AIDS and Behavior

, Volume 15, Issue 5, pp 1011–1016 | Cite as

Crossing Over: Drug Network Characteristics and Injection Risk Along the China–Myanmar Border

Original Paper


Border areas are important locations for understanding HIV transmission. This study examines individual and network correlates of border crossing and equipment sharing among methadone maintenance clients in Ruili City, a Chinese city on the Myanmar border. Data are from 298 clients enrolled in the Ruili Methadone Treatment Center. Clients were interviewed about drug use, HIV/AIDS knowledge, treatment motivation, and their social networks. Multinomial and logistic regression analysis were performed. Thirty percent of clients reported injecting in Myanmar. Compared to drug networks that usually inject in China, networks that inject equally in both places (border crossing) are more likely to share equipment. The association between HIV positive status and border-crossing was marginally significant and robust. Results indicate some added degree of risk among clients and drug networks who border-cross to use drugs. More research is needed to understand this phenomenon.


Border Injection risk behavior Drug networks China Drug treatment 



This study was conducted through a dissertation award to W. Liu by the AIDS International Training and Research Program at UIC through funding from the Fogarty International Center, NIH (D43TW001419-09). The Ruili CDC under the leadership of Dr. Li Zhoulin and the Mayor’s office of the City of Ruili also contributed support.


