To determine the HIV and hepatitis C virus (HCV) geographical distribution among drug users in China, a systematic literature review of 40 peer-reviewed publications (comprising 15,565 drug users) was conducted. Of the total drug users, 10,724 were found to be injection drug users (IDUs) and 4841 were non-injection drug users (non-IDUs). Various studies identified that among IDUs and non-IDUs, the overall HIV prevalence rates were 12.55% and 1.05%, and the HCV prevalence rates were 66.97% and 18.30%, respectively. The HIV prevalence rate ranged from 0% (Anhui and Inner Mongolia) to 52.51% (Yunnan) among IDUs, and from 0% to 19.80% among non-IDUs correspondingly. The HCV prevalence rate ranged from 11.43% (Shannxi) to 90.77% (Hubei) among IDUs, and from 0% (Anhui) to 40.00% (Fujian) among non-IDUs. Based on the high prevalence of HIV and HCV among drug users, scaling-up harm reduction was required from ‘heroin trafficking areas’ to other areas in China.