WAKING UP TO AIDS

The poor but scenic Yunnan province is in the forefront of China's
battle against AIDS.

IT is a quiet morning at the Da Shu Ying Health Centre, an
unobtrusive building tucked away in a warren of lower-middle class
residential housing in downtown Kunming. The excited chattering of
children playing at the adjoining primary school wafts into the
clinic's foyer. A few staff outfitted in bright white lab coats swish
around with patient files.

At around 9.30 a.m. the first patient of the day, Ou, walks in. His
hair is combed back neatly and his expression is a little tense. He
looks neither to the left nor to the right and heads straight for the
medicine counter where he hands the two attendants a prescription. A
few seconds later he is given a paper cup, the lime-green contents of
which he gulps down gratefully in one swallow. His expression
lightens and he exhales heavily in relief as he sits down on a nearby bench.

Ou is in fact a heroine addict. At 35, he has been using the drug for
over 15 years. Having been arrested and locked up in police
detoxification centres more than 10 times he had lost all hope of
ever recovering. "I came close to suicide more than once. I lost my
job, my wife divorced me and my mother died of grief," he recounts,
his voice betraying little emotion. "I lost all decency and cheated
my friends and family constantly for money," he continues.

Then around a year ago he heard of the Da Shu Ying Health Centre, one
of the eight methadone treatment clinics the local government has
opened in Kunming, capital of Yunnan province in southern China.
Methadone is a synthesised narcotic, and at these centres it is
administered to addicts orally under close medical supervision. The
aim is to help heroine addicts break their habit, keep out of trouble
with the law and ultimately remain protected from Acquired Immuno
Deficiency Syndrome (AIDS).

AIDS Capital

Yunnan, a multi-ethnic region of stunning sub-tropical scenery is one
of China's main tourist draws but it also hides a more unsavoury
reality. It is the AIDS capital of the middle kingdom, being home to
some 40,000 of the 140,000 Chinese who are officially known to be
Human Immunodeficiency Virus (HIV) positive. Experts say that in
reality there could be upwards of 200,000 HIV cases in the province
and even official estimates put the figure at around 80,000.

"We have a real crisis in Yunnan. We are doing everything in our
power to fight it but the AIDS situation is only growing worse," says
Zhang Chang An, Director of the Office for the Prevention and Control
of HIV/AIDS of the province. Zhang is unusually candid for a
government official, but then, Yunnan has been at the forefront of
China's fight against the disease.

While many of China's other regions spend more time pretending that
AIDS does not exist rather than facing up to it, Yunnan has begun to
experiment with novel pilot projects such as methadone therapy and
needle exchange programmes for intravenous drug-users. The province
has also welcomed support from international organisations and
devotes a substantial part of its over-stretched local budget to fighting HIV.

Impoverished and underdeveloped, Yunnan shares an over-4,000-km-long
porous border with the notorious golden triangle states of Laos and
Myanmar. The province thus has some of the worst drug and
prostitution problems in the country. Geographical proximity to
drug-producing areas means that heroine is easily available in a
region already experiencing wrenching social dislocation.

China is experiencing some of the fastest social and economic changes
ever witnessed in history and provinces such as Yunnan have been left
behind while the economic boom has brought prosperity to the
country's eastern seaboard. In Yunnan poverty forces young women to sell sex.

The local government is aware that this combination of growing drug
use and commercial sex is deadly and that AIDS is a potential time
bomb in the region. Last year alone 8,000 new HIV cases came to light
in the province and this is only the tip of the iceberg.

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS),
only some 25 per cent of all HIV carriers in China have been tested
for the virus, leaving 75 per cent of those infected ignorant of
their status. The vast majority of HIV-positive people in Yunnan, as
in the rest of the country, are thus unmonitored and unaccounted for.

China has an estimated 650,000 cases of HIV. With 70,000 new cases
reported last year, some experts warn that if unchecked the number
could rise to five million by 2010. "Predictions are very unreliable.
The real numbers are anyone's guess because those who actually report
into the system are so few," explains Ole Schack Hansen, Advocacy
Adviser for UNAIDS China.

Changing Attitudes

For years the Chinese government denied it had an AIDS problem at
all. The first cases of HIV were discovered in the late 1980s but
were portrayed as isolated occurrences brought into the country by
foreigners. The general lack of awareness of the disease that this
attitude led to had tragic consequences. In the early 1990s a
government-organised blood-buying programme in central China's Henan
province resulted in the contamination with HIV of the entire
province's blood supply.

Commercial blood sellers during this period paid donors for plasma.
In order to maximise profits they separated red blood cells from the
plasma and then re-infused the donors with pooled red blood cells so
that they could donate blood more frequently. An estimated 70,000 to
250,000 villagers in the province became infected with HIV as a consequence.

Because of the local government's involvement in this disastrous
scheme, the entire incident was kept under wraps for years. Local
media were banned from reporting it and activists who tried to
publicise the tragedy were jailed.

But slowly information of the incident leaked out and the
international and domestic uproar that followed has gone a long way
in changing governmental attitudes. Thus in March 2003, China
launched a programme to provide anti-retroviral drugs to all infected
blood donors in Henan province. Condom advertisements, previously
banned, made a debut on national television and radio. Government
leaders began to be photographed visiting AIDS patients in hospitals and homes.

According to Hansen the Central government has shown an increasing
commitment to fighting the disease over the last few years and
efforts have stepped up, making use of the lessons learnt from the
handling of the Severe Acute Respiratory Syndrome (SARS) epidemic of
early 2003. At the time the Chinese authorities were shown to have
deliberately under-reported infections, placing thousands of people
at potential risk. But once the cover up was exposed the authorities
moved swiftly; they sacked the Health Minister and ordered greater
transparency in reporting infections across the board.