  1. 1.
    UNAIDS. AIDS Epidemic Update 2009: Asia fact sheet. Geneva: Joint United Nations Programme on HIV/AIDS; 2009.Google Scholar
  2. 2.
    Beyrer C, Razak MH, Lisam K, Chen J, Lui W, Yu XF. Overland heroin trafficking routes and HIV-1 spread in South and South-East Asia. AIDS. 2000;14(1):75–83.PubMedCrossRefGoogle Scholar
  3. 3.
    Beyrer C. HIV/AIDS: HIV epidemiology update and transmission factors: Risks and risk contexts—16th international AIDS conference epidemiology plenary. Clin Infect Dis. 2007;44(7):981–7.PubMedCrossRefGoogle Scholar
  4. 4.
    UNESCO. HIV/AIDS in the GMS: a cross-border problem. Bulletin for prevention education in the greater Mekong subregion, Issue 1, 1–3. Thailand: HIV/AIDS Clearing House of the UNESCO Asia and Pacific Regional Bureau for Education; 2004.Google Scholar
  5. 5.
    du Guerny J, Hsu L-N, Hong C. Population movement and HIV/AIDS: the case of Ruili, Yunnan, China. UNDP Southeast Asia HIV and Development Programme; August 2003Google Scholar
  6. 6.
    Strathdee SA, Lozada R, Ojeda VD, Pollini RA, Brouwer KC, Vera A, et al. Differential effects of migration and deportation on HIV infection among male and female injection drug users in Tijuana, Mexico. PLoS One. 2008;3(7):e2690.PubMedCrossRefGoogle Scholar
  7. 7.
    Beesey A. HIV vulnerability and mobile populations: Thailand and its borders. Dev Bull. 2000;52(52):38–41.PubMedGoogle Scholar
  8. 8.
    Zhao C, Liu Z, Zhao D, Liu Y, Liang J, Tang Y, et al. Drug abuse in China. Ann N Y Acad Sci. 2004;1025:439–45.PubMedCrossRefGoogle Scholar
  9. 9.
    Zheng X, Tian C, Choi K-H, et al. Injecting drug use and HIV infection in southwest China. AIDS. 1994;8:1141–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Xia M, Kreiss JK, Holmes KK. Risk factors for HIV infection among drug users in Yunnan province, China: association with intravenous drug use and protective effect of boiling reusable needles and syringes. AIDS. 1994;8:1701–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Yu ESH, Xie Q, Zhang K, et al. HIV infection and AIDS in China, 1985 through 1994. Am J Public Health. 1996;86:1116–22.PubMedCrossRefGoogle Scholar
  12. 12.
    Ministry of Health, P. R. China and UN Theme Group on HIV/AIDS in China. China responds to AIDS: HIV/AIDS situation and needs assessment report. Beijing: Chinese Ministry of Health, November 1997.Google Scholar
  13. 13.
    Zheng X, Tian C, Choi KH, Zhang J, Cheng H, Yang X, et al. Injecting drug use and HIV infection in Southwest China. AIDS. 1994;8(8):1141–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Chu TX, Levy JA. Injection drug use and HIV/AIDS transmission in China. Cell Res. 2005;15(11–12):865–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Chantavanich S. Preventing HIV/AIDS among mobile populations in the greater Mekong subregion, Asian Development Bank, the United Nations Development Program; 2000.Google Scholar
  16. 16.
    Zheng XW, Zhang JP, Tian CQ, Cheng HH, Yang XZ, Duan S, et al. Cohort study of HIV infection among drug users in Ruili, Longchuan and Luxi of Yunnan Province, China. Biomed Environ Sci. 1993;6(4):348–51.PubMedGoogle Scholar
  17. 17.
    Yu XF, Chen J, Shao Y, Beyrer C, Liu B, Wang Z, et al. Emerging HIV infections with distinct subtypes of HIV-1 infection among injection drug users from geographically separate locations in Guangxi Province, China. J Acquir Immune Defic Syndr. 1999;22(2):180–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Xiao Y, Kristensen S, Sun J, Lu L, Vermund SH. Expansion of HIV/AIDS in China: lessons from Yunnan Province. Soc Sci Med. 2007;64(3):665–75.PubMedCrossRefGoogle Scholar
  19. 19.
    Wu Z, Sullivan SG, Wang Y, Rotheram-Borus MJ, Detels R. Evolution of China’s response to HIV/AIDS. Lancet. 2007;369(9562):679–90.PubMedCrossRefGoogle Scholar
  20. 20.
    Des Jarlais DC, Johnston P, Friedmann P, Kling R, Liu W, Ngu D, et al. Patterns of HIV prevalence among injecting drug users in the cross-border area of Lang Son Province, Vietnam, and Ning Ming County, Guangxi Province, China. BMC Public Health. 2005;5:89.PubMedCrossRefGoogle Scholar
  21. 21.
    Hammett TM, Johnston P, Kling R, Liu W, Ngu D, Tung ND, et al. Correlates of HIV status among injection drug users in a border region of Southern China and Northern Vietnam. J Acquir Immune Defic Syndr. 2005;38(2):228–35.PubMedCrossRefGoogle Scholar
  22. 22.
    Hammett TM, Kling R, Johnston P, Liu W, Ngu D, Friedmann P, et al. Patterns of HIV prevalence and HIV risk behaviors among injection drug users prior to and 24 months following implementation of cross-border HIV prevention interventions in northern Vietnam and southern China. AIDS Educ Prev. 2006;18(2):97–115.PubMedCrossRefGoogle Scholar
  23. 23.
    Bergenstrom A, Htoon YS, Sharma M, Garg R, Macdonald V, Awng H, Buhler M, Gang S. Myanmar country advocacy brief injecting drug use and HIV. A joint publication by United Nations Regional Task Force on injecting drug use and HIV/AIDS for Asia and the Pacific and HIV/AIDS Asia Regional Program, 2010.Google Scholar
  24. 24.
    De P, Cox J, Boivin J-F, Platt RW, Jolly AM. The importance of social networks in their association to drug equipment sharing among injection drug users: a review. Addiction. 2007;102(11):1730–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Williams CT, Latkin CA. Neighborhood socio-economic status, personal networks, and adult heroin and cocaine use. Am J Prev Med. 2007;32(6S):S203–10.PubMedCrossRefGoogle Scholar
  26. 26.
    Williams CT, Metzger D. Race and distance effects on regular syringe exchange program use and other injection risks: a geo-behavioral analysis. Am J Public Health. (in press)Google Scholar
  27. 27.
    Latkin C, Mandell W, Vlahov D, Oziemkowska M, Celentano D. People and places: behavioral settings and personal network characteristics as correlates of needle sharing. J Acquir Immune Defic Syndr Hum Retrovirol. 1996;13:273–80.PubMedCrossRefGoogle Scholar
  28. 28.
    Rothenberg RB, Potterat JJ, Woodhouse DE, Muth SQ, Darrow WW, Klovdahl AS. Social network dynamics and HIV transmission. AIDS. 1998;12:1529–36.PubMedCrossRefGoogle Scholar
  29. 29.
    Loftus E, Smith K, Klinger M, Fiedler J. Memory and mismemory for health events. In: Tanur JM, editor. Questions about questions: Inquiries into the cognitive bases of surveys. New York: Russell Sage Foundation; 1991. p. 102–37.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Chyvette T. Williams
    • 1
  • Wei Liu
    • 2
  • Judith A. Levy
    • 2
  1. 1.Division of Epidemiology and Biostatistics, School of Public HealthUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Division of Health Policy and AdministrationUniversity of Illinois at ChicagoChicagoUSA

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