HEROIN, IGNORANCE BOOST SPREAD OF AIDS IN CHINESE PROVINCE

KUNMING, China -- This scenic capital of China's southern Yunnan
Province has earned itself a more unsavory sobriquet -- China's AIDS capital.

Historically, this multi-ethnic region of stunning valleys and
gorges, including a site locals say is the fabled region of
Shangri-La, stood out in mostly Han China for its uniquely diverse
culture and beauty.

Now the province, where China's first HIV cases were discovered in
the early 1990s, is home to about 30,000 of the 140,000 Chinese who
are HIV-positive, according to official reports. And that's almost
certainly an underestimate, said Yang Maobin, director of Daytop, a
HIV/AIDS care center in Kunming.

Experts say that in reality there could be as many as 200,000 HIV
cases in Yunnan and 300,000 more in neighboring Guangxi Province and
western Xinjiang Province.

Part of the reason almost half of China's HIV cases are concentrated
in these areas is their proximity to the world's largest
heroin-producing areas -- Afghanistan in the case of Xinjiang and the
"Golden Triangle" countries of Thailand, Myanmar, and Laos in the
case of Yunnan and Guangxi.

Starting in the 1980s when China's economic reforms began to take
hold, relentless social change and growing inequalities led many
disaffected youth to experiment with the heroin being brought into
China by smugglers in cahoots with corrupt local officials.

That, combined with an almost total lack of AIDS awareness, has
"burnt a hole into our society," said Yang.

Yunnan's heroin addicts soon began sharing needles -- the surest way
of contracting HIV. While the risk of HIV transmission during
unprotected sex is less than 1 percent, anyone sharing a needle with
an HIV-infected person is almost certain to contract the disease, Yang said.

Zhu Jian, 29, a grim-faced HIV-positive heroin addict who frequents
Yang's clinic, said he and those in his circle of heroin addicts had
no knowledge about this.

"Nobody told us what was going on," Zhu said. "At first we didn't
know the risks" of needle-sharing. "We didn't even really know what
AIDS was. Then, when we knew, we just didn't care."

A lack of public AIDS education and alienation among hardened heroin
users is common in most countries. But in Yunnan and other western
provinces the problem is compounded by the preexisting feeling of
social dislocation within the region, which is China's poorest.
Minority groups make up about 35 percent of the local population and
often feel excluded from mainstream life in predominantly Han China.

"In China there's a clear correlation between ethnicity, poverty, and
HIV," said Joel Rehnstrom, country coordinator with the UNAIDS
program in Beijing. "However, it's a very sensitive issue, and the
causality has not been well understood because of a lack of data and studies."

Rehnstrom said that problem manifests itself in simple ways, such as
local governments that don't create communication and education
messages tailored to ethnic minorities, who often speak only halting
Mandarin, and don't create HIV testing facilities that are truly
confidential. As a result, he said, large swathes of the population
remained ignorant about HIV and are hesitant to test themselves for
the disease.

Most health experts agree that China's HIV rates are unlikely to rise
as high as those in sub-Saharan Africa -- which has more then half of
the world's 40 million HIV-positive people -- mainly because of its
better healthcare system and less-risky patterns of sexual activity.

Though the Chinese government has needle exchange programs as well as
a program to provide AIDS patients with free medications, their
effectiveness is flawed, Yang said. Many heroin addicts stay away
from the official centers where they can get free needles, and the
bureaucratic processes HIV patients need to follow to receive
medications are so cumbersome that fewer than 10,000 people are
receiving medicine.

So Yang worries that in Yunnan the problem could soon burst out of control.

"On one hand, our advantage is that for now HIV is spreading mostly
between drug users," said Yang. "On the other, this is a huge problem
because if we don't intervene into this problem now it could break
out into the general population" because "most female addicts have to
prostitute themselves" to support their habit.

Ma Chun Mei, 32, a snack food operator and heroin addict, said she
enrolled herself into Yang's clinic because she realized she was just
a step away from doing that.

"I know I would have become a prostitute because I was earning" about
$300 a month, she said quietly, "but spending all of it on drugs and
borrowing more." "Many of my friends can't bring themselves to face
their demons, so many are going the wrong way and selling
themselves." If HIV-infected sex workers spur a wider wave of
HIV/AIDS in China as they have in India, about 5 million Chinese
could get infected with the virus, the World Health Organization has warned.

Yunnan reported last year that in some areas the HIV infection rate
among pregnant women was already 1 percent, but China continues to
underspend on all public health issues, including on AIDS, according
to Henk Bekedam, the chief World Health Organization representative in Beijing.

The greater problem, Yang said, is that the fight against HIV/AIDS in
China is crippled by the entrenched prejudices that government
officials, healthcare practitioners, and the general population have
against the disease and the people it afflicts.

Zhu said when he was diagnosed with HIV, his family and friends
immediately rejected him.

"They wouldn't even let me drink water from the same glass as them,"
said Zhu. "Overnight I became something else, not fully human."

Alienated and diminished, Zhu said he left home and took to a life of
petty crime to support his habit. So far he's been arrested nine
times for botched robberies. Each time, he said, local police sent
him to compulsory six-month detoxification programs at government
rehabilitation centers, where inmates are routinely beaten,
intimidated, and humiliated.

Zhu has become fatalistic, saying the dearth of effective medications
in China means AIDS will probably kill him before heroin does.

"I come by here every day and sit around with people," said Zhu
gesturing at the group of fellow heroin addicts playing board games
in Daytop's recreation room. "But in my heart I know no one is
interested in helping me. I'm not a good person, I know. I steal and
I bully people. I'm a person. But that doesn't mean anything to
anyone. This is the dark side of Chinese society today."