In Current Issue, Panorama on October 29, 2009 at 11:57 am

Targetting drug users in HIV prevention in China

Marianna Tu, Staff Writer

Courtesy of Wikimedia Commons

Courtesy Wikimedia Commons

In 2007, 729 needle exchange programs were established in the People’s Republic of China as part of the effort to combat HIV/AIDS epidemic among intravenous (IV) drug users. These programs contribute to growing optimism surrounding government responses to HIV/AIDS, as demonstrated by UNAIDS public acknowledgment in July of 2007 of China’s Vice Minister of Health, Dr Wang Longde, and Qingdao University professor, Zhang Beichuan, for their HIV/AIDS work (UNAIDS). Countrywide, HIV/AIDS interventions are being scaled up. The 729 needle exchange programs of 2007 represent over an 800% increase from 2004, when only 90 needle-exchange programs existed country-wide (harm reduction journal).

Today, although China’s AIDS epidemic has spread throughout the nation and touched all provinces, advocacy and intervention campaigns continue to heavily target a few sub-populations. These groups notably include IV drug users, sex workers, men who have sex with men, and ethnic minorities. Experts worry that focused interventions, though innovative and localized, threaten to further harm already marginalized populations. In particular, as Chinese health workers, within and without the government, struggle to reach IV drug users in particular, legal and moral controversy abounds.

China’s stance on illegal drug is one of “zero tolerance.” In 2005 the government declared “the people’s war on drugs” and heroin (the most popular intravenous drug) trafficking in excess of 50 grams still warrants the death penalty. Penalties for users include a system of voluntary detoxification, compulsory rehabilitation and reeducation-through-labor (RTL) centers, depending on an individual’s criminal history. Human Rights Watch has reported incidents of targeted drug-related arrests at the sites of prevention services. Human rights activists point to such reports as evidence that the government’s firm stance on drug use complicates HIV/AIDS prevention services.

Chinese citizens reflect the complexity of the matter, as they speak both in support of the police action and of HIV prevention programs. Commenting through email correspondence on arrests made at needle exchange programs, Beijing resident Gao Zishen writes “if the police arrest them based on their sin (something wrong them have done), that is justified. If they did not break the rules, they should not be arrested. So, I think we should show our respect to the law in China.” Zhang Xiaodong adds, “I can’t say if it’s justified for the drug users, but it’s useful. You know it’s totally illegal in China to sell drugs.”

However, Zhang and Gao both also speak in support of needle exchange programs. Zhang writes, “for IV drug users, I think the best way is to educate them. Not just tell them it’s harmful to use that, but also bring a new life to them… I think it’s useful to gather them together to give them medical treatment and prevent the spreading of diseases.”

Police presence outside prevention services seems to be only part of the controversy. Human Rights Watch also points out troubling practices within compulsory rehabilitation and RTL centers. Human Rights Watch claims residents at these centers are not provided with regular treatment, monitoring, or medical care. Reports of unsafe sex between male guards and female inmates, as well as unsanitary drug use, raise concerns over transmission and sexual abuse.

In an environment of such high-risk sexual activity and drug use, HIV positive inmates taking antiretroviral (ARV) medicines are particularly endangered, experts worry. Studies have found that recreational drugs can interfere with the effectiveness of ARV. The additional risk of drug resistance arises from irregular or interrupted ARV supplies due to systems of guard favoritism.

Courtesy of Wikimedia Commons

Courtesy Wikimedia Commons

China is not the only country to receive criticism for its policies surrounding drugs use and HIV/AIDS. In fact, China has been favorably compared with Eastern Europe, where countries like Ukraine have documented accounts of arrests and beating by needle exchange programs. The advocacy group AVERT suggests, “40% of countries have laws that interfere with their ability to reach injecting drug users.” And while China’s drug policies are indeed strict, the number of people arrested for drugs drug and the number sent to treatment centers combined still only match one-fifth of US yearly drug arrests.

With around 44% of HIV prevalence in China attributed to IV drug use, effectively fighting this epidemic in the globe’s most populous nation requires reaching out to users. As China embarks upon the new year of the ox, efforts against HIV/AIDS will continue to be at the forefront of national and international attention.


Alcorn, Keith. “Chinese HIV prevention with drug users undermined by police.” Aidsmap News. 11 December 2008. http://www.aidsmap.com/en/news/90DE9D1E-C677-4D2A-92E4-65250632D62C.asp

“China: UNAIDS awards leadership excellence.” UNAIDS. 17 July 2007 <http://www.unaids.org:80/en/KnowledgeCentre/Resources/FeatureStories/archive/2007/20070717_China_UNAIDS_awards_leadership_excellence.asp&gt;

““China Says Drug War is Failing.” Stop the Drug War. 3 June 2005. <http://stopthedrugwar.org/chronicle/389/china.shtml&gt;

Injecting drugs,drug users, HIV & AIDS.”AVERT.13 March 2009 <http://www.avert.org/injecting.htm&gt;

Qian, Hanzhu, Joseph E Schumacher, Huey T Chen and Yu-Hua Ruan. “Injection drug use and HIV/AIDS in China: Review of current situation, prevention and policy implications.” Harm Reduction Journal 2006, 3:4 <http://www.harmreductionjournal.com/content/3/1/4&gt;


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