Recent Chinese Reports on HIV/AIDS and Sexually Transmitted Diseases

Updated July 1,  2001

Unsafe Injections: A Great Threat to China's Health

Unsafe injections are important risk factor to the spread of HIV, hepatitis and other blood-borne diseases. Unsafe injection practices are widespread in China. A 1998 - 99 survey of 3066 village immunization stations that participated in the 1996 planned immunization program found that only one-third of the stations achieved the one person - one needle ideal. This led to the PRC Ministry of Health goal of safe injections by 2000.  A 1999 study of injection practices at by 585 village, district and epidemic prevention station medical workers at 149 village immunization stations in Yingcheng City and Yinmeng counties in Hubei Province found 88 percent unsafe injections from a combination of improper sterilization of equipment (17 percent) and unsafe injection practices (40 percent) or both (43percent).  The 160 medical workers with just middle school or elementary school training had an unsafe injection rate of over 50 percent. The most highly trained 40 who had post high school vocational medical training had an unsafe injection rate of 30 percent.

Fifty-five percent of the Yingcheng City medical workers didn't know how to sterilize properly. Fifty percent of the Yumeng County medical workers didn't know either.  Only 27 percent of the village medical workers did injection procedures properly. So 73 percent did them the wrong way. Fifty-six percent said they only change needles when they notice blood on the syringe. One smaller survey of 16 village medical workers found that one third thought that the effectiveness of heat sterilization and pressure sterilization was the same.

The most common unsafe practices were reusing a needle and syringe; just changing the needle but not the syringe; and merely wiping the needle with a disinfectant and then giving the next child an injection. Ignorance among medical workers and even county and district epidemiological station managers is a m ajor problem. Many medical workers believe changing the needle but not the syringe is safe. Some know safe practices but don't believe in them since they never saw one of their patients get sick from an injection. One third of the epidemiological station managers questioned believed changing needles but not changing the syringe is safe. (Chinese Journal of Epidemiology, December 1999)

Chengdu, Sichuan Hospitals Caught Selling Many Tons of Medical Waste for Recycling

Chengdu Shangbao May 28

The Xindu branch office of the Chengdu Industrial and Commerical Bureau on March 15 seized 60 bags of waste disposable syringes weighing in all one metric ton; four bags of disposable transfusion equipment weighing a total of 70 kgs; and 5000 100 ml disposable blood containers.  Law enforcement authorities found that 14 Chengdu hospitals are involved. Since late 1999, these hospitals to make extra money have sold 2300 tons of medical waste. According to regulations, hospitals must sterililze and then destroy disposable medical equipment after use. Resale is forbidden.  Li Yong, a person involved in the sales confessed to have illegally purchased the disposable medical equipment since 1993 and sold it to a plastics reprocessing center. However, it has not been confirmed that the disposables went to the plastics reprocessing center and the investigation continues.  Confessions from people involved revealed that 14 hospitals in the Chengdu area had sold used disposables to Li Yong. The names of the hospitals involved are listed in this news story.


Dr. Gao Yaojie -- My AIDS Prevention Journey

Zhengzhou, Henan physician Dr. Gao Yaojie's account of her campaign to help the many people in rural Henan suffering from AIDS, to promote public awareness and to call on the Chinese government to act on China's AIDS crisis.

See the full text by clicking on the URL above.  Here is an excerpt:

2.  The Frustrations of AIDS Prevention Education Work

The number of people who ask me for AIDS prevention educational materials has grown steadily over the past five years.   Over the past year or so I have received over 3000 letters and ten times as many telephone calls.  Except for the swindlers among them, I feel obligated to respond to every letter I receive.  Everything seems to be going well.  In fact, it isn't.  For example the time Teacher Ding and myself went to a night club to give AIDS prevention materials to the bar girls there.  The women hid themselves as if a terrible monster had come. Some of the braver women took a look at the materials.  When they saw that it was about AIDS, they threw it into the trashcan saying,  "Old lady, get out of here! Get out!  If the customers see this no one will dare come here. They'd certainly assume we must all have HIV!"   The manager of the nightclub stormed in.  Acting as if he was confronting his enemy, he kicked us out of the nightclub.  This happens quite often. If it isn't an entertainment spot, it is a government office, a factory or a business. There are few exceptions.  There is some misunderstanding involved. Most of them think: I don't visit prostitutes and I don't sell sex so I can't possibly get HIV.  What is even more troubling is that they equate AIDS with promiscuous sexual behavior.  They say that AIDS is an immoral disease that good people don't get. They even go so far as to say that "AIDS prevention" educational materials are shameful.  Thus, in AIDS prevention educational work we have encountered many scornful looks and cold responses.  This of course is even more so when people
meet others afflicted with HIV.  When people see them on the street, they run away.  Some run away very quickly, some even stumble all over themselves in the effort to make a fast escape.  Their neighbors don't dare to speak with them,  much less pay them a visit at home. Sometimes they just move away.  When a person with AIDS dies, nobody dares to carry the coffin.  Just mentioning the word "AIDS" makes them go pale.

The upshot of all this is that I write, edit, and print a book about AIDS and give it to people but they are too embarrassed to read it. Over the last few years I have also put AIDS information into gynecology texts.  This method seems more effective and has not met with resistance.  But printing costs are high and I can't afford to do it on my own.  Self-financed AIDS prevention educational work is very difficult and frustrating.


Interview with Dr. Gao Yaojie  in the May 28, 2001 issue of "China Newsweekly"

"China Newsweekly" is sponsored by the Chinese central government's second biggest press agency, the China News Service. This article, entitled "Gao Yaojie -- There Now No Empty Spots on the Henan HIV Map" goes into considerable detail about how she has been harassed by  Henan provincial government and how they blocked issuance of her passport so that she could not receive the Jonathan Mann Award from the Global Health Council in person.  A vice Party Secretary at Dr. Gao's hospital told her, "Dr. Gao, it is best not to accept this prize. Ever since George Bush became president, U.S. - China relations have been unstable.  On top of that the airplane situation has made things even more difficult. Moreover, there is a strong anti-China tendency in the World Health Organization [sic -- perhaps the Party Secretary meant the Global Health Council?  end note], we are afraid that they would use you."

The reporter asked why most of the pressure has come from officials. Gao answered that they are afraid that her educational work will ruin their chances for promotion.  Dr. Gao said that she had experienced something similar in 1998 when she campaigned against the itenerant quack doctors who everywhere treat sexually transmitted diseases in Henan.  The Health Department got angry because as a result of that situation being exposed, the provincial governor criticized the health department.

When the reporter asked Dr. Gao about the seriousness of the situation, she answered, there have been many reports about Shangsai County where some county officials admit to there being 10,000 people infected with HIV.  But HIV is in many other areas throughout Henan Province. Zhoukou, Nanyang, Xinyang, Kaifeng, Shangqiu, Luohe, Xuchang, Pingdingshan, ....there are no blank spaces on the HIV map of Henan Province. Dr. Gao says she knows this is true because she has received over 3000 letters from all over Henan Province and many times that number of telephone calls. Dr. Gao said that selling blood has been mostly stopped in Henan but there are still some places where it continues illegally.  Dr. Gao recently investigated the case of a man who had died from taking 18000 cc of blood from him in just three days.  [Note... this is likely a plasma donor. Plasma donors can give more than whole blood donors because their blood is returned to them after some proteins are filtered out. End note]

The China Newsweekly reported noted that in the August 2000 article, she was characterized as a lonely fighter. Is it still true?  Dr. Gao said it is still true. She has contact with Prof. Gui Xien in Wuhan but he is far away and so it is hard to work together. Some people say that want to work together with Dr. Gao but have hidden motives such as using Dr. Gao to make a lot of money.

