On any given night, in 14 cities around the country, hundreds of people flock to makeshift blood collection centers in bars, bathhouses and apartments where workers test for syphilis and H.I.V., the virus that causes AIDS. The ambitious testing initiative, started in 2007, is financed by the Bill & Melinda Gates Foundation, which will spend $50 million over five years in an effort to slow the spread of AIDS in China. So far, more than 110,000 people have been tested.

But the Gates H.I.V. prevention program in China is unusual because it offers a financial incentive to those drawing the blood — about $9 per sample and an additional $44 for those that come back positive — which is shared with donors. The program has provoked a flurry of criticism from some established AIDS organizations that say the money has given rise to a network of fly-by-night groups whose only interest is collecting money.

Here in Tianjin, a northern city of 11 million people, two dozen organizations have sprung up in the past year, many of them run by bar owners or bureaucrats affiliated with the government. Some of the groups do not provide counseling to those giving blood and make little effort to help those who test positive get medical treatment.

“Gates has created a huge blood-buying operation that only cares about money, not about people,” said Ma Tiecheng, who runs a seven-year-old AIDS organization in the northwest city of Shenyang. “I’ve seen people getting four H.I.V. tests a day.”

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The bar in Dali, a tourist town in the southwestern province of Yunnan, aimed to provide a place where homosexuals could meet in a relaxed atmosphere and get information about HIV/AIDS prevention, he told AFP by phone.

China’s health ministry warned on Tuesday that homosexual transmission of HIV/AIDS was gaining pace. Zhang, a doctor at a hospital in Dali, said raising awareness of the disease among the gay community was “extremely important.”

The bar was due to open on December 1 — World AIDS Day — with the support of the local government, which had invested 120,000 yuan (17,600 dollars) in the NGO, he said.

“Our government leader asked me whether we could open it today, but I said the volunteers did not want to,” Zhang said, pointing out that journalists and photographers had descended en masse on Dali following news of the bar’s opening.

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At 9 AM on the morning of November 11th, 2009, I was at a hospital with two female patients who also contracted HIV from blood transfusions presenting a petition asking for justice. At 11, I was called away by someone from the local health department, and a government official came and took me away. The two women (Zhao and Cao) were taken away by the police. I was taken to a Beijing guesthouse.

On the 22nd, I was taken back to my home from Beijing by someone from the local government, ostensibly for the purposes of negotiating a settlement.

From the 23rd to the 26th, I met with people from the bureau of health, the county head for the health bureau, an associate dean from the hospital where I was infected, but we still weren’t able to reach an agreement about treatment and compensation.

On the 26th, on a pedicab on my way to the station to return to Beijing, I was suddenly joined by two strangers, who took me to a red Changhe car with the license plate “豫QDA518″ [豫 indicates it is a Henan plate], saying we’d first go to the Madian City Train Station and then go to Beijing together.

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The report, I Will Fight to My Last Breath: Barriers to Aids Treatment for Children in China, describes how HIV-infected children face challenges getting the help that they are entitled to, including gaps in the government treatment programme, poverty, the refusal or inability of some hospitals to offer treatment, and local government inertia and even interference.

The report says there is a lack of doctors trained to deal with HIV/Aids. In Henan and Yunnan, two provinces hit hard by the disease, many rural doctors cannot even recognise the symptoms and some turn away patients out of unfounded fears of contagion.

And despite government mandates that hospitals provide care, funding is often insufficient, which means there is a disincentive to identify or treat patients.

Many children die without even knowing that they had what rural people call “the no name fever”, either because the doctors never diagnosed the disease or else tried to cover it up.

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Beijing’s decision in 2001 had helped to minimise the spread of HIV/AIDS in China, Zhen Li, from the Tong Zhi awareness group, told the forum.

“Between 2005 and 2008 China made huge progress (in raising awareness of HIV/AIDS among homosexuals) in addition to working with civil society as partners,” Li said.

