HIV/AIDS in China

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The AIDS pandemic scene in East Asia is dominated by China. Much of the current spread of HIV in China is through intravenous drug abuse and prostitution. In China, the number of affected has been estimated at between 430,000 and 1.5 million by researchers, with some estimates going much higher. In many rural areas of China, where large numbers of farmers and peasants, especially in Henan province, participated in state-run, contaminated blood transfusion programs; estimates of those infected are in the tens of thousands.

The underlying government approach is that of a preemptive intervention. China is not yet near to, what many would consider, a widespread AIDS epidemic, but the infection rate has been rising sharply and the potential impact of a serious outbreak in a country as large as China would be disastrous for both its own and the world's economy.

Contents 1 History 1.1 Chronology of major HIV/AIDS developments in China 2 Epidemiology 2.1 Current numbers affected 2.2 Growth rate 2.3 Predictions 2.4 HIV subtypes 3 Transmission 3.1 High risk groups 4 Treatment 5 Control and prevention 5.1 Overview 5.2 External funding 5.3 Private sector and NGO involvement 5.4 Newer approaches to HIV prevention 6 HIV/AIDS surveillance system 7 AIDS vaccine trials 8 Awareness level 9 Criticisms and control problems 9.1 Government policies 9.2 Discrimination and stigma 9.3 Censorship 9.4 Urban-rural inequality 10 Activism 11 Blood transfusion controversy 11.1 Bloodhead scandal 11.2 Compensation 12 Socioeconomic impact 13 Media coverage 14 See also 15 External links 15.1 Information sites 15.2 Health bodies 15.3 Charities 15.4 Private sector initiatives 15.5 Media 16 Notes and references 17 Further reading

[edit] History

[edit] Chronology of major HIV/AIDS developments in China

• In 1984, Zeng Yi, an academician with the Chinese Academy of Sciences, starts HIV serum testing and confirms that the virus has entered the Chinese mainland in 1982 and infected the first Chinese in 1983.
• In 1985, China records its first death of an AIDS patient.
• In 1986, four Chinese hemophilia patients are found HIV positive after blood transfusions. The blood products were imported.
• In 1987, a 13-year-old Chinese hemophiliac, who was infected with HIV after transfusion of foreign blood products, dies of AIDS.
• In 1990, the Ministry of Health sets up the National AIDS Committee.
• In 1992, the National Health Education Institute sets up the country's first HIV/AIDS counseling hotline.
• In 1992, the government confirms that it has recorded 11 AIDS patients and announces a medium-term plan on the prevention and control of HIV/AIDS.
• In 1998, China's first 'Law on Blood Donation' takes effect on October 1. The law requires health authorities to standardize blood collection. Illegal blood collection for commercial purposes is banned.
• In 1998, on November 30, the government issues a 13-year plan (1998-2010) on the prevention and control of HIV/AIDS, which sets a target to keep the HIV positive population below 1.5 million.
• In 1999, the Ministry of Health issues an administrative guideline, emphasizing the protection of the legitimate rights of people infected with HIV.
• In August 2002, for the first time, an official of the government of China acknowledges that the country is facing an AIDS epidemic and discloses that HIV infections in China rose 67.4% in the first six months of 2001 compared with the first six months of 2000.
• In 2003, in September, Vice Health Minister Gao Qiang pledges a set of anti-HIV measures at the 58th UN Assembly's special session of AIDS. The measures mean a larger range of government responsibility on AIDS prevention and control, including free HIV treatment for poor sufferers, establishment of AIDS control centers, the legislation of AIDS-related laws and international cooperation.
• In 2003, Premier Wen Jiabao visits AIDS patients in a Beijing hospital and becomes first premier of China to publicly shake hands with AIDS patients in a bid to eliminate social discrimination.
• In 2003, the Ministry of Health and the United Nations Theme Group on HIV/AIDS in China jointly issue an assessment report on December 1, which estimates that China has 840,000 HIV positive people, of whom 80,000 have full blown AIDS. The assessment says that despite the overall low prevalence rate (an adult infection rate of less than 0.1 percent), the epidemic has spread to 31 provinces. In China the government estimated that up to 850,000 people had contracted HIV by 2000 — more than half of them having acquired the virus since 1997.
• In 2004, Vice Premier Wu Yi openly advocates behavior intervention to the high risk population at a national working meeting on HIV/AIDS in April, marking an unprecedented step forward in the fight against the disease.
• In 2004, on November 30, President Hu Jintao visits AIDS patients in Beijing for face-to-face talks.
• In 2006, the Ministry of Health, UNAIDS and the World Health Organization jointly issue an assessment in January in Beijing, lowering the estimated number of HIV/AIDS cases in China to 650,000, nearly 200,000 less than the 2003 estimate. The assessment also estimates that China has 75,000 AIDS patients.
• In 2006, a new rule issued by the State Council on the prevention and control of HIV/AIDS takes effect on March 1.

