HIV/AIDS battle enters new phase
Criticism of China's handling of HIV/AIDS is sounding weaker than ever as the government has invested more money and adopted a more transparent reporting system in the past few years.
It seems talk of the fight against HIV has died down, compared to reports of the epidemic during the 1990s.
But under the calmer waters are turbulent currents and concealed obstacles.
In the past, in every report about HIV control work issued by the health authorities at various levels, progress was always mentioned first and problems buried in the small print near the bottom.
Usually these problems included a simple lack of money, medicine, doctors and other professional workers; the difficulty of monitoring and intervention among high-risk groups; as well as poor public awareness.
Now problems have to be mentioned at the very beginning of official reports, along with fresh obstacles.
The sticking points holding up epidemic control - at least some of them - are even more important than long-standing problems. There are four areas which need special attention.
First, people who need money and support the most wait in despair and difficulty the longest. They are victims in remote areas, who account for at least 70 per cent of the country's total. They are the doctors who work in the villages and towns, who get little or no financial support from the various levels of government. China's medical welfare system has given priority to the comparatively rich, the majority of whom live in urban areas, from the very beginning.
As a result, about 1 billion Chinese, the majority of whom are residents in rural areas, are still not covered by any medical insurance. Almost all HIV/AIDS sufferers cannot afford expensive medical treatment without support. They depend totally on money granted by governments to fight the disease.
Currently the central government spends at least 200 million yuan (US$24.7 million) annually on control and prevention of the epidemic. But it is far from enough to deal with the nationwide epidemic that has infected at least 840,000 people.
The funding is usually given to governments at the lowest levels, so no one can tell exactly how much of it actually reaches those in need. Official reports show most township hospitals, which should be the focus of the public health service in rural areas, are penniless and frustrated. Village doctors, most of whom have to do farm work to raise extra income, get little, if any, money from governments.
The central government, therefore, must change its medical welfare system strategy and begin to focus on improving the status of the poor through better control and prevention work.
Second, the orders or policies made by the central government are often discounted or blocked by lower level governments.
Top Chinese leaders, including President Hu Jintao and Premier Wen Jiabao, have visited HIV/AIDS patients and asked for priority to be given to HIV/AIDS prevention and control.
But awareness among local officials, many of whom still regard economic growth as the most important indicator of successful careers, lags far behind. As a result, the central government spends a lot of money every year, but many local governments do not invest it wisely.
Many local authorities base the amount of work they do on the money the central government gives them. Worse, some move that funding to other fields.
Third, co-ordinating efforts of different departments and regions is a big problem. All of the provinces, autonomous regions and municipalities have victims of the HIV epidemic. But in the opinion of many government officials, HIV/AIDS is very serious only in Central China's Henan Province and Southwest China's Yunnan Province.
Those two provincial governments have made tireless efforts in recent years to fight the disease. But other local officials, feeling fortunate that their areas have escaped the worst of the epidemic, show a careless attitude that may have a negative impact in the near future.
In addition, through intervention activities such as public education, condom distribution, clean syringe exchanges and even methadone treatment, conflicts have arisen between different departments of the government. As health authorities distribute condoms among prostitutes and their clients, and provide clean syringes and methadone to drug users, public security departments are charged with clamping down on these groups.
Finally, China needs more non-government organizations and communities to participate in the fight against the HIV/AIDS epidemic, and more encouraging policies should be adopted to persuade groups and individuals to join the campaign.
But the rules for establishing NGOs and charities in China are very strict, so development is sluggish. As a result, the public, including various enterprises, institutions and individuals, is hesitant to donate money for or lend a hand to HIV/AIDS sufferers.
(China Daily 10/27/2005 page4)
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