SARS, AIDS and China's Cover-Up

Scathing article in the International Herald Tribune on what the Chinese government should have learned from its botched efforts to cover up the SARS epidemic. Among its insightful conclusions:

The half-baked reform of China's health system is nothing short of scandalous and the country is now paying for it. Peasants -- who can least afford it -- must shoulder their entire medical burden, while the wealthy party elite and state employees enjoy a lavishly subsidized health system that consumes most of the state health budget. Only those who can afford to pay can expect treatment for SARS, AIDS or other modern plagues. The Communist Party should be taxing the rich to subsidize the poor, not the other way around.

I was working on a report on AIDS in China just as the SARS cover-up blew up in the Party's face, and the similarities between the two scandals is uncanny. There is one major difference between them, however, and that is what stands out the most: AIDS is still neglected and swept under the carpet in China. No officials have been fired for the cover-up, for the suppression of data and the quashing of efforts to inform the vulnerable public.

Reason? With SARS, everyone is at risk -- the young, the healthy, the elderly, etc. SARS is an equal-opportunity virus. It threatens tourists and businesspeople; it could even infect Party members. AIDS, on the other hand, selects as its victims those who, to the CCP, don't matter very much -- sex trade workers, impoverished peasants who sell blood in remote rural provinces, injection drug users, and of course, the group that doesn't even exist in China, homosexuals.

At the moment, millions and millions of Chinese citizens are at risk of contracting AIDS, and the government is doing next to nothing, especially compared to what it is doing, finally, about SARS. Long after the SARS epidemic has been contained, the AIDS threat will continue to mount, even to the point of turning China into "the next Africa" in terms of AIDS devastation. This neglect, this silence, this willful denial of a tragedy utterly without precedent in terms of lives affected -- this is the greatest sin that the Chinese Communist Party will have on its conscience.

As I read the latest UN materials, I have to admit that even I was startled at just how awful the situation has become and how atrociously the government has dealt with it.. Equally startling are the reasons AIDS has had such an easy time spreading, basically unchallenged, throughout the country. It all goes back to the government and its obsession with "looking good." The parallels with the current SARS crisis are abundant and rich.

As this document is being prepared, China finds itself embroiled in controversy over the way that it has handled the outbreak of SARS. The New York Times has written, "China's Ministry of Health still says that there is no evidence that the disease can be acquired in Beijing. What is clear, though, is that Chinese doctors knew a lot about SARS long before it had a name or had left China's borders, and chose not to share that information for many months."

Unfortunately, this scenario more or less mirrors the way China has handled its AIDS crisis, the process being denial, resistance, grudging acceptance of the need to cooperate, followed by the nightmare of a full-blown health crisis that could have been lessened had the government taken action earlier.

All indicators show that China is on the brink of an unprecedented explosion of the AIDS epidemic. The latest data, prepared by UNAIDS, the Joint United Nation Program on HIV/AIDS, indicate there were well over 1 million cases of AIDS at the end of 2001 and that this number will most likely mushroom to 10 million by 2010. About 70 percent of those infected are peasants living in rural areas.

Only in the mid-1990s did China start to acknowledge the worsening crisis, and the central government has been slow to take action. Currently only a few Chinese hospitals, all in the big coastal cities and far from the vast majority of infected citizens, are equipped to treat AIDS, and the cost of treatment is far too high for average citizens to afford. These factors, combined with the unwillingness of the government at the local level to take actions such as prevention awareness, converge to increase the likelihood of a future AIDS tragedy in China.

The main cause of AIDS in China has not been sexual transmission but contaminated needles, mainly those shared by injection drug users, but also needles used in unsanitary ways during paid plasma collection. In poorer parts of China, selling blood is a common way to earn extra money, especially for drug users and commercial sex workers. Tragically, many of the blood-collecting companies are unlicensed and illegal, and their use of contaminated needles has been a major factor in spreading the disease. Furthermore, those who sell blood to these companies are often in the most high-risk groups and have already been infected with HIV. Their blood is not tested, and is mixed into the blood pool and sold. Most of this occurs in poor, remote areas of China where there is less likely to be interference from authorities.

