Regular article Impact of methadone on drug use and risky sex in China Han-Zhu Qian, (M.D., Ph.D.) a, ⁎ , Chun Hao, (M.D.) b , Yuhua Ruan, (Ph.D.) b, ⁎ , Holly M. Cassell, (M.P.H.) a , Kanglin Chen, (B.S.) c , Guangming Qin, (B.S.) d , Lu Yin, (M.D., M.S.) b , Joseph E. Schumacher, (Ph.D.) a , Shu Liang, (M.S.) d , Yiming Shao, (M.D., Ph.D.) b a Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA b State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China c Xichang Center for STD and Leprosy Control, Xichang County, Sichuan Province, China d Sichuan Provincial Center for Disease Control and Prevention, Chengdu, Sichuan Province, China Received 13 February 2007; received in revised form 8 June 2007; accepted 1 July 2007 Abstract This study examined the impact of methadone on drug-using and risky sexual behaviors among 557 heroin injection drug users in one of the first methadone programs in China. Structured questionnaires were administered to collect data on methadone utilization, drug use, and risky sexual behaviors. Blood samples were tested for blood-borne infections. Multivariate logistic analyses revealed that, among opioid- addicted individuals, methadone participants were less likely to use or inject drugs and share needles than nonparticipants. They also were less likely to have multiple sexual partners or have unprotected sex. Those currently enrolled in methadone maintenance had lower risk of using and injecting drugs than those who were no longer receiving methadone. Data suggest positive, short-term impact on these important behaviors, but further studies are needed to examine the long-term impact of methadone treatment on disease rates. © 2008 Elsevier Inc. All rights reserved. Keywords: Heroin; Injection drug use; Methadone maintenance therapy; HIV; China 1. Introduction Although unprotected sex between men and women is globally the most common way of transmitting HIV, injection drug use (IDU) is the second most important force. Sharing of needles and paraphernalia in particular drives the epidemic in many countries outside Africa (Aceijas, Stimson, Hickman, & Rhodes, 2004; Fuller et al., 2003; Ruan et al., 2004, 2005; Shah et al., 1996; UNAIDS, 2006). Drug abuse also facilitates HIV transmission in indirect ways. Under the influence of drugs, users are more likely to engage in unprotected sex, and thereby they may transmit or become infected with HIV (Darrow et al., 2005; Edlin et al., 1994). In addition, drug users may trade sex for drugs, which has been observed in both female and male substance-using populations (Edlin et al., 1994; Kuyper et al., 2004; Ruan et al., 2006). One effective measure to reduce HIV risk among injection opioid drug users is methadone maintenance therapy (MMT). Long-acting oral methadone can effectively sup- press use of short-acting opioid drugs (i.e., heroin) and reduce drug-injecting and needle-sharing practices. Provi- sion of MMT is a well-evaluated harm-reduction strategy in Western countries. Studies have shown that MMT can suppress cravings for opioid drugs, decrease risk for injection-related HIV and other infectious diseases, reduce Journal of Substance Abuse Treatment 34 (2008) 391 – 397 ⁎ Corresponding authors. Han-Zhu Qian is to be contacted at MT 645, 1530 3rd Avenue South, Birmingham, AL, USA. Yuhua Ruan, 27 Nanwei Road, Xuanwu District, Beijing 100050, China. E-mail addresses: qianhz@yahoo.com (H.-Z. Qian), yh_ruan@sohu (Y. Ruan). 0740-5472/08/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.jsat.2007.07.002