Decreasing HIV, Syphilis, and Hepatitis C Infection After a Decade of Harm Reduction Implementation Among Drug Users in Southwestern Areas of China.

OBJECTIVE: Since 2003, the Chinese central government has implemented several harm reduction and preventive measures to control HIV. We aim to describe epidemiological trends of HIV, hepatitis C virus (HCV), and syphilis in Guangxi drug users after the policy implementation.

METHOD: A total of 12,161-15,870 drug users in Guangxi, China, were recruited annually from 2009 to 2015 through community outreach or snowball sampling. The participants' demographics, behavior, and infection status were used to characterize rates of protective behaviors and disease prevalence (HIV, syphilis, and HCV). Chi-squared trend testing was used.

RESULTS: Relative to baseline, the prevalence of HIV, HCV, and syphilis decreased from 13.6% to 6.2%, 68.0% to 50.5%, and 8.5% to 5.2%, respectively, by 2015. Concurrently, the rate of injecting drugs, needle sharing, unprotected last sexual encounter, and regular unprotected intercourse decreased from 82.6% to 64.5%, 24.1% to 5.5%, 66.6% to 39.7%, and 74.0% to 51.2%, respectively. The usage of prevention services, methadone maintenance therapy or needle exchange, peer education programs, HIV testing in the previous year, and knowledge of HIV status increased from 63.4% to 93.6%, 52.0% to 56.6%, 37.4% to 43.1%, 45.3% to 91.3%, and 76.7% to 99.4%, respectively, from 2009 to 2015.

CONCLUSIONS: After a decade of HIV control policies, this was the first Chinese study to show a decreasing prevalence of HIV, HCV, and syphilis in the context of increasing uptake of protective services and behaviors.