The epidemic is worse in provinces with a higher level of commercial sex and intravenous drug abuse. It is not surprising that the most severely affected area is along China's southwest territory, bordering "The Golden Triangle" along the Myanmar, Laos and Thai borders, a region famous for its heavy trade in heroin, methamphetamines and other illegal drugs. In the northwest province of Xinjiang there has also been a huge outbreak due to prostitution, sharing of needles for drug injection, and little to no awareness of AIDS and its prevention.

AIDS in China has been a taboo topic for years, and to a large extent it remains so today. This is key to understanding the evolution of the AIDS epidemic in China, and why confronting it is so challenging.

The Chinese culture and government tend to frown on sex education and to discourage open dialogue on controversial subjects like AIDS, which has made it difficult to raise awareness, especially in the rural parts of the country. Most Chinese citizens, especially in rural areas, are frightened to discuss sex-related topics, and have a hard time gathering the courage even to purchase condoms.

As the current SARS crisis demonstrates, both the central and provincial governments are highly reluctant to discuss anything that might reflect poorly on the image of China, as this might have an adverse effect on tourism and/or foreign investment. Officially there is still no prostitution, no drug abuse, and no blood donation scandal in China.

While in recent years the central government has become more involved in raising awareness of AIDS and taking steps to prevent and contain it, the local and provincial governments have been slow to follow suit. Often they make the situation more difficult by refusing to acknowledge the AIDS crisis as it might reflect poorly on them. It is at the local/provincial level that most of China's 1.2 billion citizens deal with their government, and where they turn for help.

Because of the government's avoidance of the issue, the general public has little knowledge of AIDS and how it is affecting China. This in turn creates fear of AIDS patients, who are often fired from their jobs or banned from attending school. This contributes to a vicious circle, where the AIDS victims chooses not to seek help for fear of losing their job or facing public disgrace.

Even today AIDS has "no face" in China; it was only in 2001, at the Beijing International AIDS congress, that the first infected man was allowed to speak to a public audience. This was after the central government had implemented its "Five-year Plan of Action to Contain and Control of HIV/AIDS" with a set of specific goals for grappling with AIDS. Since that time, in 2002, there was actually a public wedding of an AIDS-infected couple, indicating a further shift toward coming to terms with the disease.

Still, the five-year plan continues to present AIDS strictly as a medical problem without considering the broader social-economic implications of the crisis. Thus, public awareness remains low. Some of the legislation has actually made the situation worse, especially at provincial and local levels. Many local governments simply do not want to know or let others know about AIDS in their respective regions, as it might make them look bad. So information is suppressed. In addition, local officials worry that an honest assessment of prostitution, illegal plasma collection and drug abuse in their region would lead to their being accused of incompetency.

Laws based on prejudice and fear exacerbate rather than curb the epidemic. Employers in Beijing, for example, are required to report "suspected AIDS patients" to local health authorities, reinforcing the notion that AIDS victims will be punished. In Hebei, all citizens with STDs are banned from entering school, getting married or working in service-related fields. Local and provincial laws are frequently in direct contradiction to national AIDS guidelines prepared by the central government's Ministry of Health.

International experience shows that restrictive laws and punitive measures have little effect in curbing AIDS, while there is no question that they can have a negative impact on both prevention and care. In a punitive environment, vulnerable people will be more inclined to avoid preventive outreach, and people will decline getting tested for HIV for fear of punishment and/or stigmatization.

At the heart of the entire problem is awareness. When AIDS first surfaced in the US, the mantra for years was "Siilence equals death." Sadly, that formula has proven to be totally correct when it comes to China. Keeping silent and ignoring the reality of AIDS has made the situation in China infinitely worse than it could/should have been.

Simply acknowledging the existence of these issues, let alone taking bold action on them, is challenging in a cultural environment that is inclined to minimize or ignore its problems, especially those related to traditionally "untouchable" topics like drugs, prostitution and homosexuality. Let us hope that the small steps China is only just beginning to take continue to accelerate, gathering increased momentum and determination. There is no time to waste.

Long after the SARS epidemic has been contained, the AIDS threat will continue to mount, even to the point of turning China into "the next Africa" in terms of AIDS devastation.

For the record, I believe that the writer of the above article is a homosexual himself, so this may have colored his viewpoint a little.

I have read that there is a very high rate of (heterosexual) promiscuity in Africa, and also that the strain of HIV virus is more virulent than what is common in the US. I wonder about China - are people more monogamous there, or are they promiscuous? Those two factors - especially peoples' behaviors - will determine whether AIDS becomes widespread like in Africa or not. I notice he calles prostitutes "sex workers" - that kind of politically correct "values neutral" speech is kind of nauseating and does nothing to help stop the spread of STDs.

