HIV sub-epidemics in China

The AIDS epidemic in China consists of several different sub-epidemics that often overlap and intersect with each other. High prevalence groups in China include injecting drugs users, men who have sex with men, former plasma donors, commercial sex workers and migrant workers. UNAIDS predicts that amongst these sub-populations, there are an estimated 30–50 million people who are at risk of exposure to HIV²³.

Although it is customary to associate HIV/AIDS in China with these high-risk groups, boundaries are becoming increasingly blurred as the virus finds its way into the general population, and sex becomes the dominant transmission route²⁴.

Injecting drugs users

In 1989 HIV was detected amongst injecting drug users (IDUs) in Yunnan province²⁵. Needle sharing drove the epidemic and HIV spread rapidly to IDUs in neighbouring cities and along drug trafficking routes. By 2002 HIV was present amongst IDUs in all mainland Chinese provinces. It is believed that IDUs may have been the core source for all later sub-epidemics in China

In 2007 there were a reported 937,000 registered injecting drug users in China²⁷, although unofficial estimates put the number closer to three or four million.

A zero tolerance attitude to drug use meant that the government was slow to implement HIV prevention and control measures for IDUs. Prevention activities tended to focus on posters outlining the harmful effects of drug use, or concentrated on reducing supply and demand.

In the late 1990s the Chinese government began to show a change in attitude towards preventing HIV transmission among injecting drug users²⁸.

A pilot began in Guangdong in 2000. After initial positive results showed that participants were almost three times less likely to have shared needles in the past month, the programme was scaled up to approximately 92 sites in high prevalence regions²⁹. China now has more drug replacement clinics and needle social marketing programmes than any other country in Asia³⁰.

Further interventions for IDUs were also explored and in 2004 a methadone maintenance treatment programme was piloted. The programme found that the rates of heroin use, intravenous injection and crime related to drug use decreased in the pilot areas³¹. By September 2006 there were 307 methadone clinics in China, covering two thirds of the country's provinces.