Q.  Your strength as an individual is limited, have you considered working with a group.
A. As an individual I have met some much interference, how ever would it be possible to work with a group. If an organization was set up, it would be used to accuse me of "anti-party" activities.  Dr. Gao commented that her daughter lost her job in a Henan hospital and then left for Canada with her husband.  She is angry with Dr. Gao and is not in contact now. Her older daugher and husband are sick.



 

Shaanxi Blood Donor HIV Continues to Spread

Southern Weekend, March 15
by Zhao Shilung and Shang Guangwu

[Note: HIV transmission among large numbers of blood donors is not unique to Henan Province. According to the the Chinese press and some Chinese experts that there are problems with HIV among paid blood donors outside Henan Province. According to press reports there are serious problems in Shanxi, Shaanxi, Hebei,
Gansu and Hubei. There have also been press reports about illegal blood collection centers in Chongqing, Sichuan, Guangdong, and Jiangsu.  The Chongqing center closed down by police in December supplied plasma to the Kangxin Biological Products Company.

A Chinese expert said that some people who left Henan after 1995 set themselves up collecting blood in Hainan Province. Some displaced Henan "bloodheads" even moved to Vietnam to set up a blood collection business there but they were kicked out by the Vietnamese after 18 months.

But to what extent did local governments or their health departments organized the sale of blood outside of Henan Province?  One would suspect that the example of the Henan health department making lots of money by organizing massive blood collections among poor farmers in partnership with biological products companies (shengwu zhipin gongsi) would have to have inspired imitators in other provinces.

As more and more people develop full blown AIDS it will become increasingly easy to see just what the pattern of large scale paid blood collections was.  As this article emphasizes the problem of the spread of HIV among paid blood donors and to blood recipients is not just a problem left over from widespread abuses in Henan Province during the early 1990s. It continues and is not confined to Henan Province. ]

Excerpt -- full text at  HIV Among Shanglou District, Shaanxi Blood Donors :

According to the Southern Weekend report, the "departments concerned" made a study beginning last October in the seven counties and cities in the Shangluo District. By combining results from counts in various localities, they concluded that a total of 12,700 people had sold blood at some time.  The authorities, under the pretext of testing for "serious cases of hepatitis B" but actually tested for HIV.  The study included people who had sold blood, had had 12 or more injections in a full year, or were the 12 years or age or younger children of blood sellers.  According to Shaanxi Province Shanluo District epidemiology station workers, the study revealed not very many full blown AIDS cases but many HIV infections.

In the first 2000 samples tested, over 300 people were found to have HIV.  The one in 26 HIV positive ratio found was much higher than expected. After that testing stopped and the remaining 5000 people were not tested.  The government did no follow up or monitoring of people found to be infected with HIV....

Two reporters pretended to be big blood buyers from Guangdong Province. The director Lei Fujin said that he has been a bloodhead for 14 years and knows many local, Shanxi and Henan province bloodheads.  Pounding on his chest, Lei claimed to have at his disposal 2000 blood sellers and to be well known by the local hospitals.  Lei said that there were still several thousand blood sellers in Henan and that people could organize them to come to Shaanxi to sell blood.  The price would be a bit high though --- 150 RMB (USD 20) for 400 cc of blood.  Lei said that the Nanshang blood collection station would be reopened in just a few days.

The Shangluo district epidemiological station checked people who had received blood from the local blood collection stations. Problems have already arisen because of poor management there. Thirty of the ninety blood recipients checked had problems. Thirty of them had the so-called "severe hepatitis B".

What is frightening, concludes Southern Weekend, is that with the epidemiological agencies completely in the dark, just where is this virus ridden blood going?  Just how many people are getting HIV from blood transfusions or from medicines made from HIV infected blood?  That is a mystery that must be solved one day.


In Henan "AIDS Villages" Up to 62 Percent HIV Infection Rate

Chinese text at http://dailynews.sina.com.cn/c/197541.html

[What is new in this March 2 Jiangnan Ribao report is its focus on the role of local and provincial government health workers in setting up blood banks and recruiting paid blood donors who became infected with HIV. This is the first report to appear in the PRC press  that reveals that it was the health department and epidemiological station workers who organized much of the blood sales.   A collection of translations from the Chinese press on HIV in China is available at   Recent Reports on HIV/AIDS and STDs in China at http://www.usembassy-china.org.cn/english/sandt/hivartic.html ]

Excerpt:  Selling Blood Brought On the Disaster

How did these honest farmers come down with the epidemic disease of the century?

From the 1970s to the 1990s, owing to the negligence of the responsible  departments,  blood collection centers intended to save lives and heal the injured and to serve the people became the focus of people who cared about nothing  but big profits.  There was a mad rush to establish blood collection centers.  In on Henan Province District along, thirty-three blood collection centers  were established.  In Shangsai County alone four were established.  Some were private, some were run by the health departments, and some were run by administrative  or collective enterprises.  Some were set up with the necessary technical skills and facilities. Others
were set up without them.

More and more farmers, eager to escape poverty, became blood donors.  Selling blood came to be seen as a good way to get rich.   At the time,  one small blood collection station in Shangsai County [translator's note: population 1.2 million] had over 5500 registered blood donors.  Every day 444 - 500 people would go to the blood collection station to sell blood. Many others  went outside the county to sell their blood elsewhere.  Groups of blood sellers went to north to Zhengzhou and Kaifeng, west to Pingdingshan and Jiaozuo, and south to Wuhan etc.  Some set up organizations and chose a leader so as to put them in touch with blood selling industry.

During the late 1980s,. "blood heads" appeared among the legions of blood  sellers. Three types of people served as bloodheads: workers at the health department epidemiological stations; friends and relatives of workers at the health department epidemiological stations;  and clever  blood sellers with the right social  connections.  The blood heads were actually business people who would resell the blood at a high profit after it had been collected.

For the sake of making money, they were reckless with people's lives. There was no physical examination when blood was sold. There were no tests done on the blood.  If you've got blood, they'll take it. No one was refused. The equipment used was not sterilized and the same needle was used on many people. Thus there was a great deal of cross infection.  Disease spread rapidly amongst the blood sellers and so blood selling created a great disaster.

A full text english translation of the March 2 Jiangnan Ribao article is available at  Henan AIDS Villages Up to 62 Percent HIV Infection Rate


 China Health News And the Henan Province Health Scandal Cover-up

The full Chinese text is on the Aizhi Action Program web site at Chinese original text -- China Health News and the Henan Health Scandal Cover-up

by Wan Yanhai,  Coordinator for the Aizhi (Beijing) Action Program   January 20, 2001  Tuesday
Web site:  http://www.aizhi.org    Email: hiwan@public.bta.net.cn

[Note: Wan is author of an August 2000 Beijing Youth Daily article about HIV in Henan Province. End note]

Summary: Over the past year, Chinese media outside the health field, foreign media, web media and independent researchers have revealed many problems  involving the sale of blood and AIDS in Henan Province.  They also revealed the responsibility that the Henan public health administration and it leading organization have for the spread of AIDS, and after AIDS appeared, the role of Henan Province Department of Health Director Liu Quanxi in suppressing the views of experts and mass media.  However, over the past two years, China Health News, which is controlled by the Chinese Ministry of Health,  made many reports about health in Henan Province.  However, that newspaper pretended not to know about and not even to have heard about how the sale of blood had led to the spread of HIV in that province.  On the contrary, China Health News continually reported how the health authorities in Henan Province were strengthening the management of hospitals, improving the blood safety assurance system, and represented Liu Quanxi as a man who was concerned  about the people's health and who was propelling reform forwards.  China Health News covered up the Henan Province public health scandal.  Official  web sites sites also kept silent about Henan AIDS and the sale of blood.

