this population are involved in multiple HIV and sexual risk

The survey has indicated that
many of this population are involved in multiple HIV and
sexual risk behaviours including needle sharing and abstaining
from condom use during regular and commercial
sexual intercourse. Previous research suggested reasons
for such risky behaviour including that heroin addicts do
not use condoms as they find themselves too intoxicated
to protect themselves during sexual inter-course
(Prakash 2003). In reference to needle sharing, IDUs
have been shown to lack the ability to perceive long-term
outcomes (such as HIV infection) as a result of their current
behaviour (Odum et al., 2000; Loxley and Davidson,
1998). Despite many having engaged in behaviours
highly associated with the transmission of HIV and the
majority of the population knowing what HIV was at the
time, a large percentage of those surveyed have never
had a HIV test before. Although the proportion of men
who have sex with men, another sub-group who are
known to be at a higher risk of HIV, was negligible
(0.5%), condom use was inconsistent.
Preliminary analysis indicated that inconsistent condom
use was associated with males, older age, those who
have no knowledge about HIV, the unemployed and
those that were married. Results from this study confirm
existing evidence showing that a higher frequency of
heroin injection is associated with sharing needles and
inconsistent condom use (Perngmark et al., 2004;
Lundgren et al., 2005). However, following logistic
regression analysis, only occupational and marital status
were significant independent predictors of condom use
during vaginal sex. A possible reason for those unemployed
failing to use condoms could be financial in nature
which could suggest a need for widening the access of
free condoms to this population.
Although this study has found that over a third of drug
users have shared needles in the past with a quarter of
them having done so recently, previous research carried
out amongst Chinese drug addicts has suggested this
figure to be higher (between 50 - 80%) (Hong-bo et al.,
2004, Youchan et al., 2002). Access to the needle
exchange centre in Dali City could be one possible
explanation to the lower needle sharing prevalence
following the needle exchange program set up in China
since 2004. This study also refutes previous evidence
that being from an ethnic minority predisposes drug
addicts to needle sharing as it was found that Han
Chinese drug addicts were more likely to share needle
(Yang et al., 2006).
Limitations of study
Although this study has given a detailed insight into the
risky behaviours amongst heroin addicts in rural China, it
was not possible to conclude whether those who were
identified as having engaged in risk behaviours
associated with HIV were actually at greater risk without
knowing their HIV sero-prevalence. We could not offer
such a service as HIV testing was not allowed by the
rehabilitation centres. Furthermore as data from this
study was largely self-reporting, the reliability answers
from the questionnaire may come into question for three
reasons. On average inmates had been receiving
treatment at the centre for 6 months at the time of
interviewing, commenting on their behaviours 6 months
previously could have resulted in an element of recall
bias. Secondly pre-admission opium intoxication may
have also influenced their ability to remember past
behaviours and lastly condom use remains highly
stigmatised in China which could lead to a subsequent
underreporting. Additionally this study only included
heroin users enrolled in the Dali detoxification therefore
omitting drug users in the community. As a result
conclusions from this study may not be generaliseable to
the wider population of drug users in China. In light of
these limitations, further research could be carried out in
this field identifying drug users in treatment and in the
community, their HIV risk behaviours and their HIV status