Exploring HIV prevention among injection drug users: A qualitative assessment of stakeholder perceptions toward methadone maintenance clinics in Yunnan Province, China

Background: Injection drug use (IDU) is an ongoing public health crisis in China and one of the largest contributors to the transmission of HIV/AIDS; sentinel sites in Yunnan show upwards of 80% of IDUs are HIV-positive. Though the government has rapidly scaled-up methadone maintenance treatment clinics, they have not been extensively evaluated to explore factors influencing rates of attendance.

Methods: Using in-depth interviews conducted from February 2008-June 2008 with 35 participants—IDUs and key stakeholders—we explored factors influencing the facilitators and barriers to accessing methadone clinics in Kunming City, China. Interviews were digitally recorded, transcribed verbatim, and translated. Content analysis was conducted to identify themes including general attitudes toward methadone treatment and harm reduction, barriers and challenges to accessing methadone, and suggestions for improvement.

Results: Themes that emerged included responses to methadone and its side effects and fear of discrimination, loss of privacy, and police interference. Low levels of knowledge and awareness were uniformly reported. Respondents also provided suggestions for improvement; raising awareness of harm reduction and HIV, offering services such as psychological counseling, job training and behavioral therapy, and increasing communication between police, government, and public health officials.

Conclusions: High rates of HIV infection among IDUs in China have prompted public health responses including the scale-up of methadone clinics. Additional adaptations are necessary, however, to increase methadone utilization among IDUs. Our results may inform policy strategists in implementing social-structural changes to create enabling environments that facilitate increasing access to methadone among injection drug users in Kunming.