HIV/AIDS in Yunnan

China's first AIDS case was identified in 1985 in a dying tourist. [Settle E. AIDS in China: an annotated chronology: 1985–2003. Montreal: China AIDS Survey, 2003] In 1989, the first indigenous cases were reported as an outbreak in 146 infected heroin users in Yunnan province, near China's southwest border. [Ma Y, Li ZZ, Zhang KX. Identifi cation of HIV infection among drug users in China. Zhonghua Liu Xing Bing Xue Za Zhi 1990; 11:184–85 (in Chinese).]

Heroin flow

Heroin flows into Yunnan Province from neighboring Vietnam, Laos and Myanmar, bringing with it HIV. The province's first cases were reported in 1989. With a population of 44 million, Yunnan now has only 200 health workers trained for the disease. Officials estimate that the province has 80,000 infected people, most of them intravenous drug users who have spread the disease by sharing needles. In Gejiu, a city of 310,000 people on a route favored by drug traffickers, initial rounds of AIDS testing in recent years found more than 1,000 people with HIV, nearly all drug users or prostitutes. Unlike some other provinces, Yunnan has welcomed international nonprofit groups and support from Britain, Australia and, more recently, the United States [Chinese City Emerges As Model in AIDS Fight (June 16) by JIM YARDLEY. The New York Times (2005)] .

'3 Needles'

"3 Needles" is a 2005 dramatic film depicting the lives of people in Yunnan during the survival of the HIV/AIDS epidemic. One of the film's protagonists, a pregnant black-market operative played by Lucy Liu, makes her living as a blood smuggler. When several blood donors begin to get sick and die, she realize the jeopardy for entire village's safety and beyond. "3 Needles" is an attempt to visualize the profound experience of Gao Yaojie and many others as we can read in The New York Times sequel [Detained AIDS Doctor Allowed to Visit U.S. Later, China Says (February 17); China Covers Up Detention of AIDS Doctor (February 16); China Places AIDS Activist Under House Arrest (February 6) by JIM YARDLEY. The New York Times (2007)] .

Needle exchange

Since 2001, the of the State Council of the People's Republic of China has officially advocated needle social marketing as an HIV prevention measure [State Council of the People’s Republic of China. China’s action plan on HIV/AIDS prevention and containment (2001–2005). State Council Document (2001) number 40. Beijing, 2001 (in Chinese)] . Evidence from research and study tours to countries such as Australia [Bowtell W. Australia. In: Yamamoto T, Itoh S, eds. Fighting a rising tide: the response to AIDS in East Asia, 1st edn. Tokyo: Japan Center for International Exchange, 2006: 19–52] , which runs successful needle exchange programmes, prompted the Ministry of Health (China) to support the first such programme in Yunnan province and Guangxi Zhuang Autonomous Region in 1999. On the basis of the successes of the pilot, the programme began scale-up in 2004 and plans are in place to open an additional 1500 methadone maintenance treatment clinics for about 300 000 heroin users by 2008. A National Training Centre for methadone maintenance treatment has been established in Yunnan to provide clinical and technical support.

Commercial sex

Commercial sex work is illegal in China; hence, brothels are illegal and commercial sex workers operate out of places of entertainment (eg, karaoke bars), hotels, hair-dressing salons, or on the street [Gil VE, Wang MS, Anderson AF, Lin GM, Wu ZO. Prostitutes, prostitution and Sexually transmitted disease/HIV transmission in mainland China. Soc Sci Med 1996; 42: 141–52.] . The traditional strategy for controlling HIV transmission through commercial sex workers has been the development of stricter laws to prevent risky behaviours [Standing Committee of the National People’s Congress. Decision on the strict prohibition against prostitution and whoring. Beijing, 1991 (in Chinese)] , accompanied by raids on suspected sex establishments by public security officials [Husain L. Policing AIDS in China: offi cial discourses, change, continuity, and unoffi cial voices. In: Christiansen F, Dosch J, Caroline R, Hamelman S, eds. Leeds East Asia Papers. Leeds: Department of East Asia Studies, University of Leeds, 2004] [Gil VE, Wang MS, Anderson AF, Lin GM, Wu ZO. Prostitutes, prostitution and STD/HIV transmission in mainland China. Soc Sci Med 1996; 42: 141–52.] . In 1996–97, following the success of prevention interventions in neighbouring Thailand [Anon. Thailand condom campaign reduced AIDS infections by fifty percent. AIDS Wkly Plus 1996; Aug 12, 19] , the Chinese CDC launched the first intervention projects to promote safer sex behaviours to prevent HIV and other sexually transmitted diseases in commercial sex workers working at entertainment establishments in Yunnan [Wu Z. Final Report for Intervention on Female Prostitutes in Yunnan. Final Report to the World Bank. Beijing, China: Chinese Academy of Preventive Medicine, 1997] [Wu Z. Promoting condom use among female prostitutes in natural settings in Yunnan, China. 12th International AIDS Conference; Geneva, Switzerland; June 28–July 3, 1998.] .

