Over past three decades,many prevention strategies have been proven effective in reducing human immunodeficiency virus (HIV) transmission.However,none of these strategies alone are effective to stop the spread of HIV.This review discusses a few key prevention strategies,including testing,harm reduction,prevention,prophylaxis,and modern communication strategies.We argue that although there are great challenges remaining to stop HIV transmission via sexual contact and injecting drug use routes,the combination of these effective strategies,control HIV epidemic can be achieved.

OBJECTIVETo evaluate HIV risk behaviors among heroin drug users who were treated in methadone maintenance treatment (MMT) clinics.

METHODSA prospective cohort study recruited and followed up clients of eight MMT clinics treated no more than two and half months in Guizhou province, China. Through face-to-face interviews, the baseline and following up informations were collected. And the baseline information included both demographic information and HIV risk behaviors, the following up informations included only HIV risk behaviors. The baseline investigation started in June, 2006 and the following up investigation finished in June, 2007. A total of 1003 heroin drug users were recruited at baseline, among them 666 (66.4%) were still at treatment by the end of follow up and 469 (70.4%) clients participated in the follow up interview. Wilcoxon two sample test and McNemar test were used to test for changes in HIV risk behaviors between baseline and following up investigation.

RESULTSAmong the 469 MMT clients who were followed up, the average days of reported heroin use decreased from 26.4 to 0.9 in the past 30 days (Z = 27.21, P < 0.05). Average days of alcohol use at baseline were 3.3 but 3.7 at follow up (Z = 0.45, P = 0.96). Needle-sharing behavior reported in the past 30 days decreased from 1.3% at baseline to 0.2% at follow up (χ(2) = 5.00, P = 0.025). At baseline, 5.5% (26/469) subjects reported having multiple sex partners in the past 30 days compared to 3.4% (16/469) at following up (χ(2) = 3.18, P = 0.08).6.4% (30/469) subjects reported casual sex with non-regular sex partners in the past 30 days at baseline compared to 5.1% (24/469) at following up (χ(2) = 0.95, P = 0.33). Of those who reported having casual sex relationship in the past 30 days 56.7% (17/30) reported using condoms at baseline but 58.3% (14/24) reported using condoms at follow up (χ(2) = 1.96, P = 0.16).

CONCLUSIONMMT was observed to decrease needle-sharing HIV risk behavior. However, decreased HIV sexual risk behaviors were not observed at statistical significant level.

Adult ; Female ; HIV Infections ; psychology ; Heroin Dependence ; drug therapy ; psychology ; Humans ; Male ; Methadone ; administration & dosage ; therapeutic use ; Opiate Substitution Treatment ; Prospective Studies ; Risk-Taking ; Sexual Behavior

OBJECTIVETo investigate the proportion of methadone maintenance treatment (MMT) clients continuing to use heroin and to explore its associated risk factors.

METHODSAll 1003 heroin addictive patients were recruited from eight MMT clinics in Guizhou province and followed up for 14 months. During the 14 months, each MMT client received random urine tests. MMT clinics, gender, marital status, employment, ethnicity, religion, previous drug using method, having a history being in detoxification program, age, methadone dosage, education level and length of drug use were treated as potential predicting variables into the GEE model.

RESULTSThe average age of the 1003 clients was (33.3 +/- 6.1) years old, the average length of drug use was (8.0 +/- 4.0) years, and the average daily methadone dosage was (38.0 +/- 16.6) mg. Among the 1003 clients, 26.0% were female drug users, 15.5% were divorced and 35.8% had a full time job. The rate of positive urine samples was approximately 30% for the first 10 months of follow-up, after which the positive rate decreased. The model found that different MMT clinics, the average daily methadone dosage (RR = 0.98, P = 0.003), treatment duration (RR = 0.95, P = 0.029) and years of education (RR = 0.94, P = 0.014) were associated with patients positive urine test.

CONCLUSIONContinued heroin use was common in MMT clinics in Guizhou province; increasing the dosage of methadone and the duration in the treatment program might decrease the continued use of heroin among clients in MMT clinics.

Adolescent ; Adult ; Ambulatory Care ; China ; epidemiology ; Female ; Heroin Dependence ; drug therapy ; epidemiology ; Humans ; Male ; Methadone ; therapeutic use ; Risk Factors ; Risk-Taking ; Young Adult