Development and implementation of a cross-border HIV prevention intervention for injection drug users in Ning Ming County (Guangxi Province), China and Lang Son Province, Vietnam

This paper describes the background and early implementation of a peer-based HIV prevention intervention involving social marketing of sterile needles and syringes for injection drug users (IDUs) in a border region of northern Vietnam and southern China. Peer educators collect and safely dispose of used needles and syringes and provide IDUs with a choice of new needles/syringes or vouchers redeemable in pharmacies and clinics for new needles/syringes. The project arose from a pattern of changing drug use and increasing HIV infection in the region but its development took 4 years and faced many challenges. Implementation of the intervention posed a new set of challenges for the participating health departments, police, peer educators, pharmacists, injection drug users, and the communities at large. Early implementation of the project has revealed successful multi-sectoral collaboration, and broad acceptance by IDUs of pharmacy vouchers and distribution of new needles/syringes. However, IDUs' persistent fear of the police, particularly in Vietnam, has required reliance on separate collection by peer educators of used needles/syringes and distribution of pharmacy vouchers and new needles. In China, new needles/syringes and vouchers are largely being provided through exchange. Understanding the development and implementation challenges and the strategies that were successful in overcoming them (including the importance of being flexible and adaptable to contextual factors) may be useful to those interested in launching similar, much-needed interventions in other parts of the world.