THE “PEOPLE’S WAR” AGAINST DRUGS AND HIV/AIDS

June 26 marks the 18th annual “International Day Against Drug Abuse and Illicit Trafficking,” a time when UN member nations reflect upon the goal of creating drug-free societies. China has regularly marked the day with media campaigns, rallies and executions of drug dealers. However, as the top leadership of the country has increasingly recognized the serious economic and social consequences of an unchecked HIV/AIDS epidemic, the Chinese government has taken dramatic steps to address the impact of HIV/AIDS on intravenous drug users. These steps have inevitably affected Beijing’s drug policies as well.

Drug use in post-revolutionary China was virtually non-existence prior to the reform and opening period in 1979. Since 1979, however, illicit drug use has steadily been on the rise. Coinciding with considerable economic growth and an increase in personal mobility, drug use quickly became more prominent in Chinese society, with public security authorities registering 70,000 abusers in 1990. This number doubled to 148,000 in 1992, and doubled again to 300,000 by 1993. In 2003, China’s Vice Minister of Public Security stated that 1.05 million drug abusers had been registered by authorities, with more than 600,000 abusing heroin – the numbers of drug abusers who are not registered with authorities is estimated to be four to five times higher. [1] Drug abusers are largely male, between the ages of 15 and 35, and are most numerous in the border provinces of Yunnan, Guangxi, Xinjiang, and along drug trafficking routes in the southwest provinces of Sichuan, Guizhou, Hunan and Jiangxi. Significant numbers of drug abusers are also found in cities and more developed provinces. [2]

Heroin originating in Myanmar is the most trafficked substance in China. Smuggled into Yunnan and Guangxi provinces, it is ultimately destined for Xinjiang province (where large numbers of users are found) or cities along China’s prosperous East Coast, where it is either consumed or smuggled abroad. There are wildly divergent estimates of the total amount of heroin produced in Myanmar and trafficked through China (amphetamines and ketamines are also trafficked in smaller quantities), ranging between 80 and 2,300 tons per year. [3] Whatever the actual quantity, there is little doubt that amounts trafficked to China have increased rapidly, partly due to Thailand’s new “War on Drugs,” launched in February 2003. Thailand’s crack down forced many traffickers to shift northward to land routes in China in order to reach smuggling-export hubs in Fuzhou, Guangzhou and Hong Kong.

“People’s War” Against Drugs

The public security bureau and justice ministry have taken aggressive steps to control drug trafficking and drug abuse, both by interdicting drug supplies and reducing demand among users. In April 2005, politburo member and Minister of Public Security Zhou Yongkang announced a “people’s war” on drugs, formalizing a crack-down on drug trafficking and use that had been escalating since mid-2004. Approximately 10 tons of heroin were seized in 2003, and another 10.8 tons in 2004, a marked increase from the 4 tons seized in 1993. In 2004, 66,900 trafficking suspects were arrested. [4]

The current war on drugs in China has been characterized by a significant expansion of demand-reduction activities against users as well. Growing anti-drug budgets have been used for police training, operations, and equipment, and to build new detention and detoxification facilities intended to get drug users “off the street.” Yunnan province was reportedly provided $100 million from the central government for the campaign, which is expected to last three years, while Xinjiang and Guangxi provinces have also received significant funds. [5] The large budget allocations to several provinces are also being used to pay informants, which has reportedly increased arrest-rates of dealers and users considerably.

Nation-wide, public security officers detained 273,000 drug users in 2004, placing them in compulsory rehabilitation and detoxification facilities. Over 68,000 were detained in “re-education through labor” facilities operated by justice ministry bureaus. As of 2004, the ministries of public security and justice operated 583 drug rehab centers with a capacity of 116,054 beds, and 165 “drug-rehabilitation through education and labor” facilities with 143,000 beds. [6] Detention terms in rehab centers are short, lasting six months to one year, with repeat offenders and dealers sentenced to longer terms at the labor camps. Drug users are routinely tested for HIV/AIDS when they are detained, though reportedly most detainees are not informed of their results.

