I just spent a week hanging out with heroin users and sex workers. When a friend heard that I was trying to help them, he wisely suggested that I was wasting my time. If I was too naïve, the doctors of Xichang Center for Disease Control (CDC) were even more stupid than I. They have spent the last year and a half working with these “bad elements” of society. It is because of their compassion and patience that I am able to bring you the story of Liangshan.
Story of Liangshan
Report by Humphrey Wou, Photo illustrations by Aaron Deemer and Humphrey Wou
Xichang is the capital of the Liangshan (Cool Mountains) Prefecture in Sichuan. Liangshan Prefecture has more than 50% of the HIV infection cases, and only 12% of the landmass of the province. This is the land of the Yi people, situated right on China’s Ancient Tea Horse Trade Route. Minority women, carrying their babies and traveling by foot, smuggle heroin across the mountain pass from Kunming in Yunnan Province, more than 1,000 km away. Even with a mark up of 1,000%, heroin is cheap and readily available in Xichang.
Mr. Ta (not his real name) was not a typical farmer. He married his wife when they were both 18. They had two children. His father was a respected village official. He owned a clothing shop, a long-haul cargo truck and a couple of other businesses. At one time his wealth exceeded half of a million yuan. In a place where the average income is 1,500 yuan, ten years ago he was practically a millionaire. Then a perfect picture was shattered by his curiosity about heroin.
To look at Miss Xi (not her real name), you would not have guessed that she is only 28, and that she once was a good student. Her parents were divorced when she was four years old and she went to live with a family friend who was three generations her senior. The man she called Grandfather loved her well. But when Xi was 17, she failed an important college entrance test. She was so depressed that she slit her wrists. Her friends gave her some free medicine to smoke, to calm her thoughts. By the time she realized the harm, she was hooked and the medicine was no longer free. At 18, she became a prostitute, moved away and broke her Grandfather’s heart.
Heroin is cheap. It only costs your wealth, your family, and your life. Ta and Xi have seen the death of many friends. One died of an overdose under a bridge. One hung herself with her own pants on a balcony. One set herself on fire in her bedroom. And many have died from a contaminated supply.
Life is a blur for heroin users. For Ta, he was no longer interested in work. He began to sell everything he owned, his business, his truck, his home. His wife divorced him. His parents stopped speaking to him. His children were ashamed of him. On many occasions he thought about killing himself to release his loved ones from their grief.
For Xi, the day began with shooting up. Then she would go out to look for a client, so she could pay for her next fix. After shooting up a second time, she would doze off for a while, then wake up to look for tricks. The cycle had repeated itself three, four, five times a day, for the past nine years.
Two years ago, Dr. Feng was an inexperienced young doctor at the local CDC clinic. China’s medical professionals are not trained in HIV/AIDS counseling. When he met his first client who tested positive, he sat silently with him for 15 minutes without knowing what to say. He just kept offering him cigarettes and Kleenex. Last May, he met Ta under similar circumstances. Ta was dumbfounded when he learned that he was HIV positive. He went to call his ex-wife. Dr. Feng listened to him crying in the next room. He hated the fact that he did not have some magical soothing words for them.
Ta’s wife is a hardy woman, with a dark, healthy complexion. She is, in many respects, a model farmer’s wife. She does farm chores, cooks, takes care of the animals, and puts everyone else’s needs ahead of her own. And in her spare time, she makes beautiful hand-embroidered shoe insoles.
Even though she and Ta have been divorced for more than five years (Ta himself has never admitted this fact), they remain on speaking terms. This man was the one she had married when she was 18. This man was the one she had had two children with. And this man would always be a part of her life.
The news of his HIV status was overwhelming. She made, to her, an obvious decision. She went back to him. “He’s got that disease,” she mumbled without looking at me as she stitched an insole with colored threads. “He needs someone to take care of him. The kids are almost grown, and we are both in our thirties. So I just came back.” I have heard of HIV separating lovers, but not bringing them back together again. She said she was not educated and she didn’t know what to say. But her actions were the most eloquent speech I had ever heard.
Ta got HIV from sharing needles. Thanks to their separation, Ta’s wife tested negative. The possession of needles is not illegal in China. But the cost, about 10 yuan, is prohibitive for drug addicts. They would prefer to buy a little more heroin, than waste money on clean needles. Dipping a used needle in hot water or wiping it with alcohol is the only precaution they will take, and not always that.
Drug use is against the law in China. Amazingly, despite conservative criticism, Yunnan, Guangxi and Sichuan have established needle exchange programs. These programs function with the support of foreign NGOs like the China-UK Project and the Daytop Center. Although these west China provinces are far less developed economically, their policies dealing with drugs, HIV/AIDS, and the environment are far more progressive than those of many of China’s big cities.
Vice Governor Liu of the Liangshan Prefecture has repeatedly told me that the health of the people is the responsibility of the government. Fighting HIV/AIDS is of the utmost importance to her. This vivacious woman who wears no make-up, but is always impeccably dressed, means what she says. She and the local CDC directors went to Beijing to request permission and funding to create a methadone pilot program for Xichang. So far, eight test sites have been approved and two are in operation. Xichang is one of the two.
Although Xi had never met Vice Governor Xu, she was one of the first direct beneficiaries of the methadone program. Quitting heroin is very difficult. The relapse rate is above 90%. Methadone greatly improves one’s odds of kicking the habit. But with the limited availability and expense of imported methadone, the applicants are carefully screened.
Dr. Jiang recalled that she first met Xi when Xi had been arrested. She was being held with 27 others in a space of about 200 sq. ft. Xi was so desperate for heroin that she put her fingers against a door jam and slammed the door. Bleeding all over herself, she begged to be taken to an infirmary.
