Wall Street Journal - August 4, 2003
Leslie Chang, Staff Reporter of The Wall Street Journal

China last week declared its last 12 SARS patients free of the virus, marking the final chapter in a months-long campaign to contain the disease. Now, some activists and health officials are seeing signs that the government is turning its focus to AIDS. The government estimates that HIV, the virus that causes AIDS, could infect as many as 10 million Chinese by 2010.

Activists cite a growing recognition among Chinese officials that the same factors that initially fueled the spread of SARS -- official denial, the lack of access to affordable health care and a strong social stigma -- characterize China's AIDS situation as well.

"I'm quite optimistic there could be a positive snowball effect from SARS," says Luc Van Leemput, head of mission for the Belgian section of humanitarian group Medecins Sans Frontieres, or Doctors Without Borders, which launched a clinic in May to treat AIDS patients in a prefecture in the central province of Hubei.

Public health in China is getting more attention than ever before, as officials acknowledge that the decrepit state of the health-care system helped SARS to spread. The health sector now has a high-level advocate in Wu Yi, a respected vice premier who was named acting health minister at the height of the SARS outbreak.

Ms. Wu has described AIDS as a "long-term war" that will be her next focus after SARS and has asked for an extensive briefing on the disease in China, according to an official familiar with the conversations. The health ministry also has requested a doubling of the annual AIDS budget from the current $12.5 million.

China's HIV patients, estimated to number more than one million, could use the help. Despite official recognition in recent years of the seriousness of AIDS, the country lacks a comprehensive national program to treat and prevent the disease, which has hit hardest in rural areas. Instead, China is dotted with small-scale pilot projects, many run by foreign government or nongovernmental organizations working on a local level.

"All over China we've seen little good projects, but little good projects don't stop an epidemic. What you need to do is take these projects to scale, and that takes top-level leadership," says Billy Stewart, who heads a British government-funded project to run AIDS programs in two Chinese provinces.

In addition, China lacks a corps of doctors, especially in rural areas, who know how to treat AIDS and its accompanying infections. And local governments have sometimes resorted to harsh measures. About a dozen villagers in Shangcai county, a farming area hard-hit by AIDS in central Henan province, were arrested in June. Officials say the villagers were detained for destroying public property at a protest. But villagers say that the local government retaliated for the protest by hiring hundreds of armed police to ransack their homes and beat residents. During the mid-1990s, Henan was the epicenter of blood-buying operations, in which unsanitary methods of blood collection spread the disease.

To some extent, China is already moving ahead on AIDS. The government supplies some 4,000 patients with domestically made components of the AIDS cocktail of drugs free, as part of a pilot project that aims to bring AIDS treatment and prevention programs to about 50 counties in seven central Chinese provinces this year.

It has started running AIDS training for more than 100 doctors at the provincial and county level. It has applied to the Global Fund to Fight AIDS, Tuberculosis and Malaria for a $98 million grant to help fund these programs, with the goal to eventually replicate it nationwide. The fund's decision is expected by October. The Chinese government also appears to be giving more attention to international cooperation on AIDS.

China's window of opportunity to fight AIDS, post-SARS, may be limited.

Some activists fear that Ms. Wu's health-ministry position is only temporary, giving urgency to her efforts to push the AIDS fight now. They also worry that local officials may have learned the wrong lesson from SARS: that enforced quarantines, travel bans and other forceful measures credited with helping stop the virus's spread are the best way to combat all disease.

Write to Leslie Chang at leslie.chang@wsj.com
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