INJECTING DRUG-USE AND HIV-INFECTION IN SOUTHWEST CHINA

Objectives: To determine the prevalence of drug injection among drug u sers, the seroprevalence of HIV and risk factors for HIV infection amo ng injecting drug users (IDU), and to determine heterosexual transmiss ion of HIV among IDU and their spouses in southwest China. Methods: Us ing a cross-sectional design, we conducted an HIV seroprevalence and b ehavioral survey in three rural counties of Yunnan province, Ruili, Lo ngchuan and luxi in southwest China, bordering Myanmar (Burma). A tota l of 860 drug users were recruited in randomly selected communities at the three study sites (response rate, 97%). In addition, a random sam ple of 62 wives of HIV-infected IDU were assembled from 460 known HIV- positive IDU in Ruili and Longchuan (response rate, 81%). Results: In the sample of 860 drug users, 33% reported injecting drugs. Among the 282 subjects who injected drugs, 82% began intravenous drug use after 1988; 64% injected drugs at least once every day. All subjects shared needles but none cleaned the injection equipment with alcohol or bleac h. Overall, 49% tested HIV-positive. HIV seropositivity was independen tly correlated with a longer history of drug injecting, daily injectin g, frequent needle-sharing, being younger, and living in Ruili county. Among the 62 wives of HIV-positive IDU, none used condoms during sex and 10% tested HIV-positive. Conclusions: We conclude that the introdu ction of HIV into drug-using communities and the rapid increase in her oin injecting in this population appear to have triggered an explosive HIV epidemic among IDU in southwest China. We recommend that AIDS pre vention efforts should begin immediately and focus on discouraging the shift from opium smoking to heroin injecting, needle-sharing, and unp rotected sex among drug users and their partners.