Exploring stakeholder perceptions of facilitators and barriers to accessing methadone maintenance clinics in Yunnan Province, China

Abstract

Injection drug use is an ongoing public health crisis in China and one of the largest contributors to the transmission of HIV/AIDS. Though the government has rapidly scaled up methadone maintenance treatment clinics, they have not been extensively evaluated to analyze factors influencing rates of attendance. We explored the facilitators and barriers to accessing methadone maintenance clinics in Kunming City, Yunnan Province, China. Using in-depth qualitative interviews conducted from February 2008 to June 2008 with 35 informants – injection drug users (IDUs) and key stakeholders – we explored factors that determine whether drug users decide to present at methadone clinics. Interviews were digitally recorded with consent, transcribed verbatim, and translated. Content analysis was conducted to identify themes which included general attitudes toward methadone treatment, barriers and challenges to access, and suggestions for improvement. Within these, topics included responses to methadone, its side effects, and fear of discrimination, loss of privacy, and police interference. Respondents also listed numerous suggestions for improvement including raising awareness of harm reduction both among drug users and the community, providing additional support in the form of psychological counseling, job training and behavioral therapy, and increasing communication between police, government, and public health officials. High rates of HIV infection among IDUs in China have prompted public health responses including the scale up of methadone maintenance clinics. Our results may inform policy strategists in implementing social–structural changes to create enabling environments that facilitate an increase in access to methadone clinics among IDUs in Kunming.

Keywords:

• China
• HIV/AIDS
• harm reduction
• methadone maintenance treatment

Acknowledgements

This research was funded through the first author's Fulbright Grant through the Institute for International Education, and by support from the Chinese Center for Disease Control: National Center for AIDS and STDs. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Chinese Center for Disease Control. The authors gratefully acknowledge the contributions of study participants and Daytop staff in Kunming, China for assistance with data collection, Wang LiMing for her help translating the questionnaire, Ted Hammett for his thoughtful comments, and to the students in the Medical Anthropology Seminar and Kumi Smith for their edits and support throughout this entire process.