1. 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

2. Contributors ɠ Dr. Wu Zunyou, China CDC ɠ China’s National NEP Working Group ɠ China Ministry of Health ɠ International community: Global Fund US, UK et al. ɠ AIDS 2012 Conference Secretariat

3. Why China Initiated NEPs? ɠ Large number of heroin users more than 1 million ɠ High HIV prevalence 6% nationwide ɠ Prevalent high-risk behavior among drug users: high needle sharing low condom use ɠ NEP has been proven to be an effective harm reduction strategy worldwide. 2 HIV sentinel surveillance data on IDUs, 1995-2009

4. 4 Evidence-based Evolution ɠ A small pilot feasibility study in 1997, sponsored by World AIDS Foundation ɠ The first NEP Workshop in 1997, hosted by Chinese Preventive Medicine Academy. ɠ A scale-up pilot study in two provinces in 1999, sponsored by China Ministry of Health. ɠ Implementation in four provinces since 2000, sponsored by China-UK Program and China-Australia Program. ɠ Scale-up nationwide since 2003, sponsored by China CARE program.

5. Milestones in China’s NEP 1998 2001 20022003 2004 20052006 2007 2008 20092010 20001999 First NEP workshop in China (1997) China CARE project （ 2003) Scale up Pilot NEP study in 2 provinces （ 1999) 3 rd Five year Action Plan （ 2011-2015 ） Preparation Phase （ Before 1999) Pilot Phase （ 1999 to 2003) National Scale-up Phase （ Since Jul, 2003) Web-based Data Management System (2008) 1 st Five-year AIDS Plan (2001-2005) 2 nd Five-year AIDS Plan (2006-2010)

6. 6 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

7. Geographical Distribution XINJIANG QINGHAI YUNNAN GUANGXI GUANGDONG SICHUAN NINGXIA SHAANXI GUIZHOU HUNAN HUBEI JIANGXI BEIJING JIANGSU ZHEJIANG FUJIAN HAINAN CHONGQING By March 2012, 966 NEP sites 466 counties in 18 provinces, covering 44,530 injecting drug users monthly (50 drug users per site)

8. NEP in China ɠ Financial sources: Before 2010: Government & international support; After 2010: Government ɠ NEP operators: Peer educators, CDCs, NGOs, pharmacies ɠ Participants of NEP: Heroin users recruited from community 8 NEP Guideline

9. Web-based Data Management System 9

10. ɠ Misunderstanding of drug use and debate on NEP still exists. ɠ Lack of comprehensive evaluation on the role of NEP in HIV prevention in China. ɠ Which NEP model is better in China? Peer educators (how can we know they really distribute?) Health workers NGO? Challenges

11. ɠ Decrease the negative attitude toward drug use and NEPs. ɠ Strengthen the leadership on NEPs. ɠ Implement the comprehensive evaluation on NEPs. ɠ Encourage the active involvement of target population: e.g. Community-based organizations (CBOs), Grass-rooted organizations Next Steps

12. Thank you !