Who's Infected?As is common in many parts of the world, HIV has gone from a disease of people in a few high risk groups to a disease that is found in every population. Still, these high risk groups account for most of the country's infections.
- IV Drug Users - In a country where about three percent of its citizens are IV drug users, those people account for about 60 percent of all new HIV infections. China has a zero tolerance drug policy meaning anyone caught using IV drugs has to go to mandatory incarcerated drug rehabilitation. One would think such an environment would be a perfect way to educate about HIV. However, the implementation of HIV and AIDS education programs as part of drug rehab has been slow. Prevention messages have been limited to a few posters explaining HIV risk and prevention.
- Blood Products - Despite all the problems with the Chinese blood supply in the past, the government continues to prohibit the importation of blood products. Blood donor centers are driven by profit, meaning that many of the commercial centers cut corners to make more money, even if it means breaking the law. It's estimated that about 10 percent of all new infections are from infected blood products. Compare that to the U.S., whose infection rate from blood products has been eliminated, and you understand what a big problem the tainted blood supply is in China.
- Sex Workers - The growing problem of prostitution in China is fueled mostly by economic need. Prostitution is illegal in China with government sponsored "rehab" facilities for those women caught taking money for sex. However, the rehab centers primarily teach the evils of prostitution and not the health risk that prostitution poses to the women involved. Condom use is erratic. Women have been arrested for carrying condoms, assumed to be a sign of prostitution. Because of this, sex workers seldom initiate condom use. This combined with culturally acceptable sexism prevents most women from taking the lead in safer sex practices.
- Men Who Have Sex With Men (MSM) - While homosexuality is not illegal, it does carry significant stigma. It is this stigma that decreases the accessibility to safer sex information and HIV education. Gay men feel there is no safe haven for them to discuss risks and concerns. Gay men are encouraged to suppress their homosexuality and marry women. Many do but continue to have unsafe sex with other men, placing their wives at considerable risk when they have sex within the marriage. While MSM do not account for a large number of HIV cases now, about half of all MSM practice unsafe sex, so experts fear this will cause a sharp increase in the number of new HIV cases very soon.
- Migrants - China's 120 million migrants are very mobile, moving across the country wherever the work takes them. This mobility makes them vulnerable to HIV. Traveling to new, unfamiliar places, migrants are reluctant to access HIV prevention services if there are any. They may travel to areas where condoms are scarce or difficult to access. In addition, many migrants are young single males. The money they earn is significant and is sometimes used for drugs and prostitutes in order to combat the loneliness of being on the road. Those men who are married, come back from their travels and place their wives at risk by having unsafe sex with them after having unsafe sex on the road.
HIV PreventionNot until 1998 did China have a national, long-term plan to combat HIV. The notion of condom ads was quickly shot down by the Chinese government after an ad played one time on the national television network in 1999. Condoms were viewed as illegal sexual tools by China's State Administration of Industry and Commerce and were banned from the airwaves. That ban persisted until 2001 when the Chinese Ministry of Health reclassified condoms as "medical devices" instead of a sexual commodity. Still, condoms are not an acceptable part of mainstream China, they are in short supply and are of poor quality.
Recently it was reported that circumcision can be an effective way to reduce the risk of HIV transmission. The belief is that circumcision could be a good choice for those countries like China that have limited resources to devote to condom education and distribution. However, an article in the China Daily reported that officials were not sold on the benefits of circumcision and would not officially condone the practice.
Risk-reduction education and needle exchange programs are expanding across China. The Chinese government has mandated that HIV education and awareness efforts were to be directed to the general public in an effort to reverse prejudice and stigma. In 1998 China promised to launch HIV curriculum in schools however to this day no such program is in place.
High risk groups continue to be made scapegoats of the HIV problem. Gay men have no refuge from the prejudice, severely interfering with efforts to educate that population. Groups that wish to sponsor or launch public HIV education campaigns are reluctant to do so for fear of severely damaging their public image.
The State of HIV CareDespite rising HIV rates, very few are able to get basic HIV care. The government encourages production of domestic versions of some HIV drugs; however, these have been found to be scarce and of poor quality. For those who have access to these drugs, the side effects are dramatically worse than the patented versions, making adherence difficult. By 2004, only about 12,000 people were taking HIV meds regularly.
The government has initiated what they call Four Frees and One Care Policy. The initiative consists of:
- Free meds for rural and financially troubled urban areas.
- Free HIV testing and counseling.
- Free medications to infected pregnant women.
- Free school for children orphaned by HIV and AIDS.
- HIV care and economic assistance for those living with HIV.
While the notion is a good one, making it a reality is a long way off.
Sources:Kanabus, A.; ""HIV/AIDS in China"; Avert.org; 10 Feb 2007.
Li, Chenyang.; "The Sage and the 2nd. Sex: Confucianism Ethics and Gender." Open Court 2000. 17th. Edition; Chicago 2000.
U.S. Department of State.; "Background Note: China"; Washington DC: 01 Jan 2007.