Suchergebnisse

China's state-run methadone maintenance treatment (MMT) program was launched in 2003 in response to the growing HIV/AIDS epidemic and increasing criticism of compulsory rehabilitation centers. In conjunction with providing methadone replacement therapy, the Chinese state began promoting a politicized discourse of guān'ài 关爱 (care and love) as a more effective and humane method for dealing with drug users. While the medicalization of addiction as a chronic brain disease requiring long-term pharmaceutical treatment marked a watershed moment in the debate over drug control in China, the affective recasting of addiction as a social condition worthy of care is potentially even more revolutionary. But to what extent has this project transformed Chinese drug users into a legitimate target of (state) care? Based on ethnographic fieldwork conducted in Yunnan province from 2013 to 2019, we examine how various stakeholders in China's MMT program (including methadone recipients, clinicians, public health officials, police officers, and the general public) have attempted to translate the discourse of guān'ài into workable practices and relationships based on divergent understandings of how to care for and about Chinese drug users. Our analysis shows how attending to the everyday dynamics of guān'ài in the People's War on Drugs provides a novel approach to theorizing the fraught politics of care.

IntroductionWorldwide, people who use drugs (PWUD) are among the populations at highest risk for HIV infection. In China, PWUD are primarily sentenced to compulsory detainment centres, in which access to healthcare, including HIV treatment and prevention services, is limited or non‐existent. In 2008, China's 2008 Anti‐Drug Law encouraged the development and use of community‐based drug dependence rehabilitation, yet there is limited evidence evaluating the efficacy and challenges of this model in China. In this study, we explore these challenges and describe how cooperation between law enforcement and health departments can meet the needs of PWUD.MethodsIn 2015, we conducted semi‐structured, in‐depth interviews with all four staff members and 16 clients of the Ping An Centre No. 1 for community‐based drug treatment, three local police officers and three officials from the local Centre for Disease Control. Interviews explored obstacles in implementing community‐based drug dependence treatment and efforts to resolve these difficulties. Transcripts were coded and analyzed with qualitative data analysis software (MAXQDA 11).ResultsWe identified three challenges to community‐based drug treatment at the Ping An Centre No. 1: (1) suboptimal coordination among parties involved, (2) a divergence in attitudes towards PWUD and harm reduction between law enforcement and health officials and (3) conflicting performance targets for police and health officials that undermine the shared goal of treatment. We also identified the take‐home methadone maintenance treatment model at the Ping An Centre No. 1 as an example of an early successful collaboration between the police, the health department and PWUD.ConclusionsTo overcome barriers to effective community‐based drug treatment, we recommend aligning the goals of law enforcement and public health agencies towards health‐based performance indicators. Furthermore, tensions between PWUD and police need to be addressed and trust between them fostered, using community‐based treatment centres as mediators. The preliminary success of the take‐home methadone maintenance treatment pilot can serve as an example of how collaboration with the police and other government agencies can meet the needs of PWUD and contribute to the success of community‐based treatment.