CLOCK IS TICKING; WILL CHINA MOVE TO HALT AIDS?

CHINA DESERVES great credit for its successful campaign against SARS, the
severe acute respiratory syndrome that turned up early this year. Within
months thousands were infected, partly because of China's attempt -- at
first -- to keep news of the often deadly airborne disease secret, thereby
allowing the infection to seed in and be transported out. But China has a
monumentally more menacing disease infecting its vast population and would
do well to heed its own recent lesson, learned the hard way from its bitter
experience with SARS.

Few appreciate how fully China could succeed in combating the far more
lethal HIV, even as this virus is moving beyond target groups of drug
abusers and sex workers and is infiltrating every major city, according to
Dr. Yichen Lu of the Harvard AIDS Institute.

China has the medical and pharmaceutical means, manpower, and social
discipline to win its battle against HIV. Otherwise, states a joint report
by the Chinese Ministry of Health and the United Nations, the potential
remains for an onslaught so severe it is viewed as ''China's Titanic Peril.''

Though HIV has been trickling into China for a decade or more, the pace has
picked up in recent years. Yet, its presence is still not getting the
attention that SARS did. Now there is little time to forestall an
explosion. Lu says there are three main reasons why HIV is burgeoning:

Rising drug abuse not only in outlying areas where China borders the
historically drug-sodden Golden Triangle of Burma, Laos, and Thailand, but
also among people deep inside China, its major cities, and their inner-cities.

Blood-contaminated HIV. In the mid-1990s, hundreds of blood collection
centers were set up in China's farming provinces where donors would be
plentiful. Poor farmers, and their wives and adult children, would be paid
for blood. The idea was to pool the donated blood, extract the plasma
(valued for its by-products, such as gamma globulin and clotting factors),
and then re-inject the donors with the remaining red blood cells to prevent
anemia and enable them to donate every few days.

Virtually overnight, batches of pooled blood -- plasma, blood products, and
the red blood cells -- were contaminated. Thousands -- blood recipients and
donors alike -- were infected before the government discovered the problem
in 1997. Largely because so many rural Chinese were dependent on donating
blood to earn a living, it took nearly three years to outlaw the practice.

In 1998, the scale of the problem became painfully clear when 99 percent of
donated blood samples proved HIV positive. However, rogue blood banks
continued the pooling practice long after. As a result, in some farm
communities, nearly all adults became infected with HIV /AIDS and
two-thirds of mothers passed it on to newborns. Further, with nearly 100
million young adult Chinese migrating yearly between rural areas and
cities, HIV travels with them.

Newly available commercial sex workers and the double-digit percent annual
increase of cases of sexually transmitted diseases since early 1980s. In
major cities along China's sprawling coastline, sex workers now are
plentiful, and publicize the availability of heterosexual and homosexual
services. Old cultural taboos are giving way as modernization takes hold
with nightclubs and ethnic bars.

In many ways China is a victim of its remarkable prosperity. More
disposable income provides ready cash for drugs and sexual activity.
China's businessmen regularly make trips outside the country to Thailand,
Hong Kong, and Vietnam, where they engage in risky sex and use drugs -- and
bring home HIV and other sexually transmitted diseases.

Today, China is estimated to have 1.5 million HIV-infected people. Without
heroic measures, that number is expected to grow to 15 million by the year
2010, says the United States National Intelligence Council. That's
one-third of the 45 million new infections anticipated worldwide during
that time. Two years ago, Chinese officials appeared to be warming up to
the idea of a major five-year HIV/AIDS program. They hosted an
international conference in Beijing, which drew some 3,000 AIDS specialists
from across the world, including several Boston medical authorities.

''We came away feeling that China has a real chance to prevent what has
happened in Africa,'' notes Dr. Clyde Crumpacker, professor of medicine at
Harvard Medical school and AIDS researcher. Both he and Lu point to China's
advanced and sophisticated pharmaceutical industry, with its proven
capacity to make huge quantities of cutting-edge anti-HIV drugs and other
sophisticated medicines to treat HIV co-infections.

China also has an unequalled record with vaccines against multiple
diseases, akin to what modern nations have done. But China can produce
enough of them to vaccinate 1.3 billion people yearly For years, China also
has successfully vaccinated nearly all of its children, starting with
newborns, against hepatitis B and tuberculosis.

Over three decades China also has developed enormous expertise in creating
new vaccines. And now is working on a vaccine against HIV. Some of this
research is a joint effort between the Harvard AIDS Institute and the
Institute of Virology of the Chinese Center for Disease Control.

Nominally, China has embarked on a five-year program to inform its people
about HIV, /AIDS, promote prevention, expand and update its medical labor
force, and provide modern anti-HIV treatment on a broad scale. However,
compared to the front-paged action against SARS (an entire hospital was
built in two weeks), the program to fight HIV/AIDS is relatively invisible.

Only a start has been made. Some public health campaigns on AIDS are
underway. A hot line to the countryside so people can phone in for
information about AIDS has been set up. On World AIDS Day, TV programs
feature AIDS. Treatment with antiviral drugs is free-of-charge to all who
were infected through contaminated blood transfusions. Medical training
about HIV has been expanded.

''But there is a long way to go,'' says Lu. To succeed, ''prevention
education programs need to be increased 10-fold. Programs to provide
treatment need to be broadened and access to treatment made available.''

Moreover, he says, ''China needs to put even more money and effort into
developing a vaccine. We should do it with a view toward maximizing our
capacity to supply as much of the world as is needed.''

At all costs we must prevent a 10 percent HIV/AIDS rate ''as is being seen
already in many developing nations,'' says Lu. For China -- and the world
- -- that would be disastrous.