AIDS in China

I have been working on a report on AIDS in China. As I read the latest UN materials, I have to admit that even I was startled at just how awful the situation has become and how atrociously the government has dealt with it.. Equally startling are the reasons AIDS has had such an easy time spreading, basically unchallenged, throughout the country. It all goes back to the government and its obsession with “looking good.” The parallels with the current SARS crisis are abundant and rich.

Below are some of the paragraphs I’ve written over the past few days (an ideal cure for insomnia). This was a true “learning experience,” one that gave me a new and deeper understanding of this mysterious land that I am getting ready to leave….
AIDS in China

As this document is being prepared, China finds itself embroiled in controversy over the way that it has handled the outbreak of SARS (Severe Acute Respiratory Syndrome). The New York Times has written, “China’s Ministry of Health still says that there is no evidence that the disease can be acquired in Beijing. What is clear, though, is that Chinese doctors knew a lot about SARS long before it had a name or had left China’s borders, and chose not to share that information for many months.”

Unfortunately, this scenario more or less mirrors the way China has handled its AIDS crisis, the process being denial, resistance, grudging acceptance of the need to cooperate, followed by the nightmare of a full-blown health crisis that could have been lessened had the government taken action earlier.

All indicators show that China is on the brink of an unprecedented explosion of the AIDS epidemic. The latest data, prepared by UNAIDS, the Joint United Nation Program on HIV/AIDS, indicate there were well over 1 million cases of AIDS at the end of 2001 and that this number will most likely mushroom to 10 million by 2010. About 70 percent of those infected are peasants living in rural areas.

Only in the mid-1990s did China start to acknowledge the worsening crisis, and the central government has been slow to take action. Currently only a few Chinese hospitals, all in the big coastal cities and far from the vast majority of infected citizens, are equipped to treat AIDS, and the cost of treatment is far too high for average citizens to afford. These factors, combined with the unwillingness of the government at the local level to take actions such as prevention awareness, converge to increase the likelihood of a future AIDS tragedy in China.

The main cause of AIDS in China has not been sexual transmission but contaminated needles, mainly those shared by injection drug users, but also needles used in unsanitary ways during paid plasma collection. In poorer parts of China, selling blood is a common way to earn extra money, especially for drug users and commercial sex workers. Tragically, many of the blood-collecting companies are unlicensed and illegal, and their use of contaminated needles has been a major factor in spreading the disease. Furthermore, those who sell blood to these companies are often in the most high-risk groups and have already been infected with HIV. Their blood is not tested, and is mixed into the blood pool and sold. Most of this occurs in poor, remote areas of China where there is less likely to be interference from authorities.

The epidemic is worse in provinces with a higher level of commercial sex and intravenous drug abuse. It is not surprising that the most severely affected area is along China’s southwest territory, bordering “The Golden Triangle” along the Myanmar, Laos and Thai borders, a region famous for its heavy trade in heroin, methamphetamines and other illegal drugs. In the northwest province of Xinjiang there has also been a huge outbreak due to prostitution, sharing of needles for drug injection, and little to no awareness of AIDS and its prevention.

AIDS in China has been a taboo topic for years, and to a large extent it remains so today. This is key to understanding the evolution of the AIDS epidemic in China, and why confronting it is so challenging.

The Chinese culture and government tend to frown on sex education and to discourage open dialogue on controversial subjects like AIDS, which has made it difficult to raise awareness, especially in the rural parts of the country. Most Chinese citizens, especially in rural areas, are frightened to discuss sex-related topics, and have a hard time gathering the courage even to purchase condoms. Their local governing officials usually harbor the same fears.

As the current SARS crisis demonstrates, both the central and provincial governments are highly reluctant to discuss anything that might reflect poorly on the image of China, as this might have an adverse effect on tourism and/or foreign investment. Officially there is still no prostitution, no drug abuse, and no blood donation scandal in China.

While in recent years the central government has become more involved in raising awareness of AIDS and taking steps to prevent and contain it, the local and provincial governments have been slow to follow suit. Often they make the situation more difficult by refusing to acknowledge the AIDS crisis as it might reflect poorly on them. It is at the local/provincial level that most of China’s 1.2 billion citizens deal with their government, and where they turn for help.

Because of the government’s avoidance of the issue, the general public has little knowledge of AIDS and how it is affecting China. This in turn creates fear of AIDS patients, who are often fired from their jobs or banned from attending school. This contributes to a vicious circle, where the AIDS victims chooses not to seek help for fear of losing their job or facing public disgrace.

