How civil society can influence national drug policy

By Thomas Cai

Thomas Cai is a Programme Advisor at AIDS Care China.

New HIV infections among people who inject drugs have increased by a staggering one third, from 114,000 in 2011 to 152,000 in 2015. Supporting people with harm reduction services such as methadone programmes and providing clean injecting equipment helps keep individuals safer and curbs new infections.

While many governments are reluctant to support harm reduction approaches (as was evident in the disappointing outcome of UNGASS 2016), events like the recent Commission on Narcotic Drugs (CND) present important opportunities for civil society to influence governments to put international agreements around drug policy into practice.

On 12-17 March, I represented AIDS Care China at the 60th session of the CND in Vienna, where drug control agencies from all over the world meet to discuss drug policy. At a side event organised by the Alliance in partnership with Aidsfonds, International Drug Policy Consortium and Harm Reduction International, I presented AIDS Care China’s experiences of working with local governments in Yunnan and Hubei provinces to pilot and promote community-based drug treatment and harm reduction service models.

Registration at an IDU drop in centre, Emei

Registration at a drop in centre for people who inject drugs, in Emei, China. ©International HIV/AIDS Alliance

Piloting community-based drug treatment

In partnership with the local health and law enforcement authorities, we piloted two community-based drug treatment centres to which people who are arrested by the police can be referred. These voluntary treatment centres provide access to methadone maintenance therapy (MMT), support for treatment adherence and support to manage their daily lives. These centres are effective, holistic and human rights based alternatives to the standard compulsory drug rehabilitation centres.

Take-home methadone and community-based drug dependency treatment services are now available to more than 400 people who use drugs in Yunnan and Hubei provinces. Yunnan authorities are developing guidelines to roll out take-home MMT services to the entire province, and the peer-driven intervention model piloted by AIDS Care China is now being funded by the government and rolled out more widely.

These interventions have contributed to the fact that, in Yunnan province, over 25% of the people on anti-retroviral therapy (ART) are people who use drugs, and 94% of those on ART have achieved viral load suppression. Because of this high rate of viral load suppression, and improved quality of MMT services, new HIV infections among people who use drugs and access harm reduction services dropped by 88% from 1.19% in 2008 to 0.14% in 2016.

Taking services to scale

The impact of the pilot will be limited unless it is scaled up by the Chinese government to reach a larger share of the 2 million people who inject drugs in China. Despite the new drug control law decriminalising drug use and encouraging community-based drug treatment, compulsory drug detoxification centres (where people are incarcerated for years) are still the norm. Because these centres do not offer adequate support for people to stay off drugs, the proportion of people who relapse into drug use after they are released is high.

However, there have been some recent successes on a national level. Through my participation in international meetings such as CND and others organised by UNODC, I had the chance to meet and engage with national government officials responsible for drug control and treatment. I shared the results from our pilots and discussed the possibility of replicating the models nationally, triggering invites to further discussions with national government officials. Our community-based drug treatment model is now recommended in the draft national drug treatment strategy.

Opportunities to engage

Harm reduction services in China are, as in many other countries, provided within the framework of drug control strategy and practice. Platforms like CND and UNGASS are therefore important opportunities for harm reduction advocates to engage and influence international and national drug policies.

This year’s CND was particularly important because it was the first one after UNGASS 2016, where the outcome document included, for the first time ever, language around public health and treatment-oriented approaches to combat drug use problems.

Engaging with drug control and law enforcement agencies can seem daunting to civil society organisations who are used to working primarily with health authorities, but experience shows that we can carve out a space for ourselves in such events, and that it can yield important results.

Disappointingly, the Chinese delegation to UNGASS in 2016 was among those who objected to the term ‘harm reduction’ being mentioned in the final outcome document. The foreign affairs officials who make up the national delegations to these international events are often not aware of developments in the health sector, and do not adequately represent the part of their government that is already embracing harm reduction approaches. It is our role as civil society to demonstrate that harm reduction and drug control objectives can be achieved in other ways than compulsory rehabilitation.

I hope that in the key events over the next years, the Chinese delegation to the 61st and 62nd CND sessions and UNGASS 2019 will talk more proudly about their successes in harm reduction and drug treatment. This could help influence other governments to adopt evidenced-based drug control policies and assume a more progressive approach to harm reduction services for people who use drugs.