However, elsewhere in Asia “highly prohibitive legal frameworks” against homosexuality were aiding the spread of an HIV epidemic among homosexual men, the forum’s organisers said in a statement.

On Tuesday, the WHO urged for increased AIDS prevention strategies for gay men in Asia:

A December 2007 review found that in Cambodia and Vietnam, homosexual men were more likely to contract HIV compared with the general population, while in China the risk for homosexual men was 45 times higher than for men in general.

According to the WHO, Asia has the world’s largest number of “men having sex with men,” estimated at 10 million.

See also past CDT posts on AIDS in China.

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A report by the country’s state media said HIV/Aids had led to the deaths of almost 7,000 people in the first nine months of 2008.

The number of deaths caused by tuberculosis and rabies fell back into second and third place.

The numbers are increasing dramatically – China’s Ministry of Health say that until three years ago, fewer than 8,000 people altogether had died from HIV/Aids.

By last year, the total had risen to five times that many.

Many have criticized the government for its responses to the crisis in the past. From The Independent:

The Health Ministry confirmed 264,302 accumulated cases of HIV/Aids by the end of September last year. Of those cases, 34,864 had died in those nine months. In China, the disease is mainly transmitted sexually, but the virus initially spread because of unsanitary blood plasma-buying schemes and tainted transfusions in hospitals. The first reported case of Aids in China was in 1982. Three years later, the government announced the first death from the disease. Yet concerns persist that local officials are under-reporting the figures. The United Nations’ health and Aids bodies, for example, estimate that, by the end of 2007, 700,000 people in China were HIV positive. Local officials are thought still to be fearful of recriminations if their localities buck national trends. In the old days, sexually transmitted diseases were officially eradicated – the Communist Party’s grip on personal behaviour, as well as the gathering of statistics, was absolute.

But it took many years to start to undo the long era of suspicion. In 2003, Premier Wen Jiabao became China’s first senior leader to shake hands publicly with an Aids patient; not long after, President Hu Jintao was photographed embracing Aids patients.

News of the urgency of the AIDS epidemic comes shortly after news of the start of a national sex education campaign in China. From Reuters:

China on Sunday launched a national sex education campaign aimed at breaking traditional taboos and getting more people to seek treatment for sexually transmitted diseases and infertility.

Just seven percent of women and slightly more than eight percent of men seek immediate medical help for sexual problems, while more a third of people never seek help, said one of the campaign’s advisors.

“These numbers are shocking,” Xia Enlan, head of the obstetrics and gynaecology department of the Capital University of Sciences’ Fuxing Hospital, told a news conference.

Current.tv offers a human perspective on local officials’ handling of the AIDS epidemic. A description of the video, from their website:

In the early 1990s, villagers around central China were organized by local governments to sell their blood. But some of these village blood selling businesses were unhygenic and many villagers contracted HIV/AIDS. Angela Sun braves the wrath of local officials to visit a village in Hebei Province where 20% of the residents contracted HIV/AIDS.

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The student with shaggy hair hanging low over his eyes, his head pulled turtle-like into a leather jacket, was plainly embarrassed by his ignorance.

Not until three months ago, when he got back the results of his blood test, had the 22-year-old art student at a Beijing university heard of the term HIV. None of his friends knew how to use condoms or had any idea why they should.

“By the time they realized, it was too late,” said the student, who asked not to be named.

Belatedly, China is trying to get out the word about the AIDS virus and officials are doing it in the typically oversize way that befits the world’s most populous nation, deploying an army of volunteers.

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Organizers [of the ceremony at the Bird's Nest] said the fear of being stigmatized at work or in their communities is discouraging many people at risk of HIV infection from being tested. HIV is the virus that causes AIDS.

After years of denying that AIDS was a problem, Chinese leaders have shifted gears in recent years, confronting the disease more openly and promising anonymous testing, free treatment for the poor and a ban on discrimination against people with the virus.

