Chicago Tribune - October 3, 2002
Michael A. Lev, Tribune foreign correspondent

The challenge for the Chicagoans, as they quickly learned during a recent visit, would be to get the Chinese to overcome their political and cultural squeamishness about how the AIDS virus is spread.

For much of the meeting, it did not look good, particularly regarding homosexual transmission of HIV. No one on the Chinese side wanted to tackle the issue. One government official insisted during a tea break that Hangzhou, a vibrant industrial hub of 1.7 million people, could not possibly have more than 20 gay men.

Yet Keith Waterbrook, a medical administrator and leader of the delegation from Chicago's Howard Brown Health Center, stayed upbeat. By the end of the day the Chinese made an important decision to visit Chicago where they will see Howard Brown workers reach out to some of those most at risk--the type of people who, in China, live in the shadows.

"We'll bring three or four prevention people from here to Chicago, and they are going to be in the streets," Waterbrook explained. "They are going to be working with prostitutes and bathhouses. They are going to be getting the whole thing."

The new emphasis comes at a crucial time for the nation. HIV and AIDS are close to exploding in five of the world's most populous countries, including China, and could produce 50 million to 75 million cases by the end of the decade in those countries, according to a National Intelligence Council report released this week.

AIDS prevention efforts have been slow in China, where a conservative culture and Marxist ideology have prevented the government from thinking progressively about social problems. The government prefers to keep bad news buried and is uncomfortable giving private organizations the power to operate. Sensitive subjects associated with the transmission of AIDS--including homosexual activity, prostitution and intravenous drug use--are taboo.

Signs of change

In August, for example, one of the few Chinese activists on AIDS and homosexuality, Wan Yanhai, disappeared into the hands of state security in Beijing for several weeks after he disseminated over the Internet a government report on tainted blood banks. If not for a vocal international campaign, Wan most likely would have faced a prison sentence instead of being granted an apparently unconditional release.

People who follow health issues say that Hangzhou's initiative with Howard Brown is part of an emerging trend in China to set aside political and social sensitivities to fight AIDS.

"Things that you thought were impossible a year or so ago are beginning to happen, like seeing nightclubs distribute condoms," said a Western diplomat who follows the issue.

After stalling for years, China has become more open during the past year and estimates that 1 million Chinese are HIV-positive or have AIDS. If no prevention work is done, China predicts, that number will skyrocket to 10 million by 2010.

The avenues of infection in China include homosexual activity, IV drug use and the spread of tainted blood by underground businesses that buy plasma in rural areas.

The daylong meeting in Hangzhou with officials from the Zhejiang Provincial Health Bureau offered a rare opportunity to look into the workings of the government. It showed that some people in the Chinese public-health sector are committed to confronting AIDS and are slowly setting aside old stigmas.

Though the Chinese side preferred not to make a big deal of it, the most remarkable and encouraging aspect of their relationship with Chicagoans is that Howard Brown is a gay- and lesbian-focused health organization, a concept unheard of in communist China.

Personal ties build trust

The progress in Hangzhou would have been unlikely if it were not for the close relationship between one of the Chicagoans and one of the Chinese.

Over a decade, and through a variety of jobs that involved medical exchange work with China, Waterbrook--who grew up in suburban Chicago and is executive director of Howard Brown--developed a working rapport with Zhejiang health officials, specifically with an English- and French-speaking one named Shen Rongde.

The two men, both 56, became friends. When Waterbrook, who was married, understood in his 40s that he was gay, the first person he told was Shen.

"I sent a fax to him," Waterbrook recalled, "and he immediately wrote back to me and said that I have a right to do whatever makes me happy. He said I should not feel bad and that he will always be my friend."

Still, Waterbrook said, it took years of friendly badgering to get Shen's commitment to work on AIDS. A decade ago, when he first broached the subject, Waterbrook recalled that Shen replied that China did not have an AIDS problem because it did not have any gay people.

Shen remains cautious on the subject of how the government can address some of these sensitive issues. Waterbrook wants one of the health employees who will visit Chicago to be gay, but Shen said there was no way to recognize who is homosexual and it would be unimaginable for someone to step forward.

"Well, ask someone to go who you think is gay," Waterbrook suggested over lunch with Shen.

"That would be very, very hard," Shen said.

"OK then, rephrase it," Waterbrook said. "Ask who would feel comfortable going into that kind of environment, to bathhouses or bars."

Those sorts of issues--separating the work of the health bureau from social taboos or legal questions--flummoxed the Chinese all through their meetings with the Howard Brown people.

The Chinese were fascinated, but also appalled, that Howard Brown workers knew there were approximately 30,000 prostitutes in Chicago and that they could develop relationships with people committing illegal acts.

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