The following is an excerpt from an ANCD report:
The People’s Republic of China, a communist state, is the most populous country in the world with a population of 1.34 billion in 2008. The capital, Beijing, has a population of more than 17 million. China is a signatory to the IDADIN.
Amphetamine-type stimulant use
Heroin remains the primary drug of concern in China but amphetamine-type stimulants, both pills and crystal, have recently taken over from opium as the second most frequently used drug in China (United Nations Office on Drugs and Crime, 2010b). Furthermore there has been an annual increase in recorded use of crystal and pills between 2003 and 2007. In 2009 there were more than 1.3 million registered drug users, of which an estimated 27 per cent were ATS users (United Nations Office on Drugs and Crime, 2010b). More than 97 000 of these were newly registered in 2009 (China National Narcotics Control Commission, 2010). The Chinese Government recognises that this number is likely to be an under-estimate of the number of drug users in the country. Other estimates put the number of drug users as high as 6–8 million (Devaney, Reid & Baldwin, 2006). Crystal methamphetamine is commonly inhaled or smoked (United Nations Office on Drugs and Crime, 2010b).
Injecting drug use
The number of injecting drug users in China is estimated to be 2.3 million (mid-range estimate), although other estimates are somewhat higher at 2.35 million current PWID (Mathers et al., 2008). The injection of ATS is known to occur but remains difficult to assess. In 2006 the National Surveillance Centre on Drug Abuse suggested 11 per cent of ATS users were injecting (United Nations Office on Drugs and Crime, 2010b).
Manufacture and trafficking of amphetamine-type stimulants
Following law enforcement initiatives implemented in 2009 significant seizures of precursor chemicals and precursor manufacturing centres have occurred. More than 40 metric tonnes of ephedrine-containing compounds and more than 400kg of ephedrine were seized across 21 provinces (United Nations Office on Drugs and Crime, 2010b). Crystal methamphetamine used in China is primarily manufactured domestically. However, an increasing number of ATS pills are being brought into China from Myanmar. The pills are thought to enter China by land into Yunnan province (United Nations Office on Drugs and Crime, 2010b).
Drug seizures
More than 40 million ATS pills were seized during 2009, more than six times the number seized in the previous year. Seizures of crystal methamphetamine remained stable between 2005 and 2008 but fell by 50 per cent between 2008 and 2009 (5523kg in 2008 and 2518kg in 2009) (United Nations Office on Drugs and Crime, 2010b).
Drug-related arrests
China does not disaggregate drug arrests by the type of drug for which an arrest occurred. Overall, more than 90 000 drug-related arrests were made during 2009, an increase of 20 per cent on the previous year (United Nations Office on Drugs and Crime, 2010b).
Drug treatment
During 2009, 47 000 drug users entered community drug treatment centres and 173 000 were detained in compulsory drug detoxification centres. However, a classification of drug user by drug type was not reported (United Nations Office on Drugs and Crime, 2010b). China has more than 700 compulsory rehabilitation centres and 300 re-education through labour camps and, in 2006, 300 000 drug users were being held across 746 compulsory drug treatment centres (World Health Organization, 2010b).
HIV in the community and among injecting drug users
Population prevalence of HIV in China is in the region of 0.06 per cent and in 2009 there were an estimated 740 000 cumulative cases of HIV and 48 000 new diagnoses of HIV (Wang et al., 2010). According to sentinel surveillance data, an estimated 9.3 per cent of PWID were infected with HIV (China Ministry of Health, 2010). However, in some Chinese provinces the prevalence is reportedly more than 50 per cent (Yunnan, Xinjiang, Sichuan, Guangxi, Guizhou and Guangdong). This report further suggests that HIV among PWID, sex workers, STI clients and pregnant women is stabilising while that among MSM is rising. In large and medium cities the prevalence among MSM is in the region of 5 per cent while, in main cities in the south-west of China, prevalence among MSM is 10 per cent or more. This study estimates 15 per cent of HIV cases are the result of homosexual sexual contact (Wang et al., 2010). Overall the majority (59%) of HIV infections are reported to be sexually transmitted, 44 per cent heterosexual and 15 per cent homosexual (Wang et al., 2010).
HIV testing
The 2009 National HIV Sentinel Surveillance indicated that 36 per cent of sex workers, 45 per cent of MSM, and 37 per cent of PWID surveyed had participated in HIV testing and reportedly knew the results (China Ministry of Health, 2010).
HIV and anti-retroviral treatment
Anti-retroviral treatment is available free in China. No figures on ART availability for PWID were available, although ART is linked to OST clinics and available in some prisons (Mesquita et al., 2008).
Harm reduction
According to the Harm Reduction in Asia report in 2009, needles and syringes are available from 775 sites across 17 provinces. This report puts the average number of needles distributed per PWID per year at 110 in contrast to 2008 data from the Consensus Statement, which put the number at 32 (<1–84) with only 2 per cent of PWID accessing NSP services (Hagarty, 2010). Methadone maintenance treatment programs were first piloted in China in 2004. By 2009, the program had been expanded to more than 680 clinics serving 242 000 heroin users. This program has recently been revised to also include HIV, syphilis and hepatitis C testing and information, psychosocial support and referrals for treatment of HIV and other STIs and tuberculosis (Yin et al., 2010).
