Determinants of not sharing needles, trends in behavior, and the effectiveness of PSI's peer education campaign among injecting drug users (IDUs) in Yunnan Province, China

Background: Tracking studies were conducted in 2004 and 2006 among IDUs in Yunnan Provice, PRC. Researchers identified predictors of not sharing needles, monitored changes in risk behavior, and evaluated existing IDU interventions. Methods: Data come from a representative sample of IDUs in three compulsory detox centers in Yunnan, admitted less than 2 months prior to the survey. Multivariate analysis was used to identify predictors of not sharing needles/syringes. UNIANOVAs were used to compare findings across study years and exposure categories (2004, N = 668; 2006, N = 547). Results: No significant differences were found over time for needle sharing behavior. However, IDUs with high exposure to project interventions were more likely to report being able to obtain new needles/syringes when needed (p<.001) and had greater knowledge about HIV transmission through risky injecting behavior (p<.001). Six determinants of safe behavior were found in 2006, including positive social norms for avoiding sharing (p<0.01), knowledge of effective cleaning methods (p<0.05), keeping needles on hand for future injections (p<0.01), intention to avoid sharing (p<0.001), not knowing someone with HIV (p<0.01), and not sharing cotton/cookers (p<.01). Conclusions: Evaluation analysis revealed some impact of IDU interventions, but none yet on needle sharing. Determinants of avoiding needle sharing will be used to inform future programming and promote positive behavior change. Continued efforts must be made to teach proper needle cleaning methods, encourage IDU to be prepared with extra clean needles in advance of injecting, and promote positive social norms among IDU to avoid sharing needles/syringes among friends.