Health and Human Rights of Drug Users in Detention in Guangxi Province, China
Joseph Amon Health & Human Rights Division Human Rights Watch Outline
• Background • Methods • Results • Conclusions Background
• 5‐6 million drug users • Roughly half of all HIV infections associated with IDU • RidlRapidly expanddded community‐bdbased methadone • >350,000 drug users detained in detox, RTL – 700 detox centers, 165 re‐education through labor – Rapid expansion from 1995 on Background
• Before 2008 – 1st time offenders: 3‐6 month sentence in detox – Repeat offenders: 1‐3 years in RTL – Detox sentences may not exceed 1 year – Limited due process / oversight • June 2008 – new law – Increased powers to conduct drug search – Eliminates RTL sentences – “compulsory isolation detoxification” • 1‐3 years followed by up to 3 years in community rehabilitation Methods
• July 2007 • Site – Baise, Nanning, Guangxi Province • Legal/Policy review • Key informant interviews – Chinese government and NGOs, HCWs • RlRecently (5(<5 y) diddetained IDU iiinterviews – Notice, referral Methods
• Semi‐structured IDU interviews – IDU experiences in detox, RTL • Living conditions, health status, drug use, access to health care, labor – IDU experiences prior/post detention – IDU knowledge/access to HIV prevention in community • 3 hours • Informed consent, anonymous Results
• 20 key informant interviews • 20 IDUs contacted – 19 eligible • 15 male, 4 flfemale • 8 from Baise, 11 from Nanning – 28 – 45 years – Detained, on average: • 4 times in detox (range: 1 –8 times) • 1 RTL (range: 0 – 3) # times in Last date # times in Last date HIV IDU # detox in detox RELC in RELC status 1. 4 2006 1 2005 + 2. 8 2007 1 2004 + 3. 4 2003 0 -+ 4. 4 2007 1 2003 + 5. 2 2002 1 2006 + 6. 3 2005 1 2001 + 7. 5 2007 2 2003 + 8. 3 2007 1 2004 + 9. 3 2006 1 2000 + 10. 6 2006 2 2001 + 11. 2 2006 1 2005 dk 12. 4 2002 3 2006 dk 13. 3 2004 2 2002 + 14. 4 2003 2 2005 dk 15. 4 2002 2 2005 dk 16. 2 2005 1 2007 dk 17. 1 2006 0 - dk 18. 2 2002 0 - + 19. 2 2006 1 2007 dk Results
• Fear of Arrest – Inability to Access Community Services • Lack of Due Process –Oversight • CdiiConditions in DDietention – Mandatory HIV testing – Little access to health care – Disruption of antiretroviral therapy – HIV and TB infection risk – Physical, sexual abuse and forced labor I really can’t go out in public anymore because if police are trying to fill their quota they will arrest me when they see me.
‐ IDU
Fear of Arrest Everyone who takes methadone is identified by police…IDUs are a prime target for arrest
‐ NGO worker
Fear of Arrest Sometimes IIm’m afraid I might be sick with AIDS but I’d rather be sick and free than go get tested, get arrested, and be sikick in detox or RTL
Fear of Arrest If you get arrested when they have enough people in RTL then you are safe, but if you get arrested at another time, then you can be put into RTL
Due process I was tested in detox twice for HIV, but never told the result. ‐ IDU
Conditions in detox/RTL The CDC does not want to tell people their HIV status when they are imprisoned because they think it would cause unrest. ‐ Government official
Conditions in detox/RTL They say that detox and RTL are for quitting drugs, but it is no different from a prison. You work like a slave and dd’ton’t have access to treatment.
Conditions in detox/RTL I had no access to HIV medicines while I was in detox and then when I left I had TB…People are always sicker when they leave than they were coming in.
Conditions in detox/RTL In RTL or detox, if you are there long enough you find drugs. In RTL we would have 300 people shiharing one needle.
Conditions in detox/RTL I started taking ARV bfbefore I was put into detox. Then when I was in I had to stop.
Conditions in detox/RTL This place is hell. We are supposed to be there for quitting drugs but instead we work like we are slaves and then get beat up. We leave detox and eventually if we don’ t die, we get arrested again, and have to go through it again.
Conditions in detox/RTL Human Rights Violations
• Lack of judicial oversight • Right to the highest attainable standard of health – the ffilailure to provide adequate medica l care and HIV/TB prevention • Right to absolute protection against torture and cruel, ihinhuman, or ddidegrading treatment or punishment – forced labor – physical/sexual abuse – The UN Special Rapporteur on Torture has stated that RTL centers can “be considered a form of inhuman or degrading treatment or punishment, if not mental torture” The purpose of the detox center is really just disciplinary, it's not to give people medical care.
‐ Physician working at detox center, Nanning