Evaluation of a needle social marketing strategy to control HIV among injecting drug users in China

OBJECTIVE: To evaluate the effectiveness of a needle social marketing strategy to reduce needle sharing and hepatitis C Virus (HCV)/HIV transmission among injecting drug users (IDU) in China. DESIGN: Two-armed, prospective, community-randomized prevention trial. SETTING: Four counties/townships in Guangxi and Guangdong provinces; one randomized to intervention the other to control in each province. PARTICIPANTS: Injecting drug users: 823 (443 intervention, 382 control) at baseline and 852 (415 intervention, 407 control) at the second cross-sectional survey 12 months later. INTERVENTION: A needle social marketing programme, including promotion of safe injection norms and increased access to clean needles over a 12 month period. MAIN OUTCOME MEASURES: Cross sectional surveys at baseline and follow-up compared changes in drug using behaviours and HIV and HCV rates in the intervention and control communities. RESULTS: Needle sharing behaviours were similar in the two groups at baseline (68.4 vs. 67.8%), and dropped significantly to 35.3% in the intervention community and remained relatively stable in the control community (62.3%; P < 0.001). In a subset of cohort of new injectors, the incidence of HCV was significant lower in intervention than in control in both provinces (P < 0.001, P = 0.014) and overall (P < 0.001) but HIV was only significantly lower in intervention in Guangdong (P = 0.011). CONCLUSION: Needle social marketing can reduce risky injecting behaviour and HIV/HCV transmission among injecting drug users in China and should be expanded.