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In Depth: AIDS

The Spread of AIDS in China: A slow acknowledgment of the "capitalism loving disease"

By Meghan Laslocky

Many say it took a televised handshake for China to wake up. On World AIDS Day 2003, Prime Minister Wen Jiabao shook the hand of an HIV-positive person, and a closeup of their joined hands was broadcast around the country. Finally, with by some estimates one million AIDS victims in Henan province alone, silence was no longer an option, and the country's leaders were scrambling to come up with policies to show that they had a plan.

But until then, ignorance, discrimination, xenophobia and stubborn refusal to acknowledge, much less prevent, the spread of AIDS seemed hard-wired into China's policies.
AIDS victim grimaces in pain

HIV contaminated blood was passed into the population through unsafe transfusion practices and unsterilized equipment. It was only in 1996 that unsafe blood collection practices were made illegal.

When AIDS first surfaced in China in the mid- to late-1980s, it was dismissed as something that most Chinese didn't have to worry about: It was a foreigners' disease. In 1987, the Vice Minister of Public Health tepidly warned that if young women slept with foreigners, they could spread the disease, but at the same time added that it wasn't a particular concern because homosexuality and "abnormal" sexuality -- the territory of foreigners -- caused HIV. In 1988, the government banned importing blood in order to prevent transmission of HIV -- a move that fatefully drove up the price of "domestic" blood.

By what is known as the second phase of AIDS in China, the period from 1989-1993, AIDS was discovered among drug users in southwest Yunnan, but the disease and drug addiction were still seen as fair punishment for contact with westerners and western ways. AIDS was known as aizibing -- the "loving capitalism disease."

AIDS Spreads through Blood Selling

But around the same time, AIDS was actually breaking loose, far beyond the drug-using community, largely due to national policies -- indeed, to China's flirtation with capitalism. As the U.K. Guardian tells it, this is how AIDS blossomed from what authorities dismissed as a local outbreak to a nationwide calamity.

"When local health authorities were suddenly told to start making profits in the late 80s, as part of the country's drive toward capitalism, Henan's officials turned to their only untapped resource: the blood of the province's 90 million population. Vans were converted into mini-clinics and driven out into the countryside. Ambitious peasants established themselves as brokers to meet the demand among buyers and sellers. For an 800 cc donation, villagers were paid about $6, enough to feed a family for a week. Realizing that they could get far more for milking their veins than for tending the land, for years they lined up, day in and day out, to make donations. By the peak -- around 1995 -- Henan had become the nation's blood farm."

Given what we know about how AIDS is spread, the details of the blood selling industry are downright terrifying: Illegal blood collection agencies sprang up, in addition to government-run blood-collecting clinics, using and reusing filthy needles and unsterilized equipment. Collected blood was mixed in vats and re-injected into donors so they wouldn't become anemic. And many people donated blood several times a day.
Dr. Gao Yaojie surrounded by AIDS orphans

Internationally honored activist Dr. Gao Yaojie with some of the countless children orphaned by AIDS whose rights she has championed.

As one woman told AVERT, an international AIDS charity, "We sold our blood to make money. We sold blood to pay the local taxes, to support our kids through school, and to make a living. By working on the farm we can't make money."

In hindsight, one of the fundamental mysteries of the spread of AIDS in China is just how many people were infected by the blood-selling operations of the 1990s, and the estimates vary wildly. 69,000? 199,000? 55,000? Western experts tend to think that half a million to a million people became infected through blood selling, but no one knows for certain, and statistics in China are well-known for their imperfections. When Dr. Gao Yaojie, a doctor and AIDS activist, discovered the blood-selling scheme in Henan and began her work educating people in villages about AIDS in 1996, she saw 100 AIDS patients in seven villages -- often with two patients per family. In one family that she met, four out of the five children had sold their blood; two were already dead.

But AIDS education was still more or less forbidden, and local government officials prevented and even harassed and persecuted doctors and journalists who attempted to visit villages rife with AIDS. They didn't want investment in Henan to be threatened by bad publicity; the coverup had lethal consequences, as Professor Gui Xi'en of the AIDS Research Centre at Wuhan University notes:

I've known people who sold blood before 1996 and were infected. But in '97 and '98 they were still being invited back to hospital to donate their blood for transfusions. The problem was local doctors didn't know there was AIDS in the area. So the disease was being spread.

In those early days in Henan, AIDS was both a secret and a mystery. The few who knew it was there were puzzled by how a disease associated with needle-sharing, promiscuity, and homosexuality was cropping up in a very traditional, conservative, rural communities.
Dr. Gao Yaojie cares for AIDS patient

Dr. Gao Yaojie has become a heroine in China for her pioneering work promoting AIDS awareness.

By 1998, AIDS had spread to all 31 provinces in China, and in 2001, when entire villages were being decimated by AIDS, western media started to take notice, and the U.N. warned that China was on the brink of an epidemic "beyond belief" and suggested "drastic action."

