China is accused of “warehousing” and denying treatment to its illicit drug usersBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c101 (Published 07 January 2010) Cite this as: BMJ 2010;340:c101
The compulsory incarceration of drug users in China deprives detainees of treatment for their addiction and other diseases such as tuberculosis and HIV, and exposes them to forced labour and physical abuse, says a report by human rights campaigners.
Holding drug users in drug detention centres also exacerbates the transmission of HIV among injection drug users and into the wider community, say international organisations.
The report by New York based Human Rights Watch is based on interviews with drug users and staff from local and international non-government organisations in Yunnan and Guangxi provinces in China’s southwest—two provinces with the highest prevalence for illicit drug use in China.
Joe Amon, the health and human rights division director at Human Rights Watch, said that although a new law promulgated in June 2008 brought to an end the sentencing of drug users to re-education through labour, the incarceration of drug users in drug detention centres perpetuates the same abuses under the re-education through labour system, namely forced labour, physical abuse, and lack of basic health care. It also extends the minimum incarceration period from six to 12 months to two to three years.
“Instead of putting in place effective drug dependency treatment, the new Chinese law subjects suspected drug users to arbitrary detention and inhumane treatment,” he said.
In China injecting drug users accounted for an estimated 27% of new cases of HIV infection reported in 2008, says data from UNAIDS. In addition, more than a third (38%) of the estimated 700 000 people infected with HIV in 2007 were former or current injection drug users.
Giovanni Nicotera, head of the project office of the United Nations Office on Drugs and Crime in China, said that incarceration in drug detention centres exacerbates the risk of HIV transmission. “Our general advice is that closed settings are not conducive to the effective treatment and rehabilitation of drug users,” he said. “International evidence shows that incarceration does not diminish the likelihood of HIV transmission but increases it and therefore the spread to the community.”
Injecting drug users who are HIV positive and receiving antiretroviral treatment, who are then incarcerated in drug detention centres, may be able to continue receiving the drugs while they are in detention. However, along with other basic medical treatment, they are deprived of the routine medical monitoring that usually accompanies treatment. Some detainees decide not to continue treatment to avoid discrimination, or may not receive it at all, sources say.
“We’ve seen examples of people who are on ART [antiretroviral therapy] and methadone, then they relapse, get detained and don’t get access to ART,” said a source in an international nongovernmental organisation in southwest China. “Then you get an issue of drug resistance because they get a really long drug holiday, and from a population perspective that makes things worse.”
The Chinese authorities have recognised that the country has a serious illicit drugs problem, and has undertaken a widespread roll out of methadone clinics and needle exchange programmes in recent years, but the drug detention centres run counter to these efforts, says Dr Amon.
“Addressing illicit drug use requires developing voluntary, community based, outpatient treatment based upon effective, proven approaches to drug addiction. Warehousing large numbers of drug users and subjecting them to forced labour and physical abuse is not ‘rehabilitation’,” he said.
Cite this as: BMJ 2010;340:c101
The Human Rights Watch report, Where darkness knows no limits, is available at http://www.hrw.org/node/87467)
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