China's paradoxical policies on HIV and drug use threaten health

Based on a review of Chinese government legislation and policy documents, and interviews with 19 recently detained injection drug users and 20 officials in Guangxi Province, Elizabeth Cohen and Joseph Amon from the organization Human Rights Watch find evidence of antinarcotics policies and practices that compromise the health and human rights of drug users. While China has recently been commended for a more liberal public health response to the HIV/AIDS and injection drug use epidemics, the experience of detained drug users suggests that these individuals are in fact subjected to punitive and harmful treatment while in detoxification or "re-education through labour" centres (RELCs).

Almost all injection drug users interviewed reported that Chinese police routinely conduct surveillance of pharmacies and methadone clinics; some interviewees reported having been arrested when seeking to buy clean needles or to access methadone. Interviews with both injection drug users and officials revealed that routine HIV testing, without consent and without disclosure of the result, was the standard policy of detox facilities. HIV-infected detainees were not routinely provided medical or drug dependency treatment, including antiretroviral therapy, the authors report. Injection drug users received little or no information or means of HIV prevention, but reported numerous risk behaviors for HIV transmission while detained, such as injection drug use and unsafe sex.

The authors argue that there are significant contradictions in Chinese policies on HIV/AIDS, which promote wider rollouts of community-based methadone maintenance therapy, and on drug use, which involve more and more detention in centres that appear to violate drug users' human rights. "The failure of the Chinese government to ensure that drug users in detention receive effective treatment for drug dependency and have access to HIV prevention and treatment services while in detox or RELC constitutes a serious risk to the right to life, and jeopardizes the success of China's HIV goals," conclude the authors.

According to Cohen and Amon, in 2005 there were about 700 mandatory drug detox centres in China and 165 RELCs housing a total of more than 350,000 drug users. The Chinese government's "National People's War on Illicit Drugs" has the goal of further increasing the number of people detained.

In an expert commentary on the new study, Stephen Koester (University of Colorado, Denver), who was uninvolved in the research, notes that the accounts generated by this research "provide a sobering reality check to reports heralding China's 'bold steps to scale up' HIV prevention and treatment. They remind us," he says, "that seemingly progressive public health policies cannot fully be effective when carried out within a context of punishment and fear."

Citation: Cohen JE, Amon JJ (2008) Health and human rights concerns of drug users in detention in Guangxi Province, China. PLoS Med 5(12): e234. doi:10.1371/journal.pmed.0050234
http://medicine.pl … pmed.0050234

Source: Public Library of Science