China Stares Down Stigma

Over the years, producing news stories out of China has often involved maneuvering around the obstacles known as “sensitive topics.” In 1999, for example, our television production team’s mandatory escort from China Central Television bluntly told us: “The most sensitive topic in China this year is unemployed workers. And if your report mentions them, there will be one more unemployed worker in China -- me.”

AIDS was one of the “sensitive issues.” That’s why we felt remarkably lucky to be invited by Chinese public health officials to report on what they are doing to fight HIV and AIDS. Now, having made the trip in May, I realize that more than luck was involved: China is changing.

In the course of 12 reporting trips to China over the past 10 years, I’ve seen the attitude toward news coverage evolve, prodded by astounding economic growth and a new middle class that enjoys new freedoms and expects accountability from government. China’s new efforts against HIV/AIDS -- and willingness to have them covered -- seem to be part of these changes. They come just in time.

One of the first places we were taken in May was to a Beijing subway platform where a photo of a well-known Chinese actor looks out from a poster, urging commuters to be more aware of HIV/AIDS. In other nations, the appearance of this rather bland public service message might not be notable. But according to our hosts, the actor is the first Chinese celebrity to speak out against the disease.

While public health officials are now encouraging discussion of the disease, there’s a great deal of ignorance, fear and stigma associated with HIV to overcome. One estimate has it that only one in four of China’s 900 million rural dwellers has even heard of the disease.

Still, progress is clearly being made. After the subway, we visited a Beijing hospital where Chinese-made, generic HIV drugs are available at a cost of about $60 per month -- roughly half the salary of the average urban worker. At the hospital we met several patients, none of whom would agree to be on camera. One patient told us that his family members had pooled their money so he could travel to the hospital from a distant province. Treatment in his hometown would have been free, but he’d come because he couldn’t risk his neighbors finding out that he was HIV-positive.

De-stigmatizing the disease is going to be crucial. Like India, China could be moving toward an AIDS crisis whose social, economic and human cost could dwarf the one in Africa. The United Nations estimates that China could have as many as 10 million cases of HIV by the end of this decade. As one Chinese public health official told us, “Whether we have 1.5 million or 10 million cases in the next few years depends on how well we do our jobs.”

Throughout the 1980s, as AIDS began to appear in the United States, Africa, Europe and elsewhere, China turned a blind eye to the crisis, regarding it as a disease of foreigners. Then, in 1989, health officials in China’s southwestern province of Yunnan began to notice that people in villages along their border with Myanmar were testing positive for HIV.

Across the unguarded border, in the notorious Golden Triangle, a region nominally under the control of Myanmar, guerrilla armies rule impoverished tribes whose main income is the cultivation of opium poppies, some 60% of which, the United Nations estimates, passes into China as heroin.

As heroin use has spread in China, so has HIV. A physician at a Beijing HIV/AIDS hospital told us the rate of infection among intravenous drug users had been increasing by about 30% a year. The next phase in the spread of HIV began when local officials in populous central provinces such as Henan, Hubei and Anhui organized impoverished villagers to sell their blood plasma. Unsanitary techniques employed in that effort resulted in entire villages being infected with HIV.

For years, silence about the crisis exacerbated it, so it’s encouraging to see how the national government is now taking steps to protect China’s blood supply. One day we happened upon a bloodmobile in Beijing. A man there told us that he was giving blood for the first time because it was his patriotic duty in light of the tainted blood scandal. We were also allowed to videotape a meeting of health officials plotting a strategy to help the infected commercial plasma donors.

In Yunnan, even intravenous drug use, another topic previously deemed “too sensitive” for open discussion, is now publicly acknowledged. In one neighborhood of Kunming, the provincial capital, a storefront needle exchange clinic has been set up. Drug users come in to drop their old needles into a box and the nurses behind the counter give them clean ones, no questions asked.

At a rehab clinic, a 25-year-old recovering addict who used to work in an Internet cafe told us that a friend with whom she used to share needles committed suicide after finding out that she was HIV-positive. She herself had not been tested for HIV. But the expression on her face suggested that she knew what the outcome of such a test would be.

Even with all the progress, China still has major obstacles to face. So far, the primary means of transmission in China have been tainted needles and blood. But that may change. There are 100 million migrants in China’s booming eastern cities who have come from western rural regions in search of better lives. Millions more arrive every year. You can see them at any urban train or bus station, mainly younger, single men and women. The fear is that as they arrive, the disease will come with them. And HIV will become a largely sexually transmitted disease, as it is in much of the rest of the world.

In a city on China’s eastern coast, health officials tested marketplace workers -- the people who sell vegetables and meat in neighborhood stalls, many of whom are from rural areas. In some markets, as many as 10% to 20% of the workers tested positive for sexually transmitted diseases other than HIV. So in an effort to prevent HIV from becoming one of the STDs, health officials have started a program to teach market workers about STD prevention so that they can pass on the information to friends, customers and co-workers.

Health officials say their biggest obstacle is getting people to overcome traditional Chinese reluctance to discuss such topics. And it won’t be easy. Not only must people be educated about how the disease is transmitted and how it can be prevented, they must be educated about how it isn’t transmitted. That is, not from bug bites, handshakes and so forth. As we learned from Li, an HIV-positive hemophiliac in Beijing, societal acceptance of someone with the virus is not yet a given.

Li got HIV through a transfusion 10 years ago, and he now runs a support group in Beijing. He was happy to have us come to his office and proud to show us photos of himself with Nelson Mandela and others. But he also showed us two cellphones. One was for those friends who knew of his HIV status and his work. The other was for people who didn’t -- a group, he acknowledged that includes most of the people he knows. “I just want to have a normal life,” he told us. “I want to go shopping, go swimming and get married to my fiance. Just a normal life.”