SHANGHAI'S last privately run, voluntary drugs rehabilitation hospital is struggling to stay afloat but as UN AIDS Day approaches, there's some cause for satisfaction that it no longer sees HIV cases. Zhang Qian reports.

Only 10 to 20 patients, all heroin addicts, are treated these days at Huashi Drug Rehabilitation Hospital, a private, voluntary-admissions facility in Fengxian District that once was filled to its 80-bed capacity.

Huashi is the city's only remaining, private rehab where non-convicted drugs abusers can get help in privacy. Many just stay a week for medical detox and stabilization; some stay longer for 28 days, including group and individual psychotherapy. Few get any follow-up intervention.

The cost to patients is as low as 200 yuan (US$31.30) a day, but some are even too poor to afford that. The hospital hasn't seen HIV patients for some years.

With World AIDS Day falling tomorrow, the focus is on education and preventing transmission through sexual contact (sex has become the primary transmission means) and intravenous drug use.

Two other privately run addiction hospitals have already closed for financial reasons, one in Jinshan District and the other in Baoshan District, and eight-year-old Huashi is on the cusp of closing. It has struggled for the past three years because the number of heroin addicts seeking private treatment has dropped dramatically, and there were no supporting donations.

"If the situation doesn't get better, Huashi will have no choice but to close like the city's two other private drugs rehab hospitals," says Chen Fuda, president of Huashi Voluntary Drug Rehabilitation Hospital.

The hospital once admitted 1,500-1,700 cases a year; today it admits around 1,000. Charging 200 yuan a day doesn't cover expenses.

The only other non detention-like setting for treatment is the Shanghai Mental Health Center, which is partially supported by the government.

There is also community rehabilitation in which drug offenders are allowed to live at home and attend therapy sessions and receive medical attention.

They are monitored by police and case workers to ensure that they are in rehabilitation, at least for three years.

The number of reported heroin addicts in the city has fallen. The latest statistics for this year indicate only 321 new cases of addiction of all kinds; no more than 10 percent of them are addicted to intravenous drugs, while the others are addicted to synthetic drugs like methamphetamines, ecstasy and ice.

More aggressive law enforcement, mandatory detention and treatment for convicted drug offenders, as well as death of older addicts are cited as reasons for the decline in intravenous drug cases.

The Shanghai Narcotics Control Office reported in June there are 31,075 recorded drug addicts of all kinds in the city. Around 7,035 addicts have been clean for more than three years throughout the years, representing 23.7 percent of the total.

Official national statistics indicate that in 2008 there were 1.22 million reported cases of addiction to various drugs; in 2009 the figure was 1.33 million; in 2010, it's estimated the number of addicts under age 35 was 1.78 million; further calculation indicates the total could be 1.95 million.

Official statistics only cover reported cases and are considered low.

In Shanghai the three major approaches to addiction are state-run compulsory drug treatment in detention; addiction hospitals (now only two) and court-ordered community drug rehabilitation.

Medical detoxification usually takes only seven to 10 days, but it takes far longer to treat psychological and physical reliance on drugs.

While the number of reported intravenous drug users in the city has fallen, the cases of addition to newer drugs in the methamphetamine family, such as ice and ecstasy, have risen, especially among the young.

The new addicts pose treatment challenges to organizations traditionally dealing with intravenous and other "traditional" drugs. New addicts are younger and have different issues. The situation is especially difficult for private organizations that must support themselves.

"Unlike compulsory drug rehabilitation and court-mandated community drug rehabilitation, most of our patients come out of their own desire to quit," according to Dr Li Guangjun, medical director of Huashi Hospital. "This means that patients themselves recognize their addiction and the damage it causes."

Drugs like heroin, morphine and opium usually cause addition within two months and withdrawal symptoms show up within eight to 12 hours, while it takes much longer to get physically addicted to newer drugs and to recognize addition," Dr Li says. New drugs, the psycho-hallucinogenic party drugs like ice and ecstasy, damage the central nervous system but the physical symptoms of withdrawal may not be dramatic, he says.

