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The AIDS Epidemic in Rural China
From: Columbia University and University of Chicago
| By:
Wan Yanhai |
EDITOR'S INTRODUCTION |
As of 2002, there are an estimated 1 million people in China living with HIV. Unless effective measures are taken the total could reach 10 million by the end of the decade, according to the United Nations Program on HIV/AIDS (UNAIDS). In the 1990s, a government-sponsored blood-for-money program in the Henan province caused the most dangerous and rampant spread of the virus in China's rural communities, explains Dr. Wan Yanhai (right), coordinator of the AIZHI (AIDS) Action Project, which promotes gay and lesbian rights and HIV/AIDS patients' rights and education in China.
In November 2002, Wan spoke at the Workshop on Genders and Sexualities in Asia at the University of Chicago, and in December 2002 he spoke at a symposium titled "HIV/AIDS in Asia: Forging a Collective Response." The symposium, sponsored by the American Foundation for AIDS Research (AmFAR) and Columbia University's Mailman School for Public Health, addressed the growing HIV/AIDS crisis across Asia. Both talks are included in the feature below.
Wan helped expose the Henan blood trade scandal, which revealed that Chinese peasants had been paid to donate blood and became infected with the HIV virus as a result of unsanitary practices. According to Wan and UNAIDS, as many as 80 percent of the residents of these rural "AIDS villages" are infected with HIV--one of the highest rates of infections in the world. In the summer of 2002, Wan was detained and imprisoned for one month by the Chinese government because of his work, but he continues to push for education and access to drugs for HIV/AIDS patients in China. |
Question:What is the focus of your organization's work? |
Wan Yanhai: The AIZHI (AIDS) Action Project, a non-governmental organization (NGO), was set up in China in 1994 and we have been working for about nine years. Before 2002, this project was basically individual-based--that is, individual people working informally together and supporting each other. Only since 2002 did we start to organize ourselves as a formal group. |
When we founded our project, we set up objectives: for example, to provide AIDS education, counseling, and information and to support people with AIDS. Before 1998, our focus was on AIDS education for gay and bisexual men, and for some time we advocated the rights of gay and lesbian people in China. The AIZHI Action Project has since expanded its HIV/AIDS education and assistance programs to include sex workers and rural or migrant workers. |
One of our many achievements was that we pushed the Chinese Psychological Association to accept homosexuality and bisexuality in China, so now it is not considered an illness in China. After 1998, we set up our website and some new activities; for example, we moved our focus to patients' rights and we talked about the problems with blood transfusions and blood selling. |
The AIZHI Action Project coordinated a remarkable campaign in Henan Province, where it has turned out that hundreds of thousands of rural villagers have contracted HIV/AIDS through faulty blood collection practices. |
It is a serious situation there. After our work there, the local government, and perhaps the central government, began to notice us. This past year, 2002, we started to organize ourselves as a group and we got in some trouble. Meetings were stopped; our people were monitored and detained. I was detained for 27 days. After my release, we got liberated. We decided to set up an institute and our application was accepted by the government and legalized. We are about to plan our new objectives and structures, and hope to broaden our objectives. |
We had done a lot of advocacy work helping people to write letters. Now we need to do work to support children and to organize some outreach education to train peer educators.
Now a lot of children are affected by HIV/AIDS, including orphans left by parents who died. Also, there are no drugs--most of the treatments are just for the symptoms and not anti-virus treatments. The work of our group is chiefly to organize more publicity for people with AIDS in rural Henan. In addition, we do some advocacy work: we write letters to the government to ask them to make changes; we help people write petition letters; and we set up self-support groups. |
The people in our group are great, but professionally we were not well trained. Many of our members--students and journalists, for example--are concerned about the issues and need training. We are learning how to manage our organization and to approach funding issues. It is a new beginning for us. |
Q: China's second-round application to the Global Fund is largely for Henan or the blood-selling provinces. Do you have any thoughts on why the Global Fund decided to fund support for these regions, and if there are any concerns about the way that they are going about that? |
Wan: According to the local government estimation, there are 30,000 people infected with AIDS/HIV in Henan. Many experts, however, believe at least 1 million people are infected, and I believe the number is closer to 2 million people. In many villages, we found more than 50 percent of adults were infected. Many children had been left behind by parents who died and many students with AIDS were not allowed to go to school. In one county where we visited almost every village and invited a local activist to help, we found a severe epidemic in about 80 of the 500 villages in the county. |
Q: Why is the rate of HIV infection in rural China so high? |
Wan: In many places in China, health organizations were involved in the selling of blood plasma for years. This was quite common. But in the Henan province, the Henan provincial health department organized blood and plasma sale as policy, and motivated and organized the whole province in blood sales, which led to so many people being infected. |
We have learned that many local government leaders motivated people to share blood. In one county, a former leader spoke to a television audience and said that selling blood is patriotic, and not selling blood is unpatriotic. They used a lot of slogans to motivate people to sell blood. |