At the start of the 21st century many Western countries were also battling the reluctance of the Vatican, some Muslim nations, and other countries such as China to single out homosexuals, prostitutes, and drug dealers/users for special attention out of fear of appearing to condone their lifestyles.

[edit] Epidemiology

The Chinese government has been widely criticized for its failure to respond to the HIV/AIDS threat and for systematic suppression of information about the size of the problem.

[edit] Current numbers affected

The Ministry of Health has said there are 650,000 HIV/AIDS cases, half of them among intravenous drug users,^{[citation needed]} out of a nation of 1.3 billion people. (Although this overall estimate of HIV and AIDS cases was lowered in January 2006 – in a report put together by the Chinese government, the World Health Organisation and the Joint United Nations Programme on HIV/AIDS (UNAIDS) – from 840,000 to 650,000, officials say this reflected the use of different statistical methodology rather than a drop in the incidence.) Epidemiology experts have said that 1.5 million is closer to the true figure.

According to PRC's health ministry, there are now 183,733 registered cases of HIV/AIDS in 2006, a rise of nearly 30 percent over 2005. But the real figures are likely to be much higher as testing and surveillance techniques are limited, especially in the countryside, and entrenched discrimination may have discouraged many from reporting.

Out of the 840,000 HIV carriers in the mainland, the health ministry estimates in early 2004 that there are 80,000 suffering from AIDS. HIV cases have been reported in all the Chinese mainland's 31 provinces, autonomous regions and municipalities.^[1]

[edit] Growth rate

The potential risks are very high. The most recent data showed that the number of new cases in China rose by 70,000 in 2005, which led to some health officials to raise concerns that infections were moving from high-risk groups into the broader population. The ministry attributes 37% of the new cases to drug use and 28% to unprotected sex.

Health officials are also mindful of the experience in Africa in the 1990s - for instance, the quick rise in South Africa's incidence from 1 percent at the start of the decade to about 20 percent in 2003 – which underlines the strong case for an early and aggressive policy response.

An increase in diagnoses might mean that HIV testing has become more easily available than in preceding years, or that the stigma associated with HIV has declined, encouraging more to get tested.

[edit] Predictions

Predictions of the size of the HIV/AIDS epidemic in China have been substantially overestimated by several expert bodies. Notable examples include:

