In late 2003, a female HIV carrier in Guiyang married her healthy partner causing a great uproar in the nation's media, and provoking heated discussion as to whether HIV carriers had the right to marry. But the recent wedding of Chen Yan and Ding Guifang, both HIV positive, in Northeast China's Jilin Province last April went off without any fuss at all.

"People were nice to us," says the 36-year-old bridegroom Chen, appreciatively. Both Chen and his bride's former partners died of AIDS as a consequence of donating blood in 1995.

New bridegroom Chen says nobody challenged them with such questions at their wedding. The 200 or so guests at the wedding were all very positive about it. Even his parents, who had broken off relations with their son when his marriage plans became known in their village, attended the ceremony. A local company offered to take their wedding photos for free. Another paid for their banquet. One person sent them a gold necklace and a pair of earrings as a gift, while a flower vendor provided them with flowers free of charge.

Liu Baogui, an official with the Jilin Provincial Centre for Disease Control, who had been helpful in arranging the couple's marriage, was very happy to see this positive change in attitude of the general public towards people with HIV/AIDS.

"Such respect is vital in our battle with HIV/AIDS," says Liu, adding that "many people with HIV/AIDS lead hard lives and need help."

The world is gathering for the 15th International AIDS Conference in Bangkok, Thailand, this Sunday; and China - where most people first dismissed the epidemic as something alien and remote from their country, then stigmatized it as "disgraceful" - is now more open and understanding with regard to the disease and its victims.

In the two decades since the first AIDS case was detected in China in 1985, the country, with a population of 1.3 billion, has witnessed a rapid spread of AIDS, with over 840,000 people infected with the fatal virus. By September 2001, all the country's 31 provinces, autonomous regions and municipalities had reported AIDS cases.

Many experts agree that the significant change in attitude in the government came in the late 1990s, when it was disclosed that thousands of farmers had been infected with HIV/AIDS while selling their blood. Up to that time, HIV/AIDS in China had been largely confined to drug addicts and people engaging in "indiscreet sex."

But statistics show that 11 per cent of the HIV carriers in China were infected while selling their blood plasma. Many of them were farmers desperate to augment their incomes by selling their blood, but were infected with the AIDS virus at blood centres where their blood was processed to remove the plasma then reinfused in the donors, sometimes carrying red blood cells from the contaminated pool.

The State Council set up a long-term programme in 1998 for HIV/AIDS control with 2010 as its target year, which calls for ensuring the safety of medical blood supplies and clamping down on drug abuse and prostitution.

In 2001, the central government increased its budget for HIV/AIDS prevention and control from 15 million yuan (US$1.8 million) to 100 million yuan (US$12 million) annually, and the figure reached 390 million yuan (US$47 million) last year. Another 2.5 billion yuan (US$300 million) has been earmarked to improve the construction of public blood banks in central and western China to prevent transmission through sub-standard blood collection and transfusion procedures.

Heading the government's endeavour to improve the social environment for people living with HIV/AIDS, Premier Wen Jiabao, in an unprecedented move, reached out to shake hands and talk face-to-face with three AIDS patients in a Beijing hospital on World AIDS Day, December 1, 2003.

"It was the first time for a Chinese premier to meet with AIDS patients. The message was clear. Wen was telling the whole nation 'I'm willing to help them,'" observes Ray Yip, country director for the Global AIDS Programme under the US Centre for Disease Control and Prevention.

Commending the gesture as a "milestone" in China's HIV/AIDS prevention and treatment efforts, Yip added that it showed the commitment of the new generation of Chinese leaders to tackling the issue head-on.

Concrete measures

Real action followed, and the government moved beyond education campaigns informing people of the transmission channels of the virus and warning them to avoid high-risk behaviour to initiating a series of pragmatic measures.

The Ministry of Health announced this April that the government would give free, anonymous testing and counselling to HIV carriers who have financial difficulties. Hubei and Henan provinces in Central China have pledged to offer free AIDS medication to all HIV-carriers in addition to dispatching officials to the areas most seriously hit by the epidemic.

On July 7, the ministry inked a deal with GlaxoSmithKline, a pharmaceutical giant, for the supply of Lamivadin, or 3TC, a key component in cocktail drug formulas that fight the effects of AIDS, at a reduced price to make the treatment affordable to more people.

Meanwhile, more efforts are being made to track down infected individuals so as to curb the spread of the disease, which has been another major challenge in the battle against AIDS, says a ministry official.

Of the estimated 840,000 HIV carriers in the country, only 7.4 per cent are registered and can be monitored. AIDS testing centres around China report that some of those tested simply disappear after they are informed that they were tested positive. Without detailed personal information, follow-up treatment and monitoring become virtually impossible.

Many hide themselves because they are afraid of discrimination, which is the biggest stumbling block for China's efforts in curbing the AIDS epidemic, according to Dr Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), who made a trip to China this May.

"That's why events like Chen Yan and Ding Guifang's wedding are encouraging and should be encouraged," says Dr Wu Zunyou, director of the Department of Health Education and Behavioral Intervention at the National Centre for AIDS Prevention and Control.

Wu, who has been spearheading a pilot project in four Chinese cities to distribute condoms in entertainment venues, is glad to see that the rate of condom use has risen to 75 per cent in some targeted places, but he aims at raising the figure to 100 per cent.

Other harm reduction measures designed for high-risk groups are getting scaled up. Given the fact that nearly 64 per cent of China's reported HIV/AIDS cases are caused by needle-sharing among injecting drug users, the much-disputed needle exchange programme and the use of methadone as a substitute for heroin for die-hard drug addicts are now being more positively accepted because of their effectiveness.

Although needle-sharing among intravenous drug users remains the main transmission route, statistics reveal that the proportion of sexually transmitted HIV infections had increased from 5.5 per cent in 1997 to 10.9 per cent at the end of 2002, while the proportion of mother-to-child transmission rose from 0.1 per cent to 0.4 per cent.

"China should constantly promote effective intervention measures (to prevent the spread of AIDS)," said China's Vice-Premier Wu Yi at a national working meeting on HIV/AIDS.

Worries to be addressed

Nonetheless, legal support for such measures is still absent. China's existing 300 or so laws and regulations issued at various levels on AIDS prevention and control are often contradictory. Some still classify AIDS as a venereal disease, while others require that AIDS patients be isolated.

Insiders still worry about the possible misleading messages sent out by such measures as condom promotion and needle exchange programmes, which seem in conflict with the current punitive laws against prostitution and drug use.

"We have to find a balance point between the protection of individual rights and public health," says Zhang Kong, vice-president of the China Association for the Prevention of Venereal Disease and HIV/AIDS.

The amendment draft to China's 15-year-old law on contagious disease prevention and control has cancelled the clause on forced isolation of HIV/AIDS patients, which is regarded as a major step toward eliminating discrimination against people with HIV/AIDS.

"HIV/AIDS is now percolating down from high-risk groups to the general public in China," says Yin Dakuai, former vice-minister of health. "AIDS has become an issue beyond health. It is now a matter connected with national security. It is therefore the responsibility of the government to marshal all possible resources in the fight to control the disease."

(China Daily 07/13/2004 page5)