State television Sunday showed Chinese Premier Wen Jiabao visiting a village hit particularly hard by AIDS in eastern China’s Anhui province. Wen, who makes such annual visits to mark World AIDS Day, observed Monday, held hands with children orphaned by AIDS and spoke to patients in beds.

The Chinese government’s high-profile gesture of acceptance apparently still does not extend to activists campaigning for people with HIV and AIDS.  Another AP article reports that a Chinese AIDS activist was detained by police and sent out of Beijing after participating in World AIDS Day:

Li Xige, who is HIV positive, said she had managed to escape house arrest in her rural town, but that local police tracked her to Beijing.

Li, who campaigns for compensation for victims of infected blood transfusions, said she was taken from her hotel by police early Tuesday, two days after participating in an official event at the Olympic Bird’s Nest stadium for World AIDS Day.

“Four (local) police and one township official took me on the train and accompanied me home,” Li said in a telephone interview. She said she is allowed to leave her house, although is trailed by police, and must avoid traveling to places like Beijing.

Beijing Calling weighs in with a blog post about the Chinese government’s persistent failure to educate the Chinese public about AIDS and HIV:

A survey this year of residents in six Chinese cities found more than 48 percent thought they could become infected from mosquito bites, and 18 percent believed they could catch it by being sneezed or coughed on by someone living with HIV.

In addition, nearly 32 percent thought the people who have HIV/AIDS deserved it because of their drug use or sexual behaviour; almost 48 percent would not eat with someone with HIV; and 30 percent felt children with HIV should not attend the same schools as uninfected children.

While these statistics about people’s attitudes towards HIV/AIDS are frightening, the government is doing little to dispel rumours or correct misconceptions. While Chinese state media wrote about the survey, they didn’t explain medically or scientifically there was nothing wrong with touching a person infected with HIV, or explain the almost impossible chances of getting infected from a mosquito bite.

Nor do the articles or any government information say anything about how people should practice safe sex or that say, using condoms are the best way to not only prevent HIV/AIDS but also other sexually-transmitted diseases as well as unwanted pregnancies.

The government always seems to skip a step each time when they claim they are informing their citizens. The same goes for environmental protection. They tell people to care more about the environment, but then don’t explain that this entails not littering, separating your garbage, and using less packaging and plastic bags.

Read more about AIDS in China under CDT’s AIDS tag.

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“Other at-risk groups are rather small, but this one is huge,” said Sun Xinhua, head of an office to combat AIDS that reports directly to the State Council, China’s cabinet.

China’s construction workers, miners and casual labourers have all the ingredients for HIV to spread. Often far from home, bored, and with some spare cash in their pockets, few of them use condoms when they visit prostitutes as rootless as themselves.

“You must stay away from these women and keep yourself out of trouble, especially when you are working away from home,” said Liu Guilin, 38, at a dusty construction site in eastern Beijing.

Meanwhile, it’s also been reported that a Belgian film crew reporting on the spread of AIDS in the country were beaten by thugs allegedly hired by local officials. From Reuters:

After interviewing several representatives of AIDS groups on Thursday, Belgian journalist Tom Van de Weghe and his production team from Flemish public television VRT were beaten and robbed of cash and equipment by 12 men recruited by authorities in Henan province, a VRT spokesperson said.

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AIDS, which has long thrived quietly on the fringes of Chinese society among drug addicts and recipients of tainted blood donations, is on the verge of going mainstream here.

One major cause is prostitution, a booming industry in China that has helped make sex the most common form of AIDS transmission in China.

China’s hopes of stopping the disease from turning into the country’s next health crisis may rest with the efforts of people like Guan Baoying, a 56-year-old activist who has defied standard government attitudes about high-risk groups such as prostitutes.

As a Beijing health bureaucrat until last year, Ms. Guan managed to convince the government to support regulations that require hotels to supply condoms to their guests — with the result that even in five-star hotels, condoms are a standard part of the minibar. Today, she leads the charge as the head of a nongovernment organization that helps fund outreach work with backing from the Bill & Melinda Gates Foundation.

