Pubdate: Thu, 15 Jul 2004
Source: Wall Street Journal (US)
Page: A9
Copyright: 2004 Dow Jones & Company, Inc.
Author: Gautam Naik, Staff Reporter of the Wall Street Journal
Cited: Abt Associates
Cited: National Institutes of Health
Cited: Ford Foundation
Cited: International AIDS Conference
Bookmark: (Needle Exchange)

Trying to Arrest HIV's Spread


BANGKOK, Thailand -- Public-health workers around the world are closely 
watching the promising results of an innovative program in China and 
Vietnam that suggests the spread of the AIDS virus can be contained among 
intravenous-drug users -- a high-risk, hard-to-reach group that threatens 
to hasten the disease's march across a wide swath of the globe.

Drug use is especially fueling the spread of AIDS in Eastern Europe, 
Central Asia and Russia. The worry for these countries is that unless they 
quickly find ways to lower HIV infection rates among drug users, the virus 
could proliferate via sexual contact from this high-risk group to the 
general population. The worst-case outcome: new HIV epidemics to rival the 
one that is devastating Africa. In China, about 70% of existing infections 
are needle-related, and in Vietnam, it is about 60%, according to Abt 
Associates, Cambridge, Mass., research firm that set up the program.

Of the 40 million people world-wide infected with the human 
immunodeficiency virus, about four million contracted it by sharing 
needles, according to Abt.

As part of the China-Vietnam program, a trained cadre of peer educators, 
who themselves are drug users, hands out vouchers to other drug users. The 
vouchers can be exchanged at local pharmacies for clean needles and 
syringes, and in some cases, other medicines and condoms. Police have 
agreed not to interfere with the program; pharmacists and local health 
authorities have been cajoled into supporting it.

Results from the first 12 months of the project showed that "while 
transmission of HIV has not been stopped, the number of new infections has 
gone down," said Ted Hammett of Abt.

The U.S. National Institutes of Health funded research and data collection 
for the program. The Ford Foundation funded the remainder, including the 
cost of needles and syringes. The project will run for another year. It 
reported its initial data yesterday at the International AIDS Conference here.

Needle-exchange programs have been started in dozens of places around the 
world, but progress so far has been limited. "Drug users are very 
unpopular, so there's been a tremendous failure of political leadership in 
preventing HIV in this group," said Don Des Jarlais of the Beth Israel 
Medical Center in New York, an expert on HIV and drug use and 
co-investigator of Abt's project.

Abt initiated the project three years ago in the remote mountains that 
straddle northern Vietnam and southern China. The cross-border area has 
become a major shipment route for heroin, and HIV prevalence among drug 
users is close to 20% on the Chinese side and as high as 47% on the 
Vietnamese side. In the fight against HIV, crossborder regions have proved 
a special problem because of the difficulties of predicting and monitoring 
the movement of people.

The early days weren't easy for Abt. The firm wanted to locate part of its 
program in Hunan, China, but officials balked because they were hosting a 
major horticultural fair "and didn't want to call attention to the HIV 
problem," Mr. Hammett said. Eventually, Abt chose the border region of 
China's Guangxi province and Vietnam's Lang Son province. On the Vietnamese 
side, a provincial leader at first objected to the program, fearing it 
would encourage drug use, recalled Doan Ngu, a doctor who is a consultant 
with Abt's project. The official eventually was won over.

Abt started by training local pharmacists, doctors and women's unions about 
how the program would work. While the local police retained their right to 
arrest drug users, they signed agreements promising not to interfere with 
Abt's program -- and so far have kept their word, Mr. Hammett says. The key 
step was the hiring of about 30 drug users on each side of the border as 
"peer educators." In exchange for a salary, these educators hand out 
vouchers and collect used needles and syringes from other drug users. Abt 
says the program reaches more than 60% of all drug users and hands out a 
total of about 25,000 needles and syringes a month.

"Drug users have a built-in credibility" when it comes to reaching other 
drug users, Mr. Hammett says. But, he adds, the peer educators "can be 
difficult to manage. Some have even been arrested."

Based on data collected over an initial 12-month period, the program has 
yielded some encouraging results. In China 22% of drug users surveyed said 
they had accepted a previously used needle, down from 46% a year earlier. 
Twenty-six percent said they had handed out a used needle, down from 52% a 
year earlier. In Vietnam, the self-reported rate for receiving needles fell 
to 2% from 5%; the figure for handing out needles fell to 1% from 6%. Mr. 
Hammett says he is skeptical about the accuracy of the Vietnamese figures, 
which he says seem suspiciously low.

Nonetheless, HIV prevalence among drug users remained stable in Vietnam and 
China over the 12-month period. Preliminary results of an 18-month survey 
show that the HIV rate in Vietnam fell to 37% from 47%, according to Abt. 
"We think we can conclude that, at this stage, the intervention is 
working," Mr. Hammett says.

Not everything has gone as predicted. In China the vouchers have fallen out 
of favor with drug users, so they instead are supplied with clean needles 
and syringes directly by the peer educators. Separately, a survey by Abt of 
community attitudes toward the needle-exchange program showed that 30% of 
people believed that HIV can be transmitted by eating alongside an 
HIV-positive person, while more than 30% of people said that Abt's program 
would encourage drug use.

"We've got some more education to do in this area," Mr. Hammett says.
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MAP posted-by: Richard Lake