A lot of things have to go wrong for any non-African country to even approach African rates of infection in the 25-40 percent range. But let's not understate the catastrophe of even a 5 percent infection rate in China - 5 percent of 1.3 billion people is twice the population of California.

Ironically, both AIDS and SARS have become major problems not because China is a totalitarian state but because absolute state control has collapsed. Under Mao Zedong China had an immobile population, virtually no drugs and prostitution, and a fairly comprehensive healthcare system. What AIDS and SARS demonstrate is the danger of loosening control on people's behavior while still restricting the flow of information.

...are people more monogamous there, or are they promiscuous?

Monogamous. Promiscuity by a husband is very common if not at times expected. Many prostitutes and a surprisingly large number of homosexuals.

"Reason? With SARS, everyone is at risk -- the young, the healthy, the elderly, etc. SARS is an equal-opportunity virus. It threatens tourists and businesspeople; it could even infect Party members. AIDS, on the other hand, selects as its victims those who, to the CCP, don't matter very much -- sex trade workers, impoverished peasants who sell blood in remote rural provinces, injection drug users, and of course, the group that doesn't even exist in China, homosexuals."

Not quite. The important differences are that (1) SARS is acute, meaning you get sick and die in a hurry, and it is difficult not to notice this. AIDS takes its time. (2) SARS is much more contagious than AIDS, spreading like a true pandemic and opportunistically taking advantage of modern travel to spread; and (3) SARS does not depend (much) upon individual behavior in order to infect or be infected. You can infect others with SARS merely by sharing the same space, occupying the same building, etc. AIDS requires, ahem, much more intimate contact.

--Boris

There seems to be major unrest and an uprising by the people over SARS.

This could very well turn out to be the staw by broke the Communists' back. The ruling elite are not immune from the disease, and the military, whose hospitals are filled with SARS patients, won't dare risk getting it to stop the protesting.

They've already burned down one hospital over this, so as I see, they only have a few options: a)allow the world inside to take over the control the disease, b) flee to Europe (since America won't dare let you scum inside, or c) stay and be murdered in the streets by the peasants.

I hope it's the third option. Would be Schadenfreude for Tienneman Square.

The main cause of AIDS in China has NOT been sexual transmission but contaminated needles, mainly those shared by injection drug users, but also needles used in unsanitary ways during paid plasma collection. In poorer parts of China, selling blood is a common way to earn extra money, especially for drug users and commercial sex workers. Tragically, many of the blood-collecting companies are unlicensed and illegal, and their use of contaminated needles has been a major factor in spreading the disease.

Shades of Blood Trail, the Clinton scandal wherein Arkansas prisoners' blood was illegally sold on the open market, thereby infecting tens of thousands of people with HepC and HIV, among other things, and all the while the proceeds were lining the pockets of Clintonistas.

The main cause of AIDS in China has NOT been sexual transmission...

Is not yet sexual transmission. The source(s) of AIDS in China are now well known. The question that begs to be asked now is: How will the virus continue to spread in the future?

IMO, if the heterosexual community starts to see infections, the amount of time for it's spread will not be long because of social behaviors.

especially for drug users and commercial sex workers.

Just out of curiosity, why do you call prostitutes "commercial sex workers"? And in your lexicon are there "non-commerical sex workers"? Just out of curiosity, since it's such a "values neutral" kind of pc-speech.

Please understand that when this report was written, the writer is still working and living inside China. He has to be political correct in his writing. Maybe, it is not for someone who has enjoy freedom of speech for life to understand.

Comparing to sexual transmission, a much greater proportion of AIDS victims in China are more innocent than you might have thought.... From blood donors to recipient (patients in hospitals), from mother to unborn child, from patient to unaware family members, etc. These apprantly innocent means of transmission spread AIDS much wider than sexual transmission alone and these have nothing to do with social behaviors.

I am not the writer of this report.

China Commies could always ship all their SARS infected
to all those diversity loving countries of North America
and W.Europe. Just looking at growing numbers of
SAR-deceased in Canada makes one think that just such a solution might have crossed the mind of CP heads who run our much beloved trade partner country of PRC.

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