V. Findings

The purpose of the detox center is really just disciplinary, it's not to give people medical care.

- Physician working at detox center, Nanning

Fear of Arrest and Access to Services

China's Public Security system deploys some 17,000 policemen in anti-drug squads.[26] In 2004, the authorities took into custody at least 273,000 drug users.  

IDUs say that police frequently detain drug users based upon past contact or for simply resembling a "drug user" and require them to provide a urine sample for drug screening. Nearly all IDUs interviewed by Human Rights Watch mentioned they were afraid they would be detained and arrested on the way to or from the interview, simply for being in public.

According to drug users, the threat of being identified or picked up off the street keeps people from accessing methadone therapy and needle exchange. One HIV-positive IDU named Xiao said: "I really can't go out in public anymore because if police are trying to fill their quota they will arrest me when they see me."[27]

IDUs also report that police wait outside pharmacies and methadone clinics to arrest people when they are trying to buy clean needles. An HIV-positive former IDU told Human Rights Watch that he had been arrested while leaving a methadone clinic on two separate occasions. An NGO worker in Nanning explained: "Everyone who takes methadone is identified by police. There is no confidentiality and IDUs are a prime target for arrest."[28]

A government worker explained:

The police are supposed to stay away from the methadone centers but it doesn't always happen that way. Part of the point of methadone centers is that it provides a way to keep control of drug users. From this perspective it is really the law enforcement agencies that are in charge of methadone centers. We try to market people who use methadone centers as "sick people seeking medicine" but the police still see drug users as criminals.[29]

A study in southern Guangxi Province found that police "crackdowns on drug users, committing growing numbers to detoxification centers and labor camps and driving many others underground," led to decreased use of peer education and needle and syringe exchange programs, with the average number of needles/syringes provided dropping from 12,000 per month in 2003 to 8,000 per month in 2005.[30]Another study, published in 2004, found that drug users intentionally swallowed watches, nails, glass, and sharp metal, including razor blades, to avoid being detained and sent to detox or RTL centers.[31]

Drug users also cite fear of arrest as a reason for not seeking HIV testing.  In Nanning, the HIV testing sites are either government-run or on the Nanning CDC compound and do not offer anonymous or confidential testing. IDUs expressed concern that information given to officials when registering for an HIV test would directly lead to their arrest. An NGO trying to provide confidential testing has been frustrated by the government's insistence that it provide ID numbers and other identifying information for patients. Staff of the NGO report that they have been under constant pressure from the local government to release information that they have promised patients would be kept confidential.[32]

One consequence of this policy is that drug users do not seek treatment. An IDU named Chen who did not know his serostatus said: "Sometimes I'm afraid I might be sick with AIDS but I'd rather be sick and free than go to get tested, get arrested, and be sick in detox or RTL."[33]

Another IDU, Zhou, who was in very poor health, was afraid of both getting arrested and being discriminated against. He said: "I think I might have AIDS but I am too scared to go get tested.  I don't want to get arrested and if I do have AIDS, people will be scared of me.  I'm just waiting to die."[34]

A former IDU named Liu reported that as he was leaving a Chinese CDC HIV/AIDS testing site in Nanning, having just been told that he was HIV positive, he was spotted by the police.  He explained: "I had been using drugs and decided to go get tested for HIV. I had just come from having my blood drawn on the CDC compound and police saw that my arm had an open mark and some blood.  They stopped me and put me in detox."[35]

IDUs also reported that the police routinely use informants to identify IDUs, and provide the informants with a percentage of the fines collected. Drug users say that informants include family members and neighbors.  A former detainee named Zhou said:

It's like the police are going fishing, using regular people as bait to catch drug users.  We're not hurting anyone but they still go fishing and that makes it even harder to be a normal person in society again. People already discriminate against you, and if your neighbors think they can get money from catching you, they will do it.[36]

