HIV seroconversion and risk factors among drug users receiving methadone maintenance treatment in China: A qualitative study

- We interviewed 27 newly HIV-positive methadone maintenance treatment (MMT) clients.
- Most clients could attribute their infection to either drug use (15) or sex (7).
- MMT clients struggled with drug abstinence and social pressure to use drugs.
- Regular HIV testing and HIV prevention counseling is necessary.
- Access to needle exchange programs should be improved to decrease HIV risk.

ObjectiveWe sought to explore the experiences of drug users in China who were recently diagnosed with HIV infection while engaged in methadone maintenance treatment (MMT) and to better understand their perceptions of MMT, HIV risk, and HIV prevention.MethodsWe recruited clients of MMT clinics in Chongqing and Kunming who had a baseline HIV-negative test result upon entry to MMT and had been diagnosed with HIV within the past 12 months. We conducted semi-structured qualitative interviews and thematic data analysis to identify situations and factors that increased HIV risk.ResultsAmong the 27 participants who were interviewed, 15 believed their infection was due to injection drug use, 7 attributed their infection to sexual contact, and 5 were unsure as to how they became infected. High risk behaviors were common; 18 participants continued to use drugs during treatment, and 10 engaged in unprotected sex. Common themes were the difficulty of drug abstinence despite receiving MMT, social pressure to continue using drugs, and low knowledge of effective HIV prevention measures.ConclusionWhile MMT is effective in reducing drug usage and needle sharing, many clients remain at risk of HIV infection due to continued injection drug use and unprotected sex. Clients may benefit from additional counseling on HIV prevention methods as well as structural interventions to increase the availability of clean injection equipment.