Andrew Byrne's trip to China Nov 05. Eye-opening activity and impressive progress.
Although largely on a private visit, I was invited to visit a harm reduction centre in Beijing as well as spending some time with an American public health consultant who works for both Chinese and foreign NGO's. I was also able to interview one of the first methadone patients in China and view a harm reduction centre.
On a related subject, last Friday's English language China Daily had two articles on the HIV problems in Henan province, Central China (pages 1&5). Despite quoting figures of affected local citizens in one small region (29,000 'carriers' and 16,000 with AIDS), neither addressed any continuing problem, reporting nothing but good news. They stated that 100% of the farmers who had donated blood in the past had been tested for HIV and that those who were positive were receiving anti-viral treatments paid for by the government. There was also another 'good news' story describing a mayoral official who was 'moved to tears' watching an operatic performance based on "the story of an HIV carrier that went from being in despair after suffering discrimination to regaining confidence with the support of neighbours, official and health workers" in Zhumadian city, Henan province.
It is disappointing but perhaps predictable that the People's Republic of China is still not prepared to be open about injecting drug use and homosexual transmission of HIV. To read their reports in the weekend official press one would think that the HIV problem had been solved! Yet WHO reports show otherwise and Koffe Annan himself was present when the first Beijing harm reduction centre was opened, along with high ranking Chinese officials. Nevertheless, it is clear that this sovereign country must address these matters in a manner which is effective, socially acceptable and sustainable - hence my own outsider's observations remain very much tentative.
My host and I were given a presentation by the manager of the first harm reduction centre in Beijing near one of the main trunk railway stations. They do most of their education and other work by use of outreach workers since people are very reluctant to attend in person. China is still a highly policed state (I saw three separate seemingly banal situations over two weeks where people were apparently apprehended, searched and detained).
The harm reduction centre has over a dozen education brochures on various related topics from the simple in cartoon style (which is very popular in China) to the more detailed on health issues. Needles and syringes were given out in lots of approximately 6 although more were permitted if old needles are returned. Some may be re-sold in what Americans term 'secondary needle services'. This is likely to extend the usefulness of the service in a society where there is a very major stigma and sanctions attached to drug use. Initially the centre was only distributing a few dozen syringes per day but this has risen dramatically in recent months to numbers in the hundreds per day.
We were told that since opening in May this year the centre had performed about 50 blood tests on injecting drug users. Of these about 6 were positive for HIV and 3 had AIDS clinically. Another 50-70% were positive for hepatitis C virus. We were told that at any hour of the day or night one could see dozens of injecting drugs users at one of the large railway stations in the capital.
The methadone patient who I interviewed appeared to be receiving high quality treatment. He drank his medicine under supervision on a daily basis after having a comprehensive assessment with on-going counselling. His dose had been increased to 90mg already, but a higher dose of up to 120mg was discussed. Following careful negotiation involving his case worker, as a result of his good progress his dose remained at 90mg daily. This is close to the average dose found in most well run treatment services. The patient appeared to be coping well with treatment. He was open and frank with his descriptions (via my host, who interpreted from the Pu-tong-hua or Mandarin, a language which every Australian child should be taught these days). The patient had pathology testing promptly and regularly (details unclear) and stated that he was satisfied with his treatment. Indeed, he said that he was delighted to be able to avoid heroin at last after a long drug use history with frequent relapses. I was intrigued to find out that the methadone treatment service was overseen by the police department (who also run the compulsory detoxification services in China).
Despite an apparent slowness to respond to some public health issues, it is clear that the 'new China' is moving ahead rapidly in many other respects. It is only a matter of time, I believe, before public health measures are put in place to address the above matters, considering the long history this country has of communal action for community needs. The Chinese have a strong historical record . starting with dams, bridges, 'walls' and other major works by successive dynasties. Already there are signs that pollution is being addressed (two of the days I was in Beijing were crystal clear with some haze, mist and possibly smog on others). The capital's tap water looks, smells and tastes pure, although we were advised to drink bottled water. Drainage is improving and even public conveniences around the city, while variable, are mostly clean and hygienic from what I saw in Beijing and Shanghai.
It has been a privilege to spend 2 weeks in China. I look forward to more news of this power-house society which has so much to offer (and gain from) the rest of the world. We also look forward to news on the 'second methadone clinic' and beyond (see Rachel Humeniuk and Robert Ali's article 'The first methadone clinic in Beijing' D&A Review, May 2005 issue).
