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Eliminating Discrimination
An interview with Vice President of the Chinese Association of STD & AIDS Prevention and Control on China's efforts in combatting the HIV/AIDS epidemic
 NO. 48 NOVEMBER 30, 2017

December 1 marks the 30th World AIDS Day. China, after decades of efforts, has gained momentum in HIV/AIDS prevention and control, keeping HIV/AIDS prevalence in the country at a low-level, both geographically and in terms of population groups. 

Latest data from China's National Health and Family Planning Commission (NHFPC) show that as of June 30 this year, a total of 718,270 Chinese people are currently living with HIV and 221,628 had died of AIDS-related causes. The number of fatality cases, compared with 2011, dropped by 57 percent by the end of 2015, according to an action plan rolled out by the Chinese Government in January. 

However challenges still remain. Experts believe more efforts should be made in curbing the epidemic and eliminating discrimination against people living with HIV/AIDS. 

Hao Yang, Vice President of the Chinese Association of STD & AIDS Prevention and Control, shared his views with Beijing Review reporter Li Nan on China's efforts in combatting the HIV/AIDS epidemic and what advancements in treatment have been made in recent years. The following is an edited version of his views: 

Hao Yang, Vice President of the Chinese Association of STD & AIDS Prevention and Control (SHI GANG)

Beijing Review: What has China done to prevent HIV/AIDS from spreading in recent years?

Hao Yang: The first AIDS case was reported in the early 1980s. At that time, the public knew little about the nascent disease. Therefore, the epidemic spread rapidly in some impoverished regions of the world, including African countries.

The first Chinese living with HIV, a drug user, was reported in southwestern Yunnan Province in 1989.

The Chinese Government has attached great importance to the epidemic and taken measures to prevent and control its spread since then. Fortunately, the HIV/AIDS epidemic was reined in after decades of extensive campaigning, as well as prevention and control actions.

First, HIV/AIDS prevention campaigns partly account for the reduction. Second, multi-pronged prevention and treatment measures, such as mass HIV screening programs, have been beneficial. Anyone who is reported HIV positive will receive quality treatment. Third, targeted prevention and treatment measures have been taken among high-risk groups, such as syringe-needle-sharing drug addicts and gay men, to curb the disease. In a two-pronged campaign, China has cracked down on drug dealers while also giving heroin addicts adanon, a kind of oral medicine, as a narcotics substitute to alleviate their addiction. In addition, China rolled out a program to prevent HIV transmission from mother to infant.

The year 2017 marks the 15th anniversary of China's campaign of antiretroviral therapy (ART), which has played a very important role in China's prevention and control of the HIV/AIDS epidemic.

Before 2002, many people with HIV/AIDS had no access to effective treatment because China could not produce antiretroviral drugs. The Chinese Government, aware of the growing threat, encouraged several domestic pharmaceutical factories to produce antiretroviral drugs with expired patent protection. In addition, China spent a lot of money to buy foreign antiretroviral drugs to begin ART in Henan and Anhui provinces.

It is the ART campaign that saved the lives of people living with HIV. As of June 30, more than 220,000 Chinese people had died of AIDS-related causes. Without the ART campaign, the number would have been much higher. Once a patient receives treatment, the possibility of HIV transmission from the patient to others decreases dramatically. This means a lot to curbing the HIV/AIDS epidemic.

Students at Shanxi Linfen Red Ribbon School, China's first school for children living with HIV/AIDS, have a class on May 24 (XINHUA)
Have there been any breakthroughs in pharmaceutical development relating to HIV/AIDS in China? 

To date, China hasn't invented any homegrown antiretroviral drugs. However, the Chinese Government allocated a large sum of funds to support the development of traditional Chinese medicine (TCM) in this regard more than 10 years ago. By now, TCM has come up with a therapy to strengthen AIDS patients' immunity. Comparative studies show that integration of TCM and Western medicine (WM) therapies helps improve the curative effects. A combination of TCM and WM is an advantage for China.

In China, sexual transmission is the basic route of spreading HIV. So how does China address this problem? 

In China, HIV was first transmitted by drug addicts sharing syringe needles and illegal plasma sales. With the end of paid plasma collection and a crackdown on drug abuse, sexual transmission has become the most common route.

According to NHFPC, there were 120,000 new HIV infection cases in China last year. Among them, more than 90 percent were sexually transmitted, through homosexual or heterosexual intercourse.

As we all know, there are three routes for HIV transmission: blood, sexual contact and mother-to-child transmission. Blood transmission is controllable, because it's concentrated among groups such as drug addicts and illegal plasma sellers. Mother-to-child transmission is also controllable. As soon as a pregnant woman is tested HIV positive, actions can be taken to block the virus from being transmitted from the mother to the infant.

But sexual transmission involves human behavior. It's difficult to thoroughly change people's behavior. Many cases of sexual transmission of HIV among gay men or among prostitutes are well concealed. Even if they are exposed, it's not an easy task to persuade them to have protected sex. It's a great challenge for HIV/AIDS prevention and control.

