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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 Lumpur July 2, 2013. Background. HIV epidemics in Vietnam and Southern China are driven by heroin injection and sex work.

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Cross-Border Movement and HIV Infection among People who Inject Drugs and Female Sex Workers

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  1. 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

  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?

  3. Cross-Border Heroin Trans-Shipment Routes(Beyrer, AIDS, 2000)

  4. G Gradient of HIV Prevalence by Distance from Border (Des Jarlais, BMC Pub Health, 2005)

  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)

  6. PWID cross-border movement and HIV infection: subsequent surveys (2002-2012) • Reduced frequency of purchasing drugs across border • Still compatible with gradient pattern • Suggests mature, but localized HIV epidemic among PWID

  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 PopulNutr, 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).

  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.

  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).

  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.

  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).

  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.

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