China fears AIDS time bomb

CHINA could be on the verge of a major epidemic of HIV infection,
government advisers in Beijing warn. Zhang Kong Lai a member of
China's National Expert Committee on AIDS Control, believes that the
nation is at a crucial point if it is to prevent the virus from spreading
through its population of 1.1 billion.
China's Academy of Preventive Medicine says that the number of
people infected with HIV rose from under 10 000 in 1993 to more
than 100 000 at the end of 1995, the last year for which figures are
available. Prostitution and drug abuse are fuelling the epidemic, says
Zhang, an epidemiologist at Peking Union Medical College. And in
many rural hospitals, syringes are reused after boiling, he says. "My
feeling is we still have a chance to limit the epidemic. But this is a very
critical time."
Opiate drugs, which are in common use in China, have traditionally
been smoked. At present, most of China's intravenous drug users are
concentrated in Yunnan province in the southwest of the country,
where injection has become increasingly popular (see Figure [which
shows "percentage injecting" going from zero in 1983 and rocketing to
30% and above for 1989 and 1990]). Zhang is organising urgent
studies to see if drug injection is on the increase nationwide. "If
injected drugs are becoming more popular then we have a real
problem," he says.
The policy of providing clean needles for addicts, which is thought to
have slowed the spread of HIV in some European countries, is not an
option in China. "I can't see needleexchange programmes being
allowed," Zhang says. "That would be far too controversial. It would be
politically unacceptable. So monitoring the situation and educating
people about the dangers is very important to us."
Tim Dondero of the international activities division of AIDS and HIV
research at the Centers for Disease Control and Prevention in Atlanta,
Georgia, says it is clear that intravenous drug use exists in Yunnan
province. In the rest of China, the situation is less clear, he says. But he
warns that HIV epidemics "can explode" when the virus is spread by
needles.
Over the past 15 years, heroin has been imported into China from
the "golden triangle", where Thailand, Burma and Laos meet. Given
the opportunity, drug users prefer to inject heroin rather than smoke
opium, because the effect is quicker and more powerful.
Other factors could also be fuelling the virus's spread. Peter Piot,
head of the UN's AIDS programme in Geneva, says researchers are still
not certain how safe the donated blood supply is in China. One
problem is that people are paid for donating blood, he says, which
encourages people at risk of infection, such as drug users, to sell their
blood for cash. However, Zhang says all blood products in China are
now screened.
If an AIDS epidemic does develop in China, the improvements in
HIV treatment that the West is now enjoying are unlikely to be
available to people there. "Using the drug cocktails

that you have in the West is impossible in China. It would be too
expensive," says Zhang. Researchers are planning clinical trials of
Chinese herbal medicines for AIDS.
But Zhang says the stigma of AIDS and HIV could prevent many
people from getting any sort of treatment. "People who are infected or
who think they may have been exposed to the virus are afraid to go to
a hospital," he says.