Read a summary translation of this article at  China Health News And the Henan Province Health Scandal Cover-up The article is divided into the following sections:

  • The Seriousness of the Problem
  • The Health Departments Cover Up the Truth
  • Maintaining Secrecy and Revealing Secrets
  • A Study of China Health News
  • Research methods:
  • Conclusions
  • Suggestions

  • Hundreds of Thousands of Henan Blood Donors Infected With HIV

    See  Revealing the Blood Wound of the Spread of AIDS in Henan Province
      "Blood Wound" Chinese text

    That hundreds of thousands of paid blood donors in Henan Province have HIV has been a dark secret for at least the past five years. The article below now circulates among Chinese experts in Henan Province and Chinese patriots elsewhere who can see clearly the disaster that now threatens their country. Just as the line goes in the wartime anthem,  the "Song of the Volunteers",  the "Chinese nation is at at its most dangerous time" [Zhonghua minzu dao zui weixiande shihou]. Some Chinese experts who have known this story for years but have had to keep quiet are pleased that this story is out. They agree that this story is accurate but it is not the complete story.

    Just as the press reports on HIV among blood donors first focused on the widespread HIV infections among blood donors in Shangcai County in central Henan, and have now widened to report that no, Shangcai is unfortunately not an isolated case but all too typical. Yet the problem is not confined to Henan.  The problem of paid blood donors and underground blood collection centers, as the Chinese press occasionally reports, is serious in Shanxi, Hubei, Hebei and other provinces. Paid blood donations and bloodheads also work in Beijing and Shanghai even if the problem seems to be worse in the interior provinces.Southern Weekend in October 2000 for example discussed the legion of 4000 paid blood donors in the impoverished Dingxi region of Gansu Province.  Some of this blood from donors with high rates of hepatitis and other blood borne diseases was sold to a blood products company in Lanzhou.  There the blood is made into various blood protein products sold in China as well as exported to developing countries.  The US Food and Drug Administration does not permit the importation of Chinese blood products into the USA.. The spread of HIV among blood donors and especially blood plasma donors seems to be driven by the high prices that biological products companies (some connected with the Chinese military) pay for blood plasma and their willingness to procure it illegally if need be.

    After reading the November 28 edition of Southern Weekend, a senior Chinese leader, concerned about high rates of HIV infection in the Zhoukou area of Henan Province, dispatched some central government scientists to investigate. Henan provincial health officials found an 85% HIV infection rate among 200 blood donors. But the local officials decided that this number was too high to give to the central government scientists so they proceeded to also test some healthy people and
    unrelated hospital inpatients in order to dilute the sample.


    See the English translation of  Chinese National Medium-and Long-Term Strategic Plan for HIV/AIDS Prevention and Control in China(1998-2010)

    Licenses of Five Chongqing Blood Collection Stations Cancelled by Health Authorities

     Chinese text  at http://chongqing.sohu.com/20010105/file/1180,579,100041.html

    From the Sohu.com website on January 5. Attribution to the China Health Network at the bottom of the Chinese text. Chinese text is at the URL above.

    The Ministry of Health recently ordered that local health authorities checks be made of blood collection stations to ensure that they are in compliance with the law and to suppress illegal blood plasma collection operations. The Ministry of Health ordered this actions in order to ensure the safety of the blood collected and of blood products. This is an important enforcement action of the Chinese Ministry of Health. Checks made by the Chongqing Municipality Department of Health turned up five blood plasma collection stations which were collecting blood plasma using a dangerous manual method that had been banned by regulations promulgated in 1996. The December 30, 1996 blood products management regulations requires that a machine be when taking blood plasma because  some aspects of that procedure are very difficult to do manually while maintaining sterilie conditions.  The licenses of those five blood plasma centers were cancelled and administrative fines were imposed. "Another unit will address the problem of the Chongqing Kangxin [Health New] Blood Products Co., Ltd. " which purchased blood from the five collection centers that were closed down.  The article also mentions that health authorities in Anhui Province are investigating a whole blood collection station in Chuzhou City that operated without permission. The Ministry of Health at a recent press conference stressed  that for clinical blood use, it implements regulations that require that  the blood collection stations, blood donations and the providing blood to recipients, and clinical use of blood must be supervised by the health authorities. Medical institutions may arrange for the donation of blood only at blood collection stations approved by the authorities. The news report notes that this information was released at a recent Chinese Ministry of Health press conference.

    Comment:

    Some Chinese experts believe that HIV in China is spread mostly through the blood supply (that is, contrary to many published reports, the majority of people with HIV in China are not injecting drug users) and especially among donors of blood plasma and to a lesser extent donors of whole blood. The Chinese central and especially local governments have been reluctant to acknowledge the extent of this problem publicly, although this may be beginning to change. Recent relevations in the Chinese media reveal that this large-scale transmission among blood donors in China is not confined to one county or another but is a widespread problem.

    The official estimate of the number of people living with HIV has been "over 500,000" for the past two years. Last Summer Prof. Zeng Yi of the Chinese Academy of Preventive Medicine said that there would be about one million people infected with HIV by the end of 2000. If half of these people got infected through the blood supply as donors or recipients, the number would be in the 250,000 to 500,000 range. Now if these people are not included in the overall count, which is possible since HIV surveillance in China focuses mostly on known high risk groups, this number would have to be added to other counts to come to a new total for the number of people living with HIV in China. Estimates of the numbers of people living with HIV in China are very uncertain.

    Many Chinese blood plasma donors have gotten HIV as a result of donating blood. The efficiency of HIV transmission through needles is relatively low although dirty needles are still an important problem since in many areas, particularly in interior China using needles that have not been sterilized (or are sterilized just once a day) is often the rule rather than the exception.  Blood plasma donations in which the blood of the donor is filtered through a machine to extract some blood proteins and then returned to the donor involves a much higher risk of HIV transmission since the equipment is difficult to keep clean unless very strict procedures are followed according to a Chinese expert who has worked at blood banks.

    Blood plasma donors in turn pass HIV to whole blood donors through non-sterilized needles and other equipment at blood collection centers where whole blood is given since the two populations are not really distinct -- there is a lot of crossover between people who give plasma and whole blood) and to the general populations in the blood supply since the blood plasma donors and whole blood donors are two completely distinct populations.

    Blood products companies seem to be driving the demand for blood plasma. Chinese press reports on blood plasma collections, including the one above, often ention a blood products company.  In October, a Southern Weekend article on 4000 paid blood donors in the Dingxi district of Gansu Province mentioned that considerable quantities of blood from those donors are purchased by a biological products company (xie zhipin gongsi) in Lanzhou.

    The enormous profits to be made drive a strong demand for blood plasma which is met by mostly rural Chinese who sell their blood (paid blood donations are still common, although illegal for the past several years.  Chinese blood products companies  make blood protein products that are used not only in China, but are exported to other developing countries as well. Regulating them has been very difficult for the Chinese Ministry of Health. Part  of the problem seems to be that some
    of these companies are connected to the Chinese military.