Therefore, though the number of new drug addicts increases by 20 percent each year, few seek voluntary drug treatment at an early phase, Dr Li says, another reason there are fewer patients.

Though it's rather shabby today, but still clean and tidy, the hospital is a harbor for people who want to change.

"It has to be there, otherwise, we will have no way back," says 42-year-old patient David Zheng, who has been a heroin addict for 10 years. The Shanghai resident was discharged a year ago and readmitted recently.

Zheng did three, two-year stints in compulsory rehabilitation, where lack of personal freedom and long hours of work failed to motivate him to kick the habit. Within months of his release, he was using again.

"Involuntary drug rehabilitation can help a great number of drug addicts effectively get rid of the physical addiction with strict treatments, but being forced to quit often antagonizes some users who defiantly use again when they are released," Dr Li says.

The staff of Huashi hospital also provides counseling since the psychology of addiction is difficult to overcome. Patients are encouraged to return for sessions after discharge.

After his wife finally left him two years ago, Zheng made up his mind to quit.

"I knew I had to quit," the former businessman tells Shanghai Daily. "I don't want to disguise who I am in public and read discrimination in people's eyes," he says. "Every doctor and nurse here treats me well, like a patient, not like a bad guy, which strengthens my determination to start a new life."

Zheng quit using after two weeks of treatment - far from enough, most experts say. He used again just a few days ago when he was in a low mood and his old friends encouraged him. He checked himself into the hospital again. That's when he spoke to Shanghai Daily.

Zheng is fortunate he can afford the 200 yuan a day - a trifling sum - for treatment, accommodation and meals. Many people cannot afford even that.

"I know it's cruel, but we have no choice," says president Chen. "We at least have to cover our expenses."

But Huashi has already cut expenses as much as possible; it hasn't upgraded the facility or equipment, raised salaries or given bonuses. Doctors only earn around 3,000 yuan a month, nurses around 1,600 yuan.

"We always feel terrible when we see patients leave midway in their treatment since they cannot pay for further treatment," says Dr Chen Min, Huashi's director of rehabilitation.

She remembers a patient who was admitted for treatment three months ago, with 2,000 yuan in hand. He said his teenage daughter gave him all her savings and pocket money and begged him to try again to quit heroin.

"The man was on his knees and crying like a child. He said he was so ashamed because he depended on his daughter's mercy. It was his last chance and he had to succeed," Dr Chen says.

After two weeks, the man left and hasn't returned, as he had promised, for follow up and counseling. Dr Chen says she hopes it's because he finally kicked the habit, not because he didn't have the money.

"Involvement by society for drugs control and rehabilitation is always encouraged as a channel for salvation of drug addicts," says Ji Baorong, director of the research office of Shanghai Narcotics Control Office. "But supporting non-government, non-compulsory addiction is very complicated and it's still being studied," Ji says.

Few addicts seek treatment voluntarily and consistently attend counseling, so profits are low. Necessary strict regulation of such hospitals has led the government to hesitate to give immediate support and call for careful study.

Kicking substance abuse is a long and arduous process both physically and psychologically and long-term studies are needed in China to determine what kind of methods are most effective.

China drug use

Dr Chen Zhongdan, China national UNAIDS program officer, told a forum in November that in 2010 there were 15.9 million intravenous drug users worldwide, while 3 million are estimated to be HIV-positive.

He estimated that China has 5-6 million drug addicts, much higher than official figures.

China's Health Ministry reported that this year (2011) there were 439,000 reported cases of HIV infection, 164,000 reported AIDS patients and 86,000 deaths among AIDS patients.

The Shanghai Health Bureau reports that from 1987-2010, there were 5,992 reported HIV infections in the city; 1,213 AIDS patients and 241 deaths.

The Shanghai Narcotics Control Office reported in June there were 31,075 recorded drug addicts of all kinds in the city, while the reported number was 32,000 in 2009 and 34,000 in 2008.