Peer-based behavioral health program for drug users in China: a pilot study

Abstract

BackgroundMany injection drug users (IDUs) in China have high risk sexual behaviors that contribute to the spread of HIV infection. Although many IDUs in China move through drug rehabilitation centers, this opportunity for sexual health education has largely been overlooked.MethodsA convenience sample of 667 drug users from two rehabilitation centers in South China was recruited in the study. Two hundred and forty seven drug users from a single Guangdong Province rehabilitation center received the peer-based education intervention, while 420 drug users from another rehabilitation center received routine HIV/STI education and was used as the control. One hundred and eighty nine (22.1%) individuals refused to participate in the study. HIV/STI behavioral and knowledge domains were assessed at 3 months in rehabilitation centers after the intervention (first follow-up) and at 2-23 months in the community after release (second follow-up).ResultsDrug users who completed the intervention reported more frequent condom use with casual sex partners (60.0% vs. 12.5% condom use every time, p = 0.011) and less frequent injection (56.7% vs. 26.4% no injection per day, p = 0.008) at the second follow-up compared to those in the routine education group. Loss to follow up was substantial in both control and intervention groups, and was associated with living far from the detention center and having poor HIV knowledge at baseline.ConclusionsThis study shows that rehabilitation centers may be a useful location for providing behavioral HIV/STI prevention services and referral of individuals to community-based programs upon release. More research is needed on behalf of detained drug users in China who have complex social, medical, and legal needs.

Human Rights Research and Ethics Review: Protecting Individuals or Protecting the State?

“…Yet, researchers have often ignored the conditions within and lack of judicial oversight of such centers, presenting them as legitimate treatment facilities [48] , [49] . Researchers rarely report on the availability of evidence-based drug dependency treatment [48] , [50] – [55] and have obscured the status of research participants (e.g., referring to detainees as “patients” [48] or vaguely alluding to their “complex legal needs” [55] ). Published papers also often omit mention of the challenges of conducting independent research [48] , [50] – [55] .…”

“…Researchers rarely report on the availability of evidence-based drug dependency treatment [48] , [50] – [55] and have obscured the status of research participants (e.g., referring to detainees as “patients” [48] or vaguely alluding to their “complex legal needs” [55] ). Published papers also often omit mention of the challenges of conducting independent research [48] , [50] – [55] . One study acknowledged using detention center staff to witness consent [55] , potentially increasing the risk of coercion.…”

The ethics of research in compulsory drug detention centres in Asia

“…Yet detainees may come in contact with health professionals: they may be subject to mandatory HIV testing [2], forced to donate blood [4], or they may participate in scientific research, sometimes involuntarily [6]. Published research in drug detention centres has investigated issues such as risk factors for HIV infection among injecting drug users (IDU) [7–10], HIV prevalence [11], effectiveness of behavioural HIV/STI prevention interventions [12], and the efficacy of particular modalities of drug treatment [13,14]. …”

“…However, published research frequently omits mention of the involuntary detention of individuals [11,14], or does not describe the length of their detention or the non-availability of evidence-based treatment [7,8]. Research has referred vaguely to the “complex” legal needs of detainees [12], or mischaracterised their legal status by describing detainees as “in-patients” [14] or “residents” (with those detained by police being “police-referred”) [7]. …”

“…They speculate that “street IDUs may not have understood the purpose of the study, leading to refusal to participate”, without considering alternative explanations (including coerced participation of detainees) [9]. Shen and colleagues ignore the potential of coercion when they claim that they ensured valid informed consent from participants by having detention centre staff witness that consent [12]. …”