    AIDS Campaigner Harassed Locally, Praised Nationally (EST Update December 29)

    Seventy-three year old physician and anti-HIV campaigner Gao Yaojie has been harassed by the Henan provincial authorities for her frank interviews with Chinese and foreign media. The national media, however, continues to praise her volunteer work among Henan Province's poor and sick. Jiangnan Ribao, a Jiangsu Province newspaper directly under People's Daily, ran a long, laudatory article November 28 about Gao's work. The article mentions Gao's report on sexually transmitted disease among women in Henan prisons. Ninety-two percent of the 1185 women she surveyed had STDs, including several infected with HIV. Gao's strong criticism of the many quack STD clinics in the province and her efforts to help people in an "AIDS village" were also highlighted.  According to one report, the harassment of Gao by the Henan provincial authorities stopped in mid December after the Henan Communist Party Provincial Committee received an order from the Organization Department of the Communist Party Central Committee.

    Media Takes the Gloves Off in Criticizing HIV Policies -- from the December 15, 2000 Beijing Environment, Science and Technology Update

    The December 8 edition of the People’s Daily East China News pointed to the laxity of local government officials in Henan, the poverty of farmers, and the greed of illegal blood collection center operators as the key reasons why widespread illegal blood selling in eastern and southern Henan Province continued for such a long time, leading to many HIV infections. The paper also accused some government officials of helping in the set-up of some illegal blood banks. The Daily also did not spare central government officials: One-third of the 86 countries which, like China, first discovered the HIV within their borders in 1985, had established HIV/AIDS prevention organizations within 18 months. China, however, waited 13 years (until 1998) to establish its AIDS Prevention and Control Center. "We need to know how this happened," concluded the article, "for the sake of our health and our future." (People’s Daily East China News, December 8)

    In a similar vein, the Rule of Law Digest on October 2 wrote about the attempts of Shangcai County, Henan officials to cover up the county’s large number of HIV infected blood donors. The article concluded with fiery words: "An administration that lacks a sense of social responsibility does the people no good. The spread of HIV among the Shangcai County blood donors is a tragedy, but even more it is a man-made disaster. The ‘do nothing’ attitude of the local government toward illegal blood sales, and the resolute refusal to accept outside assistance after the disaster became clear (in order to "look good politically and look out for number one"), is a stealthy attack on the right to life of the people. If this cold selfish attitude of the local administration does not change, many more will suffer and die in Shangcai and the surrounding areas."

    The Chengdu Worker’s Daily, meanwhile, strongly criticized new HIV/AIDS patient restrictions established by the Sichuan Provincial Government. The "Chengdu City AIDS Prevention and Management Regulations" forbid people with HIV or AIDS from getting married, entering public baths or going to a swimming pool. On December 2, the Worker’s Daily quoted a Chengdu official as saying the "rights of the minority should be sacrificed for the sake of the majority." The Daily then commented that although the rules are well-intentioned in the context of the spread of HIV/AIDS in China, the government should not treat people with AIDS and HIV like animals. The most likely result of the law, said the newspaper, is not the stopping of the HIV virus, but the reduction of humane concern for other people. The newspaper added that Chengdu officially has 38 HIV-positive citizens, but "according to the iceberg principle there are probably 100 times that number infected in the city." The Daily also declared that AIDS in China is spreading faster than in Africa and if not brought under control, China will become like India –- "a world class HIV/AIDS disaster area." Some of these articles are summarized on the U.S. Embassy web page at http://www.usembassy-china.org.cn/english/sandt/hivartic.html


    Can Morality and Justice Serve in the Fight Against AIDS?

    [Summary translation]

     Chinese text available at   http://www.people.com.cn/GB/channel7/1219/20001208/341575.html

    People's Daily East China News [Renmin Ribao Huadong Ribao], December 8, 2000

    article by Hao Hong

    We have an opportunity to understand the truth. International AIDS Day,  like many propaganda theme days, was established by a stronger group on behalf of a weaker group.  Nonetheless, AIDS Day is a good opportunity to understand the situation of people who live with AIDS. It is also a chance to come to understand some things that have been hidden. What we understand  about HIV is just the tip of an iceberg.

    The number of people infected with HIV to take one example.

    According to the China News Network, there are 1500 people infected with HIV in Hong Kong and over 3000 in Taiwan. According to the Huasheng Monthly,  "AIDS in China has already entered with period of rapid increase.  From 1985 when the first AIDS case was discovered in China, to September 2000, HIV spread to all of China's 31 provinces,  autonomous regions and independent municipalities. The officially reported numbers are 20,711 HIV infected people of whom 741 developed AIDS and 397 have died.

    Moreover, the number of blood donors infected with HIV constantly increases. Owing to the laxity of some responsible departments from the end of the 1970s to the mid 1990s as well as the greed for profits of people who run underground blood collection centers, the selling of blood in eastern and southern Henan Province is very widespread. The direct result of this has been the explosive growth and spread of HIV in the region. Some villages where people sold blood in those years became AIDS villages today.

    According to the Southern News Network (from Nanfang  Ribao, Guangdong Province Party Committee newspaper), in Shenzhen the AIDS epidemic will soon grow explosively if suitable  prevention and propaganda work is not done within the next five years.  In Shenzhen, many of the infected are migrant workers and most have been infected by the sexual transmission of HIV. The threat of the spread of HIV to women in this group is especially great.

    According to other reports, there other reports of people with HIV and AIDS being scorned and discriminated against. China Youth Daily reported that the director of the Shanghai Contagious Diseases Academy shook hands with an AIDS patient. According to the report, the director said, "I shake hands with an AIDS patient. Stop discrimination against people with HIV and increasing humane concern about them starts with me."   The Yangcheng Evening News of Guangzhou also called on people to be sympathetic to people with HIV.

    A Youth Daily reporter asked recently, "Can morality and justice serve in the fight against AIDS?"  In many areas, the local government feels ashamed about the existence of AIDS in their area so they prevent media from reporting and even stop experts from doing survey work in their area.  Southern Weekend [Nanfang Zhoumo]  reported, "A person at the Shangcai epidemiological station who says that he is sitting atop a volcano said  privately that in Shangcai County alone, there are nearly 10,000 people infected with HIV. The person feels that in conscience he should speak out but fears for the consequences."
     

    We can only imagine what the frustration and feeling that they are just awaiting death can be for those people who have gotten the "strange disease" in the villages around Shangcai County.   Since humanitarian assistance has not reached them in time, many have no doubt been lost to despair over the "strange disease".

    We Need to Face the Problem

    So that everyone can indeed face the problem of HIV/AIDS, local goverments must first of all face the facts about HIV.

    They need to face the problem that confronts them.

    Surveys show that in western countries, intravenous drug injection and sex are the main ways in which HIV is spread. But China hasyet another -- the illegal collection of blood.  According to reports, from the 1980s to the mid 1990s, many farmers earned a living by selling blood.  Each bloodhead (xietou, who organizes a group of donors) led several dozen people to the blood collection center.  When ever the blood collection truck came, farmer rolled up their sleeves. But the needles hadn't been sterilized so that so that a needle that came from one person was then inserted directly into the vein of another person. .

    Although the government has repeatedly forbidden the illegal collection of blood, but "donors" determined to escape poverty and "bloodheads" chasing after profits have continued to collect blood in some areas. A People's Daily reporter who visited one of these underground blood collection station sought a bodyguard for fear of revenge from the blood head organization. Even some government officials are also involved in the bloodhead organization.

