San Francisco Chronicle - Friday, June 28, 2002
Sabin Russell, Chronicle Medical Writer

Released by a unit of UNAIDS at a Beijing news conference, the ominous report blames China's inadequate governmental response to the epidemic for allowing the epidemic to creep toward an "epidemic of proportions beyond belief."

The new U.N. study suggests that, while the government has begun to take the epidemic seriously, it may already be too late. "Once HIV starts spreading into the general population, the Chinese HIV epidemic will become difficult to contain, expensive to deal with, and could lead to widespread social disturbance," the authors wrote.

By its own estimates, the Chinese government forecast in 1998 that the number of HIV infections could mushroom to 10 million by 2010 unless "countermeasures" were taken.

The extent of cases actually recorded in China to date is minuscule compared with its population of 1.3 billion. There have been only 1,594 AIDS cases recorded, and 684 deaths. In San Francisco alone, 18,000 have died since the disease was discovered 21 years ago.

But the U.N. report asserts that the real extent of the epidemic in China is hidden -- escaping detection because of limited testing and widespread ignorance about the disease. It estimates that there are currently 800,000 to 1.5 million HIV infections in China, and those numbers are ready to explode.

"A potential HIV-AIDS disaster of unimaginable proportions now lies in wait to rattle the country," wrote the U.N. authors, who described the disease as "China's Titanic Peril."

U.N. officials are already concerned that a breakout into the general populace has occurred in India, where an estimated 4 million are infected in a nation of 1 billion.

"It is fair to say that the direction China and India go will determine the direction where all of Asia goes," said Dr. Desmond Johns, director of the UNAIDS New York office.

According to the report, the danger to China lies in a series of sentinel sites. The data show that AIDS has been traveling into China along the routes of the heroin trade from the "Golden Triangle" regions of Southeast Asia.

Infection rates in Yunnan province have topped 80 percent among drug users, while rates of needle sharing are as high as 95 percent in Jiangxi province.

Meanwhile, China is coping with the impact of illegal sales of blood plasma in rural regions, where blood components are recycled back to donors using contaminated machines. Thousands are believed to have been infected this way.

Despite recent steps by the Chinese government to recognize the gravity of the problem, the U.N. says policies have been counterproductive.

"Some concerned people who dare to speak out about the pending disaster are ignored or challenged, and sometimes even opposed by local authorities," the researchers said.

The report calls for greater investment in HIV prevention, more openness and "political commitment" and more "courageous leadership."

Dr. Jay Levy, a UC San Francisco virologist who has studied AIDS in China, said, "There is no question that HIV has been spreading in China without the appropriate recognition of the government."

However, he said, there are signs that the epidemic has caught the attention of the top leadership. "They are much more open now for testing and attempting to reduce transmission," Levy said.

Dr. Helene Gayle, director of HIV programs at the Bill and Melinda Gates Foundation, said China had shown in the past that it could move rapidly to battle disease.

E-mail Sabin Russell at srussell@sfchronicle.com.

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