Pubdate: Fri, 21 Dec 2001
Source: New York Times (NY)
Copyright: 2001 The New York Times Company
Contact:  http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Elisabeth Rosenthal

A POOR, ETHNIC ENCLAVE IN CHINA IS SHADOWED BY DRUGS AND H.I.V.

BUTUO, China - By day, Butuo is an ethnic backwater, where women in 
long embroidered blue skirts tote baskets filled with chunks of pig, 
and men in full-length capes carry bundles of twigs, fuel for indoor 
fire pits.

It is a place populated by China's large but impoverished Yi ethnic 
minority, where donkey carts wind past simple red mud houses dressed 
for winter, hanging heavy with chains of red pepper and yellow corn.

But late at night, scenes of Butuo are drawn with a different 
palette. Small groups of young men weave past the town's only 
intersection - pitch black except for an eerie blue glow cast by 
incongruous advertisements for mobile phones. Visitors are warned not 
to venture outside. The frigid air is pierced by a cacophony of 
singing, shouting and arguments until 4 in the morning.

At almost any time, the five unheated cells of the public security's 
drug detoxification center are overflowing with addicts, many accused 
of trafficking as well.

Located on the drug-trafficking route that connects Myanmar with 
China's northern cities, Butuo and other towns near here have become 
centers of intravenous drug use and its stubborn shadow, H.I.V. Poor 
uneducated youths use heroin as a cure for boredom and have also 
discovered that carrying drugs is an easy way to get cash.

In Butuo, a town of 10,000 in the Liangshan Yi Autonomous Prefecture, 
one official estimated there were up to 20 deaths each year from 
heroin overdoses. Hundreds of people probably carry the virus that 
causes AIDS, although health officials have no money to really check.

"The spread of H.I.V. here is worse every year," said Zhang Se'er, of 
the Butuo anti-epidemic station. "When we first saw it, in the mid-to 
late- 90's, it used to be just from drugs, but now there's sexual 
transmission as well."

Initially, officials in Liangshan tried to deny and ignore that 
H.I.V. had arrived - a response still typical of much of China. But 
by 1999, with the virus rolling through their population and no 
knowledge or money to control it, officials decided to try a 
radically new tack: They admitted to a serious AIDS problem.

They contacted Doctors Without Borders and requested assistance in 
setting up prevention programs, which now focus on drug addicts and 
prostitutes. This month, they allowed a foreign reporter to attend 
the sessions, where a number of people still had never heard of the 
deadly virus.

"At first, we didn't want to talk about it - we were filled with 
worries - and we certainly didn't want to check to see how bad it 
was," said Liu Yan, a pragmatic official who is deputy commissioner 
of Liangshan prefecture. "But then we realized that if we didn't do 
anything, 300 people could quickly become 3,000. AIDS is a global 
problem. These places are poor. They need help."

 From the standpoint of drugs and AIDS, Butuo's location is its most 
glaring liability. It sits as a crucial way station on a major route 
for both legal goods and drugs, exactly halfway between Chengdu in 
Sichuan Province and Kunming in Yunnan, which borders the 
drug-growing regions of Myanmar and Laos. In short, drugs are readily 
available.

"I was introduced to drugs by friends right here in Butuo," said a 
man, 25, with downcast eyes, wearing a dusty dark suit jacket, who 
would give only his surname, Suge.

Squatting on the dirt floor of the detoxification center, rubbing his 
hands over a heated coil, Mr. Suge recalled how he was spending up to 
100 yuan a day on heroin, or about $12, at the time of his arrest. 
The average yearly income in the county is 800 yuan, or $96.

Many of the poor, desperate people who take up work as low-level 
couriers eventually become addicts; others who start as addicts take 
up trafficking to support their habit. Although many addicts start 
inhaling heroin, most quickly turn to injection because it the most 
economical way to achieve a high. Sharing needles is just another 
form of economy.

Nearly three years ago, a survey of people in drug detoxification 
here found that 10 percent of Butuo's addicts were infected with 
H.I.V.. There has not been money for subsequent testing but the 
infection rate is almost certainly much higher now.

Once AIDS enters a population of drug users who share needles, it 
spreads with alarming speed. In the far western region of Xinjiang, 
the rate of H.I.V. infection among drug users went to 40 percent from 
10 percent between 1996 and 1997, for example.

Scientists have been able to document the quick spread of AIDS along 
drug routes in China, since the subtype of AIDS found at the Burmese 
border is somewhat unusual.

"You can actually map it year by year as it follows the route north 
skirting Tibet, arriving first in Chengdu and then north to 
Xinjiang," said Chris Beyrer of the Johns Hopkins School of Hygiene 
and Public Health, who has studied the spread of H.I.V. in Asia. "The 
Yi people are a part of the network."

For Yi youth, drugs and the easy money that surrounds the trade 
provide understandable temptations. Because there is little money in 
farming here, it is customary for young Yi people to leave Butuo to 
search for work in Kunming and Chengdu, both 14 hours away.

Like all rural migrants to Chinese cities, they work illegally 
without proper permits and tend to occupy low-status jobs. 
Deportation back to their hometowns is a constant worry.

Among migrants, the poorly educated Yi youths are at the bottom of 
the pecking order, with their strange language and alien customs. 
Though school in Liangshan is theoretically taught in Mandarin, many 
children leave school in the early grades and end up speaking only 
Yi, an unrelated tongue that has its own alphabet.

"People tend to move around a lot looking for work," said Dr. Zhang, 
who is Yi but whose parents adopted a Chinese surname so that they 
might better fit into official circles. "They do whatever work they 
can find. Sometimes they steal. Sometime they carry drugs."

Eventually they are sent home by police, or come home to marry. Their 
addictions and diseases come with them, spilling over into the 
community.

On a recent Saturday, at the beginning of the Yi New Year, 75 
prisoners were crammed into five unheated cells with bars but no 
windows to keep out the cold.

Although health professionals say that the Butuo police run more 
humane detoxification centers than most in China's vast network, 
virtually all have more to do with punishment than treatment. The 
detainees all start with a cold-turkey withdrawal from heroin, and 
then spend three months as inmates, sleeping elbow-to-elbow on mats 
on the floor and eating gruel from metal bowls that are passed 
through a hole in the cell door.

On a recent morning, one cell - the only one not locked - held more 
than a dozen Yi women, accompanied by young children. A fortresslike 
wall guards the small compound, complete with police sentries 
patrolling on top.

A group of new men was thrilled to be let out to attend a seminar, 
organized by health officials and Doctors Without Borders, on a 
disease that many said they had never heard of before. Dressed in 
suit jackets or traditional Yi capes, they straggled into a small 
cement room with peeling green paint. Some were red-eyed and jittery.

Although addicts here are not routinely tested for H.I.V., it is 
clearly around. Many of the young men, all in their 20's, are gaunt; 
deep-seated coughs occasionally resonate through the room. 
Tuberculosis is a major health problem among the addicts, the 
center's doctor said, an illness that is common during the early 
stages of H.I.V. infection.

A clean-cut young Yi in a Nautica jacket, who gave his surname, Tubi, 
said that he had recently come home to Liangshan after three years 
working on a construction site in Kunming. In a city where studies 
have found that 40 percent of addicts are infected with H.I.V., he 
shot up heroin twice a day, often sharing needles.

"Life was hard and my friends said it would help me relax a bit," he 
said. "I'd never heard of AIDS before today."
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