title: Barriers and Potential Improvements for Needle and Syringe Exchange Programs (NSPs) in China: A Qualitative Study from Perspectives of Both Health and Public Security Sectors.
abstract: This study explores the acceptability, the barriers to the implementation of needle and syringe exchange programs (NSPs) and the potential improvement strategies in China from the perspectives of governmental health and public security officials. Purposive sampling was used for recruitment of participants who had been involved in NSPs implementation. Semi-Structured individual interviews were conducted in Mandarin to address three aspects of NSPs: (1) participants' attitudes towards NSPs, (2) participants' opinions on the effectiveness and barriers of NSPs, and (3) suggestions for improving the program. Content analysis was used to analyse the translated interview data. A total of 68 participants from 12 Hunan counties were interviewed (34 from each of the Bureau of Health and the Narcotic Division). Both groups recognised the importance and effectiveness of NSPs in HIV prevention, but public security officials regarded NSPs as a temporary intervention in place of punitive measures. Most health officials (32/34) regarded the main barriers to its implementation as administrative and structural, whereas participants from Narcotics Division (n=24) questioned the legitimacy of NSPs and concerned about the poor management of drug users' risk behaviours. Close cooperation between the health and public security sectors, engagement of the drug user community and an enabling policy environment were reportedly to be critical for potential improvements of NSPs in China. Misconceptions about NSPs encourage drug users' addictive behaviour, and an unclear leadership and insufficient support de-motivate the participants from the Bureau of Health and the Narcotics Division to actively support the program implementation.
authors.affiliation: Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Fung Kuen
authors.initials: FK
authors.lastname: Koo
authors.affiliation: Hunan Provincial Centers for Disease Control and Prevention, Hunan, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Chen
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, NSW, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.
authors.forename: Eric P F
authors.initials: EP
authors.lastname: Chow
authors.affiliation: Research Center for Public Health, Tsinghua University, Beijing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Jing
authors.affiliation: Hunan Provincial Centers for Disease Control and Prevention, Hunan, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Hunan Provincial Centers for Disease Control and Prevention, Hunan, China.
authors.forename: Junshi
authors.initials: J
authors.lastname: Zhao
authors.affiliation: The Kirby Institute, UNSW Australia, Sydney, NSW, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Research Center for Public Health, Tsinghua University, Beijing, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D018671:Needle-Exchange Programs; D009339:Needles; D011634:Public Health / Q000379:methods*; D012309:Risk-Taking; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control