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Chinese AIDS victims are dying needlessly because a “tragic stigma” prevents them seeking help in a country where one fifth of people think the disease can be passed on by sharing a toilet, a top activist said on Thursday.

The government has promised to hand out free, Chinese-made drugs to anyone infected with the disease and the country’s leaders have met those living with HIV/AIDS but there is still widespread ignorance about how it is spread.

Two thirds of the 6,000 people questioned for a recent survey of six cities said they would be unwilling to live with an infected person, and a fifth said they would be unwilling to care even for a relative with the illness.

Nearly 10 percent even thought working in a room with an infected person would be enough to pass on HIV, according to the report commissioned by UNAIDS and partners.

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HIV infections jumped 8-fold over the past few years in parts of China among gay and bisexual men, according to new data from southern China.

Published in Nature, the study found that the proportion of HIV-positive women of child-bearing age doubled in the past 10 years and researchers warned the disease was moving from high-risk communities into the wider population.

There were an estimated 700,000 HIV/AIDS cases in China as of October 2007, up 8 percent compared to 2006, it said. Some 38 percent of cases were attributed to heterosexual contact, more than triple the 11 percent in 2005.

Further on:

“HIV/AIDS is spreading beyond the high risk populations, largely due to increased transmission through sexual contact. It implies that HIV/AIDS is not only a disease that affects high risk population, but the general population alike,” professor Zhang Linqi, director of the AIDS Research Center in Beijing, wrote in an email reply to questions from Reuters.

On the other hand, concerted governmental efforts to provide free antiretroviral “cocktails” to blood donor HIV/AIDS victims in the 1990s have proved effective, according to another report in Nature.  The study of treated victims found that:

[...]the mortality rate has decreased from 27.3 deaths per 100 patients per year in 2001 to 4.6 deaths per 100 patients per year in 2006. Also, the percentage of patients receiving ‘cocktail’ drugs has increased from 5% per year in 2002 to 70.5% in 2006. Importantly, patients not receiving ‘cocktail’ drugs have the greatest mortality rate.

A recent survey indicated that HIV/AIDS awareness is still quite low.

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The AIDS virus is infecting more women, heterosexual couples and gay men in China as the epidemic spreads from intravenous drug users to the general population, a study has found.

Infections transmitted by heterosexual contact rose to 38 percent of all cases in 2006, according to a study in Yunnan province. The proportion of cases in intravenous drug abusers in Yunnan declined to 40 percent that year after accounting for 100 percent of all infections in 1989. Nationally, infections have risen in women and shot up eightfold among men who have sex with other men.

The study, to be published tomorrow in the journal Nature, reported data from Yunnan, a major site of the AIDS epidemic in southwestern China. Chinese researchers who collaborated on the study cited a “dramatic increase in sexual transmission” that overcame prevention programs.

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Knowledge and awareness of AIDS and HIV transmission in China is still low, even in big cities like Shanghai, according to a survey released Friday.

More than 6,000 people in six Chinese cities were interviewed for the research — supported by UNAIDS — which also found that there was still serious stigmatisation of people living with HIV in China.

Beijing’s Renmin University conducted the survey.

Less than a fifth of respondents said they would use a condom if they had sex with a new partner, and more than 63 percent would be unwilling to accept services like hairdressing from an HIV-infected person.

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After years of inaction and denial, the government has begun to address the problem. High profile meetings between HIV patients and political leaders are one solution, intended to address the stigma and educate the public about the issue.

Just as significant is the hefty increase in funding for prevention programmes and antiretrovirals for patients. There are public information films and the first strategy addressing the needs of men who have sex with men – one of the highest risk groups.

…But when it comes to addressing difficult questions, when activists embarrass officials, or when it comes to implementing policy, the shortcomings of this zeal are clear. Experts fear that leaves China at risk of an epidemic if further improvements are not made.

