Coming AIDS Crisis in China
The New York Times,
July 16, 2001
Bates Gill, Director,
Center for Northeast Asian Policy Studies
Sarah Palmer, Virologist,
National Institutes of Health
United Nations summit on AIDS last month in New York, the
Chinese minister of health, Zhang Wenkang, made an astonishing
announcement: 600,000 people in China have AIDS or are
infected with H.I.V., the virus that causes it. The Chinese
government had never before admitted to large numbers of H.I.V.
cases. And what this estimate shows, given the conditions
fostering the spread of H.I.V. in China, is that a major
explosion of H.I.V. and AIDS will happen there.
government does not really know how many of its citizens have
H.I.V. Chinese journalists working in Henan estimate that
between 500,000 and 700,000 people in that single province are
carrying the virus. But even projections built on official
Chinese statistics, which are probably low, indicate that more
than 180,000 new cases will be added in 2002 alone. Even if
China reduces the rate of its annual growth in H.I.V. cases,
which it now reports as 30 percent, to 20 percent in five
years, its caseload under these projections would expand to
more than four million by 2010.
countries before it, China has been slow in facing up to AIDS.
Misconceptions, taboos and outright deceit have fostered
denial among both officials and the broader population. This
reluctance to be open and realistic is dangerous, as the
experience of other countries shows.
for example, deeply rooted cultural norms and taboos still
thwart frank assessments and effective preventive measures,
even though the United Nations estimates that if the disease
is not checked, a mind-boggling 37 million people in India
could be infected over the next 10 to 15 years. South Africa,
where AIDS was barely acknowledged for years and whose
president remains doubtful even now about its cause, today
holds the dismal distinction of having the world's largest
caseload of H.I.V. infection and AIDS, 4.5 million. And even
in industrialized nations, like the United States, lingering
social stigmas can still create substantial hurdles to
combating the spread of H.I.V.
But it is
possible to make headway against the disease. China should
look to its neighbor Thailand, where initial denial was
eventually overcome. Thailand has 800,000 cases of AIDS and
H.I.V. infection, but aggressive public health campaigns are
stemming the disease's spread.
one-party politics is a barrier to its facing up to AIDS.
After long labeling the disease as a Western problem, the
government will not easily switch to an attitude of openness
about this epidemic. Confronting it would require
acknowledging problems, like rural poverty, drug abuse,
prostitution and unsanitary blood collection, that defensive
local and national leaders would rather underplay or keep
government's shortsighted attitude has often revealed itself.
Because officials feared international attention, a prominent
gynecologist and H.I.V. activist, Gao Yaojie, was denied
permission to travel abroad this past spring to accept an
award for her work from the United States-based Global Health
Council. Politicians from Guangzhou Province proposed a
national law this year making it a crime to pass H.I.V. to
another person and establishing quarantine camps instead of
taking a health-care approach. In many parts of the country,
local officials obstruct access to villages with high
incidences of AIDS.
the will to fight AIDS realistically can be found, China won't
have an easy job doing it. Social and economic change has
caused new dislocations. People move around the country much
more freely than they once did, making more rapid spread of
the disease possible. Some 100 million itinerant laborers, the
floating population, as they are called, have no permanent
homes or jobs and lack any social safety net. And intravenous
drug use, prostitution, premarital sex, and histories of
multiple sex partners are all on the rise in China. Because
about two- thirds of Chinese H.I.V. carriers are poor and
poorly educated peasants and farmers, awareness of the disease
is severely limited. Indeed, the epidemic was first widely
spread in China when destitute farmers were lured by cash into
a medically unsanitary and unethical blood collection scheme.
more, medical researchers have found eight different strains
of the H.I.V.-1 virus in China, which would make treatment
complicated even if drugs were readily available. The most
widely available drugs on the market today are those that are
most effective against H.I.V.-1 strains found predominantly in
the United States and Western Europe.
health specialists from the United States Center for Disease
Control and Prevention will travel to China later this month
to help assess the H.I.V. problem. Secretary of State Colin
Powell is expected to discuss it with officials in Beijing on
his trip there at the end of this month. These are positive
signs that the two governments recognize the importance of
drawing attention to the issue.
China is to be saved from a grim future with many millions of
cases, Beijing must quickly develop effective prevention and
education strategies. And before that can happen, it must
accept the necessity of candor.
© Copyright 2001 The
New York Times