THE 6TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS EFFECTS OF HIV PROPHYLAXIS FOR INJECTING DRUG USERS (IDU) IN QUANG NAM Tran Van Kiem Quang Nam Provincial Center of HIV/AIDS Control Contents Introduction Research objectives Research objects and methods Results and discussion Conclusions Recommendations Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI INTRODUCTION  HIV/AIDS epidemic was detected in 1981, at the moment it has become a disaster globally  Over the last 30 years, many efforts have been done by countries and scientists, yet no drugs to cure the disease and no vaccine to prevent it have been invented  In Vietnam, HIV is transmitted mainly through drug injection In Quang Nam, among PLHIV detected annually, over 65% are IDUs Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI RESEARCH OBJECTIVES  In Quang Nam, there has been no research on IDUs as well as prophylaxis to prevent HIV transmission in this group This research is carried out to achieve objectives: To identify HIV prevalence rate and describe HIV transmission risk behaviors of IDUs in Quang Nam in 2011; To evaluate the effects of HIV prophylaxis for IDUs in Quang Nam (2012-2013) Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI RESEARCH OBJECTS AND METHODS Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI Research objects Male IDUs, ≥ 18 years old, participating in the research voluntarily Research site: 05 districts/city including Tam Ky, Thang Binh, Phu Ninh, Que Sơn and Phuoc Son Research period: 03 stages - Survey of the situation: Oct – Dec 2011 - Community intervention: 02 years, from Jan 2012 to December 2013 - Post-intervention survey: Jan - Mar 2014 Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI Research design Research design: This is a community intervention study, comparing pre and post-intervention without a control group Sample size As a result of the calculation, n=416 In fact, the survey is done with 430 IDUs Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI Research design Sampling: Purposive sampling in districts/city Mapping of gathering points: making a map of all gathering points of IDUs in districts Sample is distributed to districts Making a list of communes with IDUs in the districts and calculating the average number of ICUs per commune Randomly select communes until the number of IDUs for one district is reached; and continuing to so until reaching the required number of IDUs in districts/city Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI Contents of interventions After the 1st survey: - Conducting a consensus building conference and building the plan -Building and strengthening the network of peers and collaborators -Organizing technical training After that, implementing interventions for years Education and communication: direct communication by peers and collaborators, communication on mass media, distribution of materials Distribution of condoms free of charge Exchange of syringes free of charge Fixed and mobile VCT Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI Data treatment and research ethics Data treatment: Data are entered into EpiData software and analyzed by Stata, Excel Research ethics: Approved by the Medical Ethics Committee Accepted by local governments IDUs participate in the research voluntarily and their information is kept confidential Research findings are used to serve IDUs only, not for any other purposes Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI Drug injecting behaviors (continued) Reasons for sharing syringes The most common reason for sharing syringes is because there are insufficient syringes (accounting for 41,7%) and not have enoughHội money for having separate syringes (36,1%) nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI Sexual behaviors Using condoms when having sexual intercourse with female sex workers (FSW) over the past 12 months Only 65,5% often use condoms in sexual intercourse with FSW This proportion is similar to that of Nghe An (63,3%), Quang Ninh (68,8%) and is higher than that of Da Nang (50,4%), Ho Chi Minh city (39,3%) Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI Sexual behaviors (continued) Using condoms when having sexual intercourse with casual partners over the past 12 months Only 29,2% often use condoms, 57,3% sometimes use them and 13,5% never use them This means the risk of HIV transmission from IDUs to FSW or their casual partners is very high due to unsafe sex Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI HIV infection among IDUs The current prevalence rate is 6,3%, which is lower than that of the country of 13,4% (survey in 2011) This prevalence rate is lower than many Northern and Southern provinces: Dien Bien (48%), Quang Ninh (43%), Ho Chi Minh city (36%) However it is higher than Da Nang (1,0%) and Quang Tri (3,9%) which are in the same region Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI EFFECTS AFTER YEARS OF INTERVENTION Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI Effects of voluntary counselling and testing (VCT) Forms of HIV counselling and testing VCT has been increased from 74,2% before interventions to 88,2% after interventions VCT is an important factor in HIV/AIDS care and treatment Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI Effects in terms of accessibility After years of intervention, IDUs have better access to HIV prevention activities There have been considerable changes to accessibility to condoms, syringes and their knowledge Changed behaviors of IDUs Sharing of syringes months before and after interventions The proportion of IDUs sharing syringes over the past months has been reduced from 33,5% to 22,6% (KPI = 32,6%) This result is consistent with the finding of a survey conducted by NIHE in 2012 Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI Changed behaviors of IDUs (continued) Sharing syringes in the last month Sharing syringes in the last injection The proportion of IDUs sharing syringes in the last month has been reduced from 21,2% before interventions to 13,7% Similarly, the proportion of IDUs sharing syringes in the last injection has been reduced from 5,6% to 3,3% Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI Using condoms in sexual intercourse in the past 12 months The proportion of IUDs using condoms frequently with FSW has been increased from 65,6% to 86,1% (KPI = 31,3%); with casual partners: increased from 29,2% to 56,1% (KPI = Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI Changed HIV prevalence HIV prevalence rate before and after interventions HIV prevalence rate has been reduced from 6,3% before interventions to 4,4% after interventions (KPI = 29,6%) This shows the effects of prophylaxis Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI CONCLUSIONS Situation of HIV infection among IDUs in 2011  The HIV prevalence rate among IDUs in Quang Nam in 2011 is 6,3%  The proportion of IDUs sharing syringes over the past months is 33,5% and in the last month is 21,2%  The proportion of IDUs using condoms frequently in the past 12 months with wife/girl-friend is 13,3%, with FSW is 65,6% and with casual partners is 29,2% Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI CONCLUSIONS (continued) Effects after years of intervention  The proportion of IDUs sharing syringes in the past month has been reduced from 33,5% to 2,6% Similarly, the proportion of IDUs sharing syringes in the previous month has been reduced from 21,2% to 13,7%  The proportion of IUDs using condoms frequently with FSW has been increased from 65,6% to 86,1%, with casual partners: increased from 29,2% to 56,1%  HIV prevalence has been reduced from 6,3% to 4,4% Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI RECOMMENDATIONS 1) To continue to strengthen prophylaxis in order to prevent HIV transmission in research sites to guarantee sustainability 2) To expand and implement prophylaxis in other districts of the province Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI THANK YOU Hội nghị Khoa học Quốc gia Phòng, chống HIV/AIDS lần thứ VI