    We Need to Be Aware of the Gap Between China and the Rest of the World

    China lags far behind many other countries the money invested in the fights against HIV/AIDS, in the establishment of related organizations, and in the control of HIV through science and technology.  According to a news item in Southern Weekend,  China in its response to the first AIDS case in the country was fully twelve years slower than some other countries.  Making a global comparison, 37 percent of all goverments that discovered the first case of AIDS in their country had an AIDS prevention program in place within 18 months.  But in the case of China it was 13 years after the first case was discovered in 1985 that the Chinese Ministry of Health in July 1998 established the AIDS Prevention and Control Center.  The editor of this item commented, "Faced with rapidly growing numbers of HIV infections, although we are far from having any real accomplishments in the fight against HIV, considering how this happened might be beneficial for our health and our future."

    According to an article in "Beijing Youth Daily",  accepting people with AIDS is a matter of protecting ourselves.  We can go further and say that facing the problem is a matter of saving ourselves.


    HIV Among Paid Blood Donors Widespread in Eastern and Southern Henan

    Southern Weekend Nov. 30, 2000

    The Nov. 30, 2000 Nanfang Zhoumo front page along with page two and three are full of stories about the very great number of  Chinese paid blood donors who have HIV. The most significant portion of the Southern Weekend report on the large-scale spread of HIV among farm villages in Henan is in the middle
    of a long article on P. 2. The article URL is HIV Among Paid Blood Donors in Henan (Chinese text) http://210.75.40.27/ZM/0011/30/zmjd3005.htm ..

    "According to an informed source,  the HIV-infected blood donors are most commonly found south of the Yellow River in the eastern and southern parts of the province in the regions of Kaifeng, Shangqiu, Zhoukou and Zhumadian. In these four regions, every single county has HIV infected people."

    Prof. Gao Yaojie, famous for helping people with HIV frequently receives letters asking for help from all four regions at her own expense [note: she was also mentioned in the recent New York Times and Time articles and has been harassed by the authorities lately]  but a Dr. Li of Shangcai County said that physicians there have contact with even more people sick with AIDS.

    An article on p.2 goes into great detail the great numbers of farmers in Shangcai County, Henan who gave blood at plasma collection stations between 1990 and 1995.  A responsible person at the Shangcai epidemiological station said that he is sitting on a volcano said privately that in Shangcai County alone, there are nearly 10,000 people infected with HIV in Shangcai County alone. The person feels that in conscience he should speak out but fears for the consequences.

    This is by far the most detailed and comprehensive treatment of this very sensitive issue in the PRC press.  Previous articles might have mentioned Shangcai, but did not give any strong notion of the geographic spread or the vast numbers of people involved.

    Estimates of the number of blood donors with HIV go as high as two million but there is no way of really knowing and people with any idea have generally felt too intimidated to talk about it.

    The story does not mention the role of blood products companies that set up collection stations in many parts of the countryside in the early 1990s. Some of these companies still illegally purchase plasma on the black market and so still create a demand for the underground blood plasma collection stations to fill.
    In the article, blame is placed on the blood heads who organized groups of "donors".

    U.S. Embassy Beijing reports on HIV in China:
     

  • AIDS in China: From Drugs to Blood to Sex December 2000
  • AIDS in China: Yunnan Province Confronts HIV December 2000
  • PRC AIDS: Mid 2000 Overview June 2000
  • PRC AIDS: Advice for U.S. Collaborators June 2000
  • PRC Henan Rural County: No AIDS Here? (posters) April 2000
  • PRC Blood Donors and the Spread of Rural AIDS March 2000
  •  PRC AIDS: International AIDS Vaccine Workshop December 1999
  • The December 1998 AIDS Day Exhibit in Beijing December 1998
  • AIDS Day 1997: China Responds to AIDS
  • Flying Blind on a Growing Epidemic: AIDS in China
  • HIV/AIDS in China: A World of Contradictions
  • AIDS in China: A View From the Ministry of Public Health
  • HIV/AIDS -- What Chinese Experts Say
  • AIDS and Homosexuality in China
  • Keeping China's Blood Supply Free of HIV/AIDS
  • China Responds to HIV/AIDS

  •  

     
     
     


    Journal: HIV Very High Among Paid Donors of Blood Plasma, But Where: That’s A Secret

    Chinese Journal of Epidemiology December 2000

    Researchers from the Ministry of Health National AIDS Prevention and Control Center report found very high rates of HIV infection at three underground blood plasma collection centers in a “certain province”.  According to the report, which appeared in the December 2000 issue of the Chinese Journal of Epidemiology,   after confirmatory tests were done 74 percent of nearly 100 “donors” tested at three illegal underground blood plasma collection centers had HIV.  Half of the
    “donors” had been selling blood since at least 1996.  Most were between 20 and 40 years of age, but one was just 16 years old.  Some of the “donors” were also drug addicts or prostitutes.  At two of the illegal blood collection centers, each person would give between three and six bags of plasma (1200 – 2400 ml) per day.  Donors give blood for five to six days, rest two days, and then begin again.

    According to the report, a new group of “donors” is rotated in every two to three months.   According to the report, donors are given no physical exam and the center is very dirty.  These centers are often located in remote, impoverished areas to avoid interference from the police.  The centers are well organized and maintain strict security so that outsiders won’t know what is going on.  The authors concluded that there can be absolutely no doubt that underground blood plasma collection centers spread HIV among blood donors.  The big profits to be made from blood products and the blood plasma from which they are made induce
    “blood heads” to organize donors and “blood lords”  to organize these underground blood plasma collection centers.  These illegal blood plasma collection centers are a very serious obstacle to the control of HIV in China.

    [Note: Another  report in the February 2000 issue of the same journal [See "PRC Blood Donors and the Spread of Rural AIDS"  on the Embassy Beijing EST webpage] by some of the same authors discussed the prevalence of HIV among blood donors in an area of "a certain province in central China". ]
     

    See also the very detailed report of an August 17, 2000 visit by a Chinese reporter to Shangcai County  that appeared in the October 2, 2000 rule of law digest. The reporter met with much stonewalling from county and village officials. The people in the village complained "Dozens of reporters come through here but nobody every does anything."  The efforts of Hubei University Professor Gui to help the people of the village and the frustrations that he has had with the authorities are
    also discussed. The article starts out by mentioning that rumors circulate in Shangcai County that some of the AIDS suffers to take revenge on others are injecting their blood into watermelons. These seems to be one of the panicky rumors that circulate in such situations.  The report is more detailed that the report that appeared
    in the Huaxi Dushibao in January 2000 in that names are named and the efforts of the authorities to cover things up are clear. It is similar in that it focuses on Wenlou Village but contains some references (such as people from other villages saying, our village is even worse than Wenlou Village)  that suggest that the problem is far more widespread that it might at first appear.  The scope of this problem seems to be gradually emerging despite years of secrecy about this problem. Southern
    Weekend on p. 2 of the Nov. 30 issue quoted an unnamed source at the Shangcai Epidemic Prevention Station as saying that there are nearly 10,000 people with HIV in Shangcai County.

    See the Chinese text of the Chinese reporter's visit to Shangcai County at  Henan has an AIDS Village!  at http://news.cn.tom.com/maya/news/gn/item/2000_10/337620.shtml

    According to one expert, a military-affiliated blood collection station operated in Shangcai County until the mid 1990s.


