A Working Chain is Extending from the Police via the Backbones of the Drug Abstainers to Ordinary Drug Abstainers in the Detoxification Centre

——Experience Gained from the Educational Programme between the Fellow Drug users in Anshan, Liaoning Province

Center for Disease Prevention and Control of Anshan Liaoning Province
  

Basically, the Drug Rehabilitation Center of Anshan Liaoning Province has developed its framework of HIV/AIDS prevention and intervention. The success of the intervention resulted from the effective communication and understandings between government sectors, the enthusiastic participation of the police and the drug abstainers, indepth and targeting technology support and the working chain of police— the backbones of the abstainers —ordinary abstainers, which formed in the education between fellow drug users. In the meantime, the education of the relative of the abstainers has made certain effect of the intervention. The center has made some beneficial exploration of keeping the high-risk teenagers from drugs and teaching them living skills to prevent HIV/AIDS in the area of rare drugs, and has provided us with precious experience.

——Editor

On Mar.18th, 2004, a woman who nearly reached sixty came to Center for Disease Prevention and Control of Anshan and presented the staff here with a silk banner which says “Your kindness was so touching that our patients could feel deeply moved” to thank them for their considerate care for and help of her son called T (infected with HIV/AIDS). T was a drug addict, who was diagnosed as positive in a HIV/ AIDS test after sharing with others. Learning the result of the test, T’s family was thrown into despair and helplessness. At the time, Center for Disease Prevention and Control of Anshan lent a hand. They applied for the minimum expense for maintaining living-standard granted by the Civil Welfare Department and succeeded; with the help and support of legal sectors, they sent T into a detoxification center while he received training in the programme of Liaoning Drug users’ Improving the Living Skills carried out in Anshan in 2004. During the programme, T advised other drug users by using his own experience to give up drugs and keep away from HIV/AIDS. With joint effort, T was able to abstain from drugs and cheered up and now he could even make a living by himself.
 
    
Up to June 2005, there have been 22 cases of HIV/AIDS detected in Anshan, Liaoning. The cases,  dominantly male adults, caught the disease by sharing needles and having sexual contact. According to statistics, there were 3572 registered drug users in Anshan, with the proportion of injecting drug user as high as 90 percent, most of which had experienced needle sharing. Thus it is imperative to control the spread of HIV/AIDS among the drug users in Anshan and it is necessary to carry out advocacy, education and intervention in the detox center where there were more drug addicts.
    
In 2004, the Cooperation for HIV/AIDS Control and Prevention Programme of United Nations Children’s Fund appropriated funds to support the Strategic Planning , and the Advocacy Programme for Prevention of HIV/AIDS in Anshan. And the perform of these programme further improve the standards for prevention of HIV/AIDS in Anshan

1. Intensifying the Training of the policemen in the center
  
As the administrators of the detox center, their understandings and support to AIDS prevention are crucial to the quality of the programme in the center. Therefore as the first step of the programme, a training lasting 5 days was given to the 60 police officers in this center. In order to do the training job well, the Public Health Office of Anshan has made several contacts with the Police Station of Anshan and Justice Office of Anshan in order to coordinate their efforts and issued a document titled ‘The Notice about Holding the Training Class to Improve the Living Skill of Liaoning’s Drug users.’  In fact, considering the insufficient manpower of the Police Station and the Justice Office of Anshan, it is difficult to a certain extent for them to finish the work. In view of this, the workers of the programme patiently made several contacts with the two government sectors and at last won their understandings and supports.  To ensure the success of the training, the two government sectors also gave the staff of the programme a lot of reasonable suggestions. For example, they suggested that police officers should be transferred from different anti-drug sectors to attend the training class since the routine job of an anti-drug department might be influenced by withdrawing all the trainees from a single department; besides, they suggested that the officers working in the front line should be withdrew to attend the class as much as possible and the insufficient manpower may be made up by the police working in the office or having their holiday so that not only the daily work for police affairs would not be delayed , but also the requirement on the number of the police attending the class and the training quality could be met; furthermore, they proposed that the parents of the drug users should be invited to the training symposium so that the parents could work together with the police and justice sectors to administrate the drug users during their abstinence and after their release. After short-term training, the trainees were made known the basic information about the prevention of HIV/AIDS.
 
