HIV/AIDS, SARS, and Public Health in China
The scale and nature of the emerging HIV/AIDS epidemic in China has been a particular concern of the Commission over the past year.(206) The most significant concerns include the speed of transmission of the disease among the populations of intravenous (IV) drug users, the relatively weak response from the central government, and the likelihood that the disease may eventually be a substantial drag on economic growth.(207) The Chinese government is taking
considerable steps to confront HIV/AIDS, but it must overcome
contradictory policies, underfunded programs, rivalry between national and
local institutions, social prejudice, and a continued lack of public
awareness, education, and prevention before it can avert an HIV/AIDS
catastrophe.
With respect to the U.S. policy response, the Commission heard repeated advice from U.S. experts that the President and the Congress should continue to raise HIV/AIDS issues with the highest levels of the Chinese leadership, citing the epidemic as an international concern that cannot be solved without action from the top.(208)
China's reaction to HIV/AIDS has been similar to early reactions elsewhere: shame and denial, stigmatization of the victims of the disease, and an impulse to enact punitive laws and regulations that drive patients into hiding. Official Chinese government estimates
show that 1 million people were living with HIV in China by the middle of 2002,(209) while the United Nations estimates that up to 1.5 million people are currently infected. The United Nations and others predict that China is at risk of an HIV/AIDS epidemic that could reach a scale of 10 million to 20 million infected Chinese citizens by the year 2010.(210) In recent years, the Chinese government has slowly been coming to terms with the rapid rise of HIV/AIDS throughout China after a prolonged period of denial. Nevertheless, China's health care system is ill-prepared to fully confront what the United Nations Theme Group on HIV/AIDS in China considers to be a situation "on the verge of a catastrophe that could result in unimaginable human suffering, economic loss, and social devastation."(211)
In 2001, the Chinese government began recognizing the
emerging crisis and initiated national-level programs to address the
epidemic. A 5-year AIDS action plan, announced in mid-2001, and
negotiations with pharmaceutical companies for affordable retroviral
treatment, marked a growing awareness and initial commitment to confront
HIV/AIDS. Another positive step toward accepting the country's HIV/AIDS
challenge came in December 2001 when Zhang Wenkang, then the health
minister, acknowledged that the practice of blood plasma collection in the
late 1980s and early 1990s contributed to the spread of HIV to 23 of
China's 31 provinces, centrally administered municipalities, and
autonomous regions. In April 2003, the Chinese government began providing
free AIDS drugs to thousands of HIV patients in Henan, Hubei, Hunan,
Anhui, and Sichuan Provinces who contracted the virus after selling their
blood as part of China's practice of blood plasma collection. Government
programs are also treating patients in other provinces, and Chinese and
foreign observers expect the program to expand.
In July 2003, Chinese Vice-Premier Wu Yi, who became the Minister of Health after Zhang Wenkang was dismissed over the SARS debacle, announced continued cooperation between China's Ministry of Health and the United Nations Development Program to "reinforce the nation's fight against HIV/AIDS and other public health problems."(212) After a trip to China in January 2003 to examine China's approach to HIV/AIDS, a U.S. think tank's HIV/AIDS delegation found that the Chinese government is finally making progress on this issue:
The Chinese approach to HIV/AIDS is moving in the right direction, albeit slowly. The Chinese Ministry of Health recognizes the enormity and complexity of the threat and is leading a serious effort to preempt it, through increased funding, improved intra-governmental coordination, expanded pilot training programs, improved preventative education and awareness, and an enlarged dialogue with the international community on new partnerships.(213) Despite China's recent
progress in fighting HIV/AIDS, authorities have made numerous missteps,
particularly at the local level. Corrupt and inept practices, prejudices,
and lack of understanding have made a bad situation even worse,
demonstrating that necessary policy-level improvements have yet to be
realized on the ground. While the new national policies on fighting
HIV/AIDS that the Ministry of Health has been promoting signify positive
movement, local authorities appear to be less progressive in attitude and
incapable of implementing new measures.
In testimony at a Commission roundtable in September 2002, two U.S. scholars emphasized that local inaction and stonewalling by provincial authorities, as well as lack of cooperation or enthusiasm from the security apparatus, complicate the ability of the
Ministry of Health and others to address the HIV/AIDS problem.(214)
An incident in Henan Province illustrates the difference in attitudes between national and local authorities. On June 22, 2003, police officers and local thugs raided Xiongqiao village, an "AIDS village" in Henan where several hundred residents contracted HIV
due to the unsanitary blood collection practices of the late 1980s and early 1990s. The law enforcement squads smashed property, assaulted residents, and arrested 13 farmers. Farmers from the village had appealed to local officials to receive previously promised government assistance for AIDS patients.(215) Approximately 700 of the 3,000 residents in Xiongqiao have been diagnosed as HIV positive, with 400 of them living with full-blown AIDS. Some residents and other observers believe the raid was an example of local authorities persecuting HIV/AIDS sufferers using repressive measures when victims seek access to promised treatment, aid, or care. A U.S. NGO offered the view that police in Henan Province, where many "AIDS villages" exist because it is the center of the blood collection scandal in which local authorities were complicit, are increasing their use of arbitrary arrests and violence against HIVpositive protestors. "Henan authorities seem to want to sweep their role in the AIDS epidemic under the rug by silencing protestors" who are seeking access to treatment and care of HIV/AIDS patients, and who are frustrated with the misappropriation of state AIDS funding.(216)
Other setbacks include problems surfacing in the Chinese government's program offering free AIDS drugs to thousands of farmers who contracted HIV after selling blood.(217) Although the program,
which was launched in April 2003, significantly advances China's fight
against HIV/AIDS, it also lacks sufficient numbers of qualified doctors to
properly administer the drugs and help the patients maintain lifelong
treatment. Qualified doctors are especially necessary to help the patients
endure the strong side effects of the drugs, intensified by the use of
older, locally-manufactured drugs. As a result of these side effects and
the dearth of suitable doctors to keep patients on the approved course of
treatment, many patients are dropping out of the program. These problems
highlight the fact that China is ill-equipped to successfully fight
HIV/AIDS on its own.
