Health and human rights concerns of drug users in detention in Guangxi Province, China.
Health and human rights concerns of drug users in detention in Guangxi Province, China.
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DOI：
10.1371/journal.pmed.0050234
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发表时间：
2008-12-09
期刊：
影响因子：
15.8
通讯作者：
Amon JJ
中科院分区：
文献类型：
--
作者：
Cohen JE;Amon JJ
尽管戒毒所和劳教所是中国最常见的药物依赖治疗形式，但有关吸毒者在此类环境中的经历的报道却很少。我们评估了拘留对吸毒者获得艾滋病毒预防和治疗服务的影响以及由此对基本人权保护造成的威胁。审查了中国政府的艾滋病毒和禁毒立法和政策文件，并对广西省南宁市和百色市的 19 名注射吸毒者 (IDU) 和 20 名政府和非政府组织官员进行了深入和关键的知情人访谈。艾滋病毒和禁毒政策存在重大矛盾，例如社区美沙酮维持治疗的同时扩大和戒毒所和劳教中心拘留的吸毒者人数不断增加。 IDU 研究参与者报告称，平均吸毒时间为 14 年（范围为 8-23 年），并被限制戒毒四次（范围为 1 至 8 次）和劳教中心一次（范围为 0 至 3 次）。无论目前吸毒情况如何，吸毒者都表示强烈担心被警察认出并被拘留。主要知情人和注射吸毒者报告说，在未经同意和不披露结果的情况下进行常规艾滋病毒检测是戒毒所和劳动教养中心设施的标准政策，并且感染艾滋病毒的被拘留者没有定期获得医疗或药物依赖治疗，包括抗逆转录病毒治疗。注射吸毒者很少或根本没有获得艾滋病毒预防的信息或手段，但报告了在拘留期间存在大量传播艾滋病毒的危险行为。法律和政策审查以及对中国广西省最近被拘留的吸毒者和主要线人的采访发现，禁毒政策和做法似乎侵犯人权并危害吸毒者健康的证据。伊丽莎白·科恩和约瑟夫·阿蒙根据对中国政府立法和政策文件的审查，并通过对最近被拘留的注射吸毒者和广西省官员的采访，发现了可能损害吸毒者健康和人权的禁毒政策和做法的证据。自从艾滋病（获得性免疫缺陷综合症）流行以来，注射吸毒者（IDU）共用针头一直是人类免疫缺陷病毒（HIV）（一种导致艾滋病的血源性病毒）的主要传播途径。例如，在中国，艾滋病的流行始于1989年，当时在云南西南部发现了146名艾滋病毒呈阳性的注射吸毒者。到1998年，中国各地都有艾滋病毒感染报告，其中60%～70%是注射吸毒者。目前，中国近一半的新发艾滋病毒感染者与注射吸毒有关，中国70万艾滋病病毒感染者中，有26.6万人是吸毒者。面对这些数字，中国政府最近采取了措施，减少中国约 3-400 万注射吸毒者中艾滋病毒的传播。这些措施包括增加美沙酮维持治疗诊所和针具交换的提供，以及制定针对注射吸毒者的艾滋病毒预防计划。除了这些进步的公共卫生实践之外，中国还制定了极其严厉的禁毒政策。注射吸毒者通常会在未经法律审查的情况下被关进戒毒中心或被送往劳动教养中心，有时会关押多年。 2005年，这些中心收容了超过35万名吸毒者，但人们对这些中心的条件以及中国的禁毒政策如何影响人权或获得艾滋病毒预防和治疗服务的情况知之甚少。在这项研究中，研究人员通过采访注射吸毒者和“关键知情人”（为注射吸毒者提供服务的政府官员和非政府组织[NGO]成员）了解他们在中国广西省两个城市的戒毒中心和劳教中心的经历来调查这些问题。研究人员招募了19名最近被关押在戒毒所或劳教所的吸毒者和20名关键知情人（包括一名戒毒所医生和一名前劳教所警卫）。在访谈中，研究人员使用半结构化问卷询问参与者在戒毒所和劳教所的经历。所有注射吸毒者都报告说，他们在拘留期间多次接受艾滋病毒检测，但即使他们要求，也从未给出检测结果。主要知情人证实，戒毒所和劳教所目前的政策是重复进行艾滋病病毒检测而不公开结果。所有注射吸毒者都对拘留期间无法获得足够的医疗服务表示担忧。特别是，大多数在拘留前服用抗逆转录病毒药物的吸毒者在拘留期间无法继续接受治疗，尽管有两人通过与看守协商获得了抗逆转录病毒药物。吸毒者和主要举报人还指出，戒毒所和劳教所提供的艾滋病毒预防信息和手段很少，而且这两类中心都存在注射吸毒和不安全性行为等与艾滋病毒相关的危险行为。最后，注射吸毒者报告说，即使没有吸毒，他们也害怕被警察认出并被拘留，这使得他们不敢寻求艾滋病毒检测、艾滋病毒治疗和戒除毒瘾的帮助。除了规模小之外，这项研究还存在一些局限性。例如，由于注射吸毒者是自我选择的——他们回复询问是否接受采访的海报——他们的观点可能不能代表所有注射吸毒者。同样，接受采访的关键知情人可能与选择不参与的人有不同的看法。此外，这里报告的结果不能推广到中国其他地区。然而，注射吸毒者报告并得到主要知情人证实的一致经历表明，中国的禁毒政策和做法侵犯了注射吸毒者的人权，使他们难以获得艾滋病毒预防和治疗或充分的毒瘾治疗，从而危及他们的健康。这种情况如果不加以补救，可能会危及中国控制艾滋病毒流行的努力。请通过此摘要的在线版本访问这些网站：http://dx.doi.org/10.1371/journal.pmed.0050234。国际艾滋病慈善机构 Steve Koester Avert 在 PLoS Medicine Perspective 中进一步讨论了这项研究，提供了有关艾滋病毒/艾滋病各个方面的信息，包括中国的艾滋病毒和艾滋病以及艾滋病毒预防、减少危害和注射吸毒。联合国艾滋病规划署 2008 年国家进展报告提供了有关中国艾滋病情况的最新详细信息。 HIVInSite 提供了有关中国艾滋病毒/艾滋病的更多信息的链接。人权观察致力于中国的健康和人权以及人权发展 美国国家药物滥用研究所提供了一本题为《毒瘾治疗原则：基于研究的指南》的小册子（英文和西班牙文） 联合国毒品和犯罪问题办公室提供了有关监狱中艾滋病毒/艾滋病的信息
Although confinement in drug detoxification (“detox”) and re-education through labor (RTL) centers is the most common form of treatment for drug dependence in China, little has been published about the experience of drug users in such settings. We conducted an assessment of the impact of detention on drug users' access to HIV prevention and treatment services and consequent threats to fundamental human rights protections. Chinese government HIV and anti-narcotics legislation and policy documents were reviewed, and in-depth and key informant interviews were conducted with 19 injection drug users (IDUs) and 20 government and nongovernmental organization officials in Nanning and Baise, Guangxi Province. Significant contradictions were