  A police officer who has received training said ‘I have never received training about drugs and HIV/AIDS so comprehensive, so authoritative, and so systematic. I not only further understand the trend of HIV/AIDS epidemic, the information about its prevention, the drug-related harms, the abstaining measures, but also acquainted myself with how to improve the living skill of the drug abstainers and how to avoid exposure to HIV/AIDS in my profession and its coping principles, which lay a good foundation for our training the backbones of the drug abstainers in the next stage.’
                                                          
2. Training Well the Backbone of the Drug Abstainers
 
Likewise, the training of backbone of the drug abstainers is crucial to the quality of the programme, for they are the joints in the chain of police—backbone of drug abstainers— drug abstainers. Thus, the staff and the officer in the Reform School of Anshan carefully selected 30 drug abstainers who were articulate as the backbone of the programme of fellow education and trained them. In order to make the drug abstainers well aware of the information about the prevention of HIV/AIDS and living skills so that they could play a role in the education of their fellows, the Reform School have some favorable policies for those drug abstainers who were outstanding in the education of their fellows. For example, points could be added to performance score of a drug user if he/she is good for his/her commutation. With the joint effort of the police and the backbone of drug users, the backbone training class lasting 3 days achieved a great success.

T took part in the backbone training. His conscientiousness influenced other trainees. One of the trainees who had entered the Reform School for three times said: “In the past I only knew that the drugs are harmful to health, but I didn’t know that it has relations to HIV/AIDS and that sharing needles may cause HIV/AIDS. I used to share needles with others and I am overcome with fear when I recollect these experiences. For my own sake, and for the sake of my family, I would transform my bad habits, never using drugs again, never sharing needles with others again.”

Relative people was in a symposium

3. Drug users Teaching Their Fellows

It is an important measure to prevent HIV/AIDS from spreading. In order to let all the drug users receive the training to prevent HIV/AIDS and improve living skill, the well-trained backbones picked out from the drug abstainers were made to educate their fellows, with each backbone in charge of 7 or 8 other drug abstainers. Supervised by the officer, they spent one week completing the fellow education task. They sat together as if they had been friends, talking, discussing, passing and reading the materials for advocacy and training from hand to hand and information about the prevention of HIV/AIDS has become their subject in their spare time. All 234 drug abstainers in the detox center have been educated by their fellows. In the process of fellow education, each backbone has taught his class rather conscientiously and they feel that the Center for Disease Prevention and Control and the Reform School have bestowed the responsibility to advocates the information about HIV/AIDS on them, which improved their confidence and awareness of participation and which let them feel that they had not been rejected by society, so actually, they have taught themselves while teaching others. T was made to take the responsibility for No.9 ward. He cautioned those drug users not to follow him with the knowledge he had learned and his own experiences
 

A fellow educator said: “I used to assume that it is the job of the workers in Center for Disease Prevention and Control to publicize the information about the prevention of HIV/AIDS and I never expected that I would be a teacher, instructing the drug abstainers in the prevention of HIV/AIDS and how to improve living skill. I’d like be a volunteer to let everybody know the information about prevention and therapy of HIV/AIDS after I leave the Center.”

4. Educate the Relatives of the Drug Abstainers

It is necessary for the relatives of the Drug Abstainers to help them continue abstaining after they left the Detox centerso that we can work together to fight against HIV/AIDS. In order that the drug abstainers would be understood and would not be discriminated by their family, the staff of the Center for Disease Prevention and Control particularly invited the relatives or parents of the abstainers to attend the training or symposium. By study and communion, not only the staff further understood how the drug users start to use drugs for the first time and how they  relapse , but also the relative and the parents realized that how important the care for the drug abstainers was for their complete abstinence from drugs. 

These relatives said that they had made up their mind to reform and educate them with goodwill, friendship and relationship of family so that they might completely abstain from drugs as soon as possible and improve their living skills.

