United Press International - September 3, 2003
Kathleen Hwang

U.N. figures put the number of people living with HIV/AIDS in China at between 800,000 and 1.5 million; the New York-based Human Rights Watch, based on its own research, suspects that the number is much higher. Both agree the figure could jump to 10 million by 2010 if current trends continue.

Through eight months of investigations in Beijing, Hong Kong and Yunnan province, Human Rights Watch found that people who were HIV-positive were often refused healthcare, were stigmatized and sometimes ousted from their work places and even their homes. Local government officials concealed or tolerated the situation rather than combating it, researchers found.

Chinese laws allow for mandatory HIV testing of certain categories of people, including foreigners. They permit quarantine for testing or treatment. And they provide no recourse for victims of discrimination.

Public health officials make little or no effort to combat widespread ignorance and fear of the disease.

"In many places hospitals lock their AIDS wards, for fear they would drive away paying customers," said Brad Adams, Asia Director of Human Rights Watch. "It's simply a business decision."

It was a business decision that led to the most insidious spread of the HIV virus through public health centers in the 1990s. Seeking to take advantage of a demand for blood plasma, local clinics encouraged rural residents to sell their blood. Health workers extracted the plasma, then combined the blood and reinjected it into the original donors, leaving up to a million of them infected with HIV.

The scandal came to light in Henan province in 1996, but this year, in its application to the Global Fund for support in combating AIDS, China revealed the program had affected six other central Chinese provinces as well.

HRW conducted much of its research in Yunnan province, which borders Myanmar, which is a major producer of heroin and opium. Injection drug users there have been testing positive for HIV since the early 1990s, and this area has become the epicenter of the epidemic.

Official Chinese statistics attribute 66.5 percent of HIV infections to needle-sharing among drug users, and U.N. reports estimate that up to 70 percent of drug users are HIV-positive in parts of China's Yunnan and Xinjiang provinces.

Yunnan police regularly round up drug users and confine them for up to 3 months in detoxification centers where they receive no counseling or healthcare and are subject to forced labor. Adams described these centers as "unsanitary, dark, smelly, with poor food and poor treatment from personnel."

It's not surprising that people who suspect they may be HIV-positive hesitate to come forward for testing. As their condition worsens, AIDS patients may wander from place to place to avoid exposure. Much of China's floating population, rural migrants who seek work in big cities, are HIV-positive, says Adams.

Poor sanitary conditions are common in hospitals and clinics, particularly in rural areas, where the careless handling of blood products and the reuse of unsterilized needles are legendary.

Government officials have attempted to muzzle the media where AIDS is concerned, much as they initially did when the crisis over severe acute respiratory syndrome came to light early this year, out of fear reports will have negative economic and social consequences.

"SARS caught the attention of the Chinese because it was affecting Hong Kong," said Adams. In that instance, he said, China demonstrated that it could take control of a crisis, but has not shown the same will with regard to AIDS.

"China has the ability to use state media to get this information to the people," he said. "But those who have the problem are largely driven underground."

Researchers have found that many Chinese believe AIDS can be caught by shaking hands or sharing dishes, or from mosquito bites. From time to time reports spread through major cities that desperate AIDS sufferers are wandering the streets and jabbing people with infected needles.

HRW acknowledged there are pockets of success in the war against AIDS in China. A law passed in Suzhou in 2002, for example, bans discrimination based on HIV status.

"It's a piece of model legislation for China," commented Adams. But he pointed out that it does not go so far as to provide treatment for those who contract HIV, or compensation for those who are infected through the public health care system.

China has applied to the Global Fund, an international public-private venture to fight AIDS and other endemic diseases, to provide antiretroviral drugs and treatment to 50,000 people with HIV/AIDS in seven central provinces.

This seems to indicate a more enlightened approach among healthcare officials, perhaps inspired by their experience with SARS. But those who live and work with AIDS hope for much more.

AIDS activists would like to see those responsible for the blood-collection scandal brought to justice, and steps taken to ensure that it doesn't recur. They hope that the firing of the Beijing mayor and the minister of Health for their mishandling of the SARS crisis this spring indicates a new level of accountability in the public-health sector.

In addition, the human rights group would like to see restrictions on freedom of speech and of association lifted, to allow people living with HIV/AIDS to articulate their plight and let NGOs offer them the physical and moral support they need.

As Adams put it, "What we'd like to say to the Chinese is, you have a huge public health problem. You've been treating it in a way that makes it a human rights problem."

He points to Hong Kong as an example of a model the Chinese could emulate. Social stigma is still a problem, but excellent healthcare, anti-discrimination laws, and the existence of supportive non-governmental organizations make life in Hong Kong much more bearable for people living with HIV/AIDS.

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