Multiple sources, including NGO workers and people who work closely with the local government, said that police are particularly aggressive in detaining drug users in the days preceding June 26, the International Day Against Drug Abuse and Illicit Trafficking. According to IDUs, on this day and other "high profile" days, they could be picked up by police based upon their past record and sent to detoxification, even if they were not currently using drugs, simply as part of efforts to increase the count of "drug users" detained. An IDU named Zhang said: "The police recognize us because we've been in detox before. They just pick us up off the streets and bring us to the police station."[37]

Such barriers to accessing health information, sterile needles/syringes, and opiate substitution therapy, which have been recognized both globally[38] and by China as effective, interfere with the right to obtain the highest standard of health.International law recognizes the human right to obtain lifesaving health services without fear of punishment or discrimination. Article 12(c) of the ICESCR specifically obliges states to take all steps necessary for "the prevention, treatment and control of epidemic . . . diseases," which include "the establishment of prevention and education programmes for behaviour-related health concerns such as sexually-transmitted diseases, in particular HIV/AIDS."[39]

Realization of the highest attainable standard of health requires that the state ensure equality of access to a system of health care and provide health information and services without discrimination, and protect confidential information.[40] According to the UN Committee on Economic, Social and Cultural Rights, the right also requires states to take affirmative steps to promote health and to refrain from conduct that limits people's abilities to safeguard their health.[41] Laws and policies that "are likely to result in . . . unnecessary morbidity and preventable mortality" constitute specific breaches of the obligation to respect the right to health.[42]

Assignment to Detox or RTL centers

Although drug use is illegal in China, it is considered a violation of administrative law, which dictates that "drug takers must be rehabilitated."[43] Prior to the enactment of the June 2008 reform of Chinese drug laws,[44] Chinese law dictated that first-time offenders be sent to a drug detoxification center for between three to six months and repeat offenders be sentenced to re-education through labor (RTL) centers  for a period of from one to three years.[45]

In practice, multiple sentences to detoxification centers were common, for periods of up to one year. Drug users were sentenced following a positive urine test by local authorities and had little access to due process protections. Drug users and government officials said that the decision to put a drug user in a detox or RTL center was not based upon any medical assessment or criteria, and reflected a wide range of factors including the occupancy levels of different facilities, the amount of money that a drug user or his/her family can provide for fines or fees, and past history of detention.

First-time drug users were not routinely sent to RTL centers, but drug users who had been in detox once before could be returned to detox, sent to RTL, or released. One drug user said: "If you get arrested when they have enough people in RTL then you are safe, but if you get arrested at another time, then you can be put into RTL."[46]

According to Zhang, another drug user:

One time when I got picked up by the police I just gave them money and they didn't bring me to detox.  When I got arrested after I knew I had AIDS, my family tried to give them money to keep me from detox because they were scared, but the police have quotas and so refused the money and I had to go to detox even though I was sick.[47]

The detention of drug users without charge or trial violates basic principles of international law. The International Covenant on Civil and Political Rights (ICCPR), article 9, provides that any person "deprived of his liberty by arrest or detention shall be entitled to take proceedings before a court, in order that that court may decide without delay on the lawfulness of his detention and order his release if the detention is not lawful."[48] The UN Human Rights Committee, which monitors compliance with the ICCPR, has interpreted this provision to apply "to all deprivations of liberty, whether in criminal cases or in other cases such as, for example, mental illness, vagrancy, drug addiction, educational purposes, immigration control, etc."[49]Article 14 of the ICCPR provides basic fair trial rights, including the right to a public hearing and to be presumed innocent until proven guilty.[50] The UN Body of Principles for the Protection of All Persons Under Any Form of Detention similarly provides that persons "not be kept in detention without being given effective opportunity to be heard promptly by a judicial or other authority. A detained person shall have the right to defend himself or to be assisted by counsel as prescribed by law."[51]

Conditions in Detox and RTL Centers

The lack of available therapy and prison-like conditions in drug detoxification and re-education through labor centers violate internationally accepted standards for effective drug dependency treatment. In addition, such centers facilitate the development and spread of drug resistant HIV and tuberculosis, and inflict upon drug users physical and sexual violence and psychological abuse.[52] Most drug users are charged for their time in these facilities,[53] are forced to work long hours without pay, or both.