The SARS epidemic in fact served as a clarion call for raising
awareness of infectious diseases in general, and the battle against
AIDS benefited as a result. Today, over 20,000 patients with AIDS are
receiving anti-retroviral drug treatment nationwide. From $12 million
in 2001, the Central government budget for fighting AIDS rose to $100
million at the end of 2005.

A national programme called the "four frees and one care" is
currently being promulgated. It includes free medication for rural
residents and those with financial difficulties in urban areas; free
voluntary counselling and testing for all; free drugs for pregnant
women; and free schooling for children orphaned by the disease.

"All the right policies are now in place. The problem as usual is in
the implementation," said Hansen. "The localities often interpret the
Centre's directives in their own way and many of those who should be
getting anti-retrovirals for free don't," he added. Nationwide only
about 25 per cent of those infected with HIV are in fact receiving
appropriate medication and China had 25,000 AIDS-related deaths last year.

Yunnan's authorities , however, are doing much better than most other
local governments. Despite being one of China's poorest provinces,
all of Yunnan's 1,600 known AIDS patients are receiving free
treatment. A one-year course of anti-retroviral medication costs
anywhere between RMB4,000 and RMB6,000 ($500 and$750). The per capita
income in Yunnan is roughly $900.

In 2005, the province spent a total of RMB250 million ($31 million)
in fighting AIDS, around half of which came from the Central
government, and the remaining portion came from the provincial and
local authorities. Yunnan has established 284 voluntary counselling
and testing sites and all hotels and entertainment centres in the
region have been ordered to make condoms available on their premises.

A 200-bed, RMB139 million ($ 17.3 million) hospital especially for
the treatment of AIDS is currently under construction in a town 30 km
west of Kunming. Hundreds of health workers have been trained in
administering anti-retroviral medication and police officers are
given training to sensitise them to the special risks faced by drug-users.

The province has also established several needle-exchange centres,
where intravenous drug users can bring in used needles and exchange
them for new, sterilised ones. According to Zhang the province
distributed 800,000 clean needles in 2005.

Over 50 methadone clinics, with a total of 3,500 registered patients,
have been opened province-wide and mobile methadone vans that will
visit addicts who are unable to travel at their homes are being planned.

At the Da Shu Ying Health Centre, Li Yu, its director, revealed that
250 patients had registered since the centre opened a year ago. In
addition to providing the addicts with controlled doses of methadone
at highly subsidised prices (each patient pays only RMB10, or $ 1.25
a day), the clinic also promotes AIDS awareness and provides
counselling services.

Zhang, however, said none of these efforts was adequate. "We need
more money, more international assistance, more medicines, more of
everything," he said blandly.

Dr. Wang Yu, head of the new AIDS hospital that is coming up outside
Kunming, agrees that the province faces several weighty challenges.

The biggest worry, she says, is that the AIDS epidemic is no longer
confined to drug-users. While over 60 per cent of the province's HIV
cases are still to be found among Yunnan's 70,000 known drug
offenders, the percentage of drug addicts in the total number of
HIV-positive cases is falling.

Currently some 30 per cent of those with HIV in the province
contracted the virus sexually. "We can say that AIDS has already
entered the mainstream of society in Yunnan," Wang concludes.

This is in fact a problem across China. Nationwide only 44.4 per cent
of the total HIV cases comprise intravenous drug-users. While 10.7
per cent are former commercial blood and plasma donors, almost 20 per
cent comprise sex workers and their clients.

Moreover, as Grace Hafner, director of the China programme for
Population Services International (PSI), a U.S.-based group that
operates a counselling centre for drug users in Kunming, points out,
the stigma faced by HIV-positive people remains huge. Stories abound
of doctors in rural areas refusing to treat patients with AIDS.
Shunned by family and friends they thus go underground rather than seek help.

Wang adds that locating and identifying people affected by HIV has in
fact become more difficult following recent legislation intended to
help those with the disease. Since all AIDS patients are now entitled
to free medication in Yunnan province, patients have been required
since 2004 to give their real names and addresses to health workers.
This has however had the unintended effect of discouraging people to
come forward for treatment. The stigma surrounding the disease
prevents many from revealing their identity even if the alternative
is certain death.

Finally, the conflicting priorities of law enforcers and health
workers continue to complicate the fight against AIDS. Drugs are
illegal in China and most police officers view drug-users as
criminals to be cleared off the street and forcibly locked up in
police-run detoxification centres. Those rounded up spend three to
six months in boot-camp-like conditions but over 90 per cent of the
inmates return to drugs once released. In order to qualify for
treatment at a methadone centre a patient must have spent at least
two spells in a detoxification centre, although the health bureau of
Yunnan is trying to have this requirement rescinded.

While AIDS awareness sessions are supposed to be part of the regime
at police detoxification centres, the main thrust is in fact on
discipline and forcibly keeping users away from drugs. Zhou, a
50-year-old addict who started using heroine in 1988 and recently
joined a methadone clinic for treatment, has spent eight spells in
police detoxification centres. He now spends most afternoons at a
PSI-run drop-in clinic for addicts in Kunming in the company of
others like him; drug-users who are trying desperately to quit.

"I knew nothing about the connection between AIDS and drug use until
I came to PSI around a year ago. I have taken drugs for more than 20
years and spent endless months in police centres but I still knew
nothing until I attended some of the PSI awareness talks," he says.

Zhou lost his job as a taxi driver seven years ago and has been
unemployed since. He is divorced and has not seen his son in several
months. He smiles wearily: "I am lucky I didn't get sick. But not
everyone is as lucky."