How prevalent is the HIV/AIDS epidemic on Chinese campuses?

Unfortunately, recent years have seen rapid growth of new HIV/AIDS infections in colleges and universities. In 2011, a total of 770 students were newly confirmed to be HIV positive. Five years later, the figure of newly known cases surged to 2,674, up more than three times. The rapid growth shows that the epidemic is spreading swiftly on campuses.

Students today are open-minded about sex and homosexual encounters. The reason for increasing HIV transmission among students lies in frequent unprotected sex, which refers to sexual contact that does not involve the use of condoms.

In addition, there is a basic rule for the spread of epidemics. When the infected population is limited, the disease is transmitted slowly. When the population increases to a certain number, the disease spreads rapidly. The rule is proven to be true not only on campuses, but also in the whole society.

The Chinese Government and some NGOs have taken targeted actions to fix the problem. Since 2015, the Chinese Association of STD & AIDS Prevention and Control has invited dozens of NGOs and celebrities to visit more than 50 colleges and universities to promote HIV/AIDS prevention tips and protected sex. The campaign is aimed at raising the awareness of how the HIV/AIDS epidemic is spreading on campuses.

The celebrities include Chinese President Xi Jinping's wife Peng Liyuan, renowned actor Pu Cunxin and actress Jiang Wenli. Peng is also the Goodwill Ambassador for Tuberculosis and HIV/AIDS with the World Health Organization (WHO). They went to campuses and communicated with students in person, setting good examples to the public.

After two years of campus campaigns, more and more students are becoming aware of how to prevent being infected. If all students can use condoms or biomedical prevention when having sex, then the HIV/AIDS epidemic will be effectively kept off campuses.

What has China done to minimize discrimination against people living with HIV/AIDS?

To eliminate discrimination against people living with HIV/AIDS has been high on the Chinese Government's agenda since 2000. Widespread HIV stigma and discrimination will discourage people living with HIV/AIDS to expose their status to doctors. This is very dangerous. If no one knows a patient is HIV infected, no action will be taken to cure him or her.

Therefore, China has made great efforts to minimize discrimination against people living with HIV/AIDS. The government reiterates that there are only three routes of HIV transmission: blood, sex and mother to child. The virus will not be spread through daily life contact. People living with HIV/AIDS should be treated equally. Only by rooting out the public's fear of HIV/AIDS can the discrimination be eliminated, and people living with HIV/AIDS coexist with other members of society in harmony.

The anti-discrimination campaign does work. With an increase in awareness, there are less incidents of discrimination. Many people living with HIV/AIDS have received help from the public. China's first school for children living with HIV/AIDS, Shanxi Linfen Red Ribbon School, was established in 2006. Students who graduated from the school, with the help of the public, have either found jobs or been admitted into universities or colleges. Decent life is good for their health.

But it's not an easy task to root out all the people's fear of HIV/AIDS. Not everyone studies medicine. It's very difficult to get them acquainted with the ways HIV is transmitted. I believe more campaigns are needed to eliminate such fears.

What's the role of Chinese NGOs in preventing and controlling the spread of HIV/AIDS?

It's an innovative move for China to encourage NGOs to partake in HIV/AIDS prevention and control. The government takes the lead in the fight against the epidemic, but it cannot take on all the responsibilities. The government has limited access to some HIV-infected or high risk groups such as gay men. But some NGOs can reach them easily.

Some NGOs keep in close touch with the government, like the Chinese Association of STD & AIDS Prevention and Control, liaising between the government and people living with HIV/AIDS.

Some community-level NGOs were founded by people living with HIV/AIDS. They team up, share their treatment experience, and persuade their peers to receive medical treatment, helping to prevent further spread of the virus. There is a patient who set up a website that brings people living with HIV/AIDS together. They not only share treatment experiences, but also help newcomers to take medication and test regularly. Several thousand people living with HIV/AIDS from Yunnan Province and Guangxi Zhuang Autonomous Region have received medical treatment with the help of the website. I have to say that these NGOs have contributed a lot to HIV/AIDS prevention and control.

But there is a long way to go before Chinese NGOs play a bigger role in curbing the epidemic. The government has to help them and further regulate some of their operations

How to understand the theme of this year's AIDS Day?

The theme is Right to Health. To be specific, in China, it means to take responsibility for HIV/AIDS prevention, to share the right of health and to build a healthy China together.

To take responsibility for HIV/AIDS prevention is advocated by UNAIDS, which calls on governments, the public and people living with HIV to team up and face the challenge together. To share the right of health means that everyone, whether people or those living with HIV/AIDS, shares equal rights to pursue a healthy life. The ultimate goal is to build a healthy China together, an initiative highlighted in the report delivered by President Xi at the 19th National Congress of the Communist Party of China on October 18.

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Copyedited by Francisco Little

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