Lack of Drug Dependency Treatment

According to State Council regulations, patients in compulsory rehabilitation centers must be provided with "medical and psychological treatment, legal education and moral education."[54] Drug users, NGO representatives, and government officials, however, all agree that drug users are provided no effective medical or psychological treatment.  One IDU, Kang, said:

It used to be that you could buy certain medications when you first got put into detox to help with withdrawal. But it was only given if you could pay for it. There was no supervision of it, people would just keep on buying these drugs which would help them sleep. They would become addicted to these new drugs, inside detox, and then the detox center would make money on all the people buying the withdrawal medication.[55]

Another former detainee, Xiao, said:

They say that detox and RTL are supposed to be for quitting drugs, but there is no way that it is different from a normal prison. You work like a slave and don't have access to drugs.[56]

The UNODC lists best practices for treating drug dependence and preventing the spread of HIV. These best practices include access to substitution therapy (such as buprenorphine and morphine) for those dependent on opiates; information on HIV prevention and treatment options; treatment for symptoms of withdrawal; confidential HIV testing and counseling; and general psychological support, among others.[57] At the detox and RTL centers in Guangxi none of these interventions were offered at the time of our interviews. The lack of standardization for detox practices around China results in a hodgepodge of different treatments, including no treatment whatsoever, Chinese herbal medicine, and electric shock therapy, but according to Chinese Ministry of Health officials, as of June 2008, methadone was not available in any detox or RTL centers in the country.[58]

A 2006 study of behavioral change of IDUs who have spent time in Chinese detox centers found no correlation between confinement in the centers and drug use.[59] Other studies have similarly found high relapse rates among those who are sent to detox and RTL centers.[60]Contributing to high relapse rates is the lack of behavioral intervention or linkage post-detention to effective community based treatment for sustained therapy.[61] It is widely recognized that detoxification treatment alone is unlikely to be effective, and that counseling and the development of a"therapeutic alliance" between patient and provider is critical to sustained impact.[62]

The failure to ensure access to methadone or other opiate substitution therapy represents not only a violation in the right to the highest attainable standard of health, but may result in violations of basic obligations to protect detainees from exposure to inhuman or degrading treatment. Forced, abrupt opioid withdrawal can cause profound mental and physical pain, and in turn, cause detainees to risk HIV and other blood-borne diseases by inducing drug users to share injection equipment to deal with withdrawal symptoms.[63] 

Mandatory HIV Testing

Once detained, IDUs report that they are repeatedly tested for HIV, but never provided the result. Some interviewees say that when released from detox they are told they can go to the local CDC and look up the results. An IDU named Peng said: "The local CDC came to give us an AIDS test but didn't give the results.  Nobody goes to get the results when they are released because they don't want to get arrested right when they get out of detox."[64]

Lu, another IDU, said:

I was tested in detox twice for HIV, most recently in 2006, but was never told the result.  Then when I got out I was so sick that I went to the clinic.  I was scared of getting arrested but I have a son and I didn't want to die.  They tested me and told me I have AIDS.[65]

IDUs report that when they tried to get information on their HIV serostatus from guards they were unable to do so. An IDU named Xue said: "When we were in detox we asked the guards if we had AIDS and they said, 'Oh, it doesn't matter, you won't die that fast from AIDS.'"[66]

Xiao, an HIV-positive IDU said: "I was tested for HIV every time I was in a detox center but was never told my results.  Last year an NGO did free testing.  That's how I found out I have AIDS."[67]

Multiple sources confirm that testing without informing people of the result is the current Chinese CDC policy for individuals in prisons and in detox and RTL centers throughout the country. A Chinese government official said:

The CDC does not want to tell people their HIV status when they are imprisoned because they are think it would cause unrest among the detainees.[68]

A source from an international organization that works very closely with the Chinese government said:

Obviously we see this as a big issue and it has been brought up with the Ministry of Health on multiple occasions. We really haven't seen any progress on this problem. Apparently the government is concerned that if people are told their status they will demand treatment and services. All those people protesting would be too much for a detox center to handle.[69]

An NGO worker told Human Rights Watch: "The government does the HIV testing in detox centers so that they will have the data.  They don't use the results to help people get treatment or to help prevent an infected person from spreading it further."[70]

Human rights standards set out certain due process criteria for the conduct of medical testing, such as the requirements of informed consent and confidentiality. These requirements are based on legally protected rights including those of security of person, to health, and to privacy and apply to any medical procedure, not just to HIV testing.[71] HIV testing may not be performed without the explicit informed consent of the individual concerned.