HIV/AIDS and New Policies to Address Drug Use

Because many heroin injectors in China lack access to clean injecting equipment on a daily basis and most are not educated about health risks, large numbers of heroin addicts share needles in China, thereby transmitting blood borne diseases such as hepatitis, syphilis and HIV/AIDS. China currently estimates that there are 840,000 HIV-positive persons in China, with approximately 42 percent of the identified cases caused by sharing of injection equipment. (Less than 10 percent of estimated cases have been identified and registered with public health authorities). [7] Within the large drug-injecting population, HIV prevalence is as high as 89 percent in parts of Xinjiang and is over 20 percent in Yunnan and Guangxi provinces, making HIV/AIDS a significant public health concern. [8]

In early April 2004, Vice Premier (and then Minister of Health) Wu Yi convened a national HIV/AIDS meeting designed to mobilize China’s vast bureaucracy and to promulgate policies that would more effectively address the alarmingly rapid growth in HIV/AIDS cases. The policies disseminated by the State Council at that meeting specifically endorsed public health and security officials to apply “harm reduction” principles to prevent the spread of HIV/AIDS. “Harm reduction” refers to a public health concept of mitigating the health consequences from certain behaviors such as unprotected sex and the sharing of needles in order to reduce the transmission of infectious disease. The measures now endorsed by the government effectively legalize and encourage the expansion of clean needle-exchange programs (where a drug user can exchange a used needle for a new one), and methadone substitution therapy. Methadone is an opiate substitute that can be administered by public health authorities to wean addicts off heroin while avoiding withdrawal symptoms and eliminating the use of injection equipment.

The ministry of health is actively embracing the concept of methadone clinics, and has ambitious plans to expand the program, due partly to expanding domestic budgets and large grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria and other international donor organizations. With 12 government methadone clinics currently in operation, the Ministry of Health expects to have 34 clinics by the end of June, 100 by the end of 2005, and up to 1,500 clinics opened in the next three years. These clinics have a goal of eventually placing as many as 300,000 addicts on methadone. Preliminary studies conducted by health authorities have found significant decreases in criminal activities among addicts participating in existing methadone programs, providing additional impetus for expansion of the program. Local health bureaus have also recently been instructed to establish “High-risk Population Prevention Work Teams” responsible for managing data collection, reporting, outreach, and intervention efforts focusing on various groups at heightened risk of contracting HIV/AIDS, particularly drug users.

However, in China, as in many other countries, public health and public security authorities frequently approach drug abuse from different perspectives, leading to conflicting approaches at local levels. The crack down and detention of drug users in China reflects inconsistent interpretations of “harm reduction.” Public security officers consider arrest and detention an effective measure for stopping public drug use and reducing the harm associated with it. However, while security officials comment that they support the public health bureaus’ efforts, they stop short of explicitly supporting harm reduction policies themselves. The public security bureau’s “zero tolerance” approach towards drug use presents a challenge to public health officials, particularly when police officers detain drug users in close proximity to methadone and needle-exchange clinics or follow outreach health workers to neighborhoods where clean needles are distributed, thereby undermining the “open” environment that harm reduction initiatives require to operate successfully. This dilemma is by no means unique to China.

The public health effort that is now being pursued in China to contend with HIV/AIDS is changing the context in which the government addresses drug abusers and engages citizens outside of mainstream society. The ministry of health recognizes these challenges and is increasingly advocating for civil society to play a role in reaching out to marginalized groups, such as drug users and others engaged in illegal activities that pose a public health threat, including commercial sex workers. This presents a unique opportunity for NGOs to expand their very limited role in China. International experience in harm reduction and drug control are already regularly shared between Chinese public health doctors and police with their global counterparts.

As anti-drug efforts intersect with the HIV/AIDS control agenda, the nexus can potentially lead to greater provision of comprehensive drug addiction treatment and temper uncompromising approaches towards drug users and harm reduction within the security and justice apparatuses. The threat of an HIV/AIDS epidemic has made the government and the public more sensitive to the issues of intravenous drug use. Preventing and harm reduction may ultimately require more services to both rural and urban drug users, as well as inmates within the detention system, including treatment, counseling, education, and even skills training to help drug abusers reintegrate into society upon their release. The urgency with which the Chinese government is addressing HIV/AIDS raises the potential for international or multisectoral cooperation within the detention system which would likely lead to incremental reforms and increased transparency.

Notes:

1. Vice Minister of Public Security Luo Feng’s Press Briefing during the 10th National People’s Congress, March 1, 2004. Transcript distributed by the State Council Information Office, www.china.org.cn.

2. “More than 70% of drug addicts are youths under 35,” People’s Daily, February 13, 2004.

3. “Myanmar Strategic Programme Framework,” United Nations Office on Drugs and Crime, November 2, 2004. page 1.

4. “Last Year’s Anti-drug Achievements,” State Council Information Center (www.China.org.cn), May 27, 2005.

5. Interview with Beijing-based expert in public health and government HIV/AIDS programs, May 9, 2005.

6. “China has 740,000 drug addicts: police,” People’s Daily, June 21, 2004.

7. Ministry of Health Statistics, 2005.

8. China’s State Council AIDS Working Committee and United Nations Theme Group on HIV/AIDS in China, A Joint Assessment, December 1, 2004.