title: Predictors of HIV infection and prevalence for syphilis infection among injection drug users in China: community-based surveys along major drug trafficking routes.
abstract: OBJECTIVE
  To assess the predictors and prevalence of HIV infection among injection drug users in highly endemic regions along major drug trafficking routes in three Chinese provinces.
  
  
  METHODS
  We enrolled participants using community outreach and peer referrals. Questionnaire-based interviews provided demographic, drug use, and sexual behavior information. HIV was tested via ELISA and syphilis by RPR.
  
  
  RESULTS
  Of the 689 participants, 51.8% were HIV-infected, with persons living in Guangxi having significantly lower prevalence (16.4%) than those from Xinjiang and Yunnan (66.8% and 67.1%, respectively). Syphilis seropositivity was noted in 5.4%. Longer duration of IDU, greater awareness of HIV transmission routes, and living in Xinjiang or Yunnan were associated with HIV seropositivity on multivariable analysis. Independent risk factors differed between sites. In Guangxi, being male and having a longer duration of IDU were independent risk factors for HIV infection; in Xinjiang, older age and sharing needles and/or syringes were independent factors; in Yunnan, more frequent drug injection, greater awareness of HIV transmission routes, and higher income were independent predictors of HIV seropositivity.
  
  
  CONCLUSIONS
  Prevalence rates of HIV among IDUs in China are more than two out of three in some venues. Risk factors include longer duration of IDU and needle sharing. Also associated with HIV were factors that may indicate some success in education in higher risk persons, such as higher knowledge. A systemic community-level intervention with respect to evidenced-based, population-level interventions to stem the spread of HIV from IDU in China should include needle exchange, opiate agonist-based drug treatment, condom distribution along with promotion, and advocacy for community-based VCT with bridges to HIV preventive services and care.
authors: Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN 37232, USA. yujiang.jia@vanderbilt.edu
authors: Yujiang
authors: Y
authors: Jia
authors: Fan
authors: F
authors: Lu
authors: Gang
authors: G
authors: Zeng
authors: Xinhua
authors: X
authors: Sun
authors: Yan
authors: Y
authors: Xiao
authors: Lin
authors: L
authors: Lu
authors: Wei
authors: W
authors: Liu
authors: Mingjian
authors: M
authors: Ni
authors: Shuquan
authors: S
authors: Qu
authors: Chunmei
authors: C
authors: Li
authors: Jianbo
authors: J
authors: Liu
authors: Pingsheng
authors: P
authors: Wu
authors: Sten H
authors: SH
authors: Vermund