- Email: [email protected]
China faces AIDS
EDITORIAL
THE LANCET Volume 358, Number 9284
China faces AIDS For a variety of complex social and political reasons, China has been slow to respond to the HIV/AIDS epidemic. But last month, for the first time, a top Chinese official held a press conference to discuss HIV and AIDS in China. At the conference held on Aug 23 in Beijing, Deputy Health Minister Yin Dakui admitted that the epidemic in China was now very serious and went on to acknowledge that the government’s efforts to stem the spread of the infection had not been effective. To many observers, the press conference and Yin’s admissions were welcome signs that Chinese government has decided to come to grips with the epidemic. Because surveillance efforts in China have focused primarily on relatively small populations of high-risk groups, the true scope of China’s HIV/AIDS epidemic is unknown. But it is clear the situation is serious. Chinese officials estimate that 600 000 Chinese are now infected with HIV. But international groups say the true number is closer to 1·5 million and predict that if the epidemic continues to spread at its current rate that number will climb to 10 million over the next four years and to 20 million by the end of 2010. Today, the most serious epidemic is located in southwestern China in the provinces bordering the parts of Myanmar, Laos, and Thailand, where the heroin-producing region known as the Golden Triangle is found. Here intravenous drug use is high and needle-sharing common. In some cities in the province of Yunnan HIV infection rates among intravenous drug users are in some cases as high as 80%. A second major epidemic now appears underway among impoverished rural villagers who sold their blood to commercial blood product companies in the 1990s. In order to prevent anaemia and allow the villagers to give their blood more often, these companies, after pooling the blood and extracting the plasma, re-infused the red cells taken from the pooled blood. Although the practice is now outlawed, it is feared that tens of thousands, some say a million or more, are now infected with HIV as the result of this practice. Infection rates among other at-risk groups are also unknown. China’s economic and social turmoil has THE LANCET • Vol 358 • September 8, 2001
led to an explosion in the number of poor women who have turned to prostitution. There has been no concerted effort to teach these women about AIDS and prevention. Infection rates among sex workers in some sentinel sites in the south are running as high as 10%. Another group about which little is known are men who have sex with men. Although homosexuality is not illegal in China it carries such social opprobrium that this community remains underground. Also of great concern is China’s “floating population” of as many as 120 million migrant workers who have flooded into the cities from rural areas in search of work. Young, unmarried, and far from home, many engage in high-risk sexual behaviours. Adolescents are also at risk as changes in social norms have led to an increase in sexual activity among this age group. They, like the rest of China’s population, have been taught little about AIDS and few know how to protect themselves from infection. Throughout China condom use is rare and rates of sexually transmitted infections are soaring. What is needed now is a comprehensive national effort that will involve all sectors of society including people who are currently ostracised and shunned. For guidance, the Chinese should harness the expertise of the international AIDS community which now has 20 years of experience combating this epidemic and has developed practical interventions that have proven to be cost-effective in a wide variety of cultures and surely can be adapted for China. These interventions include mass-education campaigns to educate the entire population about the nature of HIV and AIDS, programmes to promote condom use and the use of sterile injection equipment, outreach to marginalised high-risk groups, and compassionate care for those who are infected with the virus. Throughout their long history the Chinese people have faced great challenges with energy and determination. This epidemic is a new and difficult challenge, but it is one they can meet. The Lancet 773
For personal use. Only reproduce with permission from The Lancet Publishing Group.
THE LANCET Volume 358, Number 9284
China faces AIDS For a variety of complex social and political reasons, China has been slow to respond to the HIV/AIDS epidemic. But last month, for the first time, a top Chinese official held a press conference to discuss HIV and AIDS in China. At the conference held on Aug 23 in Beijing, Deputy Health Minister Yin Dakui admitted that the epidemic in China was now very serious and went on to acknowledge that the government’s efforts to stem the spread of the infection had not been effective. To many observers, the press conference and Yin’s admissions were welcome signs that Chinese government has decided to come to grips with the epidemic. Because surveillance efforts in China have focused primarily on relatively small populations of high-risk groups, the true scope of China’s HIV/AIDS epidemic is unknown. But it is clear the situation is serious. Chinese officials estimate that 600 000 Chinese are now infected with HIV. But international groups say the true number is closer to 1·5 million and predict that if the epidemic continues to spread at its current rate that number will climb to 10 million over the next four years and to 20 million by the end of 2010. Today, the most serious epidemic is located in southwestern China in the provinces bordering the parts of Myanmar, Laos, and Thailand, where the heroin-producing region known as the Golden Triangle is found. Here intravenous drug use is high and needle-sharing common. In some cities in the province of Yunnan HIV infection rates among intravenous drug users are in some cases as high as 80%. A second major epidemic now appears underway among impoverished rural villagers who sold their blood to commercial blood product companies in the 1990s. In order to prevent anaemia and allow the villagers to give their blood more often, these companies, after pooling the blood and extracting the plasma, re-infused the red cells taken from the pooled blood. Although the practice is now outlawed, it is feared that tens of thousands, some say a million or more, are now infected with HIV as the result of this practice. Infection rates among other at-risk groups are also unknown. China’s economic and social turmoil has THE LANCET • Vol 358 • September 8, 2001
led to an explosion in the number of poor women who have turned to prostitution. There has been no concerted effort to teach these women about AIDS and prevention. Infection rates among sex workers in some sentinel sites in the south are running as high as 10%. Another group about which little is known are men who have sex with men. Although homosexuality is not illegal in China it carries such social opprobrium that this community remains underground. Also of great concern is China’s “floating population” of as many as 120 million migrant workers who have flooded into the cities from rural areas in search of work. Young, unmarried, and far from home, many engage in high-risk sexual behaviours. Adolescents are also at risk as changes in social norms have led to an increase in sexual activity among this age group. They, like the rest of China’s population, have been taught little about AIDS and few know how to protect themselves from infection. Throughout China condom use is rare and rates of sexually transmitted infections are soaring. What is needed now is a comprehensive national effort that will involve all sectors of society including people who are currently ostracised and shunned. For guidance, the Chinese should harness the expertise of the international AIDS community which now has 20 years of experience combating this epidemic and has developed practical interventions that have proven to be cost-effective in a wide variety of cultures and surely can be adapted for China. These interventions include mass-education campaigns to educate the entire population about the nature of HIV and AIDS, programmes to promote condom use and the use of sterile injection equipment, outreach to marginalised high-risk groups, and compassionate care for those who are infected with the virus. Throughout their long history the Chinese people have faced great challenges with energy and determination. This epidemic is a new and difficult challenge, but it is one they can meet. The Lancet 773
For personal use. Only reproduce with permission from The Lancet Publishing Group.