The Second International AIDS Society Conference on HIV Pathogenesis and Treatment, held in Paris earlier this month, gave yet another impetus for Chinese researchers to step up their efforts, on all fronts, to fight the disease.

The biggest HIV/AIDS research conference this year highlighted the fact that prevention of the spread of HIV/AIDS in populous countries such as China and India is crucial in the global battle against it.

Chinese researchers are well aware of what they are up against as they search for the best methods to prevent the spread of the pandemic and the most effective drugs to combat it.

Treatment

During the conference, the participants discussed a number of important social strategies for HIV/AIDS treatment.

"Although it's still impossible for AIDS patients to fully recover from AIDS after treatment, their quality of life could be boosted," said Dai Zhicheng, deputy director of the Chinese Association of STD (sexually transmitted diseases) & AIDS Prevention and Control, a non-governmental organization.

When receiving treatment, HIV/AIDS patients will also learn about how best to protect their families and others from infection.

Those patients whose symptoms are relieved significantly and their chance to pass on the infection is limited are encouraged to take up employment to reduce the burden on society.

"Treatment itself is not enough, and it should be combined with psychological consultation, care, and economic relief," said Dai.

The Chinese Government has already initiated a treatment programme covering 50 to 100 counties with high levels of HIV infection. Tens of millions of yuan has been appropriated to buy medicines for HIV/AIDS sufferers.

Wu Zunyou, a research scientist and director of the Division of Health Education & Behavioural Intervention under the National Centre for AIDS/STD Control and Prevention, said that "the present treatment resources mainly cover the group of people infected through plasma donations around the mid 90s, particularly in Henan and Anhui provinces.

In the two provinces, many poor people who sold blood during this period, often to unlicensed operators, were unknowingly infected with HIV by the use of unhygienic and contaminated equipment.

"Extending the treatment to other AIDS groups will be the next step of our work," said Wu.

Risk groups

Both Dai and Wu said they have been working very hard to track the high risk groups, an important aspect in preventing the spread of HIV/AIDS in the country.

Those in the mid 90s who sold their blood once constituted a significant risk group according to Dai, but now that problem has been tackled in most parts of the country by enforcing strict management and procedures in centralizing blood donation centres.

"HIV transmission through blood could and should be reduced to a very low level, and is the easiest to be contained," said Dai.

According to their estimate, the number of HIV infections in China could be as high as more than 1 million, a dramatic increase from a few, isolated cases in the mid-1980s.

The current largest risk group is intravenous drug users (IDUs), primarily in Southwest China.

"When the disease was first identified in the southwestern corner of our country, people in other regions never imagined that one day they would also be exposed to its scourge," said Wu.

But in just five years, the HIV virus spread out of Southwest China's Yunnan Province and had extended to the whole country by last year.

According to Dai, the number of intravenous drug users is still increasing. The percentage of such drug addicts now account for 53.3 per cent of all addicts and more than 40 per cent of them share needles.

Sex workers make up the second largest risk group for HIV infection.

Dai said he believes HIV/AIDS infection via sexual transmission will probably become the main channel for its spread.

The number of reported STDs has increased more than 100-fold between 1985 and 2001, according to a joint China CDC (Centre for Disease Control and Prevention)-US CDC HIV surveillance assessment report published this year.

"STD patients are most likely to acquire or transmit HIV, with the risk increased three to five times as high as those of other people. Containing STDs is of vital importance for curbing the HIV/AIDS epidemic in China," he said.

Dai said a good way to prevent STDs and AIDS is the use of condoms. However, a Chinese CDC survey conducted in some regions in 2001 revealed that the level of condom use within the group engaging in high-risk sexual behaviour was as low as 9.1 per cent.

Wu and his colleagues from the national centre for HIV/AIDS and STDs have also conducted a large number of surveys. For instance, the HIV infection rate among sex workers in a city, which Wu declined to name, was as high as 6 per cent.

"This surveillance data makes us very worried," said Wu.

Dai, who participated in an AIDS intervention programme last November in Jiangchuan County, Yunnan Province, said he had face-to-face talks with 80 sex workers from the county, all around the age of 20. Dai said they reported that they were ashamed to tell their families about the work they were involved in.

"They said they needed money for marriage or for supporting the family and they couldn't find other jobs that pay as well," said Dai.

The third largest high-risk group are homosexuals, although the activities of this particular group tend to be kept underground and little is known about them, he said.

Dai's association has carried out research of gay groups in Harbin, Shenyang and Dalian in Northeast China, and found 1 to 3 per cent of the respondents to their survey tested positive for HIV.

Dai said that apart from the identified three high risk groups which can be closely monitored, the large floating population produced as a result of the rapidly growing Chinese economy also requires vigilance.

As a relatively stable part of a floating population, those migrating from the countryside to the cities to seek job opportunities have acquired little or no medical care. As they generally have no access to the television or radio programmes, health education has not reached them effectively.

"Public health programmes have yet to work out ways to include this part of the population," said Dai.

Another part of the floating population is generated by the tourism and business activities which also need more vigilance.

Removing obstacles

Both Dai and Wu believe that more effective measures should be promoted to prevent the possible spread of HIV.

"At present, effective drugs and vaccines have not lived up to their early promise," Dai said. "Intervention has proved worldwide to be the only effective measure to address this issue."

However, efforts to promote the use of condoms and clean needles have also aroused debate between HIV/AIDS prevention workers and the public and officials at large.

"Extending the use of clean needles among the drug using community and the use of condoms among possible sex workers remains a controversial issue, both in law and in traditional modes of thought," said Professor Wu.

Some people are against the very idea of publicizing their use, saying that would encourage illegal drug use and prostitution.

Meanwhile, the law forbids advertisements of products relating to sexual activities. As a result, the open advertising and publicizing of condoms as merchandise remains restricted, even though their use can substantially reduce the risk of infection and transmission of the HIV virus.

Wu revealed that the new Five-Year Action Plan, a national policy paper by the State Council which was made public in May of 2001, approved the use of the heroin substitute methadone and clean needles.

Wu said these new policies will significantly enhance national HIV/AIDS prevention, but their implementation has been much slower than expected.

The provinces of Hunan and Yunnan have submitted a report to the Chinese CDC to undertake a pilot project of methadone treatment with drug users.

Two weeks ago, a joint meeting of the General Administration of Quality Supervision, Inspection and Quarantine, State Food and Drug Administration, Ministry of Health, and Ministry of Public Security addressed the issues of the need for stricter supervision on production, delivery and markets to ensure the quality of condoms to a higher standard.

However, further work still needs to be co-ordinated to address the question of advertising condoms and greater public acceptance of their use.

Both Dai and Wu highlighted the importance and necessity of learning from those experiences which have already proven effective in other developing countries.

"According to the HIV/AIDS epidemiological study, the measures and strategies of containing the epidemic tend to be similar and mature," said Wu.

"The SARS epidemic should serve as a turning point for our prevention and control work, for the top leaders have shown more concern for public health," said Wu, adding: "I am seeing more hopeful signs."

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