Even today AIDS has “no face” in China; it was only in 2001, at the Beijing International AIDS congress, that the first infected man was allowed to speak to a public audience. This was after the central government had implemented its “Five-year Plan of Action to Contain and Control of HIV/AIDS” with a set of specific goals for grappling with AIDS. Since that time, in 2002, there was actually a public wedding of an AIDS-infected couple, indicating a further shift toward coming to terms with the disease.

Still, the five-year plan continues to present AIDS strictly as a medical problem without considering the broader social-economic implications of the crisis. Thus, public awareness remains low. Some of the legislation has actually made the situation worse, especially at provincial and local levels. Many local governments simply do not want to know or let others know about AIDS in their respective regions, as it might make them look bad. So information is suppressed. In addition, local officials worry that an honest assessment of prostitution, illegal plasma collection and drug abuse in their region would lead to their being accused of incompetency.

Laws based on prejudice and fear exacerbate rather than curb the epidemic. Employers in Beijing, for example, are required to report “suspected AIDS patients” to local health authorities, reinforcing the notion that AIDS victims will be punished. In Hebei, all citizens with STDs are banned from entering school, getting married or working in service-related fields. Local and provincial laws are frequently in direct contradiction to national AIDS guidelines prepared by the central government’s Ministry of Health.

International experience shows that restrictive laws and punitive measures have little effect in curbing AIDS, while there is no question that they can have a negative impact on both prevention and care. In a punitive environment, vulnerable people will be more inclined to avoid preventive outreach, and people will decline getting tested for HIV for fear of punishment and/or stigmatization.

At the heart of the entire problem is awareness. When AIDS first surfaced in the US, the mantra for years was “Siilence equals death.” Sadly, that formula has proven to be totally correct when it comes to China. Keeping silent and ignoring the reality of AIDS has made the situation in China infinitely worse than it could/should have been.

Simply acknowledging the existence of these issues, let alone taking bold action on them, is challenging in a cultural environment that is inclined to minimize or ignore its problems, especially those related to traditionally “untouchable” topics like drugs, prostitution and homosexuality. Let us hope that the small steps China is only just beginning to take continue to accelerate, gathering increased momentum and determination. There is no time to waste.

______________

Richard Burger is the author of Behind the Red Door: Sex in China, an exploration of China's sexual revolution and its clash with traditional Chinese values.

The Discussion: 23 Comments

Hello,

I am writing a research paper on this particular subject for my Modern China class at university in New York City. Do you know of any books that discuss the history or how AIDS became so widespread? You mentioned a couple reasons but for my purposes, I some book resources that cite those or others reasons as being the causes.

Thank you,

Aaron
aaronmichaeltesta@hotmail.com

January 19, 2004 @ 6:16 am | Comment

United Nations is by far your best resource. They have some great reports you can search for. It’s too recent a problem for books to be written about it.

January 19, 2004 @ 7:02 am | Comment

Yes, it’s really a tragedy. But even more tragic, most Chinese people are willing to cheer the government rather than question them. In china, most people believe sacrifice of individual rights is justifiable for the “long-term” well being of the whole society. The only problem with this logic is who has the right to define the society’s highest interest. In China, the answer is clear: the political leaders. One Guardian article characterized China as “a peculiar blend of profit-at-all-cost capitalism and hide-and-control communism”. This is really perfect description of modern China. The irony is this unusual marriage between market economy and communist political system seems to work very well, evidenced by China’s booming economy. But the economic reform has also produced a large number of “losers”, including millions of unemployed workers from previous state-owned enterprises, farmers, and migration workers in urban areas. The attention to this group from the government comes out of concern for “social stability” rather than for their welfare. Corruption, widening revenue gap, and social injustice are deemed by many as “normal and inevitable” phenomena in the course of economic development. Seems all the “bad” things will be taken care of when the country is fully modernized. I sincerely hope this is true. But I really doubt we may realize “full modernization” without giving due attention to the “losers” in our society. The development of a society is an interactive process rather than a linear track. History has proved that the best way to “direct” the development of a society is to establish a mechanism to grant all the social groups an opportunity to impact social policies. This mechanism is named ‘democracy’. The task of coordinating the conflicting interest in a non-violent manner is by no means easy, so democracy may give rise to a lot of problems. But it is still superior to dictatorship, although the latter may be much more “efficient” in the short run. However, many believe that they find the counterevidence for this conclusion in China’s fast growing economy, and this is used as a rationale for maintaining the current Chinese political system. Maybe only time can tell us what is the right answer. Maybe I’m just a stupid young person obsessed with bizarre and useless thoughts. Maybe China is really in perfect shape to embrace an era of unprecedented prosperity that we have been dreaming for centuries. But I sincerely hope the tragedy of AIDS village will have a place in future history textbook to tell our children the price we have paid for the prosperity.

