Kent Ewing
As World AIDS Day passed last week in China, something remarkable happened: Beijing took notice, allowing an acclaimed US-made documentary on the disease to be aired on state television. An abridged version of Robert Bilheimer’s A Closer Walk was shown on China Central Television on Friday and rerun Sunday and Monday. It was viewed by as many as 400 million people in a country on the cusp of a possible explosion of the human immunodeficiency virus (HIV).
The fact that the 75-minute documentary, narrated by actors Will Smith and Glenn Close, premiered three years ago in the West is a reminder that Beijing is playing a catch-up game in its attempts to come to grips with a disease that has the potential to disrupt President Hu Jintao’s vision of building a harmonious society.
Drawing a lesson from the outbreak of severe acute respiratory syndrome (SARS) in early 2003, Chinese leaders now may have realized that covering up an epidemic could only serve to spoil “social harmony”. Perhaps because of this, Beijing now takes a high-profile, positive stance to deal with a possible HIV explosion. Hence the fight against AIDS in China now is endowed with a political significance.
In addition to airing Bilheimer’s documentary, last Friday, Premier Wen Jiabao also invited orphans from Henan province whose parents died of AIDS to visit Zhongnanhai, headquarters of China’s power center. With the move, Wen obviously meant to draw the nation’s attention to the problem.
In spite of - or perhaps because of - China’s belated efforts to confront the problem, state media report a nearly 30% rise in registered HIV cases from January to October. According to the Ministry of Health, 183,733 cases have been reported so far this year, 39,644 more than last year. The ministry attributes 37% of the new cases to drug use and 28% to unprotected sex.
Part of the increase is due to stepped-up vigilance and testing, but experts continue to say that the total of 650,000 cases acknowledged by the ministry represents just the tip of the iceberg in China.
The country’s best-known AIDS activist, Wan Yanhai, believes China suffers 10 times the number of HIV cases estimated by health officials. And his frank talk and aggressive approach toward AIDS have led to frequent run-ins with authorities and landed him in detention three times in the past 12 years.
Wan, 43, is the director of the country’s foremost AIDS-awareness group, the Beijing-based Aizhixing Institute of Health Education. (The Chinese characters for “Aizhixing” represent love, knowledge and action and are a play on the Chinese word for AIDS.) He was fired in 1994 from his post as a public-health official after setting up China’s first AIDS hotline and supporting equal rights for homosexuals.
In 2002, Wan disappeared for a month, accused of leaking state secrets about the grossly under-reported HIV epidemic in Henan province. In the 1990s, many of the millions of poor Henan farmers who sold blood to illicit blood centers with unsanitary practices contracted the virus and died of AIDS.
Again, officially, 69,000 people in China have been infected with HIV through selling blood or transfusions, but the real figure is undoubtedly far higher. According to Western reports, whole villages were wiped out in Henan.
Unbowed after his release last week from his most recent detention - this time a three-day stopover prompted by his efforts to organize a public forum on HIV/AIDS to coincide with World AIDS Day - Wan accused Chinese leaders of falling “asleep” as the virus spreads. He was forced to cancel his “Blood Safety, AIDS and Legal Human Rights Workshop”, which he had hoped would be attended by participants from around the world.
Despite his usual call for more action, however, Wan has been circumspect in talking to the media about his latest detention and also expressed a continuing desire to work with health officials to prevent further spread of the disease. This deft combination of confrontation followed by concession and conciliation is probably why Wan is a free man today.
The prudent but irrepressible activist’s on-and-off battle with authorities is a reminder that, at this point in China’s evolving attitude toward HIV and AIDS, the central government has put itself in a difficult position: Beijing wants to be more honest by degrees about the growing problem but not to come clean completely. Just as it is impossible to be only a little pregnant, however, it is also a tricky business to be only a little honest.
The airing of the Bilheimer documentary, which includes an interview with Vice Health Minister Wang Longde, represents a big step toward recognizing the seriousness of the issue.