     Prof. Zeng Yi contines to speak out on the AIDS menace. His warning at a CAS meeting was reported at The Rapid Spread Of AIDS Will Cause A Big Disaster For China and mentioned in the China AIDS article that appeared in the June 30 issue of Science. Here is an interview he gave to China Daily. He estimates that by year's end China will have between 600,000 - one million people with HIV and that the rate of increase is 30 percent annually.

    http://www.chinadaily.com.cn/cndydb/2000/08/d9-1aids.821.html

    From China Daily August 21

                                                    Long road ahead in fight against AIDS

         Two bottles of drugs labelled with his name are probably the most precious possessions Song Pengfei and his parents have in the spartan house they rent in southern Beijing.  Each day, he takes 11 pills, strictly following the doctor's diagnosis; No delays, interruptions or changes are allowed to the dose.
    Otherwise, he knows, the fatal virus latent in his body could break out anytime, making him another AIDS victim. Song, 18, and his family have desperately struggled to prevent that from happening ever since he was diagnosed as HIV positive, or carrying the human immunodeficiency virus,  two years ago.  Song said he contracted HIV when he was given contaminated blood during a surgical procedure at a local hospital in central Shanxi Province in February 1998.  The blood was later confirmed to have been donated by an AIDS carrier.  The media covered Song's case and made him one of the best known AIDS patients in China.
         The coverage scared his neighbours, who had never seen an AIDS case before, and drove Song's family into isolation.  But the reports also brought donations from domestic and foreign charities, which have paid for Song's expensive treatment.

         With public funding and compensation from the local hospitals, Song came to Beijing in May 1998 for treatment at the Tiantan Hospital, one of a few in China able to treat AIDS. Song's condition was stabilized after receiving the "cocktail treatment" - a combination of anti-AIDS drugs that have so far proved effective in curbing, but not killing, HIV, the virus that causes AIDS.   But the average treatment fees of around 150,000 yuan (US$18,000) have several times forced Song to the edge of quitting treatment before two international AIDS foundations   pledged to give him free drugs.

         These drugs are what buoyed Song's life and confidence until today, although his future is still uncertain.  "I want to go to school to learn something," he said. "I want to find a job to support my parents. But no school would accept me because of the media coverage."   Song's parents are both retired workers.
    "If I want to (find a job), I'll have to conceal my identity," he said. "Some of my roommates at Tiantan Hospital are doing that now."  Song is only one of more than 500,000 HIV carriers in China, the official figure by the end of last year. Like the rest of the world, they are under threat of both death and social pressure.

         The difference is that he is a little luckier to have access to the normal treatment that is out of the reach of most AIDS patients in China.  Although a couple of medicine brands widely used today in AIDS treatment, such as AZT, have been granted licence for sale in China, they are too expensive for most patients, a  doctor confirmed.  "They are only slightly cheaper than in the overseas market," said Dr Shao Yiming.  On the other side, the number of HIV carriers in China is now shooting up as the nation has entered a fast lane in terms of AIDS spreading, warned Zeng Yi, a leading Chinese  researcher.

         Zeng Yi, a trail-blazing AIDS researcher in China, predicted that the number of HIV carriers will reach 600,000-1 million by the end of this year.  He pointed out that the number of China's HIV carriers has increased by 30 per cent annually in the past few years.  "Based on precedents of other countries, there is a time of rapid increase in the number of HIV carriers following a preliminary period of slow spread," he said. "China is now in  such a phase."

         Without effective checking of the rising trend, the situation is very likely to get out of control, he warned.  Zeng, director of the Department of Tumour Viruses and HIV at Beijing's Institute of Virology, has tracked AIDS research since the early 1980s.  Since the first AIDS case in China was reported 15 years ago, the disease has been raging across the country.   Based on the World Health Organization (WHO) report, China ranked fourth in Asia and 17th internationally in the number of HIV carriers by the end of last year.   Zeng complained about the lack of public awareness and investment in AIDS research and prevention in China.

         "The primary problem now is that people are still divided over the urgency of these issues," he said.  However, Zeng and many other Chinese researchers realized the urgency long ago and began fighting the disease on two major frontiers: basic research and dissemination of  AIDS-prevention knowledge.

         A few Chinese research centres, led by the AIDS Control and Prevention Centre under the Ministry of Health, are engaged in AIDS treatment and vaccine research.   The centre now focuses on the research and development of AIDS vaccine, according to Shao Yimin, deputy director of the centre.
    Over the past five years, they have experimented with several types of vaccines, such as the DNA vaccine, and observed positive results in the laboratory, he said.
     Experiments suggested that one of the vaccines called VLP (virus-like particles) has succeeded to a certain degree in "educating" the immune systems of mice to fight HIV.

         Shao expects all the experiments will be completed by the end of this year. "Then we'll submit a report to the State Administration of Medicine," he said. "If the report is approved, we'll apply for clinical trials."   Shao said any vaccine must get through a three-phase clinical trial before being approved for production and normal use. This process generally lasts 6-8 years, during which the vaccines are given to an increasing number of volunteers to examine its safety and effectiveness.  Ever since the first clinical trials of an AIDS vaccine in 1987, over 20 vaccines have been tested in the world on thousands of volunteers but none have passed muster, Shao said.  Sixteen vaccine candidates are now in clinical trials internationally, two of which are in the third phase, said Shao.  One major reason for the difficulty in coming up with a vaccine is that HIV, unlike other known viruses, is notoriously hard to eradicate because of its ability to mutate.  "A vaccine may prove effective in fighting HIV in a certain stage, but in most cases, the HIV variants will soon offset its effect," he said.  But Shao said the development of new vaccines has sped up internationally and the laboratory experiments take less time than before.

         Meanwhile, the conception of immunity has changed among AIDS researchers, who tend to believe that a 100 per cent effective AIDS vaccine is impossible at least in the  foreseeable future.  The 70-80 per cent effectiveness should be accepted if it can bring the disease under control, he said.   Shao's lab is also researching a virus similar to HIV in the hopes of better understanding HIV.  The virus, Equine Infectious Anemia (EIAV), is the only virus in the lentivirus family against which a vaccine has been developed and put into use in the world.  The vaccine has been used over the past 20 years in China and achieved great success.

         "This research is quite promising," he said. "By comparing the biological properties of the two viruses, we may hopefully find clues to a suitable vaccine."  As for the research on treatment, he said the centre is preparing an experiment on the interval treatment recently suggested by leading AIDS researchers.  The treatment fits an interval in the succession of drug taking, which seems to reduce side-effects and prevents the viral load from increasing.  If widely used, it may significantly cut down the cost of treatment as patients will no longer have to take drugs daily.  But Shao admitted that both drugs and vaccines would not cure AIDS once and for all, even if an effective type is announced in the future.

         Zeng predicted that such an announcement will not be possible in eight to 10 years given the international advances in the field. "We are still a long way off," he said.   Therefore, the best cure in a foreseeable future is to prevent HIV infection, he suggested.  "Countless examples in other countries suggest that education of the public, especially those in high-risk groups, is an effective and practical way to curb AIDS," he said.  "Ignorance is the major enemy in the fight against AIDS," he added.  An example Zeng often cites is Thailand, where continued education and intervention measures by government led to a dramatic fall in the number of HIV carriers.   Popularization of knowledge about AIDS has improved in the past years in China, but is still below the expectations of many experts.

         While the disease has been widely recognized in urban areas through media reports, AIDS is still a foreign word in many rural areas. Experts believe most HIV carriers now live in  rural China.   Even among those who have some knowledge of the disease, misunderstanding and horror prevail. Based on a recent survey conducted by the China Social Survey Firm in four big cities, 75 per cent of those surveyed said they would avoid AIDS patients and 45 per cent  believed the disease was a consequence of moral degeneration.  A direct reason for this ignorance is that for many people, AIDS is equated with mis-behaviour and death, said Zhang Beichuan, an AIDS researcher.  Instead, it should be replaced as unsafe behaviour and serious consequence, he suggested.

