Transcript China Thailand RPA - Temple University

Background
The National Institutes of Health has funded
HPTN 058: A Phase III randomized
controlled trial to evaluate the efficacy of
drug treatment in prevention of HIV infection
among opiate dependent injectors (“the 058
Trial”). The trial will be conducted at Heng
Chien, Guangxi Zhuang Autonomous
Region, Urumqi, Xinjiang Uighur
Autonomous Region of China and Chiang
Mai, Thailand. Recognizing the potential for
injection drug users (IDUs) to be exposed to
excess risk of arrest or other negative legal
consequences by virtue of their participation
in the research study, the HPTN 058
protocol requires the annual monitoring of
law and its implementation related to IDUs
participating in the trial. To assess the risks
to IDUs of participating in the clinical trial,
the HPTN 058 Protocol Team commissioned
this report.
Research Procedures
Laws related to possible research risk were
collected and analyzed by a qualified
Chinese lawyer using standard legal
research methods. National and local laws
were collected in nine domains: drug use
(including drug control laws, syringe laws,
needle exchange programs and drug
treatment); HIV-specific criminal exposure or
transmission; criminal justice/procedure;
right to health care and right to HIV
treatment; reportability of HIV, AIDS, and
STDs; HIV testing laws; privacy of medical
information; anti-discrimination provisions,
and any other laws that influence risk or
stigma among drug users in a significant
way.
Research Procedures
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The qualitative research team was trained
on the applicable law and research
procedures prior to conducting interviews.
The researchers identified and recruited 44
key informants at each of the two study
sites. The research protocol was reviewed
and approved by the applicable Institutional
Review Boards at Temple University and the
China Centers for Disease Control.
The RPA identifies three types of key
informants:
1) systems participants who have a good overall
view of police/health/drug systems which may
impact on the transmission of HIV among IDUs;
2) interactor participants who interact with IDUs on a
day to day basis and are able to provide
information about how each system works at a
practical level; and
3) IDU participants who describe their daily
interaction with law enforcement, as well as the
legal, public health, and drug treatment systems
with which they interact.
IDU Interview Subjects
(n=32)
Heng
Chien
Urumqi
Total
Gender
Male
Female
Ethnicity
Han
Minority
Living Area
Rural
15
1
12
4
27
5
15
1
2
14
17
15
16
0
16
Urban
0
16
16
Systems and Interactor
Interview Subjects (n= 56
Legal Systems
Prison official
Judge
Prosecutor
Policy-maker or local authorities
Legal Interactors
Police: Supervisory
Police: Street-level
Prison guards
Public Health Systems
Public health authorities
Drug treatment facilities: officials
Director of NGO working with HIV
Harm reduction director
1
1
1
1
2
2
2
1
1
1
1
Systems and Interactor
Interview Subjects (n= 56)
Public Health Interactors
Public health clinicians
2
Emergency ward physicians
2
Harm reduction workers
2
Drug treatment facilities: staff
2
NGO staff working in HIV
2
Research System and Interactors
People with > 6 months
3
experience staffing an IDU
research project
Investigators operating an IDU
1
research project
TOTAL (per site)
28
Specific Aims
1) To use RPA tools to document laws and
law enforcement practices in Heng
Chien, Guangxi Autonomous Region and
Urumqi, Xinjiang Uighur Autonomous
Region that may increase risks faced by
the injection drug user participating in the
058 Trial;
2) To compile and deliver to the 058 Trial
protocol team and other stakeholders a
comprehensive risk analysis based upon
the findings of the RPA that clearly
indicates any evidence of elevated risk to
participants that may result from their
screening and enrollment in the study;
3) To recommend to the protocol team
strategies to reduce or eliminate possible
law and enforcement related risks posed
by study screening and enrollment
procedures.
Law on the Books
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Drug possession, distribution and
production are subject to serious
punishment including the death penalty.
 As to drug users, the law prescribes
detention for no more than 15 days a
fine of less than 2000 RMB.
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Besides these penalties, the drug user
could be sent to a detoxification center for 3
to 6 months’ treatment. If he/she is found to
have relapsed after detoxification, he/she
could be sent to a reeducation camp for up
to 3 years’ rehabilitation labor.
Individual drug use/ possession of small
amounts is often handled under the
Security Administrative Punishment
Regulations, a set of general powers
exercised by the public security organs to
respond to breaches of public order
deemed too minor for criminal punishment.[
Compulsory Registration
and Treatment
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Drug users who are identified by the
police are subject to registration, and
may be entered into treatment or reeducation through an administrative
process.
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The “treatment,” which in many if not most
cases can include cold-turkey
detoxification, lasts between three months
and one year. People in treatment facilities
are expected to work. In theory they are
entitled to a wage but in practice their
“earnings” typically go to paying the costs
of their confinement.
Drug users who repeatedly relapse
graduate to another sort of administrative
rehabilitation facility, the Education through
Labor camp. Several hundred thousand
Chinese are confined in these facilities,
about a third of whom are drug users.
Findings: A public health
research project involving IDUs
cannot operate without the
cooperation of the police.

