Please feel free to talk about anything, as long as you’re nice.

Also, please listen to this new piece on National Public Radio’s Marketplace. It’s about sex shops in China, and I’m interviewed briefly. An amazing subject; sex shops there are a world of difference from those in the West.

There’s also a lengthy new article by James Fallows on the possibility of more companies, especially tech start-ups, choosing to manufacture their goods in the US, not only in China. An important new trend?

Finally, there’s a disturbing new article on the surging AIDS epidemic in China. Some heartbreaking stories. (It’s World AIDS Day today.)

And now you can continue the never-ending debate on China’s system vs. America’s, if you don’t think you’ve yet said it all.

Long-time readers know this is a topic that always annoyed me (to put it mildly) – the treatment of hepatitis B carriers as lepers, banning them from certain types of jobs and needlessly stigmatizing them.

If this story is accurate, change is finally in the air:

China is set to issue regulations to remove hepatitis B check from physical examination for school entrance and work, according to the Ministry of Health.

Mao Qunan, a spokesman with the ministry, said here Tuesday that the move was based on related organizations’ thorough demonstration in regard to whether hepatitis B carriers will affect other people’s health.

However, Mao said restrictions will still exist in jobs that may induce hepatitis B virus transmission such as blood sampling.

“The list of these special professions that need restriction will have to go through a series of legal procedures for approval,” said Mao, adding that the upcoming regulations will cover related aspects.

In addition, the results of hepatitis B tests for other medical purposes should be protected as part of examinees’ privacy, and such tests should not be carried out by force.

“As we know more about the hepatitis B virus, our prevention and treatment measures become more specific,” said Xie Rao, a senior liver disease physician with the Beijing Ditan Hospital, adding that the move showed that the country’s understanding of the disease had entered a higher level.

Hepatitis B has been around about as long as humanity itself and has been well understood for many decades. There has been no sudden breakthrough that convinced the Chinese authorities that it was safe to end the ban, and the line that their understanding has now “entered a higher level” is baffling. All they did was catch up with what’s been common knowledge around the world for years: hepatitis B carriers, like those who test positive for AIDS, pose no extraordinary danger to their colleagues.

If this actually happens and the ban is lifted, I give China credit for reversing what was a vile policy. That it took this long, ruining many people’s lives along the way, is a tragedy.

Link via Danwei.

Every once in a while my work puts me in the presence of greatness. It did so yesterday when I had the pleasure and privilege of working with South African Justice Edwin Cameron, the only public official in all of Africa to publicly state that he has AIDS. He is probably also the only openly gay official on the continent. Oxford-educated and a Rhodes Scholar, Justice Cameron’s contributions to human rights and AIDS awareness, and his personal courage, cannot be exaggerated.

Yesterday he spoke with reporters in Beijing about a recent Renmin University-UNAIDS survey [pdf file] on the attitudes of Chinese people in six cities – Kunming, Shenzhen, Shanghai, Wuhan, Zhengzhou and Beijing – toward AIDS and AIDS sufferers. The survey sampled four groups, migrant workers, blue collar workers, white collar workers and youth, and it provides some depressing if not especially surprising findings:

- More than 48% of respondents thought they could contract HIV from a mosquito bite, and over 18% by having an HIV positive person sneeze or cough on them.

- Around 83% of interviewees had never searched for information on HIV/AIDS.

- Nearly 30 % did not know how to use a condom correctly.

- Only 19 % said they would use a condom if they had sex with a new partner.

- Nearly 11% of respondents had had sex with people who were not their spouse, girlfriend or boyfriend during the past 6 months; 42% of those respondents had not used condoms.

- 30% think HIV positive children should not be allowed to study at the same schools as uninfected children.

- Nearly 65% would be unwilling to live in same household with an HIV-infected person and 48% of interviewees would be unwilling to eat with an HIV-infected person.

In 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 and awareness. In terms of treatment, there has been huge progress in China, including anti-discrimination laws and free retrovirals for anyone with AIDS. The government needs to do much, more, however. Justice Cameron said, for example, that while the government provides free retrovirals for treatment of AIDS, people must still pay for medications for opportunistic infections from their own pockets, which can easily impoverish them.

