Philbin Morgan M, FuJie Zhang
HIV Center for Clinical & Behavioral Studies Columbia University and the NY State Psychiatric Institute, New York City, New York, United States of America.
Treatment and Care Division, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
PLoS One. 2014 Feb 3;9(2):e86873. doi: 10.1371/journal.pone.0086873. eCollection 2014.
Injection drug use is an ongoing urban health crisis in China and one of the largest drivers of the transmission of HIV/AIDS. Sentinel surveillance sites in Yunnan province show upwards of 20% of injection drug users (IDUs) are HIV positive. Though the Ministry of Health has scaled-up needle exchange programs (NEPs), they have not received official government recognition nor have they been extensively evaluated to explore factors influencing their acceptability and feasibility. Using in-depth qualitative interviews conducted from February to July 2008 with 35 participants consisting of IDUs and other key stakeholders, we explored facilitators and barriers to accessing needle exchange programs in Kunming, the capital of Yunnan province. Content analysis was conducted to identify themes including attitudes toward NEPs and harm reduction, barriers to access, and suggestions for improvement. Themes that emerged included fears of breached confidentiality and police interference at the exchange sites and tensions between the public health and law enforcement perspective. Low levels of NEP-related knowledge and awareness were uniformly reported among interviewees. Suggestions to facilitate an increase in NEP acceptance included raising awareness of harm reduction and HIV more generally, offering services such as psychological counseling, job training and behavioral therapy at NEPs, and increasing communication between police, government, and public health officials. High rates of HIV infection among injection drug users in China have prompted rapid scale up of NEPs. Additional adaptations are necessary, however, to increase needle exchange use among injection drug users. This study finds that an urgent need to raise awareness of NEPs among policy makers and IDUs and act upon identified steps for developing social-structural interventions to create enabling environments that facilitate increased access to NEPs among injection drug users in Kunming.
注射吸毒在中国一直是城市面临的健康危机，也是艾滋病毒/艾滋病传播的最大驱动因素之一。云南省的哨点监测数据显示，超过20%的注射吸毒者艾滋病毒检测呈阳性。尽管卫生部已扩大了针具交换项目（NEPs），但这些项目尚未得到政府的官方认可，也未得到广泛评估以探究影响其可接受性和可行性的因素。我们于2008年2月至7月对35名参与者进行了深入的定性访谈，这些参与者包括注射吸毒者和其他关键利益相关者，以探究云南省省会昆明市在获取针具交换项目方面的促进因素和障碍。通过内容分析确定了一些主题，包括对针具交换项目和减少伤害的态度、获取项目的障碍以及改进建议。出现的主题包括对交换点保密性被破坏和警方干预的担忧，以及公共卫生与执法视角之间的紧张关系。受访者普遍表示对与针具交换项目相关的知识和意识水平较低。促进针具交换项目接受度提高的建议包括更广泛地提高对减少伤害和艾滋病毒的认识，在针具交换项目中提供心理咨询、职业培训和行为治疗等服务，以及加强警方、政府和公共卫生官员之间的沟通。中国注射吸毒者中艾滋病毒感染率居高不下，促使针具交换项目迅速扩大。然而，还需要进行更多调整，以增加注射吸毒者对针具交换的使用。本研究发现，迫切需要提高政策制定者和注射吸毒者对针具交换项目的认识，并按照确定的步骤采取行动，制定社会结构干预措施，营造有利环境，以促进昆明市注射吸毒者更多地获取针具交换项目。
