Current estimates

Current estimates by UNAIDS estimate that 700,000 people were living with HIV in China in 2007²⁰. This figure is lower than the previously published estimate of 840,000 in 2003. This is not because prevalence is falling, but is due to better data and improved methods of estimation. However, massive under reporting, especially in the rural areas, means that even the revised figures may be inaccurate.

UNAIDS and other organisations had previously estimated that by 2010 there could be a generalised epidemic with between ten and twenty million HIV positive Chinese²². Although this is no longer anticipated there is still potential for a severe epidemic in China.

The history of AIDS in China

n 1989, 146 injecting drug users (IDUs) in Southwest Yunnan were identified as HIV positive. By the end of the year the total number of infected people was reported as 153 Chinese and 41 foreigners¹⁰. At that time AIDS and drug addiction were seen as consequences of contact with the West, and AIDS was known as aizibing, the "loving capitalism disease"¹¹.

By late 1994 it was clear that the reported AIDS cases amongst IDUs in Yunnan had signalled the beginning of an epidemic amongst drug users. National figures for HIV infection were growing quickly – in 1996 the Minister of Health, Chen Min-Zhang, put the number of infections at between 50,000 and 100,000¹² - and new cases were being reported in more regions. By 1998, HIV infections had been reported in all 31 provinces, autonomous regions and municipalities, with drug users accounting for 60-70% of reported infections¹³.

The sharp increase in AIDS cases in China in the 1990s was also attributed to a large number of people infected through blood donation, which was widely reported by the western press, as well as transmission through heterosexual sex, which increased steadily to represent 7% of all HIV infections¹⁴.

There was a notable shift in government response to the epidemic in the new millennium. On World AIDS Day 2001, stories and testimonials of those infected with HIV alongside a television drama about AIDS reflected a far greater willingness to discuss the emerging epidemic

he same year, the "China Plan of Action to Contain, Prevent and Control HIV/AIDS (2001-2005)" was published, which included plans to screen all blood for clinical use for HIV¹⁶.

In 2003, the Health Minister’s change in attitude was evident, it is widely felt that the 2003 SARS epidemic prompted the change as it demonstrated to the government the impact public health could have on social and economic stability. He described the fight against AIDS as a "long-term war" and, as well as showing a new willingness to accept overseas assistance, requested that China’s AIDS budget of US$12.5 million be doubled.¹⁷.

On World AIDS Day 2003, Wen Jiabao became the first Chinese premier to shake hands with an HIV-positive person

The history of AIDS in China

China’s first AIDS case was reported in Beijing in 1985⁶. In the following five years a small number of further cases were reported among foreigners and Chinese, who were infected overseas or by imported blood products⁷.

During the early stages of the AIDS epidemic the Health Ministry concentrated its prevention efforts on the risk of infection from abroad. In 1986 it announced that it planned to test all foreign students for AIDS who had been in the country for more than a year, and students entering China would require a certificate from their country of origin testifying that they were not infected with HIV⁸. Although a National Programme for AIDS Prevention and Control was set up in 1987, the Public Health Authorities reported that AIDS would not become established as homosexuality and "abnormal" sexuality - thought to be the main causes of the spread of HIV - were a "limited" problem

Testing

The general consensus among those fighting AIDS worldwide is that HIV testing should be carried out voluntarily, with the consent of the individual concerned. This view has been supported by the Indian government and NACO, who have helped to establish hundreds of voluntary counselling and testing (VCT) centres in India. By the end of 2005 there were 873 VCT centres in India, compared to just 62 in 1997. ⁴¹ These centres tested 225,600 people for HIV during 2005. ⁴² In 2007 there was a dramatic scale-up - 4245 testing and counselling centres were in operation by December 2007

Although voluntary testing is officially supported in India, some states have tried to implement policies that would force people to be tested for HIV against their will. In Goa, the state government recently planned to make HIV tests compulsory before marriage, and in Punjab it has been proposed that all people wishing to obtain or retain a driver’s license should be tested for HIV. ⁴⁴ Neither of these plans has come to pass, but they have concerned activists, who argue that HIV testing should never be imposed on people against their wishes.

Unfortunately, cases of people being tested without their consent or knowledge are common in Indian hospitals. In one 2002 study, it was suggested that over 95% of patients listed for surgical procedures are tested against their will, often resulting in their surgery being cancelled. ⁴⁵ Hospital staff and health professionals, much like the rest of the Indian population, are often unaware of the facts about HIV. This leads to unnecessary fears and, in some cases, causes them to stigmatise HIV positive people and discriminate against them, including testing them without consent.

Who is affected by HIV and AIDS in India?

eople living with HIV in India come from incredibly diverse backgrounds, cultures and lifestyles. The vast majority of infections occur through heterosexual sex, and most of those who become infected would not fall into the category of ‘high-risk groups’ - although members of such groups, including sex workers, men who have sex with men, truck drivers and migrant workers, do face a proportionately higher risk of infection.

Nagaland

Nagaland is another small northeastern state, with a population of two million, where injecting drug use has again been the driving force behind the spread of HIV. In 2006, the HIV prevalence at antenatal clinics was 0.93%, and the rate among female sex workers was 16.40%.

Manipur

Manipur is a small state of some 2.2 million people in the northeast of India. The nearness of Manipur to Myanmar (Burma), and therefore to the Golden Triangle drug trail, has made it a major transit route for drug smuggling, with drugs easily available. HIV prevalence among injecting drug users is around 20%, and the virus is no longer confined to this group, but has spread further to the female sexual partners of drug users and their children. ³² The HIV prevalence at antenatal clinics in Manipur has exceeded 1% in all recent years. The 2005-2006 survey found that 1.13% of the general population was infected - the highest of all states surveyed.