AIDS SCOURGE TRAVELS FAST ON ANCIENT CHINESE ROAD

RUILI, China -- This ancient road has had many names: Old tea-horse
trail. The Burma Road. Route 320. But the label that matters most
today is one that appears on no sign at all: the AIDS road.

Past truck-stop brothels and through disease-ravaged cities and
villages in China's far southwest Yunnan province, this two-lane road
carves the path of an HIV epidemic that is growing faster than
international health officials previously thought.

This is the main road through the epicenter of AIDS in the world's
most populous country, where a new national study shows that 200
people are being infected every day. It is a central artery through
which sex, drugs and trade are spreading the virus into previously
untouched swaths of the population, researchers say.

There are ominous precedents. Key trucking routes like this helped
spread AIDS to tens of millions of people in India and Africa, the
world's worst-hit regions, starting with drug users and prostitutes,
then truck drivers and, ultimately, their families. As China's
surging economy fuels the construction of thousands of miles of new
roads, health officials, activists and frontline doctors are racing
to curb the Chinese epidemic before a similar explosion occurs.

"Most Chinese people still think that only drug users and sex workers
are affected," said Wang Jing, an HIV counselor in the provincial
capital, Kunming, "but . . . the disease has begun affecting everyone."

After initially denying it had an AIDS problem, China acknowledged
the full scale of the epidemic in 2003 and has made strides in
embracing foreign aid, tackling drug abuse and providing medical
care, AIDS experts say.

To journey along the road to Ruili, Baoshan, Mengshi, Kunming and
many stops in between is to traverse a timeline of China's struggle
with AIDS: the origins, the present and the obstacles ahead. Life
along the road also illustrates how a shortage of government funds,
the stigma surrounding the virus and public misunderstanding of its
spread into the wider population are threatening efforts to control
the epidemic.

The largest survey on AIDS in China, released Jan. 25, showed that
the rate of infection is rising, with 70,000 new cases reported last
year. More important, the joint study by China, the World Health
Organization and the United Nations' AIDS program found that the
disease is moving into the general population, with a growing share
of infection in pregnant women and the spouses of men who visit prostitutes.

"Sex work is moving it toward the general population," said Henk
Bekedam, the China representative for WHO. The new infection rate, he
said, showed the situation in China was "more serious than we thought."

Ground zero of China's AIDS epidemic is this remote border town,
where Route 320 begins its 500-mile journey north to Kunming as an
inconspicuous ribbon of dirt veering over the boundary from Myanmar.

Pivotal City For Centuries

Ruili has a reputation as China's gateway to Southeast Asia, where
explorers, armies and criminals have gravitated for centuries to swap
jade, arms and poppies. Some of China's earliest AIDS cases were
found here in 1989, and by the mid-90s the mix of Chinese and Burmese
heroin addicts and prostitutes accounted for more HIV cases than any
other city in the country. When the government vowed to strike hard
against prostitution, police simply closed the karaoke bars and "hair
salons," sending sex workers into even darker corners of society.

But Ruili now illustrates China's efforts to stem the epidemic. The
government has opened 10 methadone clinics to help wean addicts from
heroin, and foreign-aid groups are permitted to promote testing and
condom use among prostitutes.

That new approach is on display at the Rainbow Center, a
foreign-funded non-governmental organization in Kunming, where former
and current drug users slip into a nondescript two-story building to
spend their days together, pick up free needles and condoms, and get
tested for HIV, with the assurance that they won't be arrested when
they step outside, as they still are in much of China.

"Many of those programs were illegal until last year," said Hu Jin of
Save the Children UK. "In the past, just holding condoms could be
used as evidence to arrest [sex workers]."

But China's challenge has moved beyond simply high-risk populations.
The task is educating a population that misperceives the virus as the
exclusive scourge of drug addicts and prostitutes. The road north
through the mountains--part of the Burma Road supply line used by
U.S. and Chinese troops in World War II--is lined with scores of
hamlets such as Sugarcane Garden Village, little more than a cluster
of palm trees, small stone homes and an elementary school. The
population of 1,100 makes its living planting vegetables and rice and
selling snacks to truck drivers.

"Our No. 1 problem? Drugs," said Yang Senbin, 62, a farmer. "It will
ruin your life. We hate this problem."

Yang lives amid one of the densest concentrations of AIDS cases in
China, but asked if he has ever met a person living with the disease,
he said he didn't think so.

That's because people with HIV in China rarely dare to reveal it. In
her denim jacket and lightweight black scarf, 33-year-old Ma looks
like anyone else in a Kunming restaurant. Ma, who didn't want her
full name used, contracted HIV after 10 years of shooting heroin,
which she took up as a teenager because it seemed as though everyone
else was doing it, she said.