• In 2002, a UN-commissioned report, emotively entitled China's Titanic peril,^[2] estimated that China had about 1 million cases of HIV, and that it was on the brink of an "explosive HIV/AIDS epidemic... with an imminent risk to widespread dissemination to the general population". The report continued: "a potential HIV/AIDS disaster of unimaginable proportion now lies in wait."
• In Septmember 2002, the US National Intelligence Council estimated that 1-2 million people were living with HIV in China, and predicted 10-15 million cases by 2010.^[3] The National Intelligence Council claimed that these figures were more reliable than previous estimates because they did not rely on official Chinese sources, which the National Intelligence Council asserted "systematically understate the actual figures", but rather incorporated assessments by academics and non-governmental organizations working in the field.
• In November 2002, the American Enterprise Institute as the AIDS typhoon.^[4] This report emphasized the probable damage to the economy because HIV would spread among young educated urban people.
• In April 2004, the Center for Strategic and International Studies (Washington, DC, USA), HIV/AIDS was referred to as China's timebomb.^[5]
• The number of people infected with HIV/AIDS in China "could rise to 10 million in the next six years unless the government acts urgently and effectively to prevent an epidemic", the Joint UN Program on HIV/AIDS said in its 2004 biennial report on the global AIDS epidemic. The virus has spread to all provinces of China but with no distinct pattern of infection, and there are “extremely serious” epidemics in parts of the country despite a low rate of the disease nationwide of about 0.1 percent, the report said.

[edit] HIV subtypes

The subtypes of HIV-1 found in China include B, Thai B, A, C, D, E, F, G, and BC and BB recombinants. However, the epidemiological distribution and relative importance of these subtypes need further study.

[edit] Transmission

China's HIV/AIDS epidemic can be divided into three phases.

• The first phase, in 1985-8, involved a small number of imported cases in coastal cities — mostly foreigners and overseas Chinese. Four people with haemophilia from Zhejiang province also got infected with HIV after using imported factor VIII.

• The second phase, from 1989 to 1993, began with finding HIV infection in 146 drug users among minority communities in Yunnan province in the southwest, adjacent to the “Golden Triangle” bordering Myanmar, Laos, and Vietnam.

• The third phase began in 1994, when a number of infections were reported among drug users and commercial plasma donors. In the 1990s, HIV gained a foothold in China largely due to tainted blood transfusions in hospitals and schemes to buy blood plasma, where it was collected using unsanitary means. Although the government today acknowledges responsibility in the transfusion cases, many victims still have trouble receiving compensation. By 1998 HIV infection had been reported from all 31 provinces, autonomous regions, and municipalities under control of the central government. Though drug users accounted for 60%-70% of reported HIV infections, the number of infections through heterosexual transmission had increased steadily to 7%.

[edit] High risk groups

• Sex workers/prostitutes (see: Prostitution in the People's Republic of China); Chinese authorities estimate there are 3 million to 4 million women working as prostitutes in so-called karaoke bars, hair salons, massage parlors and truck stops.
• Homosexual/bisexual men (see: Homosexuality in China)
• Intravenous drug users
• Migrant workers (the "floating population"), are invariably single, poorly paid and from less progressive regions of China where sex education remains taboo, are immediately exposed to the high-risk groups. Workers travel between work and home for the periodic visit with spouses — the virus is virtually guaranteed to affect a broad geographic range.
• Blood donors
• Healthcare workers

[edit] Treatment

The government now provides free AIDS drugs to rural residents and city-dwellers without insurance. Other measures include:

• Free voluntary counseling and testing.
• Free drugs to HIV-infected pregnant women to prevent mother-to-child transmission, and HIV testing of newborn babies.
• Free schooling for AIDS orphans.
• Care and economic assistance to the households of people living with HIV/AIDS.

[edit] Control and prevention

[edit] Overview

Early efforts to control the HIV/AIDS epidemic emphasized enforcement of laws against high-risk behavior, but that later lessons from effective interventions in pilot programs and in other countries (e.g. needle exchange programs in Australia and condom campaigns for sex workers in Thailand) have led to a more evidence-based approach.

The process of policy development have not been tidy because of tensions arising particularly from those between public health officials and the police and those within public security over the management of illegal drug use and prostitution. However, the recently announced AIDS Prevention and Control Regulations are an example of evidence-based policy, even if their implementation is highly variable across China.