I don’t really know what it is about natural leaders, the way they stand out in a crowd even when silent, and the way that they make those they’re talking with feel like they are the only person in the entire world. Edwin Cameron has those qualities, and the reporters he spoke to were visibly moved when he made an urgent appeal to them to encourage HIV sufferers in China to act as activists and to speak out the way he has. That is the only way to overcome stigma, he said., noting that what makes AIDS so insidious is that in many places it remains “a silent disease.” People suffer in silence for fear of ostracism if they tell the truth. This fear discourages Chinese people from getting tested, and those who are tested seek to hide their HIV status at all costs.

“This is a tragedy,” Justice Cameron said. “The Chinese government has a good treatment program. But there is a disturbing pattern here: 35-40,000 people in China are receiving antiviral treatment but more than double that number need treatment.” And they remain silent, and will die unnecessarily, as AIDS today is fully treatable. He pointed to activists in the US in the 1980s who generated a wave of publicity and awareness that put a human face on the disease, lessening the stigmatization in America dramatically. In China and Africa, there are few such activists. That is one of the keys to ending stimatization, he said: Africa needs a Magic Johnson to tell people they do not need to be ashamed of having AIDS.

It isn’t just a matter of fearing ostracism from friends and family, however. He said that AIDS sufferers still get turned away from health clinics in China’s provincial areas. The most poignant moment came when he described to reporters how he needed a special invitation sent from the Chinese government to its consulate in South Africa for him to be permitted entry into China. He added that when he comes to the US he must undergo an even more humiliating ordeal, being tested at the airport to determine whether his AIDS is under control (I am not sure exactly what they test for).

Hu and Wen have visited hospitals and spoken out on AIDS, he said, but efforts to educate the public remain seriously inadequate. “I beg them to do more,” Justice Cameron said.

Perhaps the most controversial topic he discussed was how markedly different the AIDS epidemic is in southern and western Africa, where the level of infection is above 11 percent. This is, he explained, “a mature epidemic, meaning that everone, gay or straight, young or old, knows someone who has died of AIDS.” This is unique; no other geography on earth has seen a massive AIDS epidemic that has spread beyond the main risk groups (injection drug users, plasma donors, “MSM” – men having sex with men – and sex trade workers). It was feared back in the time when I wrote my original post that China would be like Africa, home to a massive epidemic seeping into the mainstream, heterosexual population. It appears that will not happen. Justice Cameron said no one was sure why this phenomenon occurred only in a specific section of Africa, but said the reason could be genetic. In China, the number of people infected by shoddy plasma collection has leveled off, and the levels of infection are beginning to mirror those in other countries, with MSM and injection drug users being the most affected groups.

Working with Edwin Cameron was an inspiration. It was also inspiring to see the level of interest in this topic among the Chinese media. You can se some of the articles here and here. This was the high point of my nearly two years in China, and a day I’ll never forget.

A late-night quickie:

The European Parliament on Thursday awarded its top human rights prize to jailed Chinese dissident Hu Jia despite warnings from China that its relations with the 27-nation bloc would be seriously damaged if it did so.

In selecting Hu to receive the Sakharov Prize for Freedom of Thought, the European lawmakers said they are “sending out a signal of clear support to all those who support human rights in China.” Hu has advocated for the rights of Chinese citizens with HIV-AIDS and chronicled the arrest, detention and abuse of other activists.

After I posted a few weeks ago that I felt Hu was deserving of the Nobel Peace Prize, I had an opportunity to discuss his career with friends of mine (Westerners involved in government) who are much more familiar with his activities than I. Since then, I’ve had rather mixed feelings about Hu Jia.

His arrest is certainly prima facie evidence that today’s CCP retains much of the prickly, pig-headed, uptight, asinine qualities of yore. And yet, there’s no denying Hu was often a self-promoter, practically shouting at the government, “Arrest me,” especially considering his timing. (He was warned that such antics right before the Olympic Games would not be tolerated, and he persisted in a most in-your-face manner.) None of that even begins to justify his arrest, but maybe it raises questions about Hu’s judgment and motivations?