She is hardly the image of a street addict, yet she is the face of
China's evolving HIV problem. Even though Ma works full time helping
people with HIV get access to government services, she doesn't dare
tell her parents she is sick.

"I'm afraid they will be very disappointed," Ma said.

The recent study estimated that China has 650,000 HIV/AIDS cases,
revised from rougher estimates of 840,000. That change reflects only
a better measure of how many people were infected in a limited
outbreak tied to a blood-selling scheme. As the study's authors
cautioned, "those new numbers should not mask the fact that HIV
infections are on the rise."

That rise reflects in part the rapid growth of prostitution during
two decades of economic reform, which have fueled unemployment and
sent millions of peasants migrating in search of work. Chinese
authorities estimate there are 3 million to 4 million women working
as prostitutes in massage parlors and truck stops and so-called
karaoke bars and hair salons.

They are places such as the Chrysanthemum Inn, a dilapidated roadside
shack just up the road from Ruili. A bare bulb illuminates the
unheated dining room and a row of rooms--each with bare walls, a bed
and a pink blanket--are marked with hand-painted white numbers: 1, 2,
3. The overloaded trucks that whine to a stop here are headed
everywhere --Beijing, Shanghai and beyond.

"Are you looking for a virgin?" the lead cook asked a table of
visitors. She could produce one, she said, for about $2,500. A local
taxi driver snorted and countered that he could find one for $125.

After lunch, the cook offered sex with a female kitchen worker for
$6. But asked what it would cost for sex without a condom, she said,
"No way. Not in this day and age. Everybody's afraid of dying."

To prevention specialists, that is very encouraging--far more
encouraging than the experience of one counselor who recently
demonstrated condom use to a group of peasants by employing a banana
as a prop. When she returned weeks later, she was greeted by puzzled
villagers who pointed to the banana tree, with the condom still
affixed on a piece of fruit, and complained that its presence had
produced no benefit.

Nowhere is prostitution's role in the epidemic clearer than in
Baoshan, a low-slung mountain town of white-tile-covered buildings,
where HIV spreads mostly through sex rather than drugs, according to
the local center for disease control.

That means key players in the epidemic are people like 19-year-old
Fangfang, who spends her evenings wearing a denim miniskirt in an
open-air storefront of the red-light district, trying to entice
passersby into spending about $18 to stay a couple of hours. When she
left her remote Yunnan hometown two months ago, Fangfang was drawn by
the whispered promise of far rosier prospects than she found, she said.

"Friends had come back and told us how good the outside world is,"
she said. "But they tricked us."

Fangfang plans to go home soon. She will tell her family she worked
at a supermarket. In the meantime, she says she uses free condoms but
complains that health workers give her only three a day, so she has
to make up the shortfall with her own money. Asked whether she knows
how to avoid AIDS, she is quick to nod but later admits she is short
on details.

"Can you tell me," she said, "what are the ways the disease is transmitted?"

City health authorities estimate there are 5,000 prostitutes like her
in the Baoshan area, and they concede that, even with high-level
cooperation from party officials, they don't have the money to
adequately promote condom use among them.

"Last year the government spent half a million yuan [$62,000]" on
AIDS prevention in the area, said Yang Xuanmei, head of Baoshan's
AIDS prevention program. "That might sound like a lot of money, but
we're talking about 2.4 million people."

Condom Effort Uneven

As a result, prevention efforts are patchy. The government adopted a
high-profile condom distribution plan, and though condoms can be
found in the rooms of the high-end Landu Hotel, there are none at the
Military District Inn, where a stay is less than $4 a night.

Moreover, things are about to get much more complicated.

By next year, 50 miles of sleek new expressway will link Baoshan to
points south. From an AIDS standpoint, the new Baolong Highway poses
multiple threats: an influx of 10,000 mostly male workers, who later
will scatter to their home provinces, and then a fast new road to
boost traffic and speed the transfer of the virus.

The urgent task is getting the workers and drivers to use condoms,
which traditionally are unpopular in China--only 4 percent of
contraceptive users choose that method. The Asian Development Bank is
sponsoring a project to limit and measure the rise in HIV along the
new highway, hoping to raise condom use among men like road worker
Zhang Mingzheng.

Zhang, 58, who was carrying rocks in the fading light of a setting
sun one recent evening, laughed when asked whether he uses condoms at
local brothels. He is too old to seek out nights like that, he said.

"But the young men, sure, in the summers they go into town," he said.
"And everyone knows the truth is people don't use condoms every time."