In 2003, in response to the spread of HIV/AIDS, the Chinese government declared a strong commitment to its prevention. Long and medium term plans for controlling and preventing HIV-AIDS have been developed, and a central government coordinating committee has been formed among 33 ministries.

The government has recently approved a series of pilot programmes, such as:

• a methadone maintenance treatment programme
• a needle exchange programme for drug users who have gone through detoxification
• vending machines selling condoms have been set up in public places

The hazards related to uncontrolled illegal collection of blood and plasma were realised in 1994 after an outbreak in blood donors, and countermeasures were initiated.

A programme has been launched to deal with stigma and discrimination against people with HIV/AIDS.

• In 2006, 5,000 Beijing taxi drivers handed out HIV/AIDS information leaflets to passengers in the first 10 days of December.
• Officials in the southwestern province of Yunnan announced in 2006 that, starting on January 1 2007, Yunnan residents will be required by law to take an HIV test before marriage. There would be no charge for the test, the results of which are to be shared with prospective spouses. Yunnan, home to 25% of the country's HIV cases, borders the opium-rich Golden Triangle of Vietnam, Laos and Myanmar. The virus has been found in 128 of its 129 counties, the provincial government has said.

[edit] External funding

[edit] Private sector and NGO involvement

Since 2003, the central government showed an increasing openness on AIDS issues, making several public statements encouraging the participation of the private sector and, to some extent, NGOs. This was due, in part, to the SARS epidemic, which helped change the way in which government dealt with public health issues. For a prolonged period, the authorities did not admit to having a serious outbreak of SARS until it was a devastating problem and only then did they decide to come forward and acknowledge the real scale of the epidemic. The new-found frankness helped the government win back some credibility before the international community.

Currently, there are dozens of different projects sponsored by the private sector targeting the problem around the country, from education and awareness programmes to increasing the capacity of local NGOs. Notable cases include:

• Merck, a US pharmaceutical company, is spending about US$30m over a period of five years. The program involves training for healthcare professionals, condom distribution and identifying high-risk groups.
• Bayer, a German pharmaceutical company, has set up a training course in HIV/AIDS issues for journalists. About 300 reporters have completed the course so far at Tsinghua University in Beijing.
• Standard Chartered Bank has introduced some of the approaches it has learned from its operations in southern Africa, including awareness programs for new employees and encouraging staff to be tested.

[edit] Newer approaches to HIV prevention

[edit] HIV/AIDS surveillance system

The national surveillance system in China has three components:

• (1) National disease reporting programme for 35 notifiable communicable diseases that covers the entire population
• (2) 145 national disease surveillance points covering 1% of China's population in 31 provinces, regions, and municipalities
• (3) Several disease specific surveillance systems including one for HIV infection and AIDS

Additionally, 42 national HIV/AIDS sentinel surveillance points have been established in 23 provinces since 1995.

[edit] AIDS vaccine trials

China is currently seeking volunteers to participate in its second clinical trial of a new AIDS vaccine for early 2007, Shao Yiming, chief expert for the National Center for AIDS/STD Control and Prevention. The center is looking for men and women to participate in the trials which will take place in Beijing. He revealed the plan at a conference on Sino-U.S. AIDS vaccine research and development held on the 17 December 2006 without indicating how many participants will be involved in the trial. The vaccine was approved for clinical trials by Chinese drug authorities in November 2006. Trials on Rhesus Monkeys indicates that the vaccine is safe and effective in preventing HIV infections, Shao said.

In March of 2005 China began its first human clinical trials on an AIDS vaccine in southwestern Guangxi Zhuang Autonomous Region. The volunteers, 33 men and 16 women aged from 18 to 50, have been vaccinated and none have had adverse side effects.

According to a recent report released in 2006, there are 120 clinical trials of AIDS vaccines being conducted on humans throughout the world.

[edit] Awareness level

Public ignorance about AIDS is a major problem in China. A recent survey found 20 percent of people had never heard of the disease.

