Abstract
BackgroundAlthough confinement in drug detoxification (“detox”) and re-education through labor (RTL) centers is the most common form of treatment for drug dependence in China, little has been published about the experience of drug users in such settings. We conducted an assessment of the impact of detention on drug users' access to HIV prevention and treatment services and consequent threats to fundamental human rights protections.Methods and FindingsChinese government HIV and anti-narcotics legislation and policy documents were reviewed, and in-depth and key informant interviews were conducted with 19 injection drug users (IDUs) and 20 government and nongovernmental organization officials in Nanning and Baise, Guangxi Province. Significant contradictions were found in HIV and antinarcotics policies, exemplified by the simultaneous expansion of community-based methadone maintenance therapy and the increasing number of drug users detained in detox and RTL center facilities. IDU study participants reported, on average, having used drugs for 14 y (range 8–23 y) and had been confined to detox four times (range one to eight times) and to RTL centers once (range zero to three times). IDUs expressed an intense fear of being recognized by the police and being detained, regardless of current drug use. Key informants and IDUs reported that routine HIV testing, without consent and without disclosure of the result, was the standard policy of detox and RTL center facilities, and that HIV-infected detainees were not routinely provided medical or drug dependency treatment, including antiretroviral therapy. IDUs received little or no information or means of HIV prevention, but reported numerous risk behaviors for HIV transmission while detained.ConclusionsLegal and policy review, and interviews with recently detained IDUs and key informants in Guangxi Province, China, found evidence of anti-narcotics policies and practices that appear to violate human rights and imperil drug users' health.
Highlights
Among an estimated five to six million illegal drug users, China is believed to have between three and four million individuals who inject drugs, primarily heroin [1]
The research was conducted in the cities of Baise and Nanning in Guangxi Province in southern China and was composed of three distinct approaches: (1) review of Chinese government human immunodeficiency virus (HIV) and antinarcotics legislation and policies; (2) key informant interviews with government and nongovernmental organization (NGO) officials working in HIV and antinarcotics programs; and (3) in-depth interviews with injection drug user (IDU) who had recently been detained in detox or re-education through labor (RTL) centers
A total of 20 key informant interviews were conducted with individuals from the Chinese Center for Disease Control (CDC), provincial and city health departments, domestic and international NGOs, including medical staff at methadone and AIDS clinics, a detoxification center, and a former RTL center guard
Summary
Among an estimated five to six million illegal drug users, China is believed to have between three and four million individuals who inject drugs, primarily heroin [1]. In the past few years, the government has announced dramatic programs to address drug dependency and HIV, greatly expanding methadone maintenance therapy and HIV prevention programs targeting injection drug users (IDUs), including IDUs confined to detoxification (‘‘detox’’) and re-education through labor (RTL) centers [4,5,6,7]. These days, nearly half of new HIV infections in China are associated with injection drug use and 266,000 of the 700,000 HIV-positive people in China are drug users Faced with these figures, the Chinese government has recently introduced measures to reduce HIV transmission among the estimated 3–4 million IDUs in China. The Chinese government has recently introduced measures to reduce HIV transmission among the estimated 3–4 million IDUs in China
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