Pubdate: Sun, 12 Nov 2006
Source: New York Times (NY)
Copyright: 2006 The New York Times Company
Contact:  http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Howard W. French
Bookmark: http://www.mapinc.org/find?136 (Methadone)
Bookmark: http://www.mapinc.org/find?137 (Needle Exchange)

CHINA'S MUSLIMS AWAKE TO NEXUS OF NEEDLES AND AIDS

KASHGAR, China -- The story of Almijan, a gaunt 31-year-old former 
silk trader with nervous eyes, has all the markings of a public 
health nightmare.

A longtime heroin addiction caused him to burn through $60,000 in 
life savings. Today, he says, all of his drug friends have AIDS and 
yet continue to share needles and to have sex with a range of women 
- -- with their wives, with prostitutes, or as he said, "with whoever."

For now, Mr. Almijan, whose name like many here is a single word, 
seems to have escaped the nightmare. His father carted him off to a 
drug treatment center hundreds of miles away in Urumqi, the capital 
of Xinjiang Uighur Autonomous Region here in China's far west.

When he relapsed, he was arrested during a drug deal. That landed him 
in a new methadone clinic, opened last year in this city, where he 
spent three months cleaning himself up. He says he has repeatedly 
tested negative for H.I.V.

This day, fresh from a clinic just off of People's Square here, 
watched over by a huge statue of Mao, Mr. Almijan slurred thickly 
after drinking the dose that keeps his cravings at bay. "If I can 
help other people, I'd be happy to tell you my story," he said. He 
explained why he had embraced treatment: "My friends were dying, and 
I was very afraid."

The way the authorities handled Mr. Almijan, including his treatment 
with methadone, is part of a sea change by the Chinese public health 
establishment, which is struggling to confront an increase in 
intravenous drug use and an attendant rise in AIDS cases in Xinjiang, 
an overwhelmingly Muslim region close to the rich poppy fields of 
Afghanistan and near the border with Kyrgyzstan and Tajikistan.

With a population of about 20 million and an officially estimated 
60,000 infections, Xinjiang has one-tenth of China's AIDS cases and 
the highest H.I.V. infection rate in the country. Chinese authorities 
estimate that Kashgar Prefecture, with a population of about three 
million, has 780 cases, but public health experts here say the real 
figure is probably four times that and rising fast.

Until recently, addicts were largely left to the police, who regarded 
them as simple criminals whose drug use was to be combated 
mercilessly. Resistance to treating drug addiction as a public health 
concern has been high, mirroring what some international health 
experts say was a slow response to the virus generally in China as 
AIDS first gained a foothold.

"Some cadres are not willing to launch a public campaign against 
AIDS, fearing it would affect their image and investment in their 
locality," said Parhat Halik, the deputy commissioner for Kashgar 
Prefecture, in a speech in June. "Some are still having endless 
debates about whether to promote the use of condoms, methadone 
treatment and needle exchange programs, or standing in the way of 
initiatives to work with high-risk groups. That is our biggest 
problem in the fight against AIDS."

But since 2005, the authorities in Xinjiang have been trying 
everything from needle exchanges and drug substitution programs -- 
approaches that first became popular in the West in the 1960s -- to 
community outreach programs, often giving briefings to imams and mullahs.

The people of Xinjiang are ethnically distinct from China's Han 
majority, and have a long history of distrust of the central government.

In the narrow, winding alleys of this city, where most women wear 
veils and mosques can be found every hundred yards or so, Islamic 
clerics spoke enthusiastically about antinarcotics efforts.

"These people are killed and arrested, persecuted and punished by the 
police, and the price of their drugs becomes greater even than gold, 
and yet they continue to use them," said Abdu Kayaum, imam at a small 
brick mosque here. "If I didn't preach about these ills, I wouldn't 
be a Muslim."

At another mosque, the muezzin, or prayer caller, Abulkasim Hajim, 
put it slightly differently, saying: "This is not just a problem for 
the government, it's a problem for our people. The people who use 
drugs are going to die, but before they do so, they will waste their 
family's money and cause a lot of suffering."

Mr. Hajim might well have been speaking of Mr. Almijan, whose costly 
12-year habit ruined his family's lucrative silk trading business, 
left him deep in debt and finally reduced him to a lowly job at a small hotel.

Now, less than a month out of detention in the treatment center, he 
reports most days to the clinic near Yuandong Hospital where he goes 
voluntarily to drink a dose of methadone under the watchful eye of a 
video monitor. Each treatment costs him about $1.20.

"All my money has gone up in smoke," Mr. Almijan said, explaining 
that he lacks the capital to get back into the silk trade. "My 
friends all shared needles when I was using drugs. At least I 
understood how bad that was and only used my own."

Another heroin addict, a fruit seller dressed in a tweed jacket who 
goes by the name Ablimit, said he started injecting heroin in 1999. 
"I had a bunch of friends invite me to try heroin," he said. "They 
either shared a lot of needles or they overdosed. They're all dead now."

Mr. Ablimit, who said he had tested negative for H.I.V., has tried to 
break his heroin addiction many times, including a previous bout with 
methadone. He recently spent 45 days in a methadone treatment center 
after his wife caught him shooting up at home and threatened to leave him.

He said that while methadone had given him great relief from cravings 
for the drug, it was a not a cure. Cravings return when the methadone 
wears off, and weaning recovering heroin addicts from the replacement 
drug can be as hard as quitting heroin itself -- and some say harder.

Nowadays, Mr. Ablimit works in a neighborhood recreation center, 
where he helps counsel other addicts and reports less and less 
frequently to a methadone clinic for a dose of the drug he is trying 
to wean himself from.

"You can take methadone as long as you want," he continued, his wife 
looking on. "But I've got children and want to be a regular person. I 
want to atone for all the bad I have done."
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MAP posted-by: Beth Wehrman