[edit] Criticisms and control problems

[edit] Government policies

Health officials say there are plenty of problems in China's approach to AIDS. There are frequent reports of police crack-downs on local NGOs involved in AIDS prevention. There have also been reports of police using the presence of a condom in a sex worker's handbag to justify detention. This has been partially blamed on policy incoordination, and contradictions and conflicts between laws and regulations.

In addition, there are concerns that provincial governments have enough autonomy to sometimes stall the implementation of central government-set guidelines and some officials say there has been a reluctance from many state-owned companies to get involved in AIDS programs.

[edit] Discrimination and stigma

Many Chinese businesses have been reluctant to make voluntary commitments to non-discriminatory treatment of HIV-positive employees, often because they fear lawsuits and because they are unable to recoup the cost of HIV/AIDS related health care from company insurance policies.

[edit] Censorship

China speaks of the need for compassion and education to replace fear and ignorance in dealing with the epidemic. But the instinct to keep bad news hidden, to protect powerful officials from embarrassment, and protect the public image of the ruling Communist Party is still a powerful one in China.

[edit] Urban-rural inequality

[edit] Activism

In China, like elsewhere, HIV/AIDS activists have played and continue to play an essential role in promoting public awareness and education about the disease, helping to prevent discrimination against people living with HIV/AIDS and highlighting factors which may impede efforts to check the spread of the disease.

It has been claimed by some international human rights groups that HIV/AIDS activists in China continue to face serious obstacles in their work, including arbitrary detention, harassment and intimidation, and other human rights violations. Restrictions on travel by Dr. Gao Yaojie, a Hunan activist, have been cited in news reports.^[6]

The country's best-known AIDS activist, Wan Yanhai, believes China suffers 10 times the number of HIV cases - 650,000 - estimated by health officials.

[edit] Blood transfusion controversy

[edit] Bloodhead scandal

From the early to mid-1990s a network of businessmen and government workers, known as "bloodheads", set up hundreds of official and unofficial blood donation stations in Henan Province to supply the market for blood plasma created by hospitals and manufacturers of health products. The common practice of reusing needles, not screening for diseases, sellers traveling from station to station with false records to maximize their income, and the mixing the blood prior to centrifuging and re-injecting the separated red blood cells back into the peasant blood-sellers guaranteed the rapid spread of blood-borne diseases such as HIV and Hepatitis B.^[7]

The blood stations began to be closed down in 1995 when the scale of the HIV outbreak began to become apparent. The ensuing coverup saw government officials take credit for dealing with the crisis which they caused, the harassment of journalists attempting to cover the story, and of whole villages dying of what was to them a mysterious disease because they had not been informed that they were likely to have been infected.^[7]

In 24 August 2002 the prominent HIV/AIDS activist, Wan Yanhai, was arrested in Beijing and detained for a month for leaking an internal government report on the Henan’s AIDS crisis.^[7]

[edit] Compensation

In early December 2006, it was reported that a group of 19 people who contracted HIV from tainted blood transfusions at a hospital in the northeastern province of Heilongjiang were awarded 20 million yuan (US$2.5 million) in compensation. The landmark case involves the largest single group stricken by HIV in China. Eighteen of the victims will receive a one-off payment of $25,500 from the hospital and an additional $380 in monthly payments. Payment will go to the family of the one victim who has already died from AIDS.^{[citation needed]}

[edit] Socioeconomic impact

[edit] Media coverage

AIDSPortal news summaries on China

Chinese-American director Ruby Yang has recently made a documentary about AIDS in rural China, which premiered on 14 June 2006, entitled The Blood of Yingzhou District. [1]

On 25 November 2006, the Associated Press reported that a Chinese HIV/AIDS activist, Wan Yanhai, was apparently arrested shortly before an AIDS seminar was about to take place in Beijing. [2]

An abridged version of Robert Bilheimer's acclaimed US-made documentary A Closer Walk was shown on China Central Television (CCTV) on Friday and rerun Sunday and Monday. It was viewed by around 400 million people. The 75-minute length documentary narrated by actors Will Smith and Glenn Close, had premiered in the United States in 2003.