“We have a county-level AIDS
Working Committee which involves
Public Health, Public Security,
Education, and many other
departments. It is a multi-sectoral
coordinating committee on AIDS. In
the committee, only the Public
Security Department is the one with
which we keep very close touch. It
is impossible for us to initiate a
program involving IDUs without
sufficient communication with local
police in advance.” (Public Health
Department Official in Heng Chien)
Findings: A public health
research project involving IDUs
cannot operate without the
cooperation of the police.
“It would be too late for you to coordinate
with local police after their law
enforcement activities have had
negative impacts on you program.
Actually, we had been negotiating with
the police station long before the
initiation of our program.” (Communitybased syringe exchange program
administrator)
 “Whether or not we will go to program
sites to arrest IDUs [for confinement in
a detoxification center] depends on our
director’s attitude. If he tells us nothing
specifically about it, we will. ” (Street
level police officer in Heng Chien)
Findings: if there is cooperation
with police, the chance of
interference at the research site
is low
 Clients
were occasionally arrested
at methadone clinics and SEPs:

“Someone reported to the police that
there were drug dealers at the site.
Then the police went to the site and
arrested the peer educator. The
epidemic prevention station officials
negotiated with the police. After three
days incarceration, the educator was
released. From then on, police never
arrest IDUs at the sites. ” (IDU-7,
Heng Chien)
Findings: if there is cooperation
with police, the chance of
interference at the research site
is low
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In HPTN 033, there was no interference
at either site.
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“At the very beginning, both the
researchers and the IDUs were afraid that
the police would come to the clinic to arrest
IDUs. But it did not happen.” (Researcher at
Urumqi)
“In the process of HPTN033
implementation, the health sector and
police developed very good relations. At
first the IDUs were afraid of being arrested
by the police at the program site, but it
never happened. ” (Treatment staff member,
Heng Chien)
Findings: street level police
generally do not arrest IDUs
solely for drug use.
 Most
of the time, the IDUs being
detained can trade freedom or
short-term detoxification for
information.

“When we arrest an IDU, we will ask
him from whom he buys drugs; who
else uses drugs, and so on. To avoid
being put in detoxification for a long
time or penalized, the IDU will tell us
what we want to know. This way, we
identify drug dealers.” (Street level
police officer, Heng Chien)
Findings: street level police
generally do not arrest IDUs
solely for drug use.
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“Once you are arrested, the police
will ask who sells drugs to you,
where you get the money, and who
uses drugs with you. If you tell them
nothing, the police will use physical
violence. Nearly all the IDUs being
detained will be cooperative.” (IDU-9,
Urumqi)
“We seldom just arrest IDUs and put
them into the detoxification center.
The most important reason for us to
arrest them is to find out the drug
dealers behind them.” (Street level
police officer, Urumqi)
Findings: street level police
generally do not arrest IDUs
solely for drug use.

Unofficial “fines” are a way for local
police officers to augment their low
incomes.
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
“We have a very low wage and need to
arrest IDUs and penalize them to make
money sometimes.” (Street level police
officer, Heng Chien)
“The police called my parents and asked for
2000 RMB in exchange for my release. My
parents paid the money to them and I was
released. ” (IDU-13, Heng Chien)
“On average, we need to hand over 3,150
RMB in exchange for release or to avoid
arrest. Sometimes, we can bargain with the
police.” (IDU-9, Urumqi)
Findings: street level police
generally do not arrest IDUs
solely for drug use.
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In recent years there has been some
effort by the security authorities to
reduce the occurrence of informal
payments.
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“Formerly, the police would take money
from IDUs in exchange for release or to
avoid arrest. But now, they would not. They
sent all the IDUs being arrested to
detoxification.” (IDU-8, Urumqi)
“Before 2002, the police would take money
from me in exchange for release. But once I
am arrested nowadays, I will be sent to
detoxification center. (IDU-15, Heng Chien)
Findings: some report research
participation is protective against
police action
“A few IDU participants were even
released after being detained because
of injecting or buying drugs.” (Public
health clinician, Urumqi)
 “In October 2005, Heng Chien CDC
began syringe exchange programs in
two villages. The peer educators were
designated by both the police and the
health department. The police officials
promised that they would not arrest
IDUs at the site.” (Researcher, Heng
Chien)

Conclusions
Police vigorously enforce criminal laws and
detain hundreds of thousands of drug users
for involuntary treatment and reeducation
each year. No NGOs operate to support the
health or social status of IDUs. Nonetheless,
in the sites we investigated, research
studies, syringe exchanges and methadone
programs were able to operate with some
degree of freedom from police intrusion or
harassment of participants. Our policy
analysis identifies two key institutional
factors:
1) Public health programs for drug users have
been introduced in China as a top-down
measure, with strong support from the China
CDC and Ministry of Health;
2) At the local level, there were health-oriented
organizations that had sufficient strength
and will to negotiate with police on the
implementation of punitive drug control laws.
the RPAR tools and
training materials
are available on the
world wide web at
http://www.rpar.org.
Copies of the full China
report and other
materials are available at
the RPAR Booth
Acknowledgments
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Legal and qualitative data were collected using tools
adapted by Scott Burris and Corey Davis from the
Rapid Policy Assessment and Response toolkit.
The Rapid Policy Assessment and Response Tools
were initially developed by Scott Burris, Patrica Case
and Zita Lazzarini with the support of the
International Harm Reduction Development Program
of the Open Society Institute, and further refined
under NIDA Grant # 5 R01 DA17002-02, Zita
Lazzarini, Principal Investigator.
Wang Zhengzhi of Globe Law Firm, Beijing, collected
relevant laws and regulations.
Qualitative research was conducted and the resulting
data analyzed by Zhang Youchun, Fu Xiaoxing and
local interviewers in the site cities. Zhang and Fu
drafted the final report, which was edited by Burris
and Davis.
The team thanks Wang Ruotao and David Metzger
for their assistance in organizing and conducting the
research.
Funding was provided by the HPTN through by the
University of Pennsylvania.