HIV prevention education
Sentinel Surveillance surveys in China report that 75 per cent of sex workers, 75 per cent of MSM, and 38 per cent of PWID indicated they had received HIV prevention education during 2009. In addition, major awareness campaigns targeting the general population have been implemented across China (UNAIDS, 2010a).
Hong Kong
Hong Kong is one of two Special Administrative Regions attached to China. With a population of 7.06 million, it is a non-sovereign partial democracy with an unelected executive.
Amphetamine-type stimulant use
In the first three months of 2009, there were close to 12 000 registered drug users in Hong Kong, 1050 of whom were crystal methamphetamine users (United Nations Office on Drugs and Crime, 2010b). This represents 10–15 per cent of all registered drug users. Of users of crystal methamphetamine, 8–9 per cent of all users and 10–15 per cent of registered users reported being under the age of 21 years (Global SMART Program, 2010). The United Nations Office on Drugs and Crime suggests that a lack of nationally representative figures on crystal methamphetamine use in Hong Kong and China remains a major challenge (United Nations Office on Drugs and Crime, 2010b).
Injecting drug use
There was no available information on the rates or numbers of drug users reporting the injection of methamphetamine in either the UNODC Global SMART Program report (2010) or the Harm Reduction in Asia report (Hagarty, 2010).
Manufacture and trafficking
Two small crystal methamphetamine laboratories were dismantled in Hong Kong in 2009 (United Nations Office on Drugs and Crime, 2010b) and manufacturing of ATS in Hong Kong predominantly involves the tableting and re-packing of meth/amphetamine.
Drug seizures
While there were no seizures of ATS pills in Hong Kong during 2009 and 2008, 43.7kg of crystal methamphetamine were seized during 2009, amounts similar to those seized during 2007 and 2008 (United Nations Office on Drugs and Crime, 2010b).
Drug-related arrests
Arrests related to ATS in Hong Kong have doubled since 2004, from 390 to 788 in 2009. The highest number of arrests occurred in 2008 (874) (United Nations Office on Drugs and Crime, 2010b).
Drug treatment
No information about drug treatment offered to those using ATS was available from UNODC (United Nations Office on Drugs and Crime, 2010b). Compulsory treatment applies only to those in the prison system; there are voluntary drug treatment clinics located in six hospital sites. There are a further four residential treatment centres, a variety of halfway houses and more than 15 NGO facilities (Devaney, Reid & Baldwin, 2006).
HIV in the community and among high-risk groups
There were 396 new cases of HIV reported in Hong Kong during 2009 and the country has an overall prevalence of 0.1 per cent (Devaney, Reid & Baldwin, 2006). Overall, an estimated 9 per cent of HIV occurs among PWID, an increase of 300 per cent since 1998.
HIV testing
In 2005 more than 90 per cent of PWID received testing and knew the results (UNAIDS, 2010a).
HIV anti-retroviral treatment
No information was available concerning PWID access to HIV ART.
Prevention education
In 2004, 99 per cent of PWID reportedly had comprehensive knowledge of HIV and, in 2005, 93 per cent were thought to have been reached with prevention education (UNAIDS, 2010a). There were no data measuring HIV risk behaviours of PWID. HIV prevention education in schools and the community is based on anti-drug messages.
Harm reduction
Harm reduction in Hong Kong is limited and there are no official NSPs. However, the possession of needles and syringes is not unlawful.
Macau
Macau is one of two special administrative regions of China, the other being Hong Kong. Macau has a population of 430 000.
Amphetamine-type stimulant use
The level of ATS use in Macau is unknown, although ice and ATS are reportedly used (Devaney, Reid & Baldwin, 2006).
Manufacture, trafficking and seizures
No reports of ATS manufacturing were found. Drugs are thought to be trafficked into Macau from mainland China and Hong Kong with limited amounts from other Southeast Asian countries (Devaney, Reid & Baldwin, 2006).
Injecting drug use
Injecting is the major route of administration for heroin, although there are few reports ofthe injection of ATS. Data from the Drug Complex Treatment Centre indicated some heroin users had switched to ATS in the past year (n=6) (Macau 2).
Drug-related arrests
No information reported.
Drug treatment
There is no compulsory drug treatment in Macau. The primary detoxification unit managed by the government is geared towards heroin users. No details of treatment offered for ATS could be located. Methadone is available through government services (Macau 1).
HIV in the community and among injecting drug users
Latest figures are from 2004, which showed that approximately 18 cases of HIV among PWID were identified. These cases represented 60 per cent of all cases of HIV in Macau (UNAIDS, 2010a).
HIV testing
No information available.
HIV anti-retroviral treatment
No information available.
Prevention education
While HIV prevention education exists in Macau, no details about the scope or type of activities were found.
Harm reduction
There are currently two NSPs operating in Macau, run by NGOs with government funding. In 2010, the NSPs distributed 69 000 needles and syringes and had 258 regular registered users (Macau 1). Outreach and NSPs act as referral points to government-run methadone programs (Macau 1).