found in HIV and antinarcotics policies, exemplified by the simultaneous expansion of community-based methadone maintenance therapy and the increasing number of drug users detained in detox and RTL center facilities. IDU study participants reported, on average, having used drugs for 14 y (range 8–23 y) and had been confined to detox four times (range one to eight times) and to RTL centers once (range zero to three times). IDUs expressed an intense fear of being recognized by the police and being detained, regardless of current drug use. Key informants and IDUs reported that routine HIV testing, without consent and without disclosure of the result, was the standard policy of detox and RTL center facilities, and that HIV-infected detainees were not routinely provided medical or drug dependency treatment, including antiretroviral therapy. IDUs received little or no information or means of HIV prevention, but reported numerous risk behaviors for HIV transmission while detained. Legal and policy review, and interviews with recently detained IDUs and key informants in Guangxi Province, China, found evidence of anti-narcotics policies and practices that appear to violate human rights and imperil drug users' health. Based on their review of Chinese government legislation and policy documents, and using interviews with recently detained injection drug users and officials in Guangxi Province, Elizabeth Cohen and Joseph Amon find evidence of antinarcotics policies and practices that may compromise the health and human rights of drug users. Ever since the AIDS (acquired immunodeficiency syndrome) epidemic began, needle sharing by injection drug users (IDUs) has been a major transmission route for the human immunodeficiency virus (HIV), the blood-borne virus that causes AIDS. In China, for example, the AIDS epidemic began in earnest in 1989 when 146 HIV-positive IDUs were identified in Southwest Yunnan. By 1998, HIV infections had been reported throughout China, 60%–70% of which were in IDUs. These days, nearly half of new HIV infections in China are associated with injection drug use and 266,000 of the 700,000 HIV-positive people in China are drug users. Faced with these figures, the Chinese government has recently introduced measures to reduce HIV transmission among the estimated 3–4 million IDUs in China. These measures include increased provision of methadone maintenance treatment clinics and needle exchanges and the establishment of HIV prevention programs that target IDUs. Alongside these progressive public-health practices, China has extremely punitive anti-narcotics policies. IDUs are routinely confined without legal review in drug detoxification centers or sent to re-education through labor (RTL) centers, sometimes for many years. In 2005, these centers housed more than 350,000 drug users yet little is known about the conditions in these centers or how the Chinese anti-narcotic policy affects human rights or access to HIV prevention and treatment services. In this study, the researchers investigated these issues by interviewing IDUs and “key informants” (government officials and members of nongovernmental organizations [NGOs] who provide services to IDUs) about their experiences of detoxification centers and RTL centers in two cities in Guangxi Province, China. The researchers recruited 