International Federation of Red Cross and Red Crescent Societies - 1 December 2004
John Sparrow in Kunming

As Liu Enyun passes them, though, they remind him of official estimates that there are 80,000 people living with HIV/AIDS in Yunnan, of whom 60 per cent are injecting drug users infected by shared needles.

Liu, an officer with the Yunnan Red Cross HIV/AIDS Prevention and Care Project, is working on plans to extend operations to the station, to establish a needle exchange point, distribute condoms and conduct information campaigns targeting the neighbourhood and travellers.

It is not surprising that the Red Cross would chose to work the station, a magnet for commercial sex workers. The numbers of people it could reach is enormous. But it is also one more location through which it could reach a hidden group, people driven underground by the stigma and discrimination around HIV/AIDS.

According to state statistics there are 840,000 HIV-positive people in China but those are only the ones the state knows about. When the Joint United Nations Programme on HIV/AIDS (UNAIDS) announced last week that new infections in East Asia had climbed by nearly 50 per cent since 2002, many humanitarians were left wondering how many more people were living with the virus in China.

In truth nobody knows the real figure. It could be a million, or two, or three, or more. UNAIDS has said that there could be ten million by 2010 unless much greater action is taken. It gives a clearer indication of the dimension of the crisis China is facing.

Of one thing there can be no doubt, says the International Federation. There are millions of people hiding in the shadows of Chinese society, afraid of being tested for HIV, afraid of seeking help and advice because of the inhuman and ill-founded prejudice the virus induces.

They are as afraid of the stigma attached to the disease as they are of the disease itself, afraid of being singled out, ostracized, accused of being bad people whose errant lifestyles have made them a danger to others.

Someone known or suspected to be infected may well find it difficult to get a job, find a home, or keep the ones they have. They may lose their friends, their customers, even the support of their families. They are as a consequence forced into the shadows.

The epidemic of HIV/AIDS now sweeping China is accompanied by an epidemic of isolation and rejection that increases hugely the danger of catastrophe in this country.

For injecting drug users and commercial sex workers - groups among whom the HIV virus is firmly present in China - the stigma is double, the shadows deeper. The same goes for men who have sex with men.

"People who are gay and HIV positive in China soon disappear," says a Kunming activist, "and you will never find them. Being gay brings problems enough but being positive as well à there's no way most people can handle that."

The Yunnan Red Cross has been responding to HIV/AIDS for more than a decade, supported by the Australian Red Cross and AusAID, GlaxoSmithKline, the Hong Kong Red Cross, the Salvation Army, UNICEF and UNAIDS.

As elsewhere in the country, fighting prejudice remains high on the Red Cross agenda because, argues Audrey Swift, the International Federation's HIV/AIDS coordinator for East Asia, unless stigma and discrimination are removed it will be extremely difficult - if not impossible - for China to control the epidemic effectively.

Nowhere in Yunnan is that more evident than among drug users for whom Chinese society has zero tolerance. The province is close to the Golden Triangle, one of the world's foremost heroin producers, and Yunnan is well supplied.

China's first reported case of HIV among drug users came from Yunnan in 1989 and injecting drugs became the main cause of the spread of the virus. Along with prevention and care, the Red Cross has nurtured a greater involvement of people living with HIV/AIDS, advocacy to fight stigma and discrimination, and harm reduction efforts targeting drug users in particular.

In Yunnan - as in Xinjiang, the far western Chinese province - it is developing peer education by and for HIV-positive people, the first organization in China to support them as educators and as people who have something to give to their communities. It trains them to educate their neighbours, friends and family about HIV/AIDS and to care for those who are infected.

Scaling up education is critical in China. One survey has shown that less than nine per cent of the population is well informed about AIDS, how the virus is transmitted and how it isn't. The disease spreads accordingly but fear born of ignorance leads to stigma.

Besides dispelling the shadows around HIV/AIDS, the Red Cross believes it is vital to reach into them. Drop-in centres and hotlines all help it to make contact, and Yunnan has Sunshine Homeland for recovering drug users as well.

Run by, for and with positive people and those at risk, on two floors of a Kunming apartment block, it is what Liu Enyun describes as a breathing space, somewhere to find support, connect with peers, acquire information about HIV/AIDS, pick up job skills, regain self-respect and confidence, and in turn, the respect of the community.

When Danqing (not her real name) and her husband arrived in Sunshine Homeland three years ago they had just come off heroin after more than a decade of dependence. "We have been clean ever since," she says. "If we can go another two years I am sure we'll be clean for good. We have to, for ourselves and for our son."

The boy is 18 and they are struggling to find money to continue his education. Finding a job is tough, she says. "I went to the labour office but no one believes a drug user can stop. They said, 'It's hard enough these days for normal people to get a job, so how can we find you one?'"

Such marginalisation only sustains the social shadows and Danqing wonders how far she would get without the support of Sunshine Homeland. "No one discriminates here. Everyone is equal. You can talk about your feelings. If I could have come here several years ago I could have finished with drugs much earlier. Some people who died could still be alive as well."

Like others who arrive in Sunshine Homeland, Danqing and her husband came first for a peer education course and, willing to learn more, went on to be trained as volunteers and work in the centre daily. Besides teaching people about HIV/AIDS, it provides home-based care to HIV-positive people and job re-entry training in such things as electronics, computers and hairdressing.

Director Sun Jian sees it as a stepping stone back to society. "This place is drug-free so it helps them stay clean," he says, "and we provide the support they need to feel society hasn't given up on them. They learn to see their own value again."

Sun Jian points to some successes in the fight against stigma but concedes much remains to be done. An HIV-positive Red Cross officer whose request for anonymity reflects his own fears, confirms, "Eighty per cent of positive people are afraid." Many, he says, go without treatment rather than risk being revealed.

The officer believes Sunshine Homeland has made particular progress through home-based care training for the families of positive people. Removing their fears is crucial, he says. "If your family discriminates you are lost. My family knows and supports me but I would not tell my friends. If they knew they would shun me."

China's leaders are making enormous efforts to mobilize the nation in the fight against AIDS, and have moved against stigma, introducing legislation this year banning discrimination against people living with infectious diseases.

A new health standard for recruitment is being considered whereby HIV-positive people could become civil servants. A draft standard from the Ministry of Personnel and Ministry of Health would remove them from the list of people disqualified from public service.

On World AIDS Day, the International Federation called for the law to be enforced firmly throughout the country and for the enlightened recruitment standard to be ratified. "What greater example could there be in the critical fight against stigma?" said Alistair Henley, head of the Federation's East Asia delegation.

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