Attitudes in Rehab

There cannot be many HIV awareness programs in the world that announce themselves with brass bands, honour guards and goose-stepping police with bayonets, but that is what happened last week during a visit to China by Britain's state secretary for international development, Hilary Benn.

At first sight, the militaristic reception in Kunming, Yunnan province, seemed entirely at odds with efforts to persuade China to focus on education and treatment rather than the usual repression of groups at high risk of HIV infection. But, on closer inspection, it was perhaps more significant that a Chinese police academy is now able to accept UK money and foreign ideas for tackling an issue that has long been treated as taboo.

Yunnan - an impoverished south-eastern province that shares a long porous border with the golden triangle states of Laos and Burma - has some of the worst drug, prostitution and HIV problems in China.

At the end of last year, local officials reported 15,000 confirmed cases of the disease in the province. Because so many of those likely to have been affected live in remote mountain communities where there is little opportunity for testing, it is estimated that the actual figure is probably above 80,000 and rising at the rate of about 30% per year.

That is the bad news. The good news is that Yunnan has done more than any other province to face up to the problem rather than pretending it does not exist, which is still the approach favoured by many local governments. Yunnan has given the media greater freedom to report on the issue, welcomed support from international organisations and shown a willingness to experiment with radical pilot projects, elements of which have since been adopted nationwide.

Earlier this year, Yunnan became the first province in China to enact a local ordinance on HIV prevention. It is the first place where free condoms are provided in hotel rooms, where methadone and needle-exchange programs are offered to drug users trying to kick the habit, and where local officials are attempting outreach programs to socially ostracised groups such as sex workers and homosexuals.

Arguably more radical has been a program to re-educate the police, who are more used to fighting gun battles with drug dealers and throwing users into detention centres. Since 2002, the training program at the Yunnan police academy has included a course on HIV-Aids prevention partly funded by a grant of 380,000 RMB (£25,000) from the UK.

More than 2,000 cadets have now seen teaching materials about the disease, how to protect themselves and how to share their knowledge about prevention with high-risk groups and local communities.

It is hard to assess the impact the program has made on the streets, but police officers are at least aware that there is a different way to look at sufferers. "We used to see drug users simply as dirty criminals, now we realise they need love and sympathy," said one officer at a question-and-answer session arranged for foreign visitors.

To what extent they believe or apply the new orthodoxy is open to question. Heroin users are still routinely picked up and thrown into compulsory detoxification centres, where they endure boot-camp conditions with minimal effect. Local media estimate that 95% of those who leave such centres return to drugs.

But the local government is allowing other approaches. The Daytop clinic in Kunming uses a US-method of group therapy to help users kick the habit. It also receives funding from DFID and staff from international NGOs such as Volunteer International.

Compared to the 700 state centres, the clinic claims a vastly more successful treatment rate. Since it opened up in 1996, Daytop says a quarter of the 2,000 patients who passed through its doors have stopped using drugs for good.

The charitably funded centre has more resources than the detox centres, but it has begun sharing expertise. Staff, including HIV experts from Africa, are contributing to local education campaigns and recently, some have also been allowed to visit inmates at the detox centres to warn them of the risks of sharing needles.

There are still dangerous limitations to the government's openness. While it is now acceptable to discuss HIV education for drug users, sex workers and homosexuals, there is still widespread ignorance of the risks posed to the rest of the population through unprotected heterosexual intercourse.

Compared to the poverty of Yunnan - where young female addicts sell sex for as little as 40p - and the vast scale of the HIV problem in China, such steps are small. But they represent a model for progress, particularly compared to provinces such as Henan that are still trying to cover up a problem that reflects badly on the authorities.

The central government is clearly paying attention to what Yunnan is doing. In March, the health ministry announced plans to provide free Aids tests and treatment, as well as needle-exchange and condom promotion programs - all of which were first tried in the south. There is still some way to go before police forces around the country adopt the same "love and sympathy" policy professed by cadets at the academy in Yunnan, but attitudes are changing so fast in China that almost anything now seems possible.