Mandatory testing without disclosing the result to drug users in detention not only violates their rights, but also has severe consequences to their health, as their ability to seek appropriate care is delayed, potentially resulting in a threat to their lives.

Access to Health Care

Although HIV testing is common, drug users report that they have little access to basic health care. Hu, an IDU infected with HIV reported: "I was very worried I was going to die the last time I was in detox.  There was not enough food to eat and no one was checking my CD4 count.  I felt very weak and sick."[72]

Another IDU, Deng, said:

One reason a lot of people die in detox is that they are HIV positive, but no one is checking their CD4 count.  They don't know the symptoms of opportunistic infections [OIs]. They start getting OIs but they still have to finish their six months.  They leave detox and die soon after.[73]

IDUs uniformly say they fear getting sick and dying while in detox or RTL centers.  Tang, an IDU said:

I met a lot of people in detox who have AIDS.  They get sicker and sicker and then when they are almost dead they are let out.  They die within 20 days.  This happens often because people are already sick and they have no medical care and the detox conditions are really bad.[74]

Local NGOs confirm that conditions are bleak for HIV-positive people inside detox or RTL centers. A Chinese doctor at a local NGO explained that detox and RTL centers are not equipped to treat basic ailments, let alone opportunistic infections and HIV/AIDS. The doctor said:

If a person looks really sick, like they could be close to death, then the detox or RTL doctor can apply for a certificate of disease. These certificates take a long time to be processed and so they are rarely used in any case. Even if a person is released, they are either just let out outside the gates or they are brought to the hospital doors. The point is that the detox center won't take any responsibility for the person's health. It is very worrisome for those of us who work in health care, because detox centers are full of Hepatitis B, Hepatitis C, and TB, but there is no adequate treatment for any of this. And of course people who are HIV positive or who have AIDS already have weakened immune systems and so being put into a detox or RTC center just puts their health even more in jeopardy.[75]

One physician who had worked in a detox center stated that "if an inmate is very sick we take him to the hospital.  If he doesn't have enough money the hospital won't accept him.  What happens to the inmate at that point is not our responsibility."[76] The doctor added that "the purpose of the detox center is really just disciplinary, it's not to give people medical care."

One IDU, Jian, said:

The last time I was in detox I was really afraid I was going to die inside. They let me out when I was really sick. I almost died but my family took me to the doctor.  Then I went to an NGO and that's how I found out that I have AIDS. If I hadn't had my family I would have died when I was let out because I was really sick.[77]

NGO workers reported that sometimes they were able to provide follow-up care to a previous patient who had been detained or to ensure care for detained drug users who were gravely ill. An NGO worker said: "when we have a good relationship with a detox doctor sometimes we can get people out who are really sick. But other doctors don't want to help at all."[78]

Liu, an HIV-positive IDU who had been arrested when leaving the CDC compound, reported that he had been infected with TB while in detox. He said:

I have AIDS, I had no access to medication while I was in detox and then when I left I had TB. Unfortunately this is the same story for a lot of people.  People are always sicker when they leave than they were coming in.[79]

IDUs uniformly say they fear being infected with TB while in detox. The IDU named Du said: "Everyone is in such a small space. If your family can pay for a TB test then you might be able to get tested, but if not you just stay there until you are really sick. In the meantime you are infecting everyone else."[80]

