[sociate] NYT - City Emerges as Model in China's Effort to Reverse AIDS Record

http://www.nytimes.com/2005/06/16/international/asia/16aids.html

City Emerges as Model in China's Effort to Reverse AIDS Record
By JIM YARDLEY
Published: June 16, 2005


GEJIU, China - The storefront looks like just another downtown shop. But
inside, health workers offer tests for H.I.V. and dispense methadone to drug
users. Upstairs, a nonprofit group offers counseling and support for anyone
with H.I.V. or AIDS.

Not far away, another group has opened a drop-in center for parents of drug
users to exchange information about how to prevent H.I.V. In another office,
the city's more than 1,000 prostitutes can receive free condoms, tests for
H.I.V. or advice on how to avoid becoming infected.

Here in mountainous southwestern China, where heroin begat AIDS and AIDS
begat death, discrimination and official denial, Gejiu is emerging as a
model of how China is trying to reverse its once abysmal record on AIDS. In
the last 18 months, China's top leaders have made AIDS a national priority
and introduced a host of policies, some contentious even by Western
standards.

Not too long ago China denied it had an AIDS problem and tried to cover up a
tainted blood-selling program that infected untold thousands of farmers.
Even now, the police in some cities still arrest and harass advocates for
AIDS patients or try to conceal the presence of the disease.

But places like Gejiu are starting to carry out the central government's new
policies, including needle exchanges and making condoms available in hotel
rooms. And the Health Ministry is planning a nationwide expansion. China now
has 8 methadone clinics but wants to reach up to 5,000 by 2010.

"There are still many countries where this is against the law," said Dr.
Peter Piot, executive director of Unaids, the United Nations program on
H.I.V. and AIDS, of the needle and the methadone program.

The remaining problems are daunting. China's rural public health system is
in near collapse, and few health workers are properly trained in treating
H.I.V. or AIDS. Only one in nine infected people know they have H.I.V. A
free antiretroviral drug program hurriedly introduced by the government in
2003 has had serious problems, with roughly one in five patients dropping
out.

But international specialists agree that China's new response far surpasses
that of India and Russia, the other regional giants, which have even more
severe AIDS problems. And Beijing's newfound political will has impressed
many skeptics.

"It's clear that the senior leadership at the national level and the
leadership in this province are taking this problem very seriously," said
Randall Tobias, who leads the Bush administration's AIDS program, in a visit
in early June with Dr. Piot here in Yunnan Province.

The turning point, Dr. Piot said, came in 2003, when SARS, severe acute
respiratory syndrome, showed the government that communicable diseases could
pose not just a health threat but also a political one.

"It is SARS, to me, that made the most difference," he said. "Nothing did as
much as the fear that SARS instilled in terms of the potential for
destabilizing society."

The shift in attitude was signaled in December 2003 when Prime Minister Wen
Jiabao met with AIDS patients, a gesture later repeated by President Hu
Jintao. These symbolic steps have been accompanied by a doubling of the
government's budget for AIDS and several new policies, like needle exchanges
and condom promotion. (Until 2002, condom advertising was banned.)

Specialists agree that China does not yet face a crisis like that in Africa,
but they have predicted that more than 10 million Chinese could be infected
with AIDS by 2010 if the government does not rapidly escalate its efforts.
Since 2003, the Chinese government has estimated that 840,000 people are
H.I.V. positive while another 80,000 have AIDS. Roughly 150,000 additional
people with AIDS are believed to have died.

Heroin flows into Yunnan Province from neighboring Vietnam, Laos and
Myanmar, bringing with it H.I.V. The province's first cases were reported in
1989. With a population of 44 million, Yunnan now has only 200 health
workers trained for the disease. Officials estimate that the province has
80,000 infected people, most of them intravenous drug users who have spread
the disease by sharing needles.

In Gejiu, a city of 310,000 people on a route favored by drug traffickers,
initial rounds of AIDS testing in recent years found more than 1,000 people
with H.I.V., nearly all drug users or prostitutes. Tong Waiyuan, a vice
mayor, explained that Yunnan's new plan included needle exchanges, condom
promotion, and more testing and education and counseling. "The whole society
is involved," said Mr. Tong, wearing an AIDS pin as he briefed Dr. Piot and
Mr. Tobias.

Dr. Piot and Mr. Tobias spent three days in Yunnan to highlight cooperation
between the United States and the United Nations on AIDS. They chose Gejiu
because a handful of the projects here are being financed with international
money, some of it from the United States. Unlike some other provinces,
Yunnan has welcomed international nonprofit groups and support from Britain,
Australia and, more recently, the United States.

Nearly all of the projects in Gejiu are less than a year old, and just
beginning to jell into a viable prevention and treatment network. Huge
challenges remain.

At the methadone clinic, paid for in part with money from the United States,
Dr. Ming Xiangdong said more than 270 drug users had come for help since the
clinic opened in April 2004. Demand is so high that a larger clinic opened
in early June. But government regulations say that only drug users who have
flunked out of official detoxification centers qualify for the methadone
program - only the most hardened users.

At the Geiju Women's Center, which also gets support from the United States,
prostitutes receive education in H.I.V. prevention and the use of condoms,
as well as counseling on changing professions.

"I know lots of women with H.I.V.," said a woman at the center, who wore a
white lace dress with a cellphone dangling from a green necklace. "All of
them are still working."

She said the center's workers were trying to get infected prostitutes out of
the sex business or at least to use condoms. But prostitution, often in
karaoke clubs, frequently is the highest paying work available to women, so
prostitutes with H.I.V. sometimes keep their condition a secret.

Just as health officials are starting to reach out to prostitutes and drug
users, public security officials in Yunnan have been cracking down. AIDS
workers worry that a recent provincewide sweep of drug users will drive
people infected with H.I.V. underground and increase, rather than reduce,
the broader risk.

"They are making a group of people become like an enemy of society," said
Yang Maobin, director of Daytops, a nonprofit program in the provincial
capital of Kunming that helps drug users kick their habits.

In other provinces, the situation is often far worse. A new report by Human
Rights Watch found that advocates for AIDS patients are still harassed by
local officials. Web sites that provide AIDS information to gay people have
been shut down. And in one widely reported incident, the police burst into a
treatment center in a southern city and arrested drug users meeting with
health workers.

Another immediate challenge for the central government is the limited
availability of antiretroviral drugs. Many patients cannot tolerate the
regimen offered in the free drug program, but the government does not yet
have another regimen. Negotiations are under way with pharmaceutical
companies, but China has resisted any steps that might infringe upon patent
law.

Even so, government is moving ahead. The number of methadone clinics is
expected to reach 1,000 by 2007. This month, health officials in Beijing
announced national plans to expand needle exchanges as well as broader
outreach to prostitutes to encourage condom use.

"We have some results and achievements." said Chen Juemin, director of the
provincial health bureau. "But it is just a first step."

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