         Many experts call for continued, broad education on AIDS prevention, but economic and social hurdles constantly threaten to frustrate national efforts to curb the spread of AIDS.  According to a memo written by Zeng, China spent only US$2.75 million between 1996-97 on AIDS prevention, compared with US$4.5 million in Viet Nam and US$74 million  in Thailand.

         A more tricky issue comes from social recognition of some sensitive, yet widely used measures to prevent HIV infection, such as specific education of high-risk groups and the  distribution of condoms. Controversy has never ceased even among experts over whether China should do these things, or even formally recognize high-risk groups, such as prostitutes, long-distance truck  drivers, soldiers and drug abusers, Zeng said.  Zeng admitted it would conflict with China's traditional morality. But people will have to face up to it and make choices because an effective and economical cure will not be  available for quite a long time.

         "Preventative measures have been proven effective," he said. "The whole society should take a practical attitude towards them because they can save your life."

         Date: 08/21/2000
         Author: HE SHENG, China Daily staff
         Copyright? by China Daily


    XINHUA NEWS AGENCY BULLETIN, 25 May 2000

    CHINA: GOVERNMENT URGED TO CONTROL SPREAD OF HIV/AIDS BEIJING, May 25 (Xinhua)

    Experts from the Chinese Academy of Sciences (CAS) have urged the government to take measures to control the spread of HIV/AIDS to avoid a future crisis. The key to harnessing the deadly infectious disease lies in the prevention of HIV/AIDS among drug addicts, prostitutes, homosexuals and other people who are under greater threat of the disease, experts from the Division of Biology in the CAS pointed out in a report to the State Council.

    Statistics in the report show that intravenous drug users are China's biggest population of HIV/AIDS casualties. In some areas in Yunnan, Xinjiang, Guangxi, Sichuan and Guangdong where there are large numbers of drug addicts, the spread of HIV is rampant.

    The report said that blood transfusions are another major source of HIV infection, because some grass-roots hospitals in China do not follow the rules of the Ministry of Health and still use donated blood that has not undergone HIV testing.

    The numbers of people who are infected through sexual contact or from mothers to children are also increasing. The Ministry of Health estimated that the total number of HIV/ AIDS patients in China will reach 500,000 this year, and it might be 20 times the figure by the year 2010 if no effective disease-control measures are taken. The CAS experts urged the government to issue laws and regulations on the prevention of the disease.



    China Daily  http://www.chinadaily.com.cn
    Date: 03/02/2000

    Chinese vulnerable to HIV


    Chinese Journal for STD and AIDS Prevention and Control Vol. 5 No. 3, June 1999 [Transcription of English abstract in this PRC magazine] article on pp. 97 - 102

    The HIV/AIDS Epidemic and Key Initiatives for HIV/AIDS Prevention and Control in China in 1998

    by Sun Xinhua, Division II of Communicable Diseases Control, Department of Disease Control, Ministry of Health, Beijing 100725, China

    Abstract: By the end of 1998, 12,369 HIV positive cases had been reported to the Ministry of Health from 31 provinces, autonomous regions, and municipalities, of whom there were 417 AIDS patients and 224 had died of AIDS. Three transmission routes of HIV infection were found and injecting drug use was the leading one. It was estimated that more than 0.4 million people were living with HIV. In 1998 a total of 3306 HIV infections were reported and injecting drug use was still mainly infected may, accounting for 75.2 percent of all the infections. Xinjiang and Guangxi were the regions with the fastest moving epidemic. The number of HIV infections reported by Xinjiang ranked first in 1998, which surpassed Yunnan for the first time. In more than half sentinels of IDUs, HIV positive people have been found, whose rate of HIV infection was higher than in 1997. The sentinels with HIV infected underground prostitutes and clients increased; pregnant women had been identified to be infected HIV in some hard hit area, which reveals that HIV infection is spreading from high risk population to general population. The constraints of case report and HIV/AIDS surveillance were put forward. The key documents, policies, strategies, and major initiatives were summarized and emphasized.

    [Now looking into the article for more detail] During 1998, 3306 new cases of HIV were reported, about the same as in 1997. The provinces/autonomous regions with the most new cases were in order: Xinjiang, Yunnan, Guangxi, Sichuan, and Guangdong. HIV has been found among intravenous drug users (IDU) in 20 provinces and regions. HIV spread fastest among IDUs in Xinjiang and Guangxi. HIV is increasing among drug users and also among heterosexuals although the level of HIV transmission among heterosexuals is still quite low.

    Serious problems with HIV/AIDS reporting. Some provinces are reporting many fewer cases but this is clearly a matter of provinces not reporting cases rather than a reduction in the actual number of cases. Delays and failure to report are serious problems.

    During 1997, 3.38 million people were tested for HIV including 170,000 people who had sexually transmitted diseases or were underground prostitutes, clients of prostitutes, and intravenous drug users. But in 1998, only 1.3 million people were tested for HIV and only 70,000 people who had sexually transmitted diseases or were underground prostitutes, clients of prostitutes, and intravenous drug users.

    This sharp decline in HIV testing will make HIV detection less likely. Also important is the problem of delayed reporting, people with HIV not being reported and the failure to report HIV cases.

    On May 6, 1998, the State Council decided to issue the "Long Term Chinese HIV Prevention and Control Plan (1998 - 2005). On November 12, 1998 State Council order No. 38 called on all government departments to work to implement this plan.


    Chinese Journal of Epidemiology June 1999 pp. 131 - 134

    [Summary]

    China's AIDS Epidemic and Achievements in Its Prevention and Control

    Article by Zheng Xiwen of the AIDS Prevention and Control Center, Chinese Ministry of Health, Beijing 100050

    America and then Asia were the place where the HIV/AIDS epidemic was growing fastest. Now it is Asia with an estimated 800,000 cases in Thailand and 4 - 6 million cases in India.

    In China, the HIV situation can be summarized as over 400,000 people infected with HIV. There are people infected with HIV in all of China's 31 provinces, autonomous regions and municipalities. All three infection routes: sexual transmission, blood transmission and mother -to- infant transmission occur in China.

    Periodization of the HIV/AIDS Epidemic in China

    Between the discovery of the first HIV case in China in 1985 to December 31, 1998, there were found 12,369 cases of HIV in China and 417 cases of AIDS.

    First Period -- 1985 - 1988 Nineteen cases of HIV reported. Scattered, mostly foreigners and overseas Chinese. In Jiangxi four people got HIV from an imported blood product.

    Second Period -- 1989 - 1994 Epidemic in some areas. The Ruili, Yunan border region reported 146 cases of HIV among intravenous drug users. The infection came from abroad and spread in some cities in the Dehongzhou region. Few IDU in other parts of China have HIV. Number of HIV cases among people with sexually transmitted diseases and among underground prostitutes, and Chinese workers returning from abroad gradually increases.

    Third Period - 1995 to the present HIV epidemic widespread in China. The number of people with HIV climbs sharply. HIV among intravenous drug users spreads from Yunnan to Xinjiang, Guangxi, Sichuan and other regions. From 1995, HIV begins to appear frequently among paid blood donors. Most of these people are associated with local illegal blood and plasma collection centers. These people have a high risk of spreading HIV to other people. HIV also continues to increase among people with sexually transmitted diseases and among underground prostitutes.

    Geographic Spread As of the end of 1998, the regions reporting the most people with HIV were Yunnan, Xinjiang, Guangxi, Sichuan and Henan. In southwest and northwest China, intravenous drug users are the main group infected with HIV. In central China, the greatest numbers infected are migrant workers or paid blood donors. In southeastern coastal China and in the big cities most of the HIV infected are people with who have sexually-transmitted diseases or are underground prostitutes.