By 2001, there were some indications that the government acknowledged the problem -- blood for clinical use was to be tested, blood wasn't to be sold for profit, a television drama about AIDS was aired -- but still, local police could arrest women for carrying condoms as "proof" of prostitution, and condom advertising was banned. In Henan, the epicenter of China's AIDS problem, a condom cost the equivalent of half a day's wages. AIDS was still widely regarded as the problem of prostitutes, drug users and gay men.

The Turning Point

The year 2003, when Prime Minister Wen publicly shook the hand of an AIDS patient and China officially estimated that 840,000 of its people were living with HIV, is widely regarded as the "tipping year" for China with regard to recognition of AIDS.

Professor Gui Xien of the AIDS Research Center

Professor Gui Xi'en of the AIDS Research Center at Wuhan University.

But it took SARS to get it there. Dr. David Ho, a renowned AIDS researcher (and Time magazine's Man of the Year in 1996), says that Beijing's slow reaction to the SARS epidemic finally taught China's leaders that public health was important. "They could compare SARS and AIDS, and they could imagine the enormity of AIDS," he said in a recent interview. International pressure in the face of SARS set in, and after President Bill Clinton made a trip to China to, in Ho's words, "pound on leaders," China was finally ready to acknowledge it had a terrible problem with AIDS, and prostitutes, drug users and gay men might even be in the minority of victims; cases of HIV contracted from blood selling were in all parts of China except Tibet. Some said there were over one million victims in Henan province alone, a figure that far surpassed the government's official total estimate of 840,000.

At the end of 2003, after the handshake and the visit from Clinton, Chinese leadership rolled out what it called the "Four Frees and One Care Policy," which granted free anti-HIV drugs to rural residents or poor people in urban areas, free voluntary counseling and testing, free drugs to HIV-infected pregnant women and testing of newborns, free school for children orphaned by AIDS, and care and economic assistance to people living with HIV/AIDS. Until then, free AIDS tests were only available to sex workers and drug addicts, and the hundreds of thousands of poor people infected in rural areas suffered with no government support.

But still a survey from right around the same time indicated that only 20 percent of the population had ever heard of AIDS, and 40 percent had no idea that condoms could prevent it from being sexually transmitted.

How Could There Be Fewer Cases?

In early 2006, the Chinese government, the World Health Organization, and UNAIDS jointly estimated that 650,000 of China's people were living with HIV, including about 75,000 AIDS patients -- a reduction from the 2003 estimate of 840,000. Those who believed in the new figures said that they were more reliable than those from 2003 due to better data collection methods.
photo rests against a coffin

A local hero, Zhu Jinzhong cared for over 50 village children orphaned by AIDS following his own diagnosis. His photo leans against his coffin along with offerings of food.

The new study did show that at least the government was willing to talk about and study the problem, but critics worried that it was still a whitewash. One man who works closely with AIDS patients told the New York Times in 2006 that local officials, and individuals who have AIDS, continue to lie. "For me, it's hard to believe they are revising downward," he told the Times. "It's certainly not what I see as a frontline, grassroots AIDS worker."

Ho calls any figure generated from inside China and sanctioned by the government "a hand-waving estimate, more or less pulled out of the air." Experts outside of China, he added, agree that it's a million.

Prior to the tipping point in 2003, many experts predicted that as many as 10 to 20 million people would be infected by 2010. Ho says that with the potential influences of education and prevention programs, laws guaranteeing funding from the central government to local governments, and bans on blood selling, trajectory estimates indicate AIDS spread actually dropped last year, and he doubts the total figure will hit 10 million. "The good news is it's headed in the right direction," he said.

But there's still plenty of bad news. Healthcare infrastructure has been largely neglected in rural areas, and technology and medicine are far, far behind the west. Healthcare is almost nonexistent in rural China, home to 900 million people, Ho says. Even though discrimination has been officially outlawed by the central government, anti-discrimination policies are often ignored on the local level. Homosexuality is still stigmatized -- bachelors in China are almost unheard of -- and very few are openly gay, so there aren't communities through which risk and prevention can be openly discussed. Ho says that the rate is increasing in gay men in cities, and that commercial sex is a likely problem in cities among the heterosexual population.

According to Ho, the biggest obstacle to AIDS prevention in China is that the epidemics are largely rural. "There's a disconnect between the economic rise of urban China and the AIDS epidemic in south/central China, where the way of life has not changed in decades. There's no healthcare infrastructure. It's as bad as sub-Saharan Africa. You can divide China into rich and poor. In China, AIDS is almost all in poor China."

Meghan Laslocky is a writer, editor, and web producer. She previously worked for PBS FRONTLINE/World.


Sources:, BBC News, The New York Times, The Guardian (U.K.), interview with Dr. Gao Yaojie, interview with Dr. David Ho.

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