Chinese law requires that all patients in compulsory rehabilitation centers be provided with medical treatment.[81]  The UN Human Rights Committee has noted that persons deprived of their liberty should enjoy their fundamental rights, subject to the restrictions that are unavoidable in a closed environment."[82]  However, custodial conditions should not aggravate the suffering inherent in confinement.[83] Detainees, therefore, like all other persons, enjoy the right to the highest attainable standard of health and, in particular, the right to be treated with dignity and protected against torture and cruel, inhuman, or degrading treatment.[84]

The prohibition on inhuman or degrading treatment specifically "compels authorities not only to refrain from provoking such treatment, but also to take the practical preventive measures to protect the physical integrity and the health of persons who have been deprived of their liberty."[85]It has been recognized that failure to provide adequate health care or medical treatment to a detainee in prison may contribute to conditions amounting to "inhuman or degrading treatment."[86]

International legal instruments support the principle that prisoners are entitled to a standard of health care equivalent to that available in the general community, without discrimination based on their legal status.[87] The UN Committee on Economic, Social and Cultural Rights, in its commentary on the right to health, repeatedly stresses the importance of states' obligations to ensure access to health facilities, goods, and services to all persons, "especially the most vulnerable or marginalized sections of the population," without discrimination on the basis of "health status including HIV/AIDS" and "political, social or other status" that "has the intention or effect of nullifying or impairing equal enjoyment of the right to health." The committee notes in particular government obligations to "refrain from denying or limiting equal access for all persons, including prisoners or detainees . . . to preventive, curative, and palliative health services," and to abstain from "enforcing discriminatory practices as State policy."[88]

Disruption of Antiretroviral Therapy

Most IDUs who were on antiretroviral therapy prior to being sent to detox report that they were unable to continue therapy while institutionalized. One IDU, Deng, who was released from detox in June 2007 said: "I started taking antiretroviral drugs (ARVs) before I was put into detox.  Then when I was in [detox] I had to stop.  I was really worried about my health but there was nothing I could do."[89]

Hu, an IDU on antiretroviral therapy who has been in detox many times said: "Every time I get put into detox my treatment is interrupted. Of course it is scary but what can I do about it?"[90]

Two drug users said they were able to continue taking ARV while in detox, despite the lack of medical supervision. Every month a local NGO provided them with a supply of ARVs, which they subsequently kept stockpiled in their cells. Both reported that their ability to access the drugs was dependent on their relationship with guards.  One IDU named Su commented: "If you have a good relationship with a guard and they know you have AIDS and are taking ARV they may be willing to let the drugs in."[91]

An NGO worker in Nanning explained:

People are not treated for AIDS when they are in detox.  Twenty people in a cell is not a good environment for supervising people. The infrastructure to provide treatment is just not there, the authorities wouldn't know what is happening with the drugs. When the government talks about continuing ART for people who are in detox they are referring to the few people who are already stable.  For the rest, the vast majority, it's just not possible.[92]

Government officials and key informants in local and international NGOs providing services to drug users in detox centers confirm that continuity of ARV treatment is on a case by case basis and largely dependent on negotiations with individual guards.

The failure to ensure access to antiretroviral therapy for drug users on treatment prior to detention may compromise their health, and ultimately their lives. Incomplete adherence to treatment can lead to resistance to antiretroviral medications and therefore a reduction in available antiretroviral therapies, and has been associated with clinical progression of HIV disease and mortality.[93] Similarly, the failure to provide antiretroviral therapy to those in urgent need of treatment imperils their health and risks their lives.

HIV Infection Risk

IDUs reported that they received little or no information on HIV prevention while in detox. NGO representatives we interviewed said that they had substantial difficulty consistently getting access and are unable to conduct peer-led programs. Like the provision of ARVs, their access depended solely on the cooperativeness of individual doctors and staff members at the centers.

