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Aids in China: Scrambling to defy a bleak prediction
It is a race against inevitability, the prediction that 10 million people
in China will be infected with HIV by the year 2010. “We talk
about it like it’s way off into the future but it’s just
a few years away,” says Allen Anderson, who has studied the evolution
of this disease in China with both fascination and profound sadness.
To thwart HIV’s steady progress, Anderson, a professor at the
School of Public and Environmental Affairs, works closely with China
on preventative interventions and there is reason to be hopeful: New
Chinese leadership is finally willing to confront the problem rather
than deny it.
But Anderson admits that he is also worried. The World Health Organization
estimates that 840,000 Chinese are currently infected and this is a
conservative guess; 1.5 million is probably closer to the truth. The
vast majority of those infected have not been tested and, presumably,
are getting progressively worse while infecting others.
The story of AIDS in China is the story of sweeping economic and social
change, of heroin trafficking and prostitution, of massive migrations
from rural areas to big cities. It is also the story of stigma and ignorance,
a fatal and familiar combination wherever AIDS takes root.
 The infection first appeared north of the Golden Triangle, the border
area of Thailand, Myanmar (formerly known as Burma), and Laos, where
vast poppy fields are cultivated for opium, which is processed into
heroin. It spread rapidly along this heroin-trafficking route and through
China, quickly penetrating all levels of society. Anderson has looked
at HIV and its relationship to four major groups: prostitutes, intravenous
drug users, health care workers, and the “floating population”—the
120 million Chinese who move from rural to urban areas in search of
work.
“The men [in the floating population] leave their families
behind,” notes Anderson. “Some are bored and lonely or depressed.
They go to prostitutes or they start taking drugs. So you can see the
potential for infection is just tremendous.” And because this
is an “oscillating” migration—workers travel between
work and home for the periodic visit with spouses—the virus is
virtually guaranteed to affect a broad geographic range.
Though prostitution is flourishing, the pay is generally low so that
sex workers are loathe to spend their meager cash on condoms. Even if
they did, observes Anderson, “many of the men don’t care
to use condoms with prostitutes. They’re already using them at
home with their wives for birth control and figure, ‘I’m
out on a fling, so why should I use them now?’”
Slowly, the facts about HIV are making their way to Chinese sex workers
in spite of initial opposition from police. “How could we facilitate
condom use among prostitutes when prostitution is an offense? That was
a major hurdle for us. So there was some initial tension with law enforcement
but now everyone sees the gravity of the situation and we’re getting
a lot more cooperation. Not that there aren’t problems—prostitution
is still a crime and prostitutes are still a cloistered community and
hard to reach—but a lot of progress has been made in the last
three or four years.”
Intravenous drug use continues to be a sturdy agent of transmission
because of widespread trafficking out of the Golden Triangle, through
southern China, and up to the coastal area around Guangzhou in the Guangdong
province. “There’s a huge law enforcement push in drug interdiction
but it’s an uphill battle,” says Anderson. “The southern
border is tremendously isolated, rugged, and porous. For all the effort
and money that’s been spent, we haven’t made much progress.”
To address the problem of infection and health care workers, Anderson’s
group studied hospitals in the Guangxi Zhuang Autonomous Region, specifically
in the capital city of Nanning. Researchers were astounded by what they
discovered there. “We found a lot of misunderstanding about AIDS
among hospital workers, and that includes physicians and nurses,”
he recalls. “They had misconceptions about how the infection is
transmitted and they had rather loose procedures for infection control.
In response, we’ve created a number of interventions to get health
care workers up to speed.”
In the process, the goal isn’t only to make a medical impact but
a social one, too; with so much misunderstanding about the disease’s
transmission, it’s no surprise that AIDS patients are often stigmatized
and ostracized. “We want Chinese health care workers to be beacons
of education who bring understanding and non-discrimination to their
own neighborhoods,” he says.
Most developing countries undergo “epidemiological transition”
as the prevailing diseases shift from infectious to chronic disease—in
other words, it’s actually a strange sign of progress when malaria
and yellow fever are preempted by heart disease and cancer. China, however,
is in the unenviable position of experiencing “epidemiological
polarization” in which both disease patterns are on the rise:
chronic disease in the cities, infectious in the rural areas.
If there is any good news in this bleak picture it is the response of
China’s central government. “They’re going the extra
mile in offering AZT treatment to anyone who becomes infected with HIV,”
Anderson says. “But maybe the most positive sign of change is
also the most subtle. It’s the simple recognition of the problem,
the willingness to talk about it at the governmental level. And maybe
that discussion will filter down and people will become more open and
understanding as they get the education they need to prevent this disease.”
Anderson is a researcher, but he is also a man of deep compassion for
the people he studies, and he says that his work has changed him at
his core. “I’m much more aware now of what it means to be
a have-not in this world,” he says. “And there is something
wrong when there are drugs available to make AIDS a chronic condition,
to extend your life 15 years or more beyond the diagnosis, but you may
die in three years if you are poor.It just rips your heart out. It’s
just not right. Hopefully, through education and the participation of
governmental leaders, and by sending people into the field with a global
perspective, we can overcome those inequities.”
Allen F. Anderson is a visiting professor
at the School of Public and Environmental Affairs at Indiana University,
Bloomington. Anderson has worked on HIV/AIDS transmission and
control issues in the People’s Republic of China for over
14 years, serves as an ongoing consultant to the Chinese Foundation
for the Prevention of STD & AIDS, Beijing, and has also served
as a consultant to the Chinese Ministry of Justice concerning
AIDS control in the prison population. Anderson received his Ph.D.
in 1984 from Southern Illinois University and a certification
in Public Health from the University of North Carolina at Chapel
Hill (2004).
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