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From Science to Policy ─ Evolution of China’s Needle Exchange Program (NEP) . Xiaobin Cao Ph.D National Center for AIDS/STD Control and Prevention China CDC July 23, 2012 Washington DC. Contributors. Dr. Wu Zunyou, China CDC China’s National NEP Working Group
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From Science to Policy─ Evolution of China’s Needle Exchange Program (NEP) Xiaobin Cao Ph.D National Center for AIDS/STD Control and Prevention China CDC July 23, 2012 Washington DC
Contributors • Dr. Wu Zunyou, China CDC • China’s National NEP Working Group • China Ministry of Health • International community: Global Fund US, UK et al. • AIDS 2012 Conference Secretariat
Why China Initiated NEPs? • Large number of heroin users more than 1 million • High HIV prevalence 6% nationwide • Prevalent high-risk behavior among drug users: highneedle sharing low condom use • NEP has been proven to be an effective harm reduction strategy worldwide. HIV sentinel surveillance data on IDUs, 1995-2009
Evidence-based Evolution • A small pilot feasibility study in 1997, sponsored by World AIDS Foundation • The first NEP Workshop in 1997, hosted by Chinese Preventive Medicine Academy. • A scale-up pilot study in two provinces in 1999, sponsored by China Ministry of Health. • Implementation in four provinces since 2000, sponsored by China-UK Program and China-Australia Program. • Scale-up nationwide since 2003, sponsored by China CARE program.
Milestones in China’s NEP 1st Five-year AIDS Plan (2001-2005) Web-based Data Management System (2008) First NEP workshop in China (1997) Scale up Pilot NEP study in 2 provinces (1999) 2nd Five-year AIDS Plan (2006-2010) 3rd Five year Action Plan(2011-2015) China CARE project (2003) 2001 2008 2007 2009 2010 2004 1999 2000 2002 2003 2005 2006 1998 Preparation Phase (Before 1999) National Scale-up Phase (Since Jul, 2003) Pilot Phase (1999 to 2003)
Supportive Legislations Former Minister of Health visited NEP sties Policy and Third Five-year AIDS Action Plan (2011-2015), issued by State Council, the Central Government
Geographical Distribution XINJIANG BEIJING NINGXIA QINGHAI SHAANXI JIANGSU HUBEI SICHUAN CHONGQING ZHEJIANG JIANGXI HUNAN GUIZHOU • By March 2012, 966 NEP sites 466 counties in 18 provinces, covering 44,530 injecting drug users monthly (50 drug users per site) FUJIAN YUNNAN GUANGDONG GUANGXI HAINAN
NEP in China • Financial sources: Before 2010: Government & international support; After 2010: Government • NEP operators: Peer educators, CDCs, NGOs, pharmacies • Participants of NEP:Heroin users recruited from community NEP Guideline
Challenges • Misunderstanding of drug use and debate on NEP still exists. • Lack of comprehensive evaluation on the role of NEP in HIV prevention in China. • Which NEP model is better in China? • Peer educators (how can we know they really distribute?) • Health workers • NGO?
Next Steps • Decrease the negative attitude toward drug use and NEPs. • Strengthen the leadership on NEPs. • Implement the comprehensive evaluation on NEPs. • Encourage the active involvement of target population: e.g. Community-based organizations (CBOs), Grass-rooted organizations