WITH IGNORANCE AS THE FUEL, AIDS SPEEDS ACROSS CHINA

KUNMING, China -- Li Bai's body is on the front line of the battle to
prevent an explosion of AIDS in China. For the last seven years, the
baby-faced 23-year-old with platform sneakers and blond-streaked hair has
been using drugs -- a dangerous hobby in a city where an estimated 40
percent of intravenous drug users are now infected with H.I.V., the virus
that causes AIDS.

She has long known about AIDS, at least in a general sense. But, she
confesses, she has sometimes shared needles when shooting up. She has also
sold sex on the street, she admits, and condoms have not always been a
priority. Such behaviors put her at extraordinary risk of acquiring H.I.V.
and of spreading it.

"I'd heard of AIDS and was scared of it, but when I needed drugs or needed
money, I did what I had to do," said Ms. Li, sitting in the lounge in the
drug treatment clinic here where she was recently admitted.

AIDS in China is spreading at a breakneck pace -- reported cases are up 67
percent this year over last -- in large part because its citizens are so
poorly informed about the disease.

With only scattershot education programs, even those at very high risk of
getting AIDS often do not know how to protect themselves; many have never
even heard of H.I.V. In a country where patients generally receive no
counseling after testing positive for H.I.V., known carriers often have
only a vague idea of how it is transmitted, and they inadvertently infect
others.

As a result, a disease that was for many years confined to certain groups,
particularly drug users, has started to move quickly into the general
population, generally through sex. To make matters worse, the barriers that
tend to slow sexual transmission from high-risk to low- risk groups in the
West are extremely porous here.

In China, a huge number of poor young women work part time selling sex in a
large and amorphous sex industry. As for gay men, intense social stigma and
the pressure to carry on family lines pushes the vast majority to marry and
father children, so they have sexual relations with wives as well as male
lovers.

"China is on the verge of a catastrophe that could result in unimaginable
human suffering, economic loss and social devastation," said a recent
internal United Nations report that was not publicly released, which
criticized China for its "weak response" to AIDS.

It concluded that only immediate and aggressive action could stem the
spread: "An H.I.V./AIDS disaster of unimaginable proportions now lies in
wait to rattle the country and it can be feared that in just a couple of
years, China might count more H.I.V. infections than any other country."

China now estimates it has 600,000 people with H.I.V., although
surveillance is extremely poor in some severely affected areas and many
experts believe that number is drastically low.

Although the Chinese government has admitted this year to having a serious
AIDS problem and recently initiated a series of educational programs, many
are still in the planning stage and others are small local programs
financed by foreign organizations. Although officials here in Yunnan
Province have welcomed such efforts, many provinces have not, so
information has not permeated the poor rural regions where many Chinese
with AIDS live.

In the largest national survey to date, conducted a year ago by China's
State Family Planning Commission, 20 percent of Chinese in 12 counties
representing a cross section of the country had never heard of the disease.
Only 50 percent knew that it could be transmitted by sex.

More alarming, the most profound ignorance was found in Shangcai County in
Henan Province, where some villages have adult H.I.V. infection rates
approaching 50 percent -- the result of selling blood to collectors that
use unsanitary practices.

Forty percent of the county's residents said they did not know how AIDS
could be prevented, suggesting that they could be unknowingly passing it to
others.

Wang Zhiguo, a former blood seller from Henan Province, said in an
interview that he had not even heard of AIDS until this spring, long after
he began to suffer from AIDS-related headaches and fevers. Even today, he
is unsure whether H.I.V. can be transmitted through sex. And from mother to
infant? "I'm not clear about that either," Mr. Wang said.

Dr. Zhao Baige of the Family Planning Commission, who has pressed for more
aggressive education, said: "In our studies, less than 50 percent of people
knew that condoms could prevent the transmission of H.I.V. That shows we
have a serious prevention problem."

As the government has worked hard to rein in unhygienic practices in the
blood industry, the sex industry has become for many experts an even more
worrisome conduit.

The relaxation of economic and social controls over the last two decades
has been accompanied by a resurgence in prostitution, which had been
virtually eliminated by Mao. Today, paid sex is a common activity
associated with business trips, official junkets and sometimes tour
packages. Even small towns have businesses that function as brothels --
nominally beauty salons, massage parlors or karaoke bars.

And sex work, referred to politely by officials as "entertainment work," is
often a low-wage part-time job that poorly educated rural women cycle in
and out of when they need cash. Many have never heard of AIDS, and the mix
of ignorance, mobility and sex is an efficient way for the disease to spread.

In a low white building that used to be a shoe factory, in a small town
deep in rural Sichuan Province, five bleary-eyed young women emerged in
midafternoon from the dormitory of the karaoke bar where they have found
temporary employment. They cuddled together on a plush couch, next to a
dance hall with thick velvet curtains, surrounded by bedrooms.

