Along with other forms of administrative detention, RTL may accelerate sexually transmitted infection (STI) transmission by marginalising and stigmatising detained key populations, such as people who inject drugs and sex workers. Field research in China has shown that administrative detention shames individuals, distancing at-risk individuals from health services and social support that are necessary to prevent STIs.
There are two potential policy options for dealing with administrative detention — reform versus abolishment — that would likely impact the health and wellbeing of marginalised groups. Drawing on public health evidence from China, there are potential public health outcomes associated with administrative detention reform on the one hand and abolishment on the other.
Reforming administrative detention systems is the most likely and feasible short-term outcome associated with the recent announcement. Reform could encompass a wide range of scenarios of dealing with people who use drugs and sex workers, but would most likely continue to detain these individuals in other administrative detention facilities, such as ‘detention for education’ (收容教育) and compulsory drug rehabilitation (强制戒毒).
Administrative detention has a lengthy history of reform, shifting names and functions across time and place. For example, in 2003, the death of the young migrant student, Sun Zhigang, in the Custody and Repatriation (收容遣送) system spurred policy changes that eliminated Custody and Repatriation. But the overall architecture of administrative detention remained in place, including the detention of drug users and sex workers.
From a public health perspective, the persistent detention of marginalised groups in different detention systems would be unlikely to alter STI risk. Similar processes of shaming and structural risk associated with detention would likely increase STI risk. This begs the question about abolishment of administrative detention in China.
Although more challenging to implement, abolishing the administrative detention system could have far-reaching public health impacts. The term abolishment here is used to refer to completely ending the administrative detention of people who inject drugs and sex workers.
Public health research from China has shown that female sex workers who have never been detained are more likely to access STI/HIV services, have stronger social networks, and lower STI/HIV prevalence. Completely abolishing the system of administrative detention could help female sex workers re-gain trust in public hospital facilities, re-establish social support structures, and prevent STI/HIV. This could be particularly helpful for poor female sex workers who are more frequently detained and have some of the highest HIV prevalence rates in China. Post-incarceration re-entry programs could facilitate the process of having vulnerable groups re-integrate into the communities from which they had been detained before.
Abolishing administrative detention of drug users and sex workers is not a panacea, but it would be a valuable step towards reconfiguring the risk environment in favour of vulnerable individuals. The lives of people who inject drugs and sex workers underscores the complexity of risk taking, but research from a number of countries demonstrates that punitive policies against sex workers may have the unintended consequence of accelerating STI transmission.
Buoyed by the momentum from reforming the re-education through labour system, China now has a unique opportunity to consider abolishment. Such a task would be logistically and administratively complex, but well worth the effort.
Dr Joseph D. Tucker is Assistant Professor at the University of North Carolina School of Medicine and Director of University of North Carolina Project-China.