Evaluation of a needle social marketing strategy to control HIV among injecting drug users in China.

OBJECTIVE

To evaluate the effectiveness of a needle social marketing strategy to reduce needle sharing and hepatitis C Virus (HCV)/HIV transmission among injecting drug users (IDU) in China.

DESIGN

Two-armed, prospective, community-randomized prevention trial.

SETTING

Four counties/townships in Guangxi and Guangdong provinces; one randomized to intervention the other to control in each province.

PARTICIPANTS

Injecting drug users: 823 (443 intervention, 382 control) at baseline and 852 (415 intervention, 407 control) at the second cross-sectional survey 12 months later.

INTERVENTION

A needle social marketing programme, including promotion of safe injection norms and increased access to clean needles over a 12 month period.

MAIN OUTCOME MEASURES

Cross sectional surveys at baseline and follow-up compared changes in drug using behaviours and HIV and HCV rates in the intervention and control communities.

RESULTS

Needle sharing behaviours were similar in the two groups at baseline (68.4 vs. 67.8%), and dropped significantly to 35.3% in the intervention community and remained relatively stable in the control community (62.3%; P < 0.001). In a subset of cohort of new injectors, the incidence of HCV was significant lower in intervention than in control in both provinces (P < 0.001, P = 0.014) and overall (P < 0.001) but HIV was only significantly lower in intervention in Guangdong (P = 0.011).

CONCLUSION

Needle social marketing can reduce risky injecting behaviour and HIV/HCV transmission among injecting drug users in China and should be expanded.