Introduction – AIDS in China
Human immunodeficiency virus (HIV) has been a major infectious disease problem across the globe for several decades. The large Chinese population makes the prevalence of HIV/AIDS a major problem despite a relatively low infection rate. It is estimated that the number of AIDS cases in China is between 800,000 and 1.5 million. The reported death rate from HIV/AIDS has been increasing over time. In 2008, it was reported that 7,000 people died from the disease. This made HIV the leading cause of death by infectious disease in China. However, the CIA World Factbook reports that the current infection rate in China is 0.1%. This is a similar level to many developed countries like Japan and some members of the European Union.
The main risk factors for infection in China are attributed to prostitution, migrant work, male homosexual activity, and the use of intravenous drugs. The number of sex workers in China is estimated to be around 3-4 million across the country. They work in various places such as trucks stops, salons, massage parlors, and in so-called karaoke bars. In 2011, according to NCAIDS, the number of male homosexuals was reported as 30% of the 800,000 HIV-positive population in China.
History – before 2006
Early Control Strategies
China began to report AIDS cases in the early 1980’s. These cases were largely found in: visitors from overseas, hemophiliacs, blood donors, and transfusion patients. Initial control efforts centered around the management or prohibition of certain blood collection methods as well as certain imports. Laws were passed during this period that were directed at trying to prevent risky behavior – such as prostitution and drug use. Often, these efforts did not have the desired impact and may have led to overlooking the key reservoirs of infection in the country. A key cause of rapid HIV transmission was the uncontrolled exchange of infected blood products in the country. The government eventually accepted responsibility for the failure to prevent this problem, but many infected people were denied any compensation.
Government efforts were not followed by more proactive interventions until the early to mid-1990s. This is when China began distributing condoms and putting into place other prevention efforts such as needle exchange programs. China also began surveillance efforts in 1995 that have continued to expand in scope and reach across the country.
Early Development Policy
In the first decade of the 21st century, the government began to set medium- to long-term policies that could start to slow the infection rate. In 2002, the government reported that the actual infection rate in 2001 was 67.4% higher than previously reported in 2000. Some of this increase could be attributed to more people being tested and the increased reporting of HIV patients.
In 2003, China initiated a program known as “Four Free and One Care.” This program included free antiretroviral drugs for HIV positive patients, free treatment for pregnant mothers (to prevent mother-child infection), free voluntary counseling and testing, free school for AIDS orphans, and proactive care for people living with AIDS. This program expanded rapidly from the original locations to more than 120 sites throughout China.
Another program was the China Comprehensive AIDS Response (China CARES) to help the high prevalence areas in treating and supporting those who are suffering from the disease. At the same time, laws were passed to assist in the collection and exchange of key HIV/AIDS data amongst the ministries that needed to work together. These efforts were relatively late in the timeline of the disease in China, but they reflect the complicated decision making paths that lead to policy development in China. Unfortunately, China is not the only country that has struggled to determine the best way
of dealing with this problem.
China did send their public health officials on many tours to understand how other countries were dealing with the epidemic. The tours also facilitated teamwork amongst the different Chinease departments that spent time together on the visits. The World Health Organization (WHO), United Nations, World Bank, and various universities conducted workshops and conferences in China to help increase the level of understanding about the disease. The time it took to build these relationships is a major reason for the relatively slow response by the Chinese government.
In 2002, there were several alarming predictions about the path of AIDS in China from the American Enterprise Institute, the US National Intelligence Council and from a UN-commissioned report. Each of these reports claimed that there would be a dramatic increase, as much as 10 times greater, in AIDS infections in China by 2010-2015. Language such as AIDS typhoon, time bomb, and explosion was common in these reports. The actual numbers seem to be much less frightening than was predicted.
These predictions were based on a substantial and rapid spread of AIDS from the high risk groups to the general population. The surveillance data seems to indicate that there is no evidence of this transmission path. However, there continues to be an issue with high AIDS infection rates in the high risk groups.
The Ministry of Health reported that the rate of infection in 2006 was 640,000 people out of the population of 1.3 billion. This number was revised downward from 850,000 due to a change in the statistical methodology used to calculate it. Some epidemiologists claim that the true number of affected Chinese is closer to 1.5 million. Getting an accurate picture of the size of the problem continues to be a problem in China.
The main HIV subtypes that are common in China are the A-G, BC and BB recombinants. There needs to be additional research to identify the distribution and infection rates of these different groups.