    Age distribution: Among the 12,639 people with HIV reported, 81.9 percent (10,349) are males and 15.7 percent (1,984) are female. Gender not reported in 2.4 percent of cases.

    Age Mostly (79.0 percent) in their twenties and thirties

    HIV Transmission Route

    Intravenous drug users 69.4 percent (8776) Sexual transmission 6.6 percent (834) Blood transfusion or blood products 0.3 percent (35) Mother-to-child 0.1 percent (9 cases) Not certain 23.6 percent

    Chinese epidemiologists, using the Durfee (?) statistical method estimate the progress of the epidemic as below:

  • 1993 10,000
  • 1994 30,000
  • 1995 100,000
  • 1996 200,000
  • 1997 300,000
  • 1998 400,000

  •  

     
     
     

    Epidemiologists considering trends and measures being taken to bring the epidemic under control estimate that China will have between 600,000 and 1,000,000 people infected with HIV in the year 2000. Projections beyond that are very difficult - perhaps between 1.5 million and 10 million with HIV in China in the year 2010. The "China AIDS Prevention Mid and Long Term Plan" calls for controlling HIV at 1.5 million by the year 2010.

    The prevalence of HIV among IDUs has reached several percent. Among other risk groups such as people with sexually transmitted diseases, underground prostitutes and some paid blood donors the prevalence is about one per thousand. Among average people the prevalence is about one per 10,000.

    Epidemiology: HIV is being studied by epidemiologists in Ruili, where 30 percent of the IDUs have HIV. The proportion of HIV infected people with infected spouses rose from 3.1 percent in 1990 to 12.3 percent in 1997. HIV molecular Epidemiology has show that there are seven HIV strains in China - Thailand B, Euro-American B, C, E, A, D, and F. The most prevalent strains are Thailand B followed by C but C is confined mostly to SW and NW China. C is the most widespread strain among intravenous drug users but Thailand B is most common among paid blood donors.

    Policy" n The Chinese AIDS Prevention and Control Mid term and Long Term Plans n The October 1, 1998 Blood Law to prevent HIV transmission that occurred in the past due to the collection of blood at underground centers which did not operate according to accepted rules n Publication of "Opinions on the Management of HIV infected people and people sick with AIDS" This prohibits discrimination against people who have HIV/AIDS in workplaces, schools, hospitals etc. Revealing the name of an HIV infected person is forbidden.

    Principles for preventing AIDS. China's strategy emphasizes prevention. China wants to learn from the experiences of other countries in areas such as the use of condoms to prevent infection, needle exchange, cure of STDs, and using AZT to prevent mother-to-child HIV transmission.

    The AIDS Prevention Center at the Ministry of Health was established in February 1998 pursuant to a State Council document and a decision by central organs.

    Problems Remaining: Some government leaders do not understand the potential for the further spread of HIV and its consequences for China. A minority of leaders conceal the true situation and block measures to prevent HIV. Investment in HIV prevention is inadequate. Between 1986 and 1998 total investment throughout China was 54.80 million RMB (for an average of USD 560,000 per year). In recent years this investment has risen to 15 million RMB per year. International organizations in recent years have invested an additional 17.4 million USD. Yet the Thai government each year spends USD 80 million on HIV prevention.

    HIV/AIDS education is still inadequate. Monitoring work is inadequate. Medical personnel and the average citizen lack a proper understanding of HIV.

    Minister of Health Zheng Wenkang said, "AIDS is not a simply a public health problem. It is rather a complex social problem. All of society must get involved and share responsibility for actively working together to solve this problem. Under the leadership of the Communist Party Central Committee and the State Council and each level of Party and government organization, we must not miss any opportunity to implement all HIV prevention and control policies and measures. We must strive to build and complete this long-term social systems project so as to reduce to the greatest extend possible the harm that HIV causes to the people and society. At present, HIV is still at a low level of contagion. Prevention and control are most suitable for this period. This is our last chance to beat the epidemic."


    Spread of HIV in China Quickens, Eight Varieties Identified Over 400,000 Chinese are Infected with the HIV Virus

    A newspaper report from Fuwu Daobao, August 6, 1999

    The PRC Ministry of Health recently announced that eight varieties of the HIV virus have been identified in China. This put China among the countries that have the greatest diversity in HIV virus types.

    HIV entered its rapid growth phase in China in 1995. The number of cases discovered that year equaled the total of all cases discovered during the preceding ten years and the areas affected by HIV spread grew rapidly. Analysis of 300 random blood samples from HIV patients in China's thirty-one provinces, municipalities and autonomous regions (except for Tibet) showed that among the eight HIV strains circulating in China, the most common (47.5 percent) is the B' strain, followed by the C strain at 34.3 percent, the E strain at 9.6 percent. Four other strains in the sample comprised between 0.3 percent to 5.7 percent of the total.

    The B' strain that originated among drug users in Thailand was the most widespread strain.

    The C strain that originated among drug users in India is generally found in areas with relatively high proportions of drug users: Yunnan, Guizhou, Sichuan and Xinjiang. Moreover, the Xinjiang floating population carries this strain to eastern and southern China.

    The E strain that originated in Southeast Asia is seen mostly in the southwestern border regions of China and along the southeast coast.

    A small number of Chinese who worked in Africa brought back with them to China the African A, D, and G HIV strains. These strains are thus found in those interior provinces that export labor. The South American F strain has only been detected in Guangdong Province.

    Looking at the distribution by risk group, the B' and C strains are the most common strains among drug users. All strains have been found among sexually-transmitted HIV, but the E strain is the most common.

    According to studies, HIV virus 1 complex virus accounts for just 4.5 percent of the HIV virus in Yunnan Province. However nearly all of the HIV transmitted through Sichuan, Gansu, and Ningxia to Xinjiang is a complex virus. Through the complex virus which arises from the crossing of virus strains HIV may become more contagious. This can be seen in the different period of time the start of the epidemic to the 70 percent saturation level in different areas. It took five to six years from the start of the HIV epidemic to saturation in Yunnan Province but just two to three years in Xinjiang.

    HIV first appeared in China in 1985. The pace of HIV infection in China is now clearly picking up speed. There are now estimated to be 400,000 Chinese infected with the HIV virus but only 16,000 of these cases have been officially reported.


    From Shenyang Evening News [Shenyang Wanbao], November 26, 1999

    Summary: Shenyang City anti-epidemic officials went to the Public Security Detention and Education Center, to the Drug Detoxification Center, to administrative detention centers and other places to teach about how to prevent the spread of AIDS. December 1 is World AIDS Day. As of the end of 1998, there were 33.4 million people infected with HIV -- a number that increases by 10 percent every year. Over 95 percent of the infected people live in developing countries. Many of those infected are children. As of the end of 1998, 1.2 million children had AIDS. As of the end of September 1999, China had discovered 15,088 cases of HIV/AIDS. Fifty-eight percent of those infected are between the ages of 20 and 29. Shenyang City has discovered 26 HIV cases in the city, and four people with full-blown AIDS. Two of them have already died. Shenyang discovered seven HIV cases from 1991 - 1997, but during 1998 alone found 11 new cases. During the first 11 months of 1999, eleven new cases of HIV have been found. There is no cure for HIV and there is no effective drug therapy. Widespread education about HIV is very important.


     Healthoo: HIV/AIDS  at http://www.healthoo.com/news/zhuanti/title/aids.asp

    Those of you following HIV/AIDS in China will probably find the collection of articles from the Chinese press brought together on the Health Web-- HIV/AIDS Section useful. Many articles from the Chinese and foreign press are found there in Chinese.