19 IDUs who had been recently confined in a detoxification center or RTL center and 20 key informants (including a doctor at a detoxification center and a former RTL center guard). In the interviews the researchers used a semi-structured questionnaire to ask the participants about their experiences of detoxification centers and RTL centers. All the IDUs reported that they were repeatedly tested for HIV while in detention but never given their test results even when they asked for them. Key informants confirmed that repeated HIV testing without result disclosure is the current policy in detoxification centers and RTL centers. All the IDUs expressed concerns about inadequate access to health care in detention. In particular, most of the IDUs who were taking antiretroviral drugs before detention were unable to continue their treatment during detention, although two received antiretroviral drugs by negotiating with their guards. The IDUs and key informants also both noted that very little information or means of HIV prevention was provided in the detoxification centers and RTL centers and that HIV-related risk behaviors, including injection drug use and unsafe sex, occurred in both types of center. Finally, the IDUs reported that their fear of being recognized by the police and detained even if not taking drugs prevented them from seeking HIV tests, HIV treatment, and help for their drug addiction. This study has several limitations in addition to its small size. For example, because the IDUs were self selected—they responded to posters asking if they would be interviewed—their views may not be representative of all IDUs. Similarly, the key informants who were interviewed might have had different opinions from those who chose not to participate. Furthermore, the results reported here cannot be generalized to other areas of China. Nevertheless, the consistent experiences reported by the IDUs and confirmed by the key informants suggest that China's anti-narcotic policies and practices violate the human rights of IDUs and put their health in danger by making it hard for them to access HIV prevention and treatment or adequate treatment for their drug addiction. This situation, if not remedied, is likely to jeopardize China's attempts to control its HIV epidemic. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0050234. This study is further discussed in a PLoS Medicine Perspective by Steve Koester Avert, an international AIDS charity, provides information on all aspects of HIV/AIDS, including HIV and AIDS in China and HIV prevention, harm reduction, and injecting drug use The UNAIDS 2008 Country Progress Report provides up-to-date details about the AIDS situation in China HIVInSite provides links to more information about HIV/AIDS in China. Human Rights Watch works on health and human rights and human rights developments in China The US National Institute on Drug Abuse provides a booklet entitled Principles of Drug Addiction Treatment: A Research Based Guide (in English and Spanish) UN Office on Drugs and Crime has information on HIV/AIDS in prisons
影响因子：
168.9
作者：
Schottenfeld, Richard S.;Chawarski, Marek C.;Mazlan, Mahmud
通讯作者：
Mazlan, Mahmud
影响因子：
4.4
作者：
Hammett, TM;Bartlett, NA;Des Jarlais, DC
通讯作者：
Des Jarlais, DC
影响因子：
4.2
作者：
Liu, Hongjie;Grusky, Oscar;Li, Xiaojing
通讯作者：
Li, Xiaojing