AIDS in China
Joan Kaufman, Visiting Scholar, Harvard Law School
Congressional Briefing, September 2002

Click here for Joan Kaufman's Science Magazine article "AIDS in China: The Time to Act is Now".

1. Official Estimates:
   • 1 million HIV infected as of September 2002
   • UNAIDS Estimates: 1.2 Million infected now, 20 million by 2010



2. Key Sub groups
   • Intravenous Drug Users (officially 70% of cases)
   • Paid Blood Donors and their families (the innocent victims who are mobilizing the public response) (probably most of cases)
   • Female Commercial Sex Workers
   • Homosexual Men



3. Drug Users
   • increasing numbers
   • high relapse rates/no methadone
   • needle sharing and high HIV infection rates
   • transmission to sexual partners
   • mixing between IVDU and Sex Workers (drug use by sex workers)



4. Paid Blood Donors
   • Acquired during the 1990's through paid blood donations by poor farmers
   • Henan best known but at least 9 other provinces
   • Widespread practice: e.g. in Henan over 200 sites and many people sold blood repeatedly over years for about $5 a bag as income supplement
   • Paid blood donations prohibited in 1998 but continued in some places
   • Affected villages: over 60% of adult population infected in some Henan villages
   • Sexual/vertical transmission to spouses/offspring
   • little prevention/public education being done to prevent further spread
   • virtually no treatment/care available (although pending Global Fund application is for care/support in Henan and for Voluntary Testing and Counseling - gateway to other services)
   • Major orphan problem emerging



5. Sex Workers
   • widespread prostitution
   • high rates of STDs
   • HIV rates among sex workers increasing (Guangxi 11%, Yunnan 5%)
   • low condom use
   • clients: rural economic migrants and middle class men



6. Homosexual Men
   • Highly stigmatized and hidden, most married
   • 1/3 of hospitalized AIDS patients in 2000 in Beijing
   • Few channels for information and little prevention



7. Vulnerable Groups
   • Youth:
     Little sex education and limited AIDS knowledge Changing sexual attitudes and behaviors Low self perception of risk and low condom use
   • Rural Women
     Returning migrant husbands High rates of reproductive tract infections



8. Potential Impacts
   • compromise economic progress of last 20 years
   • Huge orphan issue in poor rural areas
   • Families falling into poverty to pay for treatment.
   • Rural Protests by innocent victims



9. Negative Constraints
   • No highest level policy leadership yet
   • Local inaction (collection of local public policy failures)
   • Fiscal devolution: health system and budgets strained in poor areas
   • High levels of discrimination/fear based laws to protect public
   • Limited civil society organizations
   • Constraints on media coverage and information
   • Complicity by local governments and denial



10. Positive Potentials
    • Recent admission of the severity of the problem and asking for help
    • Existing (albeit weakened) health infrastructure
    • Existing IEC /public education infrastructure (Family Planning IEC/Party Organs)
    • Ability to mobilize party/government around a national action agenda
    • Access to treatment and care beginning: recently announced plans to manufacture AIDS anti-retroviral drugs if drug companies don't offer reasonable price

Click here for Joan Kaufman's Science Magazine article