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| Combating AIDS: Yunnan shows the way | | |
Pallavi Aiyar
While many of China's other regions pretend that AIDS does not exist, Yunnan has begun to experiment with novel pilot projects such as the methadone therapy and needle exchange programmes.
IT IS a quiet morning at the Da Shu Ying Health Center, an unobtrusive building tucked away in a warren of lower-middle class housing in downtown Kunming. The excited chatter of children playing in the adjoining primary school wafts into the clinic's foyer. A few staff members in bright white lab coats swish around with patient files.
Around 9.30, the first patient of the day, Ou, walks in. His hair is neatly combed back, his expression a little tense. He looks neither to the left nor right and heads straight for the medicine counter, where he hands the two attendants a prescription. A few seconds later he is given a paper cup, the lime-green contents of which he gulps down gratefully in one swallow. His expression lightens and he exhales heavily in relief as he sits down on a nearby bench.
Mr. Ou is a heroin addict. Now 35, he has been using the drug for over 15 years. Arrested and locked up in police detoxification centres more than 10 times, he lost all hopes of recovering. "I came close to suicide more than once. I lost my job, my wife divorced me and my mother died of grief," he recounts, his voice betraying little emotion.
About a year ago, he heard of the Da Shu Ying Health Center — one of the eight methadone treatment clinics the local government has opened in Kunming city, capital of China's southern Yunnan province. At these centres the synthesised narcotic is administered orally, under close medical supervision. The aim is to help heroin addicts break their habit, keep out of trouble with the law and ultimately remain protected from AIDS.
The Yunnan province, a multiethnic region of stunning sub-tropical scenery, is one of China's main tourist draws. But it hides a more unsavoury reality. It is the AIDS capital of the middle kingdom, being home to some 40,000 of the 1,40,000 Chinese who are officially known to be HIV-positive. Experts say that in reality there could be upwards of 2,00,000 HIV cases in the province and even official estimates put the figure at around 80,000.
"We have a real crisis in Yunnan. We are doing everything in our power to fight it but the AIDS situation is only growing worse," says Zhang Chang An, Director of the Office for the Prevention and Control of HIV/AIDS of the province. Mr. Zhang is unusually candid for a government official, but then Yunnan has been in the forefront of China's fight against the disease.
While many of China's other regions spend more time pretending that AIDS does not exist rather than facing up to it, Yunnan has begun to experiment with novel pilot projects such as the methadone therapy and needle exchange programmes for intravenous drug users.
Impoverished and underdeveloped, Yunnan shares an over 4,000-km porous border with the notorious golden triangle states of Laos and Myanmar. The province has thus some of the worst drug and prostitution problems in all China, making it an ideal breeding ground for the HIV virus. Last year alone, 8,000 new HIV cases came to light in the province and this is only the tip of the iceberg.
According to UNAIDS, only about 25 per cent of an estimated 6,50,000 HIV carriers in China have been tested for the virus. The vast majority of the HIV-positive people in Yunnan, as in the rest of the country, are thus unmonitored and unaccounted for.
For years, the Chinese Government denied that it had an AIDS problem at all. The first cases of HIV were discovered in the late 1980s but were portrayed as isolated occurrences brought into the country by foreigners. The general lack of awareness of the disease that this attitude led to had tragic consequences. In the early 1990s, a government-organised blood-buying programme in central China's Henan province resulted in HIV contamination of the entire province's blood supply.
Commercial blood sellers during this period paid donors for plasma. To maximise profits, they separated red blood cells from the plasma and then re-infused the donors with pooled red blood cells so that they could donate blood more frequently. An estimated 70,000 to 2,50,000 villagers in the province became infected with HIV as a consequence.
Because of the local government's involvement in this disastrous scheme, the entire incident was kept under wraps for years. The media were banned from reporting it and activists who tried to publicise the tragedy jailed.
But slowly, information leaked out and the international and domestic uproar that followed has gone a long way in changing governmental attitude. In March 2003, China launched a programme to provide anti-retroviral drugs to all infected blood donors in the province.
Condom advertisements, previously banned, made a debut on national television and radio. Government leaders began to be photographed visiting AIDS patients in hospitals and homes. Over 20,000 patients with full-blown AIDS are currently receiving anti-retroviral drug treatment nationwide. Last year, the central government spent $100 million fighting the virus.
`Four frees and one care'
A national programme, "four frees and one care," now being promulgated, includes free medication for rural residents and those with financial difficulties in urban areas; free voluntary counselling and testing for all; free drugs for pregnant women and free schooling for those orphaned by the disease.
"All the right policies are now in place. The problem as usual is in the implementation," says UNAIDS' Mr. Hansen. "The localities often interpret the centre's directives in their own way and many of those who should be getting anti-retroviral for free are not," he adds.
The Yunnan province, however, is doing much better than most local governments. Despite being one of China's poorest provinces, all its 1,600 known patients with full-blown AIDS are receiving free treatment. Yunnan has established 284 voluntary counselling and testing sites and all hotels and entertainment centres in the region have been ordered to make condoms available on their premises.
The province has also established several centres where intravenous drug users can exchange used needles for new, sterilised ones. In 2005 alone, it distributed 8,00,000 clean needles, according to Mr. Zhang. Over 50 methadone clinics, with 3,500 registered patients, have been opened province-wide and methadone vans that will visit addicts unable to travel are being planned. China and Malaysia are the only two countries in Asia that use methadone treatment to prevent the spread of HIV.
But Mr. Zhang, the official heading the province's AIDS prevention drive, says none of these efforts is adequate. "We need more money, more international assistance, more medicines, more of everything," he says blandly.
Wang Yu, head of a new 200-bed, RMB 139 million ($17.3 million) AIDS hospital that is coming up outside Kunming, agrees that the province faces several weighty challenges as it grapples with the deadly virus. The biggest worry, she says, is that AIDS is no longer confined to drug users.
While over 60 per cent of the province's HIV cases are still to be found among Yunnan's 70,000 known drug offenders, the percentage of addicts in the total number of HIV positive cases is falling. Currently, 30 per cent of those with HIV in the province contracted the virus sexually. "We can say that AIDS has already entered the mainstream of society in Yunnan," Dr. Wang concludes.
And despite strenuous efforts to raise awareness of the disease, most people remain woefully ignorant, even those most at risk. Zhou, 50, who started using heroin in 1988 and recently joined a methadone clinic, spent eight spells in police detoxification centres. He now spends most afternoons at a drop-in clinic for addicts in Kunming run by the American NGO, Population Services International (PSI).
"I knew nothing about the connection between AIDS and drug use till I came to PSI about a year ago. I have taken drugs for more than 20 years and spent endless months in police detoxification centres but I still knew nothing until I attended some of the PSI awareness talks," he says.
Mr. Zhou lost his job as taxi driver seven years ago and has been unemployed since. He is divorced and hasn't seen his son in several months. He smiles wearily: "I am lucky I didn't get sick. But not everyone is as lucky."
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