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A group of Chinese HIV/AIDS sufferers appealed on Wednesday for police to release their relatives, detained after trying to complain to Premier Wen Jiabao about a hospital they said spread the HIV virus.

Wen visited Hebei province, next to Beijing, on April 5, and some residents of Shahe in the province’s south hoped to use the rare visit by the top leader to complain about a hospital whose blood transfusions they blame for spreading HIV among them and their families, said their lawyer Jiang Tianyong.

Police detained 11 petitioners at the time and seven or eight remained in detention, said Jiang.

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“It’s been hard over the years to discover the number of AIDS patients because of the social stigma,” a ministry spokesman said. The disease is spreading fast in a country where information about Aids has long been suppressed. For many years, Chinese would say HIV/Aids was a disease that affected foreigners, and could be passed through shaking hands or sharing chopsticks.

The government has finally acknowledged that it faces a battle in resolving the rise in HIV/AIDS infections. The disease is now mainly sexually transmitted; before, it had been mostly caused by intravenous drug use.

The United Nations has warned that China could have 10 million cases of HIV by 2010 unless it takes steps to educate the public and fight the epidemic.

Along with the traditional routes of infection, about 70,000 people have been infected by contaminated blood transfusions. Many blood banks in rural China are not controlled by the government and often unsanitary.

In 2006 the government banned organizations or individuals to discriminate against Aids patients or their families. However, the Health Ministry survey found that about 60 percent of city dwellers were “nervous” about contact with HIV-positive people.

Syphilis cases also rose by 24 percent.

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Premier Wen Jiabao doesn’t know that the last time he visited, 1,200 police were dispatched to seal off the road to Wenlou from the county town of Shangcai and a large number of local cadres pretended to be villagers welcoming him. Yang Songquan personally made sure that people who were likely to meet Premier Wen would answer his questions in exactly the way the Henan government wanted, without getting a single word wrong. That show of being close to the people was a waste of time and money. As soon as Premier Wen left, the local authorities breathed a sigh of relief; the country’s premier had turned out to be easy to handle. Now, large numbers of Henan police have already been stationed in Wenlou and sealed off key areas. The local government has also put some active villagers with AIDS under house arrest, usually sending two village cadres and two security guards hired by the Shangcai county police for each “troublemaker.” [Full text]

See also a documentary about AIDS in China, To Live is Better than to Die, which Hu Jia mentions in his post:

(...)
Read the rest of The Premier’s Visit to China’s Most Infamous AIDS Village – Black and White Cat (0 words)

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A research study done by the National Center for AIDS/STD Control and Prevention has concluded that the AIDS virus in China originated in 1989 with 146 drug addicts found in southwest China’s Yunnan Province.

Wu Zunyou, director of the center, disclosed this information during an AIDS-related meeting held at Tsinghua University. According to Wu, a small segment of the drug-using population in one of Yunnan’s prefectures was found infected with AIDS in 1989.

The prefecture at that time had a population of 1 million. By the end of 2006 the prefecture had 1.1 million residents with twenty thousand, or 2 percent of the total population, infected with the AIDS virus. During these 17 years, AIDS spread beyond Yunnan to the rest of China. [Full Text]

Read also Report: Sex Main Cause of HIV in China by Henry Sanderson, HIV/AIDS discrimination widespread in China–U.N. and China’s Hu presses the flesh with AIDS patients by Reuters.

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China is estimated to have about 700,000 HIV/AIDS cases, with tens of thousands of new infections each year, the government said Thursday, but activists warned the problem was far greater.

“The result of estimates is that at the end of 2007, China will have about 700,000 HIV/AIDS cases, and 85,000 with AIDS,” Health Minister Chen Zhu told a press conference in Beijing.

Chen said there were an estimated 50,000 new HIV infections in 2007, when 20,000 people died from AIDS, figures he described as a slightly better than previous years. [Full Text]

See also “Report: Sex Main Cause of HIV in China” from AP.

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