Dr. Jiang saw Xi again a few months later at a peer education workshop for HIV prevention. Xi was no longer a bloody mess. She was, however, unbearably arrogant and suspicious. She believed that the workshop was a police scheme to round up sex workers. But she came anyway, to get the 50 yuan compensation for “missed work.”
Dr. Jiang’s nonjudgmental demeanor finally affected Xi. “Everyone has vices. Some people smoke and you do drugs. You are no different than anyone else in my eyes.” Xi knew that this was a ridiculous comparison, but she appreciated the doctor’s kindness all the same.
Today, Xi is the leader of a support group for commercial sex workers. The group has expanded to more than 40 people because of her. She is well read and writes a long journal almost everyday. Dr. Jiang was very impressed with her and invited her to a leadership training workshop in Chengdu. Xi always wanted to see the outside world, even if Chengdu was only a few hours away by train. During the week’s training, she met new friends from other places: gay people, drug users, sex workers, doctors, and educators. No one looked down on her because of what she did for living. It was a strange feeling. For the first time in nine years, she felt normal.
Ta and his wife moved into a spare shed at his retired parents’ home. He was able to gradually taper off drugs on his own. His parents softened their attitude when they learned that he was HIV positive. Ta’s son, 19, was chosen as a national free-style boxing trainee. Because the whole family is unemployed, the boy cannot finish his training. Ta and his wife blame themselves for ruining their child’s future.
The Lotus Club meets once a month. This is a group of 24 people with HIV who get together for mutual support. Dr. Feng encouraged the participants to run their own club. They picked the name. Lotuses grow in mud, but emerge unsullied. They cherish the symbol; they hope to rise above drugs. Much of the discussion in these meetings centers on finding a livelihood. Dr. Feng and his director decided to try a micro loan program. They used 2,000 yuan of their own operating funds (from the China-UK grant) to provide Ta with six sheep. The idea was inspired by the CDC/China-UK “Lend a Pig” program in another village, one and half hours away from Xichang. Twenty-three farmers with HIV are lent a pig for one year. They get to keep all but one of the offspring.
Grandfather passed away on February 14, 2003. From a neighbor, Xi learned that her beloved guardian had held on for three days, waiting for Xi to come.
Grandfather gave Xi the love that her own mother had denied. He spent 200 of his 300-yuan monthly retirement money to send Xi to school. “200 yuan ($25) was barely enough for me to buy heroin for one day,” she mourned. When Xi came back for a visit, Grandfather would busy himself in the kitchen preparing meals. Altough he was on crutches, Grandfather would insist on washing the dishes. When Xi was arrested for drug use, Grandfather visited her every week. When Xi was lonely, there had always been a place for her to come home to. Although Xi never talked much about her profession, Grandfather seemed to know. “A street vendor makes four, five hundred yuan a month,” he had said. “Not bad, right?”
Memories flooded her mind as Xi rubbed Grandfather’s bad legs. Grandfather was drifting in and out of consciousness. He had so much to tell Xi. “Keep the factory’s life insurance money for yourself; the government will provide free cremation for us old workers.” In his sleep Grandfather spoke of going back to his family soon. Xi understood that Grandfather preferred to be buried near his home and his deceased relatives. But he was willing to be burned to ashes just to save money for Xi.
When Grandfather told her to go take a nap, Xi would not leave and Grandfather didn’t argue. He smiled, closed his eyes, and never woke again. Xi crawled under the covers with Grandfather and held onto the slowly cooling, stiffening body. Then she too drifted off. That was the last time she slept in her Grandfather’s room. The government took back the housing unit, as soon as its occupant of record was deceased.
When Xi received the 4,000-yuan life insurance money, she bought a plot on a mountain. She hired a few laborers to haul the coffin up a hill. She buried Grandfather at 4 o’clock in the morning. Because of a shortage of land, burials have been against the law in China for almost 20 years.
Xi purchased one gram of heroin, a lethal dosage, before she went to see Dr. Jiang. She loved the people she had met at the clinic a year before. They, especially Dr. Jiang, had been calling her, seeing her every week. Sometimes when she was absent at support group meetings, Dr. Jiang would drive around town looking for her. Xi wanted to say one last goodbye to Dr. Jiang and her friends.
Dr. Jiang noticed that Xi was late for the weekly meeting. Looking upset, Xi muttered that she could not stay long since her grandfather had passed away. Dr. Jiang knew how important Grandfather had been to her. She told Xi to skip the workshop and quickly signed the compensation chit for 50 yuan ($6.25). Not much, but it was the most valuable gift that Xi had ever received. In the past, she would tell all sorts of stories to wheedle money from these people. This time they trusted her. 50 yuan prevented her from injecting one gram of heroin.
At this point, having pasted their stories together, I have fallen in love with all of them: the compassionate young doctors, a Grandfather I will never meet, the loyal Mrs. Ta, and, of course, Ta and Xi. Ta gave me an old coin that he wore around his neck. Xi gave me six pages of her diary. They gave me their most precious treasures.
Support funds from China-UK will stop in July of next year. But Drs. Jiang and Feng will not stop. They will still be volunteering their services to help people like Ta and Xi. I asked Dr. Jiang whether it would be possible to hire Xi part-time to help with the peer education project. If she were paid 600 yuan ($75) a month, or $900 a year, she would be able to leave her profession. Jiang said yes. I asked Dr. Feng about the possibility of expanding the Lend a Sheep (or goat or pig) program. The cost would be 2,000 yuan ($250) per family. And a year later, the loan would be transferred to a new family in need. Feng said yes.
I didn’t know what to promise, but they knew. Ta promised to love and care for his wife for the rest of his days. Xi promised to find a good life for herself. The morning I left Liangshan, it rained briefly, then the sun shone again. I knew their lives would continue to be difficult. But before long they would see the sun. Before long.