Of the 15 children invited on Friday to Zhongnanhai by Premier Wen, two are HIV-positive, and the other 13 are AIDS orphans. Only a few years ago, such a gesture by a senior Chinese leader, which signified not only an increasing awareness of the disease but also sympathy for those who suffer because of it, would not have happened. But activists and health experts say it’s past time for China to move beyond symbolism to a more aggressive campaign of educating people about an epidemic that, while spreading rapidly, continues to be cloaked in ignorance and to live in the shadows of Chinese life.
Officials in the southwestern province of Yunnan took the lead recently with their announcement that, starting on January 1, residents will be required by law to take an HIV test before marriage. There will be no charge for the test, the results of which will be shared with prospective spouses.
Yunnan, home to 25% of the country’s HIV cases, borders the opium-rich Golden Triangle of Vietnam, Laos and Myanmar. The virus has been found in 128 of its 129 counties, the provincial government says.
Also this week, China Daily reported that a group of 19 people who contracted HIV from tainted blood transfusions at a hospital in the northeastern province of Heilongjiang were awarded 20 million yuan (US$2.5 million) in compensation. The landmark case involves the largest single group stricken by HIV in China.
Eighteen of the victims will receive a one-off payment of $25,500 from the hospital and an additional $380 in monthly payments. Payment will go to the family of the one victim who has already died from AIDS.
Nearly 40 million people worldwide are infected with HIV, according the latest United Nations report. Every day there are 11,000 new infections - one every eight seconds - and 8,000 deaths from the disease HIV causes, acquired immune deficiency syndrome. Almost two-thirds of those infected with the virus live in sub-Saharan Africa, which also accounts for 72% of the world’s AIDS deaths. But the report, jointly prepared by the Joint United Nations Program on HIV/AIDS and the World Health Organization (WHO), also points out alarming increases in Asia, primarily due to unsafe sex and drug use.
With Asia expected to rival Africa’s tragic HIV/AIDS story if the virus is left unchecked, the African experience should be instructive to Asian leaders, especially those in China, with its population of 1.3 billion people.
Countries that have been successful in fighting HIV and AIDS, the global record shows, are those that have been the quickest and the most honest in confronting the disease. In Africa, Uganda, whose rate of infection is declining as the worldwide rate rises, stands out as an example. In Asia, Thailand, where new HIV cases fell by 10% last year, leads the way.
We cannot expect the demure Beijing leadership to allow anything like the Thai effort to mark World AIDS Day by stringing together 23,000 condoms over 2.7 kilometers in an attempt to create the world’s “Longest Condom Chain”, but there are other useful lessons the Thais can offer.
While HIV-infection rates rise throughout the rest of the region, the disease has been slowed dramatically in Thailand as a result of a high-profile campaign for safe sex led by Mechai Viravaidya. Mechai, a former senator, is the founder of a restaurant chain called Cabbages and Condoms, where free condoms are handed out with every meal. Indeed, he has been so closely identified with the campaign that “Mechai” is now a common slang word for “condom” among Thais.
Again, it’s hard to imagine a Chinese leader today who would welcome such an association, but perhaps the danger posed by AIDS demands a more radical social shift that forces the disease out of the shadows and into the light of national life. Even China’s sketchy official data on the disease are frightening: the Shanghai government reports a 70% rise in HIV cases over past year and, according to a report in the Beijing News, surveys by the Chinese Center for Disease Control and Prevention show infection rates among homosexual men of more than 10% in some major cities.
Beijing does not have a great record of openness and honesty, especially when it comes to infectious diseases. Remember SARS? And, more recently, the WHO complained about a lack of cooperation from China’s Health Ministry over bird-flu samples - although the samples were turned over after the selection last month of a Chinese woman, former Hong Kong health director Margaret Chan, to head the WHO.
At great human cost, China has waited more than a decade to confront its HIV/AIDS crisis. But the confrontation is still not head-on.