IDUs say that in the Nanning detox centers there is virtually no education on HIV because authorities do not want to take time out of the work day. One IDU, Zhang, said:

People come to talk about AIDS prevention one day a year. It's the same day they bring in the TV cameras and the nice food. It's all to show that everything is ok in detox, even though it's all fake.[94]

A staff member of an international NGO confirmed that HIV/AIDS education at detox centers is offered at least partly with the goal of showing the outside world that detox is not simply a prison. She explained:

The first time I went to a detox center to do HIV/AIDS education I thought it was really strange that the inmates were all in a courtyard playing badminton and not seeming to live in the terrible conditions I had heard about. Then I saw the television cameras and the news crew and I realized that my talk on HIV prevention was just part of a larger propaganda campaign. Any attempts to do anything meaningful, like establish a way for people to come to our clinic and get tested when they were released from detox, were not welcomed by the detox authorities. It was very frustrating.[95]

An IDU, Zhou, said of the Nanning detox center:

They don't want to take the time to tell us about AIDS or other diseases because they want us to spend all of our time working in the factory.[96]

Former detainees report that many kinds of risk behaviors exist in both detox and RTL centers. IDUs uniformly say that illegal drugs are available in detox centers, although IDUs report different experiences accessing drugs, and some suggest that it has recently become harder to smuggle drugs. IDUs said that when drugs are available, mainly via guards, inmates share needles, makeshift or otherwise, due to the lack of access to clean injecting equipment. An IDU, Jian, said: "In RTL or detox, if you are there long enough you find drugs. In RTL we would have 300 people sharing one needle."[97]

As with HIV treatment, the Chinese government is obligated to provide drug users in detention access to HIV prevention information and services, as part of the right to health. The Committee on Economic, Social and Cultural Rights has specifically pointed out the obligation of a state under the ICESCR to provide information and means of HIV prevention, as well as treatment, to detained drug users.[98]

General Living Conditions

IDUs who had been in detox centers in Baise and Nanning reported that they lived in 15 by 15 feet (5 x 5 meter) cells shared by as many as 30 people. In Baise, IDUs who had been in detox centers reported that they were kept locked in their cells for most of the day, while IDUs in detox in Nanning reported having been obliged to perform unpaid factory work, which they characterized as "slave labor."

All IDUs we interviewed in Nanning expressed fear and anger about the factory work they performed. One IDU named Du said: "The detox center is a factory.  We work everyday, until late in the night, even if we are sick, even if we have AIDS."[99] Another, Rong, said: "We are supposed to be in detox to quit using drugs, but really we are just there to work as slaves.[100]

IDUs report that, while in detox centers, they were punished if they did not work fast enough. Punishments ranged from having food withheld, to not being allowed to sleep, to being beaten. One former detainee showed scars on his arms he suffered when he was beaten in detox for not finishing his work. Another demonstrated how guards would twist his arms behind his back, raise them, and handcuff him in that position as a punishment for not working fast enough.

IDUs said that frequently the guards would choose several inmates to act as their "little dogs."  One IDU, Chen, explained:

The guards treat their little dogs differently than everyone else. They eat better, they don't have to work. But when the guards want to beat someone they have the little dogs do it so that if the person dies the detox center in not responsible.[101]

Another IDU, Peng, said that his uncle died in detox this way. He said: "Everyone knows it was the guards who were responsible … but they said it was just another inmate. Now there is nothing our family can do."[102]

Zhou, a former inmate at the detox center in Nanning said:

This place is hell.  We are supposed to be there for quitting drugs but instead we work like we are slaves and then get beat up. We leave detox and eventually if we don't die, we get arrested again, and have to go through it again. My life is wasted.[103]

Another IDU, Wang, said: "You can't imagine a place as bad as detox. There are no human rights in these places. They treat us like slaves and like animals."[104]

International human rights law provides that all persons deprived of their liberty "shall be treated with humanity and with respect for the inherent dignity of the human person."[105]No one should be subjected to cruel, inhuman, or degrading treatment or punishment.[106] While international law permits detained persons to be required to work as part of their punishment "in consequence of a lawful order of a court,"[107] drug users in mandatory detoxification centers in Guangxi have not been required to do so by court order. International standards on the treatment of detainees provide that work undertaken be to a prisoners' benefit, and that it not be subordinated to the purpose of making a financial profit for the institution.[108]

Conditions in Re-education Through Labor (RTL) Centers

There are 165 re-education through labor (RTL) centers in China with an overall capacity to house 143,000 individuals who are typically administratively sentenced for either two or three years.[109] Run by the Ministry of Justice, the centers rely on labor by residents to supplement the costs of incarceration. RTL centers segregate detainees by sex and in some cases separate drug users from individuals sentenced for other administrative offenses.

