title: Needle and syringe exchange programmes and prevalence of HIV infection among intravenous drug users in China.
abstract: OBJECTIVE
  To examine the association between needle and syringe exchange programme (NSEP) participation and human immunodeficiency virus (HIV) infection among intravenous drug users (IDUs) in China.
  
  
  METHODS
  Cross-sectional survey study design.
  
  
  METHODS
  Six counties with active NSEP were selected from each of the seven provinces with active NSEP sampled, resulting in a sample of 42 counties in China.
  
  
  METHODS
  Subjects were aged more than 18 years and had injected drugs in the past month before the survey, but were excluded if they were currently enrolled in methadone maintenance treatment in order to avoid mixed effects.
  
  
  METHODS
  HIV prevalence was the primary measure. Odds ratios (ORs), 95% confidence intervals (CIs) and P-values were calculated to evaluate associations between HIV infection and NSEP participation.
  
  
  RESULTS
  A total of 3494 IDUs were interviewed, of whom 1928 (55.2%) were NSEP attendees (meaning they had attended NSEP at least once in their life-time). The unadjusted HIV prevalence was 13.9% among NSEP attendees and 16.5% among NSEP non-attendees (meaning IDUs who had never used NSEP services). After adjusting for potential confounders and taking into account the variation between counties, NSEP non-attendees were 1.67 times more likely to be HIV-positive compared to NSEP attendees (OR=1.67, CI=1.19-2.32, P=0.0031).
  
  
  CONCLUSIONS
  Participation in needle and syringe exchange programmes was associated with a substantially lower risk of HIV infection among intravenous drug users in China. Needle and syringe exchange programmes should be expanded to include those who are needle and syringe exchange programme non-attendees.
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Luo
authors.forename: Zunyou
authors.initials: Z
authors.lastname: Wu
authors.forename: Katharine
authors.initials: K
authors.lastname: Poundstone
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: McGoogan
authors.forename: Willa
authors.initials: W
authors.lastname: Dong
authors.forename: Lin
authors.initials: L
authors.lastname: Pang
authors.forename: Keming
authors.initials: K
authors.lastname: Rou
authors.forename: Changhe
authors.initials: C
authors.lastname: Wang
authors.forename: Xiaobin
authors.initials: X
authors.lastname: Cao
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D016485:Needle Sharing / Q000009:adverse effects*; D018671:Needle-Exchange Programs / Q000706:statistics & numerical data*; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000097:blood / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: China; HIV infection; cross-sectional study; intravenous drug users; needle and syringe exchange programme