Other obstacles hindering more rapid progress in stemming the epidemic include social prejudice and the continued lack of awareness, public education, and prevention. Joan Kaufman, a visiting scholar at Harvard Law School, summed up the difficulties facing a successful fight against HIV/AIDS in China in her testimony to a Commission roundtable:
[T]he epidemic is unfolding in China because of a collection of local public policy failures: fiscal devolution in the health system and the strained budgets in poor areas make it very difficult for local government to pay for the necessary prevention and care activities; high levels of discrimination and fear-based laws aimed at protecting the
public; a limited number of civil society organizations that could actually take up the battle; constraints on media coverage and information which make it difficult for people to
know about the AIDS epidemic and what has worked in other countries; and complicity by local governments and denial.(218)
At a September 2002 Commission roundtable on HIV/AIDS in China, U.S. experts praised an existing U.S. program grant to help Chinese agencies implement vaccine development and begin treatment trials in the 100 counties most affected by HIV. They also advocated
more U.S. technical assistance to help local governments adopt international best practices in coping with HIV and to build a nation-wide response.(219)
Footnotes
206: The United Nations' Office of the High Commissioner for Human Rights identifies HIV/AIDS as an undeniable human rights concern: "There is clear evidence that where individuals and communities are able to realize their rights - to education, free association, information, and, most importantly, non-discrimination - the personal and societal impact of HIV and AIDS are reduced. The protection and promotion of human rights are therefore essential to preventing the spread of HIV and to mitigating the social and economic impact of the pandemic. In addition, Article 21 of the Chinese Constitution states, "The state develops medical and health services, promotes modern medicine and traditional Chinese medicine . . . all to protect the people's health."
207: See, e.g., Congressional-Executive Commission on China Roundtable, HIV/AIDS in China: Can Disaster Be Averted?, 9 September 2002.
208: See, e.g., The Center for Strategic and International Studies, "Averting a Full-Blown HIV/AIDS Epidemic in China: A Report of the CSIS HIV/AIDS Delegation to China, 13-17 January 2003," February 2003. The Commission staff also directly received this advice from J. Stephen Morrison, Executive Director of the CSIS HIV/AIDS Task Force, and Bates Gill, Freeman Chair in China Studies at CSIS.
209: Joint United Nations Programme on HIV/AIDS and World Health Organization, "AIDS Epidemic Update," December 2002, 7 (3 September 2003).
210: The Center for Strategic and International Studies, "Averting a Full-Blown HIV/AIDS Epidemic in China: A Report of the CSIS HIV/AIDS Delegation to China, 13-17 January 2003," February 2003, 2.
211: United Nations Theme Group on HIV/AIDS in China, "HIV/AIDS: China's Titanic Peril - 2001 Update of the AIDS Situation and Needs Assessment Report," June 2002, 7.
212: "Chinese Vice Premier Meets UNDP Official," Xinhua, 5 July 2003 (3 September 2003).
213: CSIS, "Averting a Full-Blown HIV/AIDS Epidemic in China: A Report of the CSIS HIV/AIDS Delegation to China," 2.
214: Congressional-Executive Commission on China Roundtable, HIV/AIDS in China: Can Disaster Be Averted?, 9 September 2002, Testimony of Joan Kaufman, Visiting Scholar, East Asia Legal Studies Program, Harvard Law School, and Bates Gill, Freeman Chair in China Studies, Center for Strategic and International Studies.
215: See, e.g., "Hundreds of Police Storm 'AIDS Village' in China, Arrest 13 Farmers," Agence France-Presse, 3 July 2003, in FBIS, Doc ID CPP20030703000102; Agence France-Presse, "Group Says China Increased Arrests, Violence Against HIV Positive Protestors," 9 July 2003, in FBIS, Doc ID CPP20030709000038.
216: Human Rights Watch, "China: Police Violence Against HIV-Positive Protestors Escalates - Henan Authorities Deepen AIDS Cover-up," 9 July 2003 (3 September 2003).
217: "China Starts Offering Free AIDS Drugs but Lacks Doctors to Administer Them," Agence France-Presse, 14 July 2003 (12 August 2003).
218: Congressional-Executive Commission on China Roundtable, HIV/AIDS in China: Can Disaster Be Averted?, 9 September 2002, Testimony of Joan Kaufman, Visiting Scholar, East Asia Legal Studies Program, Harvard Law School.
219: See, e.g., ibid.; Testimony of Bates Gill, Freeman Chair in China Studies, Center for Strategic and International Studies.
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