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
0
1
2
3
4
5
6
7
8
9
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
4
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)
6
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
8
NEP Guideline
Web-based Data Management System
9
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!