From Science to Policy ─ Evolution of China’s Needle Exchange Program (NEP)

Xiaobin Cao Ph.D

National Center for AIDS/STD Control and

Prevention

China CDC

July 23, 2012 Washington DC

Contributors

ɠ Dr. Wu Zunyou, China CDC

ɠ China’s National NEP Working Group

ɠ China Ministry of Health

ɠ International community: Global Fund

US, UK et al.

ɠ AIDS 2012 Conference Secretariat

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1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

HIV

Pre

vale

nce

(%)

Why China Initiated NEPs?

ɠ Large number of heroin users

more than 1 million

ɠ High HIV prevalence

6% nationwide

ɠ Prevalent high-risk behavior

among drug users:

high needle sharing

low condom use

ɠ NEP has been proven to be an

effective harm reduction

strategy worldwide.2

HIV sentinel surveillance data on IDUs, 1995-2009

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Evidence-based Evolution

ɠ A small pilot feasibility study in 1997, sponsored by World

AIDS Foundation

ɠ The first NEP Workshop in 1997, hosted by Chinese

Preventive Medicine Academy.

ɠ A scale-up pilot study in two provinces in 1999, sponsored by

China Ministry of Health.

ɠ Implementation in four provinces since 2000, sponsored by

China-UK Program and China-Australia Program.

ɠ Scale-up nationwide since 2003, sponsored by China CARE

program.

Milestones in China’s NEP

1998 2001 2002 2003 2004 2005 2006 2007 2008 2009 201020001999

First NEP workshop in China (1997)

China CARE project （ 2003)

Scale up Pilot NEP study in 2

provinces（ 1999)

3rd Five year Action Plan（ 2011-2015）

Preparation Phase（ Before 1999)

Pilot Phase（ 1999 to 2003)

National Scale-up Phase（ Since Jul, 2003)

Web-based Data Management

System(2008)

1st Five-year AIDS Plan (2001-2005)

2nd Five-year AIDS Plan (2006-2010)

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Supportive Legislations

Former Minister of Health visited

NEP stiesPolicy and Third Five-year AIDS Action Plan (2011-

2015), issued by State Council, the Central

Government

Geographical Distribution

XINJIANG

QINGHAI

YUNNAN

GUANGXI GUANGDONG

SICHUAN

NINGXIA

SHAANXI

GUIZHOU

HUNAN

HUBEI

JIANGXI

BEIJING

JIANGSU

ZHEJIANG

FUJIAN

HAINAN

CHONGQING

By March 2012, 966 NEP sites 466 counties in 18 provinces, covering 44,530 injecting drug users monthly (50 drug users per site)

NEP in China

ɠ Financial sources:

Before 2010: Government & international support;

After 2010: Government

ɠ NEP operators: Peer educators, CDCs, NGOs, pharmacies

ɠ Participants of NEP: Heroin users recruited from community

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NEP Guideline

Web-based Data Management System

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ɠ Misunderstanding of drug use and debate on NEP still exists.

ɠ Lack of comprehensive evaluation on the

role of NEP in HIV prevention in China.

ɠ Which NEP model is better in China?• Peer educators (how can we know they really

distribute?)

• Health workers

• NGO?

Challenges

ɠ Decrease the negative attitude toward drug use and NEPs.

ɠ Strengthen the leadership on NEPs.

ɠ Implement the comprehensive evaluation on NEPs.

ɠ Encourage the active involvement of target population:e.g. Community-based organizations (CBOs),

Grass-rooted organizations

Next Steps

Thank you!