A tale of two cities - The trajectories of the dual epidemics of illicit drug use and HIV/STIs in Kunming and Qingdao in contemporary China
WORLD CONFERENCE ON STDs, STIs & HIV/AIDS
July 26-27, 2017 | Vancouver, Canada
Eastern Virginia Medical School, USA
Scientific Tracks Abstracts : Virology research J
Background: Illicit Drug abuse has been inextricably linked with the epidemics of HIV and other Sexually Transmitted Infections (STIs).The mechanisms and magnitudes of associations have varied over time and across different populations and geographical areas. In China, the early stage of the HIV epidemic was driven mainly by injecting drug use (IDU) starting in the late 1980s in Southwest China bordering the Golden Triangle – one of the three largest heroin production sites in the world. Meanwhile, alarming rates of synthetic drug use (e.g. methamphetamine, ketamine and ecstasy) have been reported particularly among young adults and sexual minority populations, coinciding with high comorbidity of mental health problems, risky sexual behaviors and HIV/STIs. Using data from qualitative interviews with key informants and other secondary resources in Kunming and Qingdao in January/March 2017, this study compares types and patterns of drug use and characteristics of drug users. It also examined the social and environmental contexts in which drug use was frequent to understand the driving forces behind the dual epidemics of illicit drug use and HIV/ STIs in contemporary China. Methods: We first complied and reviewed existing secondary data and published literature on drug use and HIV/STIs in the two cities. Informed by the findings, we designed semi-structured interview guidelines and recruited a diverse sample of 60 key informants (30 respondents each in Kunming and Qingdao), including local drug users (n=18) or their family members (n=2), community rehabilitation center doctors and social workers (n=14), local police (n=11), and taxi drivers or other people who were familiar with local drug use (n=15). Between December 2016 and February 2017, in-depth interviews and focus group discussions were conducted by trained researchers to talk about common drugs used, characteristics of drug users, cultural beliefs and norms related to drug use and sex, social and physical context of drug use sites, and factors related to the variations in drug use prevalence across communities. Results: Preliminary analyses revealed distinctive patterns of drug use between the two cities. In Qingdao, crystal methamphetamine is the single most prevalent drug, While in Kunming, multiple drugs were raised, including heroin, Magu and methamphetamine. Poly drug use is more prevalent, and the use of synthetic drug is on the rise. In both cities, heroin use, which was once the “symbol of fashion” in 1980s and 1990s, was now considered “dirty” and “out of date “, and is used mainly in private by older drug users. Heroin users also occasionally consumed synthetic drugs. Overall, the harm of heroin use had been acknowledged by both the public and drug users, while synthetic drugs were considered more fashionable, or beneficial (help losing weight, be sensational, stay energetic, release pressure, and enhance sexual pleasures) and not (or less) addictive/harmful. In both cities, drug use was more prevalent in low income communities and neighborhoods with high concentration of transient populations. Having family members or friends that used drugs was frequently reported by drug users. The crackdown of police did not seem to prevent/reduce drug use, rather, it drove drug use underground, e.g. from public entertainment venues to more hidden and mobile sites, for example, rental rooms/apartments, private vehicles and secluded places (e.g. suburbs or cemeteries). Conclusions and Discussion: Findings from this study highlighted that group norms and beliefs towards certain drugs, individuals’ social networks, and social contexts play a significant role in shaping individual perceptions about certain drugs and their choice to use drugs as well as the health consequences associated with drug use.
Hongyun Fu is an Assistant Professor at Eastern Virginia Medical School Norfolk, VA, USA