February 27, 2004 @ 5:15 pm | Comment

Hi!

Well there might be an increase in AIDS all over China. Yet relatively not more than in other countries.
And: In no other country you’ll find as many places selling condoms as here, many companies provide condoms for free to their employees. I wonder whether we really have a really clear picture about what is happening.
Cheers

June 4, 2004 @ 2:54 am | Comment

Ragnaroek, China is in more danger than many other countries becuase of the blood selling program and injection drug use, which has had a far worse effect than unprotected sex. The condom program is new and was only instituted long after this post was written. Still, it has had little effect on the increase of AIDS in China. Things are slowly improving in terms of AIDS education, but the country has a very long way to go.

June 4, 2004 @ 8:01 am | Comment

Saw a documentary (on either BBCWORLD or CNN) on what Richard mentioned, about the blood selling activities and the consequential spread of Aids. The scene was real tragic and truly frightening, a la backstreet hawker stalls and packets of collected blood in rusty buckets.

June 13, 2004 @ 7:23 am | Comment

its amazing in china everybody says there is aids but in fact i have been i china for a year and 80% girls from this place they make money by selling their bodies all the government officials are the big customers so who is going to prevent aids in china!! china will be the first country to have many people died with aids than any country in this world and its nearly to impossible to prevent this from happening!!!!

October 11, 2004 @ 11:42 pm | Comment

hey ya,
does anyone have any information about programs to combat AIDs in China or anything about AIDs among China’s minorities (my research interest is Tibetans)
cheers
Richard

November 2, 2004 @ 7:42 am | Comment

Now that I am home I’ve stopped following this issue as I used to. I’d just do some googling; there are tons of articles about China and AIDS, and I know some deal with Tibet.

November 2, 2004 @ 8:02 am | Comment

Hi! Can anyone give me information on the following: 1. current blood donation condition in China 2. statistics of health conditions that requires blood transfusion such as cancer, malaria, giving birth, leukemia, accidents, surgeries and transplants, etc. I am doing a research on it and an advocacy regarding safe blood thru voluntary blood donation.
Thanks to anyone who can help.

August 6, 2005 @ 10:22 am | Comment

Just a question – what definition of AIDS does China use? The CDC definition of one of thirty diseases plus a low white blood cell count and testing positive for an HIV antivirus, the WHO Bangui definition of prolonged fevers weight loss and diarrhoea, or something else? Is AIDS diagnosed via a test for HIV antibodies as in the West, or is it more of a guessing game as in Africa?

August 25, 2005 @ 10:21 pm | Comment

I even knew nothing about AIDS in china .I usully think it’s too far from me .But now ,I really think it’s not what I thought it was!
THANK YOU!!

November 5, 2005 @ 6:09 pm | Comment

spread of HIV/AIDS is mainly depend on the behavior of people. I think when all of the people care their behavior crectly, this disease should be controlled in the soon future. But the key is the people cannot control their behaviors, include individual sexual behavior, injected drug use, economic behevior(comercial blood selling), hospital managment.

I think AIDS should be more easily controlled than SAS, which spread through air.
But I don’t understand why people can control SAS effectively and cannot control AIDS just because the human behevior.

January 13, 2006 @ 9:39 pm | Comment

Linlin, please tell me you are not this stupid. Did you read a single word of my essay? AIDS in China came about as a direct result of a government-sponsored blood collection program. Not irresponsible human behavior. Go back and read the article, then come and comment.

January 13, 2006 @ 9:45 pm | Comment

yes,I understand you. But you cannot understand me. The government-sponsored blood collection programme belong to one of the human conmmercial behavior. Today, in China, you can not say government does not participate in the conmmercial action. Government is the representative of poeple in some extent. I just want to express that in the controlling of spreading of AIDS, government must play an important role. Any policy from the government can have important affect to the social phenomena, positive or negative.

January 13, 2006 @ 10:43 pm | Comment

In your earlier comment you didn’t say a word about government. If that was your point – that government must play a bigger role – I totally agree.