Once doctors discovered the HIV epidemic that had spread as a result of these blood sales, the health department wanted to cover up the scandal and caused trouble for the journalists. The journalist who first reported the issue in January 2000 was immediately fired by the provincial palace propaganda department. This journalist could no longer work in Henan. |
Q: In 2001 China finally submitted its application to the Global AIDS Fund for eight central provinces. Do you have any idea why the government decided it was time to focus on what for them has been a much more difficult problem to acknowledge? |
Wan: The widespread HIV epidemic was first noted by doctors in the Zhoukou district in the Henan province. The doctors involved in this discovery were all fired by the Henan provincial government. |
In 1999, another doctor found evidence for an HIV/AIDS epidemic. The doctor and the journalist who reported the story in 2000 were fired immediately. Both the local government and the central government kept silent. For the government it wasn't an issue, and we didn't know what happened. |
In the past two years (2000-2)--because of international reports and because people within the affected communities realized what had happened to them--people got really angry and organized some protests. Our group helped people there to organize support and write petition letters to the central government for drugs, education and prevention. Perhaps our government then realized that it was time to take some immediate action to provide treatment or something might happen. |
Many people died in those provinces. We found that more than 10 percent of infected people died earlier this year. |
Q: According to a projection by UNAIDS, by 2010 approximately 10 million Chinese will be infected with HIV. How do you evaluate this projection? |
Wan: The US National Intelligence Council (NIC) made some estimations in the range of between 10 and 50 million people infected by 2010. It may be worse than this. We still do not know. In one province, I estimated infection currently reaching 1 million, but it may be 2, 3, 5 million or more. We just do not know. |
Let's talk about just Henan. As I mentioned, the government reported only 30,000 people infected with HIV. We organized a local activist to help us do an accounting in about 100 counties in Henan, which have a total population of 100 million people. In one county with a population of 1.3 million, we found about 35,000 were infected--just in that one county. |
Q: Do provincial officials under-report infections out of fear of being held accountable for what happened in the mid-1990s? |
Wan: The Henan provincial health department acted to suppress any discoveries of the HIV/AIDS epidemic in rural China. But perhaps this was not just isolated to the provincial government, because we know the central government knew about the crisis in 1995. Some doctors had reported on this issue to the government, but the provincial government created trouble for involved doctors and journalists. Some lost their jobs for identifying an epidemic in 1995. |
At one time the provincial health department committee held a one-day meeting and finally came to the following conclusion: if we solve the problem of these doctors, we have solved the problem of AIDS. They were talking about how to control the protests and not control the spread of the disease. That is not just a mistake. That is a crime. |
Q: Can you give us more detail on how the government is trying to prevent further damage? |
Wan: In some places in China the policy is quite open, allowing international organizations, the UN, NGOs and government organizations to work together to further education. Also, on the national level, the government is starting to promote condom use among commercial sex workers and provide AIDS education in middle schools. In Henan, the local government does do some good things, like providing students with educational information and medical help. |
Some orphans are provided for by foundations that give money to the Chinese government, which in turn gives money to families. The problem is in general the Chinese government does not want more people to know about what has happened, because if more people realize, they will cause violence and may ask for compensation, which the government agencies are obligated to provide. |
Only when people with AIDS in villages organize protests and get media attention do the government agencies help. |
Q: Do you think that China's resources are best used on a primary care level rather than, say, trying to manufacture pharmaceuticals for AIDS? |
Wan: In general, our government does not spend much money on HIV/AIDS. The ministry of health emphasizes prevention and education. Yet even for prevention and education, the budget is quite limited. The government spends more money on blood testing to improve blood quality. Local government has spent some money on treatment, but this is quite limited. |
Our government should dedicate more money for treatment. We can't just talk about prevention without providing help. We can't just ignore the people who are already infected and let them die. I think it is very important to devote more money toward treatment. |
Q: You said your organization works on gay and lesbian issues. Are there any legal challenges you address? Also, how do you address issues regarding sexual minorities at the rural level? |
Wan: There are homosexual people in rural areas. But it is really difficult to say because many of these people are still very isolated. Most of the established gay communities we found are in the big cities. There are about 500 gay and lesbian Chinese websites and there are gay baths in almost every big city. There are some gay and lesbian hotline services provided by the community and by scholars in certain cities, and of these, some even got support from the health department for education among the gay community. The Chinese government now is much more liberal when it comes to sexuality issues than in the past. |
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