At a party for parents, when a mother was asked how her son took to drugs, she kept sobbing so that she could not even speak a word. Later she said to the staff of Center for Disease Prevention and Control, wiping her eyes: “A boy who used to be so good has become a devil by taking and retaking drugs again and again. Having listened to the lecture, I have made up my mind to watch my boy carefully so that he would not use drugs and share needles with others. The training class is excellent, for it lets all the drug users and their relatives know the relationship between drug using and HIV/AIDS”

At the symposium, the family members of the drug users proposed some valuable suggestions, for example: families, communities and the police station should work together to supervise the drug abstainers; clean needles should be exchanged for the used ones and Methadone Maintenance Therapy should be given at the community service station; the departments of labor and civil affairs  should provide the convenience in employment and life for the drug abstainers. Considering all these suggestions, the Center for Disease Prevention and Control shall begin the programme of needles exchange to explore a mode for behavioral intervention of drug users in Anshan.

5. Summing Up the Experience and Intensifying the Effect to Motivate the Comprehensive Prevention of HIV/AIDS

The police and drug abstainers benefited a lot from the programme of improving the living skills of drug abstainers in Liaoning. The public health sector and the drug abstaining supervision authorities have included the advocacy and education for the prevention of HIV/AIDS and the programme of improving the living skills of drug abstainers in Liaoning into their daily work schedule so that they could be carried out regularly, systematically and in a standard way, that is, every drug abstainer who first come into the detox center has to finish ‘three ones’, i.e. reading one book, filling out one questionnaire and watching one video about the advocacy and education of HIV/AIDS;  ‘two tests’, i.e. the tests for HIV antigen respectively on the day when a drug abstainer come into the rehabilitation and 3 months after he /she has come into the rehabilitation; ‘one exam’, i.e. the questionnaire about the HIV/AIDS knowledge for the drug abstainers in detox centers in December each year. All the activities, which has observably motivated the prevention and therapy of HIV/AIDS in Anshan, are quite effective, which can been seen from the points as follows:

Firstly, more people are made known about the programme. The proportion of the police who are aware of the prevention of HIV/AIDS has been improved from 72.5 percent before the training to 96.4 percent after the training; the proportion of the backbones among the drug abstainers who are aware of the prevention of HIV/AIDS has been improved from 62.6 percent before the training to 95.3 percent after the training; the proportion of the 234 fellows who are aware of the prevention of HIV/AIDS has been improved from 50.9 percent before the training to 90.8 percent after the training; the proportion of the drug abstainers who could use condom correctly has been improved from 30.1 percent to 90.2 percent; the proportion of the drug abstainers who could use needles correctly has been improved from 12.5 percent to 80.7 percent.

Secondly, the behaviors of the drug abstainers changed a lot. Realizing that the drug users are of high potential risk to HIV infection, the 234 drug abstainers, who has never been tested for HIV/AIDS volunteer to have the test, and they promise to change their risky behavior, refusing drugs to keep away from HIV/AIDS.

Thirdly, a team of backbones for advocacy has been fostered out. As the knowledge of the police and drug abstainers about the prevention of HIV/AIDS has been improved markedly, they have possessed the ability of advocating the prevention of HIV/AIDS and will play a kind of role in the subsequent advocacy for the prevention of HIV/AIDS in Anshan.

Fourthly, the advocacy coverage was enlarged. In the process of the programme, the workers made good use of all kinds of press media to publicize extensively, requesting broadcasting stations, television stations and news agencies to cover and report the programme from beginning to end. They also expanded the coverage by putting on the programmes such as ‘Special Lecture on Prevention of HIV/AIDS’ and ‘Advocacy and Education for Prevention of HIV/AIDS among the Drug users in Progress’ so that more citizens became aware of knowledge about HIV/AIDS.
Lastly, the information about the drug users was acquired. In the process of the programme, the workers understood the basic information about the drug users, established contacts with each other, found out the reasons for first-using and relapse, which laid a good foundation for the future programs of Needle Exchange and Methadone Maintenance Therapy.