What Works for Women and Girls

In China, methadone maintenance treatment programs, needle-syringe programs,outreach and access to HIV testing has been scaled up. The introduction of harm reduction“has been a massive turn-around in thinking by the government, particularly lawenforcement agencies, and “achieving this has required considerable cooperation andunderstanding between the Ministries of Health, Public Security, and Justice, and theFood and Drug Administration” (Sullivan and Wu, 2007: 118). China’s most recentpolicy, “Five-year action plan to control HIV/AIDS, 2006–2010” officially endorses aharm reduction policy, with the Chinese central government openly supporting harmreduction. An initial trial of methadone maintenance treatment took place in eightclinics in 2004 with data indicating reductions in heroin use, and “importantly, ofthe 177 clients who were able to be followed for HIV status, none became infected”(Sullivan and Wu, 2007: 122). 320 clinics provided methadone maintenance with additionalscale up planned and these have benefited 27,000 heroin users. Needle exchangeprograms are being scaled up from 93 locations, with plans to increase to 1,400 to serve70,000 IDUs. Needle exchange programs also provide harm reduction services, suchas condoms, HIV testing, antiretroviral treatment, etc. “China has made significantprogress towards implementing and enhancing harm reduction programs…” (Sullivanand Wu, 2007: 126). (Gray III) (However, in 2007 and 2008 in China, arbitrary arrestof suspected IDUs, mandatory HIV testing without disclosure while detained in detoxificationcenters and withholding HIV and drug dependency treatment to detainees was reported(HRW, 2008). (Gray V).) (harm reduction, drug treatment, needles, IDU, China)3. Peer education can increase protective behaviors among IDUs.A meta-analysis of 34 articles from 1990 to 2006, 16 from Sub-Saharan Africa, 16 fromEast and Central Asia and 2 from Latin America, of which four articles were on IDUs,found that peer education was significantly associated with increased condom use(Medley et al., 2008b; Medley et al., 2009). (Gray I) (IDU, peer education, condom use,Africa, East Asia, Central Asia, Latin America)A study in Vietnam with trained peer outreach workers, along with referral data systemsincreased the numbers of IDUs and sex workers who accessed VCT, from 1,230 (23%)prior to the project between October 2004 and March 2006 to 5,585 (44%) betweenApril 2006 and November 2007 (Nguyen et al., 2008d). (Gray III) (IDU, sex workers,peer education, counseling, HIV testing, Vietnam)A pilot project in Vietnam that used peer educators to provide HIV care and supportfound that conducted focus groups discussions with 38 people living with HIV, includingIDUs, found that peer support was critical. IDUs avoided health providers who they feltstigmatized them both for being IDU and HIV-positive (Maher et al., 2007). (Gray V)(IDU, peer education, Vietnam)4. Instituting harm reduction programs for IDUs in prisons can reduce HIV prevalence infemale prison populations. [See 4C. Women Prisoners and Female Partners of Male Prisoners]96 CHAPTER 4 PREVENTION FOR KEY AFFECTED POPULATIONS