- The Washington Times - Thursday, October 23, 2003

SHUANGMIAO, China — Nearly a decade after getting infected with HIV by selling her blood at an unsanitary government clinic and after years of fruitless appeals and protests to the government, farmer Li Suzhi got the medicine that might save her life.

The government has been distributing expensive anti-retroviral drugs for free to Mrs. Li and dozens of other AIDS patients in her village in eastern Henan province since July.

But after taking the cocktail of three drugs for three days, she stopped. The side effects were unbearable, she said. Other villagers say they skip doses on days when they really need to work and can’t afford to feel sick all day.

After years of denial and foot-dragging, China’s government has started responding to the country’s AIDS epidemic in a serious way. In pilot programs in 51 counties, authorities have been distributing anti-retroviral drugs to people who can least afford them — thousands of poor farmers who sold their blood amid unsanitary conditions in government-backed blood-buying drives in the 1990s.

“It’s a huge attitudinal shift,” said Ray Yip, director of the AIDS program in China for the U.S. Centers for Disease Control and Prevention. “By doing this … the government is starting to do the hard part.”

But international experts are worried that critical shortcomings in the program — including a lack of follow-up care and counseling and a shortage of trained personnel — will result in more harm than good.

“The advent of poorly monitored anti-retroviral drug treatment virtually guarantees the emergence of a drug-resistant HIV ‘superinfection’ likely to spread to other parts of China, Asia and the rest of the world,” Andrew Thompson, a researcher at the Center for Strategic and International Studies in Washington, wrote recently in the South China Morning Post.

And although attitudes of health officials in the central government have opened considerably, the preferred tactic of local officials often remains denial and suppression.

Aid workers agree that the most troubling province is Henan, China’s largest with 96 million people. Henan was most active in promoting blood-selling among farmers and is thought to have the most number of “AIDS villages,” where infection rates of 40 percent are not uncommon.

China says it has about 1 million HIV carriers. But some activists estimate that number reflects those infected with HIV through blood-selling alone and the number of AIDS villages to be as high as 1,000. The CIA has predicted the number of HIV carriers in China will rise to 10 million to 20 million by 2010.

Faced with such statistics and mounting international pressure, Beijing this year allowed two Chinese pharmaceutical firms to begin producing four AIDS drugs. The government already has started distributing the drugs in 51 counties in 11 provinces, including nine counties in Henan, and plans to expand to 100 counties by the end of the year.

The annual per-patient cost of treatment with the Chinese version of the drug cocktail is about $425, while imported drugs, available to paying customers at hospitals in Beijing, run nearly $5,000 a year.

But after years of being neglected and even abused and lied to by officials, some villagers are wary of government intervention.

“The actual situation is vastly different from what we expected,” said Xu Jie, a researcher at the National Center for AIDS/STD Control and Prevention under China’s equivalent of the CDC. “The main reason we can’t find them is because some people don’t want anything to do with health officials or getting checkups.”

For those who take the drugs, international experts have even greater fears: That low compliance with the complex drug regime might select for a more resistant form of HIV.

“It’s potentially very dangerous,” said an expert at an international aid organization working in China, who spoke on the condition of anonymity.

AIDS is still such a sensitive topic in China that many foreign aid workers fear that saying the wrong thing publicly could jeopardize their work here.

Patients are checked only once a month and are offered no counseling or treatment for AIDS-related infections.

China hopes to change that with a $98 million grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria, approved by the board last week. Much of the money, to be disbursed over five years, is to be spent training doctors in AIDS treatment and eventually increasing the number of people under treatment to 40,000 from 3,000. Experts are hailing the grant as a major turning point in China’s fight against the disease.

Yet activists worry such money will promote corruption.

“These AIDS villages are in remote and backwards places,” said Li Dan, director of Orchid, a charity helping AIDS orphans. “It’s very difficult to believe the money will be used for the people infected.”

Even health officials in Beijing express frustration at dealing with officials in the provinces.

“Local governments face all sorts of problems — building the economy, laid-off workers, overtaxation of farmers, state enterprise restructuring,” said Mr. Xu. “AIDS is not even a priority. They say, ‘You’re spending money on prostitutes or drug-users, but our laid-off workers don’t have anything to eat.’”


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