"It's hard to explain how any of us got here," said a delicate woman named
Tan, wrapped in a pink quilted bathrobe decorated with little red elves.
"But these days the economy is not good, and without a diploma it's hard to
find work, and I haven't found a husband yet." She, like others, spoke on
the condition that the town not be named.

A decade ago, Ms. Tan -- originally from a big city in western China --
would have been assigned a job by the government. But with reforms, that
practice has ended, and so she fends for herself.

The women tend to spend just a few weeks or months working here, before
moving on to other places or careers. Their clients are local officials and
businessmen, as well as the long-haul truckers who pass through. Their boss
is a police officer's wife.

"I've come here to work several times before and stayed for a couple of
weeks each time," said a woman named Zhang, a peddler in another town.
"Sometimes it's because my finances are bad," she said. "Sometimes it's
because I'm unhappy and I want to get away."

All the women said they had come to this relatively remote location because
they did not want their families to find out about their work. Most said
they had heard of AIDS, which they called "a frightening disease," since
their boss had allowed a foreign health group to hold lectures about H.I.V.
But the new arrivals were uncertain about exactly how to prevent it,
believing that a douche would solve the problem.

Such girls can be found virtually all over China, from the smallest towns
to the biggest cities, where thinly obscured sex businesses occupy many
blocks. In Kunming, a long strip of Xibao Street is lined with
"hairdressing salons" where employees dress in short, tight skirts and
leopard-print tops, where plush couches outnumber barber's chairs.

"In saunas, massage parlors, karaoke bars, dance halls -- some of the
hospitality girls also do sex work," said Wei Shanbo of the Wuhan city
health bureau at a recent seminar on AIDS. "They're in hairdressing salons,
too -- but they're special salons -- there's no pair of scissors to be found."

Recent studies by Chinese researchers have found rising levels of H.I.V.
among sex workers -- up to 10 percent in some cities -- as well as low
levels of awareness about H.I.V. and condom use. In one survey of 63 sex
workers in Shanghai from beauty parlors, bars and saunas, only 18 had heard
of AIDS and only 2 knew how it was transmitted.

Chinese doctors tend to view sex workers as the "bridge" that allows AIDS
to spread, and an increasing number of programs seek to educate this
population.

But then there are the men.

"The government always wants to say AIDS and sexually transmitted diseases
are from prostitutes," said Pan Cuiming, a professor of sociology at
People's University in Beijing. "But most of these girls are just poor
children -- they are victims -- they didn't have diseases when they
started." He noted that some were paid as little as $1.20 for sex and
lacked the power to insist on condoms.

Professor Pan and others say that education needs to focus more on the men
who bring the virus back to their spouses. Research by Professor Pan and
others suggests that the men tend to be businessmen, a group that previous
AIDS prevention efforts have not focused on.

One young man named Sun recalled his life over the last two years working
in advertising in the southern Chinese boomtown of Shenzhen, saying: "I was
making a lot of money and going to clubs and having sex with a lot of
people. I know a number were prostitutes. I sometimes used condoms,
sometimes did not."

As a result of such exploits, there is a well documented, skyrocketing rate
of sexually transmitted diseases like gonorrhea in China. That disease, for
example, quickly produces symptoms, and people tend to seek immediate
treatment. But because AIDS lies dormant for years, those who have
contracted H.I.V. are mostly yet to be counted.

The extent of the trend among China's gay population is a huge unknown,
although some specialists in Beijing say that about a third of their
patients with H.I.V. were infected during homosexual relationships.

The Chinese government is addressing the trend, although the process has
been moving slowly.

"We realize that now is the final chance for China to control H.I.V./ AIDS
at low expense," said Dr. Zhao of the Family Planning Commission.

Charged with carrying out the one-child policy, the commission has in
recent years expanded its focus to women's health and is making plans to
provide AIDS education at all of its clinics starting next year. Dr. Zhao
said nearly all of China's provinces had agreed to take part in the
program, although there had been some resistance at the local level and
only about one-third had financing.

Indeed, previous efforts to provide H.I.V. education and raise awareness
have all too often been defeated by concerns about saving face and social
conservatism. Although the "entertainment workers" at the
shoe-factory-turned-karaoke-bar are now learning proper condom use,
prostitutes in detention are more often lectured about renouncing an
immoral career than taught techniques for protected sex. Likewise, the
Jieshibang Company, a condom manufacturer, has had its safe-sex billboards
removed by local authorities in 5 of 20 cities.

"There is low acceptance of condom use, and people think that if it's
related to sex it's a bad product," said Wang Xuehai, a company executive,
adding, "our biggest barrier has been China's traditional ideas."