[edit] See also

• HIV/AIDS
• AIDS pandemic
• HIV/AIDS in Asia

[edit] External links

[edit] Information sites

• AIDSPortal page on HIV & AIDS in China - promotes knowledge sharing among networks of people responding to the AIDS epidemic
• HIV & AIDS in China — AVERT, an international HIV and AIDS charity
• China AIDS Survey — an open-source, online database dedicated to the AIDS epidemic in the People’s Republic of China
• IFC: HIV in China Briefing Book — International Finance Corporation (World Bank Group)
• Science Online Collection: HIV/AIDs in Asia - HIV/AIDS in China — Jon Cohen
• Summary Translations from the Chinese Press and Medical Journals on HIV-AIDS 1998 - 2001 from U.S. Embassy Beijing website.

[edit] Health bodies

• HIV/AIDS Programme — World Health Organization
• Joint United Nations Programme on HIV/AIDS (UNAIDS) — United Nations
  • AIDS epidemic update, December 2005 (pdf)
  • Specific country data
• UNICEF China - HIV/AIDS - Issue

[edit] Charities

• AIDS Action Network (AIZHI)
• AIDS Concern HK
• China AIDS Orphan Fund
• China HIV/AIDS Information Network
• Chinese Foundation for the Prevention of STD and AIDS
• Dongzhen — AIDS orphan support project
• HomeAIDS — an AIDS education and facilitation center
• Mangrove Support Group — for people living with AIDS
• National Center for STD and AIDS Prevention Control
• Positive Art Workshop — for people living with HIV & AIDS

[edit] Private sector initiatives

• Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria (GBC) — headquartered in New York, USA
• International Business Leaders Forum — a not-for-profit organization founded in 1990, works with business, government and civil society in the fields of responsible business and multi-stakeholder partnerships. Over nine years it has cooperated with UNAIDS to define the role of business in the prevention and treatment of HIV/AIDS.
• World Economic Forum's Global Health Initiative — launched by Kofi Annan at the 2002 WEF Annual Meeting in Davos. It catalyzes public-private partnerships, building coalitions and developing and communicating corporate best practices.

[edit] Media

• The China AIDS Media Project — produces PSAs and documentaries promoting AIDS awareness and prevention, for broadcast in China
• The Blood of Yingzhou District — Internet Movie Database

[edit] Notes and references

[edit] Further reading

• Su L, Graf M, Zhang Y, von Briesen H, Xing H, Kostler J, et al. Characterization of a virtually full-length human immunodeficiency virus type 1 genome of a prevalent intersubtype(C/B') recombinant strain in China. J Virol. 2000;74:11367–11376.
• Chen J, Zheng Z, Shao Y. Molecular-epidemiological analysis of HIV-1 initial prevalence in Guangxi, China. Zhonghua Liu Xing Bing Xue Za Zhi. 1999;20:74–77. . (Chinese).
• Zhang, K. AIDS. Bejing: PUMC Publishing House; 2000. pp. 1–4.
• Cohen MS, Ping G, Fox K, Henderson GE. Sexually transmitted diseases in the People's Republic of China in Y2K; back to the future. Sex Transm Dis. 2000;27:143–145.
• Cohen MS, Henderson GE, Aiello P, Zheng H. Successful eradication of sexually transmitted diseases in the People's Republic of China: implications for the 21st century. J Infect Dis. 1996;174(s2):s223–s229.
• Liao SS. HIV in China: epidemiology and risk factors. AIDS. 1998;12 (suppl B):s19–s25.
• Chinese Ministry of Health; UN Theme Group on HIV/AIDS in China. China responds to AIDS—HIV/AIDS situation and needs assessment report. Bejing: Chinese Ministry of Health; 1997.

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