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Harm Reduction Model for Scaling Up Government Intervention in China

This presentation discusses China's government model for harm reduction and scaling up interventions for drug use and HIV/AIDS transmission. It highlights the key policies, milestones, and strategies implemented, such as methadone maintenance treatment (MMT) and needle exchange programs (NEPs), to reduce drug use, crime, and the spread of HIV/AIDS. The presentation also emphasizes the importance of utilizing MMT services and the need to shrink heroin markets and prevent new drug users.

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Harm Reduction Model for Scaling Up Government Intervention in China

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  1. China: Government model for taking harm reduction to scalePresentation at 9th ICAAP 11 August 200910:45-12:15 Wenyuan Yin, MD, MPH Zunyou Wu, MD, PhD National Center for AIDS/STD Control and Prevention Chinese Center for Disease Control and Prevention

  2. HIV Transmission modes in China

  3. Drug use in 2008 • The registered DUs :1,127,000 • Heroin Users : 878,000 （77.5%） • Injecting drug use : 55.7% • New tyes of drugs：241,000（21.3%） • Needle sharing: 40% Resource: Annual Report on Drug Control in China, 2008-2009. (China National Narcotics Control Committee) A Joint Assessment of HIV/AIDS Prevention and Care in China(2007) (State Council AIDS Working Committee Office, UN Theme Group on AIDS in China )

  4. Types of Drugs Used in China,2008 Resource: Annual Report on Drug Control in China, 2008. (China National Narcotics Control Committee)

  5. Important Policies for Harm Reduction 2001 First 5-year action plan (2001-2005) 2004 Intensify AIDS programs 2006 AIDS Regulation 2006 Second 5-year action plan (2006-2010) 2008 Anti-Drug Law

  6. Law Enforcement HIV/AIDS Regulation (In effective since March 1, 2006) Article 27. The people’s governments at the county level or above shall coordinate the relevant government sectors in order to implement effective measures for controlling the epidemic of AIDS. The departments of Health, Public Security and Food and Drug Administration of the people’s governments in Provinces, Autonomous Regions, and Municipalities shall jointly, based on their local situation of drug use and HIV/AIDS epidemic, implement community-based drug-maintenance treatment as well as other effective intervention program for drug users.

  7. China’s Action Plan for Controlling HIV/AIDS(2006-2010) Specific Tasks (6) County (city) > 500 registered drug users, By 2007: (in urban) MMT cover > 40% (in rural) NEP cover > 30% By 2010: (in urban) MMT cover > 70% (in rural) NEP cover > 50%

  8. Basic Infrastructure

  9. HIV Testing for drug users 2004- National HIV testing campaign for high risk group, including drug users 2004- All drug users receiving MMT are able to have regular HIV testing 2004- Outreach programs for drug users, including HIV testing 2005- Normalization of HIV testing for drug users for entering treatment facilities

  10. NEP Initiated ------------------------------------------------------

  11. NEP Distribution (2009) 955 NEP Sites >40,000 IDUs

  12. Milestones in China MMT Program 1st AIDS Policy Surveillance start Evaluation of 2nd phase MMT acceptability study among Public 1st 5y Plan Evaluation of 1st phase 2nd 5y Plan AIDS Law Scale up 1st 8 MMT clinics 2nd58 MMT clinics Protocol Development • Study tour • workshops • MOH, MoPS, SFDA Policy Advocacy 1st national workshop on MMT by MOH, MoPS, SFDA MMT 1st adopted in government policy 2nd protocol issued jointly by MOH, MoPS, SFDA 1st protocol issued jointly by MOH, MoPS, SFDA

  13. Organizational Structure of the Community-based Methadone Maintenance Treatment (MMT) Program National MMT Working Group National MMT Working Group Secretariat Department of Health Department of Public Security Provincial FDA Department of Health Department of Public Security Provincial FDA Provincial MMT Working Group Provincial MMT Working GroupSecretariat County / Prefecture MMT Working Group County/ Prefecture MMT Working GroupSecretariat Ministry of Health Ministry of Public Security State FDA Other relevant technical agencies Our mission MMT clinics MMT clinics MMT clinics

  14. Expansion of MMT

  15. Expansion of MMT 2008 吉林 新疆 2 27 内蒙 北京 9 3 1 天津 山西 宁夏 3 青海 3 甘肃 2 河南 21 陕西 1 江苏 18 13 安徽 上海 湖北 四川 重庆 8 9 37 36 26 浙江 江西 27 湖南 12 48 贵州 福建 54 9 云南 23个省（自治区、直辖市）600个门诊 广东 67 广西 56 50 海南 23

  16. 21 Mobile MMT Vans （8/Yunnan; 2 each/Sichuan/Guizhou/Hunan/Guangdong/Xinjiang; and 1 each/Hubei/Chongqing/Zejiang)

  17. The growing of MMT

  18. Establishment of MMT database system • Real-time and fixed-time reporting system • Follow-up and monitoring system • Lab-based management system • Intelligent card-system (IC card)

  19. Evaluation of MMT Program

  20. HIV New Infections

  21. MMT in China in 2008: - Prevent 3,377 HIV infection • Reduce 16.5tons of heroin • Avoid $US1 billion drug trade

  22. 地震中的门诊和服药人员 捐款Donation 奉献 Dedication 救援 Succor 依从性　Adherence

  23. ART Over 67900 patients in Free ART program • 35%- Former plasma donors • 35%- Sexually infected • 16%- Drug users • 14%- Others

  24. Harm Reduction Strategy MMT: • Reduce drug use, drug related crime and • Reduce transmission of HIV/AIDS • Improve quality of life of drug users – developing a harmonious society • Shrink heroin markets • Reduce the number of new drug users MMT Services should be utilized as much as possible

  25. Harm Reduction Strategy NEPs: Only addresses injecting related AIDS epidemic,not targeted at reducing drug use or drug-related crime • Urban areas and the places where IDUs concentrated use MMT • Remote and rural areas and the places where IDUs not concentrated use NEPs

  26. Challenge • Personnel Capacity • Gaps between Policy & Implementation • Coverage of the intervention • More social and other supports

  27. Thank you!

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