant.² Although HIV prevalence among the general population is still relatively low, evidence shows that the epidemic is spreading from high risk populations such as injection drug users (IDUs) and commercial sex workers (CSWs) to the general population.¹ Factors such as needle sharing, low condom use, lack of HIV related knowledge, and social discrimination that perpetuate the HIV epidemic in the high risk groups of today are also contributing to increasing seroprevalence rates.¹ In a country that contains more than 20% of the world's population, the potential for millions of people to become HIV infected even at relatively low seroprevalence rates is a major concern.

Due to China's close proximity to the world's major heroin producing area of the golden triangle, heroin abuse and addiction first emerged as a problem in China's border region with Myanmar in Yunnan province in the late 1980s.3, 4 This development prompted the country to pass strict policies and regulations regarding drug traffic and drug abuse.3, 4 Despite these strict regulations, injection drug use has increased and spread from the border to inland China.4, 5, 6

HIV was first reported among injecting drug users in 1989 in Yunnan.⁷ By the end of 2002, all 31 of China's provinces, municipalities, and autonomous regions reported HIV infection among this population.¹ Sharing needles and syringes are the predominant mode of HIV transmission, with IDUs accounting for 71% of all HIV/AIDS reported cases in China.⁸ Although AIDS was first recognized in China in 1985, it was not identified in Xinjiang Uighur Autonomous Region in northwestern China until 1995.9, 10, 11 The first national HIV molecular epidemiology survey conducted in 1996 indicated that HIV infection in Xinjiang was a recent epidemic among HIV infected local IDUs.¹² However by the end of 2002, Xinjiang had the second highest number of reported cases of HIV/AIDS in China with the exception of Yunnan.¹⁰ Xinjiang had the highest HIV prevalence in the country when comparing the number of cases per capita.10, 11 By the end of 2003, HIV had spread to all 74 counties of the autonomous region and Urumqi, the capital city of Xinjiang, accounting for 40.7% of all 8153 HIV cases reported in Xinjiang.¹⁰ Injection drug use has been the primary route of transmission for HIV/AIDS in Xinjiang, which accounts for 90% of all reported HIV infections.10, 11 Ten years into the HIV epidemic in China, HIV seroprevalence among IDUs in some areas of Xinjiang has risen to 80%.¹ According to the Xinjiang HIV surveillance data, drug related HIV transmission accounted for 75.5% of infections detected in 2003 with other modes of HIV transmission rising.¹⁰ HIV seroprevalence rates among IDUs in other provinces of China have been reported to range from 21 to 28% in Yunnan, 11% in Sichuan, and 16% in Guangxi.13, 14, 15

The HIV Prevention Trials Network (HPTN) Preparedness Study, HPTN 033, in Urumqi, Xinjiang was a prospective cohort study to observe HIV seroincidence and describe the demographic characteristics and HIV risk behaviors of injection drug users targeted for inclusion in future HPTN studies of HIV prevention interventions. The data presented here describe the baseline characteristics of high-risk IDUs from the surrounding neighborhood districts of Urumqi screened for the HPTN 033 study and factors that were associated with HIV prevalence at baseline.

Section snippets

Setting

Urumqi is the capital of Xinjiang Uighur Autonomous Region in northwestern China with a population of approximately 2.1 million. The city is divided into 9 neighborhood districts and 1 county. The HPTN clinic is located in Urumqi's downtown Tianshan District in a neighborhood with a high concentration of IDUs.

Subject population

In order to be eligible for the study, subjects had to be HIV antibody negative at enrollment and inject drugs three or more times per week in the last month or inject drugs three or more

Results

Of the 781 persons who were tested for HIV antibody, 89% were male; the average age of the participants was 29 (SE ± 0.3) years, with a range from 18 to 59 years. Fifty-six percent were Uighur, 33% were Han and 11% were other ethnicity. Fifty-eight percent were single and 27% were married; 15% had primary education only, 44% had some secondary school and 24% had secondary school, respectively. Forty-nine percent were unemployed and 41% were employed full time. Sixty-two percent lived with parents,

Discussion

The major finding of this study, using baseline data from a prospective cohort study of IDUs in Urumqi, Xinjiang China was that HIV prevalence in this IDU population was 29% with 228 infections detected in 781 participants. This study was the first community-based study to describe HIV prevalence among IDUs in Xinjiang, China. The seroprevalence rate in this study was higher than those reported in other regions of China,13, 14, 15 but the frequency of injection drug use required for enrollment

Acknowledgements

The authors are grateful to the men and women who participated in this study. Special thanks are offered to Shao Hua Wang, Ai Hua Zhang, Jing Gong Hao, Mawlan Mamtimin, Parhat Yadikar, Yongsheng Guan, Minawar Abai, Chun Mei Zhao, Xahadetgul Sulayman, Jing Wang, Gulsum Ghuja, Ben Lai Liu, Abdurahman, Jun Wei, Abdurixit, Dongbao Yu, and Yun Xia Wang. The authors would like to acknowledge support from the Statistical Center for HIV/AIDS Research and Prevention (SCHARP), Seattle, WA and Family

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^☆: Sponsorship: This study was supported by the National Center for HIV/AIDS Prevention and Control of the Chinese Center for Disease Control and Prevention (China CDC), the Xinjiang Uighur Autonomous Region CDC, the Urumqi Municipal CDC, Johns Hopkins University, and by the National Institute of Allergy and Infectious Disease, the National Institute of Drug Abuse, the National Institute of Child Health and Development, and the National Institute of Mental Health of the United States National Institutes of Health through the HIV Prevention Trials Network (U01-A0-48011).

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Demographic characteristics and risk behaviors associated with HIV positive injecting drug users in Xinjiang, China☆

Summary

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Setting

Subject population

Results

Discussion

Acknowledgements

HIV in China: epidemiology and risk factors

AIDS

Epidemiology of HIV in China

BMJ

Identification of HIV infection among drug users in China [in Chinese]

Chin J Epidemiol