Hu did dedicate much of his time to raising awareness of AIDS and environmental issues in China. But my friends, one of whom works at the United Nations, challenged me about what Hu has actually done aside from draw attention to himself and get himself arrested. I mentioned a project he launched to help AIDS orphans in Henan, and they countered that it was more hype than anything else. “Basically he wrote some emails,” my friend countered. “Do we award the Nobel Prize to someone who just sent out emails?” Before anyone jumps on a high horse and says I’m slandering Hu Jia (whom I’ve defended many times on this blog), please understand I am only saying I don’t know – that maybe he’s an example of our emotions (mine included) making us jump to conclusions. Or maybe he actually did deserve the Nobel Prize. As I said, mixed feelings.

Whether he deserves the Sakharov Prize is up for debate, as with any prize for political activism. In any case, if this inspires greater scrutiny of China’s repressive tendencies, paranoia and eagerness to arrest anyone who threatens to shed light on them, then I’m glad Hu Jia won.

I meant to put up a one-liner, and suddenly it became a tome. Good night.

According to a report in yesterday’s WaPo, police detained AIDS activist Gao Yaojie at her home on Sunday and prevented the octogenarian doctor from traveling to Beijing to apply for a U.S. visa. Dr. Gao, instrumental in exposing the severity of China’s HIV/AIDS crisis, planned to travel to the U.S. to collect an award from Vital Voices for her work.

Gao, a retired physician, was among the first to expose Henan’s blood scandal in which millions sold blood to unsanitary, often state-run health clinics, making the province the epicenter of China’s AIDS problem.

She wrote and distributed material warning people of the risks of blood-selling, making her a target of local authorities fearful of the social stigma and political sensitivity surrounding AIDS.

The story was told to Reuters by Beijing AIDS activist Hu Jia who claims that Dr. Gao is now under house arrest and that her telephone service has been suspended.

This is the not the first time that Dr. Gao has been prevented from leaving China to receive an award for her work, Chinese authorities also barred her from traveling to award ceremonies in 2001 and 2003.

Beijing’s actions could also come up as an early issue in the 2008 presidential campaign, Hillary Rodham Clinton serves as honorary chair for Vital Voices and her name was reportedly included in the invitation letter to Dr. Gao.

UPDATE via CDT: After the issue was raised by the US Embassy in Beijing, Chinese foreign ministry spokeswoman Jiang Yu claimed that the ministry had no knowledge of Gao’s detention, according to a Reuters report. Jiang referred questions to the local Zhengzhou government (who is not talking) and reminded reporters that China was: “a country with a system of law and everyone is equal before the law.”

Richard Spencer also has a great post on his meetings with Dr. Gao and the difficulties she has had to endure as the result of her activism.

Superb opinion piece in today’s Wall Street Journal by Brad Adams, executive director of the Asian division of Human Rights Watch, about the Chinese government’s spectacularly evil efforts to cover up the story of AIDS spreading through the province of Henan from 2000-02. The epidemic was the result of illegal plasma collection in the province’s rural villages (a topic I wrote about at length here). The party member who ordered the incident hushed up was promoted and honored recently for his “important contributions to the development of the province’s sanitation industry.”

Adams describes how journalists travelling to Henan were detained by the police and expelled, while the Chinese press was ordered not to report anything at all about the epidemic. He writes:

Why would anyone lie about such a vast epidemic? The answer is simple: Covering up the spread of a stigmatized disease like AIDS might help to ensure that investment continued to pour into impoverished provinces like Henan. The Henan blood scandal sent a clear message to other local officials: if you have an epidemic, cover it up, and you’ll be rewarded.

[Sorry I can't link; this is from the print version.]

It’s kind of amusing that there is a whole fringe that equates the CCP with the government of the US. As any reader of this site knows, I am no fan of President Bush, but to write that citizens in America are treated by their government in a manner that in any way resembles the way the Chinese are treated by the CCP — it’s not only laughable, it’s scary. And infinitely dumb. Three of our big-name whistleblowers were named Time’s Man of the Year recently; in China, they’d be wasting away in jail unsung and unknown, if not shot in the head.

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.