National Needle and Syringe Exchange Program

The development of needle and syringe exchange programs (NSPs) in China can be divided into two stages: the pilot (1997–2003) and the expansion (2003 to the present). During this time, the national approach to NSP transitioned from absolute prohibition to the publicly funded provision of these services for people who inject drugs (PWID) in areas without methadone maintenance treatment (MMT). While NSP has shown effectiveness at reducing HIV transmission and injection behaviors, there are implementation challenges to be addressed. Currently, there is limited coverage of ancillary services provided through NSP, insufficient provision of high-quality clean needles and syringes, lack of civil society involvement, discrimination, stigma against PWID, and difficulties in managing peer educators. Proposed recommendations include intensified advocacy for NSP targeted toward relevant government departments, merging of redundant NSP sites, strengthened quality control of NSP, increased provision of female-friendly services, and more rigorous evaluation of NSP effectiveness. The Chinese government has made significant progress in the evolution of NSP policy and has gained significant experience through research and practice. In conjunction with MMT services, NSP can contribute to the control of HIV transmission among PWID, and there is evidence in favor of further program expansion.