Sixteen of the 19 IDUs interviewed by Human Rights Watch had been detained in RTL centers in addition to mandatory detoxification centers. Conditions in RTL centers were reported by IDUs to be nearly identical to those in detoxification and included: lack of access to effective drug dependency treatment; mandatory HIV testing without disclosure of the result; lack of access to HIV prevention information and health care, including interruption of ARVs; and significant risk of HIV infection while detained. All 16 IDUs were required to perform labor without pay.

As in detox centers, former detainees report that there is no drug dependence therapy in RTL centers. Former detainees describe RTL centers not as a places to work on overcoming addiction, but as prison factories where inhumane treatment and worsening health conditions are the order of the day. One former detainee, Peng, said: "RTL is not about drug or HIV education. RTL is just for working."[110]

Formerly detained drug users explained that they were no closer to having a productive life upon release from RTL centers, and that, on the contrary, having been away from society for two or three years they had no skills or resources to help them reintegrate.

IDUs report that, as in detox centers, mandatory HIV testing is routine in RTL centers and they are not told their test results. A former RTL center guard said that the guards used the HIV testing data to know "which female inmates they could sleep with without using a condom."  He went on to explain: "Women in RTL need comforting, especially the younger ones.  I would sleep with them to comfort them and then give them some heroin to make them feel better."[111]

Xue, an IDU, said that despite routine HIV testing, no CD4 testing is available.  "There is no CD4 count [at RTL centers].  I knew I was getting sicker but I couldn't leave because I could still work."[112]

Another IDU, Deng, said:

It's really scary when people who are HIV positive get put into RTL.  They are going to be there for two or three years and there are no CD4 counts and no ART.  We are always afraid our friends are going to die.[113]

IDUs who had been in RTL centers report that, as in detox centers, many kinds of HIV-related risk behaviors existed, yet there is virtually no education on HIV. IDUs report that a range of illicit drugs are available in RTL centers, and sharing of needles, makeshift or otherwise, is common due to the lack of access to clean injecting equipment.  One IDU said: "Family members will sometimes try to slip drugs in.  Sometimes the guards know, sometimes they don't.  When I was in RTL, if we got drugs everyone would just share the needle."[114]

Former detainees report that, as in detox centers, there is very little access to health care services, and the care that is available is for only the most basic ailments. In addition to the lack of medical services, there is no medical supervision for inmates who are HIV positive and no continuation of antiretroviral therapy. Every HIV-positive IDU we interviewed experienced an interruption in treatment while confined to RTL. One IDU named Tang said:

I knew I was HIV positive last time I was put into RTL. People from the Nanning CDC came and took my CD4 count. They wouldn't tell me what it was. They said when I was released I could go look up all of my medical information, including the CD4 count. This made me really angry and upset. If my CD4 count was low or something was wrong, what would be the point of finding out when it was already too late?[115]

The former RTL center guard we interviewed confirmed the poor conditions in RTL centers. He said: "If people weren't working hard enough we would beat them with a one meter board, or we would just kick them or beat them with our hands. Sometimes people got beaten to death. About 10 percent of people who come into RTL centers die inside." When queried on the 10 percent figure, he explained: "Well, that's the number we said, because any higher could have been called a human rights issue."[116]

Conditions in RTL centers raise the same rights violations as conditions in detoxification discussed previously. International human rights authorities have been even more outspoken in their condemnations of RTL practices. For example, the UN Special Rapporteur on Torture has characterized forced re-education through labor in China as a form of inhuman or degrading treatment, if not mental torture, and recommended that RTL centers be abolished.[117] The UN Committee on Economic, Social and Cultural Rights has expressed concern about the use of forced labor in RTL centers "without charge, trial or review" and recommended that its use be ended and urged that China ratify International Labour Organisation Convention No. 29 on forced or compulsory labor.[118]