Numbers

In 2002, a United Nations-commissioned report, entitled "China’s Titanic peril" [Eldis gateway. HIV/AIDS: China’s Titanic peril: 2001 update of the AIDS situation and needs assessment report. UNAIDS, 2002. http://www.eldis.org/static/DOC9892.htm (accessed Oct 26, 2006).] , estimating that China had about 1 million cases of HIV, and that it was on the brink of an “explosive HIV/AIDS epidemic…with an imminent risk to widespread dissemination to the general population”. The report continued: “a potential HIV/AIDS disaster of unimaginable proportion now lies in wait.” A few months later, the US National Intelligence Council estimated that 1-2 million people were living with HIV in China, and predicted 10–15 million cases by 2010 [National Intelligence Council. The next wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India, China. ICA 2002-04 D. September, 2002: http://www.fas.org/irp/nic/hiv-aids.html (accessed Oct 26, 2006)] . Other reports at this time were similarly pessimistic: from the Center for Strategic and International Studies (Washington, DC, USA), HIV/AIDS was referred to as China’s timebomb [Bates G, Morrison SJ, Thompson D, eds. Defusing China’s timebomb-sustaining the momentum of China’s HIV/AIDS response. A report of the CSIS HIV/AIDS delegation to China, April 13–18, 2004. 2004: http://www.csis.org/media/csis/pubs/040413_china_aids.pdf (accessed Oct 26, 2006).] ; and from the American Enterprise Institute as the AIDS typhoon [American Enterprise Institute, Washington, D.C. Can Asia avoid the AIDS typhoon? Nov 11, 2002: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=722 (accessed Oct 19, 2006)] . However, as Wu and colleagues note, by 2006 the number of people living with HIV/AIDS is estimated to be 650 000—a figure revised downwards by 200 000 from 2005 [Ministry of Health, People’s Republic of China, Joint United Nations Programme on HIV/AIDS, World Health Organization. Update on the HIV/AIDS epidemic and response in China. 2006: http://data.unaids.org/publications/External-Documents/RP_2005ChinaEstimation_25Jan06_en.pdf (accessed Oct 26, 2006).] . After a slow start and reluctance to recognise the existence of risk activities in its population and of the HIV epidemic, China has responded to international influences, media coverage, and scientific evidence to take bold steps to control the epidemic, using scientifically validated strategies [Wu Z, Sullivan SG, Wang Y, Rotheram-Borus MJ, Detels R. "Lancet" (2007) 369(9562):679-90] . A Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China (2004), [State Council AIDS Working Committee Offi ce, UN Theme Group on HIV/AIDS in the People's Republic of China. A joint assessment of HIV/AIDS prevention, treatment and care in China. Beijing: China Ministry of Health, 2004] developed jointly by UNAIDS and the State Council of China, estimated that China had 840 000 people living with HIV/AIDS. This figure has been revised down to 650 000 in 2005 in light of more representative data collection and more appropriate estimation methods [Ministry of Health of China, UNAIDS, WHO. 2005 update on the HIV/AIDS epidemic and response in China. Beijing: Ministry of Health, 2006] .

Yunnan ahead

Yunnan province has shown strong support for implementation and advocacy of harm-reduction strategies that reduce HIV transmission in its many drug users, whereas Henan province had been slower to respond to the needs of former plasma donors in the early stages of the epidemic [Watts J. AIDS in China: new legislation, old doubts. Lancet 2006; 367: 803–04] . The distribution of HIV in China is not even, and is concentrated in areas with high drug use (eg, Yunnan, Guangxi, Xinjiang, and Sichuan) and in areas where people were infected through unsafe blood or plasma donation (eg, Henan, Anhui, Hebei, Shanxi, and Hubei). The number of cases ranges dramatically between provinces (see the map of China on your right), with, for example, just 20 cases reported from Tibet but well over 40 000 in neighbouring Yunnan.

ee also

* HIV/AIDS in the People's Republic of China
* Gao Yaojie

References