Assessing HIV/AIDS Initiatives in China - Center for Strategic and ...

Bates Gill 23
Although the methadone pilot clinics show promise, they face significant challenges.
Drop-out rates are high, frequently because many methadone patients continue to use
opiates (though often at much reduced volumes than pre-methadone enrollment). This
results in the subsequent detention of many methadone patients testing positive for
opiates and the reincarceration of these patients in detox centers, prisons, or labor camps.
Public Security Bureau officers operating detox centers report that inmates coming off
methadone suffer from greater withdrawal symptoms than heroin addicts. Increased
training for methadone clinic operators (as well as greater experience) can potentially
improve their ability to correctly estimate dosage, which can potentially reduce the
addict’s need to supplement their methadone regimen with opiates. Improving interaction
and communication between clinic operators and patients as well as establishing ancillary
services such as counseling, peer-led therapy, and job training, will likely improve the
overall results. In addition, although the fee charged for methadone treatment may seem
nominal, it may be prohibitive to some IDUs, especially those who, because of their
condition, arrest record, and other factors, have a more difficult time securing
employment.
Expanding Voluntary Counseling and Testing (VCT) and Peer Education
HIV testing has significantly increased, recently, in China. As the testing program
expands, a number of counseling and innovative outreach techniques utilizing peer
groups to identify and engage marginalized, high-risk persons have demonstrated some
success.
HIV testing is extensive throughout China and is on the rise. Individuals are tested for
HIV in numerous settings, often without their knowledge, such as when persons apply for
civil service jobs, seek surgical treatment, or wish to deliver a baby in a hospital. Public
health officials are, however, increasingly seeing the value of expanding voluntary
counseling and testing, or VCT. While many health workers sometimes confuse the “c”
for “coercion,” other public health workers are counseling at-risk persons about the
consequences of their behavior with compassion and convincing them to get tested as
part of a prevention and education process. The advent of free ARV therapy enhances
this practice, increasing the willingness of at-risk persons to participate, knowing that
there is accessible treatment available if they need it. As testing expands and more people
know their status, there is growing need for peer support and peer education, both to
support those who are HIV-positive and negative and to reach out, identify, and educate
at-risk people in the community, particularly those who are reluctant to directly engage
with authorities.
The MOH and the Ministry of Finance drafted national VCT guidelines and
regulations in 2004, strengthening the implementation process for free testing set out as
part of the “four frees and one care” policy. The CDC has carried out massive testing
campaigns of high-risk populations, including large cohorts of former plasma donors in
Henan province, IDUs in Yunnan province, and incarcerated populations in prisons and
detoxification centers. Effectively capturing the data generated by testing is extremely
valuable to epidemiologists who track the epidemic and inform policymakers who must
allocate resources and plot strategies to prevent and control the spread of HIV. VCT
testing policies are now widely promoted in bright yellow posters featuring celebrity