Cross-Border Movement and HIV Infection among People who Inject Drugs and Female Sex Workers
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Cross-Border Movement and HIV Infection among People who Inject Drugs and Female Sex Workers Theodore M. Hammett, Ph.D. Ryan Kling, M.A. IAS Conference: Kuala Lumpur July 2, 2013
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Cross-Border Movement and HIV Infection among People who Inject Drugs and Female Sex Workers Theodore M. Hammett, Ph.D. Ryan Kling, M.A. IAS Conference: Kuala Lumpur July 2, 2013. Background. HIV epidemics in Vietnam and Southern China are driven by heroin injection and sex work. - PowerPoint PPT Presentation
Transcript of Cross-Border Movement and HIV Infection among People who Inject Drugs and Female Sex Workers
Cross-Border Movement and HIV Infection among People who Inject Drugs and Female Sex Workers
Theodore M. Hammett, Ph.D.Ryan Kling, M.A.
IAS Conference: Kuala LumpurJuly 2, 2013
Abt Associates | pg 2
Background
HIV epidemics in Vietnam and Southern China are driven by heroin injection and sex work.
Epidemics of heroin injection and HIV spread along drug trans-shipment routes (Beyrer, AIDS, 2000).
In N. Vietnam and S. China, HIV probably spread from South to North (gradient of HIV prevalence: Des Jarlais, BMC Pub Health, 2005).
In the same area, Vietnamese sex workers cross border to work in China. Cross-Border project (2002-2012): peer-based interventions,
needle/syringe and condom provision for PWID and women at risk (including SW) in Ning Ming (Guangxi), China and Lang Son, Vietnam; serial cross-sectional surveys (2002-2012).
Question: relationship between PWID and SW cross-border movement and HIV infection?
Abt Associates | pg 3
Cross-Border Heroin Trans-Shipment Routes(Beyrer, AIDS, 2000)
Abt Associates | pg 4
G Gradient of HIV Prevalence by Distance from Border (Des Jarlais, BMC Pub Health, 2005)
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Abt Associates | pg 5
PWID cross-border movement and HIV infection: baseline, 2002
Consistent with gradient pattern of HIV prevalence and movement of epidemic from south to north.
(Hammett, JAIDS, 2005)
% purchased drugs across border
Mean times/month
Relationship to HIV infection
Ning Ming 3.4% 0.43 OR 1.23, p=0.009
Lang Son 2.9% 0.08 OR 0.49, p=0.056
Abt Associates | pg 6
PWID cross-border movement and HIV infection: subsequent surveys (2002-2012)
% purchased drugs across border
Mean times/month
Relationship to HIV infection(pooled data)
Ning Ming 1%-4% 0.1-1.4 OR 1.008, p=0.38
Lang Son 1%-5% 0.01-0.3 OR 0.689, p=0.03
Reduced frequency of purchasing drugs across border Still compatible with gradient pattern Suggests mature, but localized HIV epidemic among
PWID
Abt Associates | pg 7
PWID results from other places
Injection-related border crossing to Myanmar was related to HIV infection among PWID recruited in Ruili (Yunnan), China methadone program (OR 3.31, p=010)(Williams, AIDS Behav, 2011).
Review by Nepal (J Health Popul Nutr, 2007) suggests, but cannot conclusively demonstrate, a bi-directional pattern of PWID crossing the Nepal-India border related to higher HIV prevalence.
San Diego PWID who injected in Tijuana were more likely to share injection equipment (24%) than those who injected only in the U.S (12%) (p<0.01)(Volkmann, J Immigrant Minority Health, 2012).
Abt Associates | pg 8
SW cross-border movement and HIV infection
Cross-Border project WaR surveys: virtually no SW reported working across the border.
Suggests relatively stable patterns of SW residence with very little day-to-day border crossing.
Small cell sizes made it impossible to analyze effect of border crossing on HIV infection.
Abt Associates | pg 9
SW results from other places
In Nanning (Guangxi), Chinese SW were more likely than cross-border (Vietnamese) SW to practice consistent condom use with clients (88% to 40%, p=0.001); HIV prevalence was 2% among Chinese vs 4% among cross-border SW (n.s.)(Chen, Chin J Dis Control Prev, 2010).
Another study in Guangxi found 8% HIV prevalence among Vietnamese SW vs. 1% in total sample (Zhou, AIDS Care, 2013).
Among SW in 5 border provinces of Vietnam (Lai Chau [China], Quang Tri [Lao], and Dong Thap, An Giang, and Kien Giang [Cambodia], HIV infection was associated with SW outside Vietnam (OR 3.02, p=0.062)(Thuong, Sex Trans Infect, 2005).
Abt Associates | pg 10
Cross-Border HIV prevention interventions
Interventions for PWID:
– Cross-Border project, Vietnam and China: sharp reductions in HIV incidence (Hammett, PLoS One, 2012); interventions continue with support from World Bank, DFID, and Global Fund.
– Methadone program in Ruili serves many PWID from Myanmar (UNAIDS China, Background Paper: Cross-Border Programming, 2011).
Interventions for SW:
– Cross-Border project: Peer-based interventions on Vietnam-China border; bilingual Vietnamese PE cross into China and work with Vietnamese SW, in collaboration with local authorities and INGOs; have rescued trafficked Vietnamese SW from China.
Abt Associates | pg 11
Cross-Border HIV prevention interventions (cont.)
Interventions for multiple MARPs:
– AusAID HAARP’s Cross-Border component supported multiple interventions on the China-Vietnam and China-Myanmar borders (UNAIDS China, Background Paper: Cross-Border Programming, 2011).
– Health Poverty Action: cross-border interventions for PWID and SW on China-Myanmar border (www.healthpoverty action.org).
Abt Associates | pg 12
Conclusions/Recommendations
Border crossing PWID and SW may be at higher risk for HIV than those who do not cross borders.
Relatively few cross-border interventions have been implemented or sustained.
Interventions should address risks associated with border crossing.
Bilingual PE can be extremely valuable in working with Vietnamese SW in China, Lao and Cambodia.
Interventions should be coordinated between officials and organizations working on both sides of the border.