January 14, 2006 @ 12:28 am | Comment

An excellent thesis.
Some suggestions and comments:
1, Causes:
Contaminations through blood products;
Drug users;
Sexual workers;
Sexual behavior without condon protection.
I guess the first cause account over 50%.
2, Geography:
Henan province. AIDS village.
3, Characteristics:
Always related to poverty. Blood transfusion.
4, Culture:
It is still the tradition of one partner attitude for most people in China. Sex education is still not popular, and that is the most reason people living in rural area feel shy,even shame in talking about sex, and deny using of condom.
5. Role of government:
The invest in Public health from government is rare, even the government has already recognized the severety. It is really a pity. But it should be an inavoidable responsibility of the government. Currently WHO has put certain funds on the study and prevention AIDS in China. But an open and transparency information release system is still lagged behind as of the government control in China. It is a shame indeed! And that is why there is less information in publicity.

February 21, 2006 @ 8:17 pm | Comment

In the United States, people sell their blood for $25 to $35. Ask around the homeless missions and college towns (Ann Arbor has one of the larger blood “donation” centers.) The Japanese and Europeans try to move toward a humanitarian, truly donation model. So when blood selling became prevelant in China in the early 1990′s, the poor villagers in South Henan found a way to make 80 yen per donation (I observed the paying, but suspect that they paid 40 to get into the station.) Because the local Health Department officials ran the blood station behind the scenes, the central BJ Minister of Public Health actually had to come direct from BJ to raid the Henan stations. (Chinese generally have a low opinion of Henan law and order, where even the courts are raided.) This, the local control and profit from blood selling was why AIDS spread so fast in the 1990′s (I found the first 4 cases in plasma samples from HuangChuen, Henan in 1994.) The BJ Minister of Public Health, and whole China had been working frantically behind the scenes. All the same, UN, the Gates Foundation, and the western world could not understand the situation, and blame spread of AIDS on drug use and sex. It is the poor villagers in the most remote areas, out of reach of the central BJ Minister of Public Health who contracted AIDS and became the Orphan Village reported in the Next Magazine, HK. The same Minister of Public Health suddenly and misteriously met his fate in 2005, when he was fired for “hiding the SARS situation.” It is for failing to control first, the AIDS and then the SARS situation that Dr. Zhang Wang Kang was replaced by the iron maiden, Vice Premier Wu I that year.
O, God Bless America. May we help the world control their drug and sex habits.

July 4, 2006 @ 8:06 pm | Comment

I, with journalists, was detained in an Aids village in Henan in November 2001.

The most effective way to tackle Aids epidemic
is to:

Bring the responsible officials ( local and central) into justice. Then use the communist way to tell the truth to public and take immediate actions to rescue those Aids victims
nationwide and worldwide.

September 22, 2006 @ 11:05 pm | Comment

Ok.. very good your analysis.. But what is doing the US Government, there is a cure but don’t tell.??? or Maybe is not as important as other things (WAR-OIL), Here in china the people culture and regulations make a little more difficult to contract AIDS and get infected, also The chinese government don’t talk about this but at least makes plan by itself and don’t relay on investment companies or labs,
GOV AIDS WEBSITE, http://www.china.org.cn/english/features/aids/112999.htm I agree the Goverment should do more but the people culture is quite different from Africa, America and India (bcause sometimes problem is people behavior). I think while China became more developed will be the easier for the AIDS to spread… BYE. WE CAN HELP FIGHTING.

October 15, 2006 @ 6:52 pm | Comment

[...] difficulties gays face in China (I know, a lot has changed since I wrote that in 2002) as well as the unacknowledged crisis of AIDS in China (another topic this filmmaker has focused on). It’s good to see these topics [...]

October 11, 2008 @ 5:54 pm | Pingback

[...] other words, we haven’t made much progress since I first started writing about this topic five years ago, at least not in terms of people’s attitudes. In terms of treatment, there has been huge [...]

October 31, 2008 @ 12:20 pm | Pingback

Ni hao … It is interesting to read these comments and I wish there was more common grounds of helping each other with the AIDS situation -and with everything else- In every country similar problems -human problems- cause AIDS, namely poverty, lack of education and human behaviour. All countries have much to improve in these fields and it would be most productive to share good ideas, instead of talking to each other as enemies. The enemy is the AIDS virus now … We can all benefit from mutual friendship and cooperation. Best wishes to all, Gio.

May 25, 2009 @ 6:45 am | Comment

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