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Current Overview of HIV/AIDS in China

http://www.casy.org/overview.htm

The Chinese government currently estimates up to one million Chinese citizens may be infected with the AIDS virus.  However, experts agree that these figures do not accurately reflect the actual number because China lacks the resources to carry out extensive surveillance in the countryside. Additionally, current surveillance protocols primarily cover only specific high risk groups. Because of these limitations, it is estimated that only five percent of HIV cases in China are reported. UN and World Heath experts believe the real figure lies between 1.5 and two million, and the United Nations Program on AIDS (UNAIDS) projects China could have between 10 and 15 million HIV cases by the year 2010. Although this number represents only a small percentage of China’s vast 1.2 billion population, the sheer numbers of people at risk is staggering.

Statistics
 

While addressing the HIV/AIDS High-level Meeting of the UN General Assembly on 22 September 2003, Gao Qiang, Executive Vice Minister of Health, reported China has 840,000 people now living with HIV, some 80,000 people with AIDS symptoms. In 2002 alone, the number of HIV cases rose 140 percent. Since China’s first reported AIDS case in 1985, 150,000 people have died of AIDS.  This dramatic increase from previous government reports is the result of a new surveillance system carried out jointly by Ministry of Health (MOH), UNAIDS and the World Health Organization (WHO).  Prior to this announcement, the Ministry of Health officials had officially documented 40,560 HIV cases, of which 2,639 developed AIDS cases and 1,410 have died.  

The 15 - 29 age group makes up 60 percent of the total HIV population, while the 30 - 39 age group is the second largest group. HIV victims under 19 years old account for 9.5 percent.  The ratio of infected men to women has fallen from nine to one in the early 1990s to three to one in 2001.  HIV/AIDS cases are located in all 31 provinces, autonomous regions and municipalities with over 70 percent in the countryside.  Some 36 percent of all HIV cases are among China's ethnic minorities, which make up only eight percent of the population and are primarily concentrated in the border provinces of Yunnan province (southwest), Guangxi Zhuang Autonomous Region (southwest) and Xinjiang Uyghur Autonomous Region (west).

Modes of Transmission
 

Intravenous drugs users
China's AIDS epidemic is still fairly localized among three major sub-groups. Intravenous drugs users (IDU) who share needles account for 61.6 percent of HIV cases, and are primarily located in Yunnan province, Guangxi Zhuang Autonomous Region and Xinjiang Uyghur Autonomous Region. In these three regions, up to 80 percent of IDUs are HIV positive. At the end of 2002, the National Narcotic Control Commission (NNCC) reported China has one million registered drug users, up 11 percent from 2001; nearly half use intravenous drugs and 25 percent share needles. Some 2,148 of China's 2,863 counties have reported drug abuse problems.

Blood donors
Commercial blood donors infected through unsafe blood donation practices during the 1990s account for 9.4 percent of HIV infections. Originally thought to be contained to rural residents of China's east-central provinces, the problem is now known to be more widespread. On 26 December 2002, former Health Minister Zhang Wenkang acknowledged 23 provinces, autonomous regions and municipalities were affected with unhygienic blood collection.  The actual number of people infected with HIV through tainted blood transfusions is unknown, but experts estimated there could be over one million victims in Henan province alone.  A recent survey showed the prevalence rate among commercial blood donors in rural eastern China was 12.5 percent and 2.1 percent among their non-donor spouses. And, in January 2002, the Henan Health Department reported that 80 percent of Houyang village residents were HIV positive. Of its 4,000 residents between the ages of 16 and 55, some 90 percent have participated in illegal blood donations. More than 400 villagers have developed AIDS, and 150 have died between November 2000 and November 2001.  In Wenlou village of Shangcai county, Henan province over 60 percent of the population is HIV positive.

Heterosexual unprotected sex
Heterosexual unsafe sex accounts for 8.4 percent of China's HIV infections. The majority of heterosexual transmission is between sex workers and their clients. During the mid to late 1980s, China's commercial sex industry reappeared in coastal cities and quickly extended inland. It is estimated China currently has more than 3 million sex workers. Mirroring the increase in prostitution, sexually transmitted disease (STD) rates in China have increased "100 fold" since 1986 when China publicly confirmed its first cases of STDs in 22 years. In 1988 alone, China reported 56,090 STD cases, and by December 1989 the total number of reported annual STD cases reached 204,077. In 2002 alone, more than 740,000 cases of STDs were reported. Dai Zhicheng, Deputy Director of the Chinese Association of STD and AIDS Prevention and Control, acknowledged curing STD is vital to controlling AIDS in China. "STD patients are most likely to acquire or transmit HIV, with the risk increased three to five times as high as those of other people," said Dai.  In 2000, the HIV prevalence rate among sex workers in Yunnan, Guangxi and Guangdong was as high as 11 percent. In Shanghai, 65 percent of HIV infections are through heterosexual transmission.

Male-to-male unprotected sex
While not considered as having reached epidemic rates of infection, HIV transmission through male-to-male unprotected sex is on the rise.  Unprotected homosexual sex is estimated to account for 0.2 percent of HIV infections in China.  Although there is no comprehensive surveillance data on HIV transmission through male-to-male sex, both of Beijing's AIDS designated hospitals report about one third of their patients contracted HIV through male-to-male sex. Furthermore, a recent survey of gay groups conducted by the Chinese Association of STD/AIDS Prevention and Control in China's northern cities of Harbin, Shenyang and Dalian showed one to three percent of respondents tested positive for HIV.  In November 1989, China reported its first indigenous HIV infection.  It was reported the man contracted HIV through homosexual sex.

Mother-to-infant
The HIV infection rate through mother-to-infant transmission is 0.3 percent. However, health officials believe this rate will increase as the number of women becoming infected increases. In 1995, the first confirmed case of mother-to-infant transmission was reported in Yunnan province, and by 2002, 102 HIV-1 positive women gave birth to 112 newborns (53 male, 52 female and 7 unknown) of which 34 infants were HIV positive and 54 were negative, two were suspected of having HIV and 22 were untested.  Yunnan, Xinjiang, Henan and Guangdong have the highest numbers of mother-to-infant transmissions. The true extent of HIV cases caused by mother-to-infant transmission may be far worse. To date only a few mother-to-infant prevalence surveys have been conducted in high-infection rate areas, and local health agencies have limited diagnostic equipment to test newborns. Therefore, the actual number of children being infected through mother-to-infant transmission is unknown.

[China HIV/AIDS Chronology]
[China HIV/AIDS Blood Supply Chronology]

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