When Premier Wen Jiabao visited the AIDS ward at Ditan Hospital of Beijing and shook hands with three AIDS patients on December 1, World AIDS Day, 2003, it was the first time that a Chinese premier had met with AIDS patients on a public occasion. The unprecedented move was seen by the world as a symbolic display of government commitment to fighting the disease.

On the eve of this year's World AIDS Day, Wen paid his second visit to Shangcai County of Henan Province, which has one of China's highest AIDS incidences due to illegal blood deals in the 1990s. Hands were shaken, dumplings were eaten and vegetable sales were promoted. In Wenlou Village, Wen learned that the people's traditional vegetable farming had been hampered by sluggish sales due to some buyers' suspicions of "HIV-poisoned" vegetables. He told villagers half-jokingly, "You can tell them that the premier has eaten Wenlou's vegetables today."

In an apparent gesture to show the Central Government's resolution to tackle the growing AIDS problem in the country, Chinese President Hu Jintao also visited AIDS control medical staff in Beijing on November 30. Hu called on more people to join in the efforts to create "a sound social environment" for AIDS control.

If there is any reason to smile amid China's AIDS crisis, it is the encouraging figures of the Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China (2007), released by the State Council AIDS Working Committee Office and the UN Theme Group on AIDS in China on November 29.

According to the report, China will have an estimated 50,000 new infections in 2007, compared with 70,000 in 2005; and among the 700,000 people living with HIV/AIDS in China, over 40,000 had received antiretroviral treatment by the end of October.

Of the 50,000 new infections this year, 44.7 percent were through heterosexual transmission, 12.2 percent from men having sex with men, and 42 percent from intravenous drug use (IDU), the report said.

In the past, more than half the infections were caused by IDU. The changing picture in China is in line with the international trend of major HIV transmission modes, which is gradually shifting from IDU to unsafe sex, Health Minister Chen Zhu noted.

Vulnerable group

The day before World AIDS Day, officials from several government ministries were invited to an online broadcast discussion at Xinhuanet.com.cn on preventing the spread of HIV/AIDS among rural laborers working in cities, which has been identified by the Chinese Government as a group particularly vulnerable to HIV/AIDS infection in recent years.

Of China's 120 million farmers who have migrated to cities to find employment, the majority are aged between 20 and 40 and have only received middle school education or lower.

"Different from the majority of married people, migrant workers mostly live far away from their spouses. When their sexual needs cannot be satisfied, they are inclined to pay for sex. We should always bear their special situation in mind when talking about the sexual transmission of HIV/AIDS in China," said Zhang Jian, a senior official of the National Population and Family Planning Commission.

At the end of 2005, the State Council ordered over 10 government departments to launch a national campaign for educating migrant workers about AIDS transmission. One goal of the program, which will last until the end of 2010, is to supply over 85 percent of migrant workers with the necessary knowledge to protect themselves against AIDS.

Positive progress in this national campaign has been achieved over the last two years. According to Zhang, more than 6,000 new organizations nationwide have specialized in publicizing AIDS prevention knowledge to migrant workers.

The Global Business Coalition on HIV/AIDS (GBC), a non-governmental organization aimed at leveraging the power of the business community to fight HIV/AIDS, tuberculosis and malaria epidemics worldwide, set up its China advisory committee in April. During the weeklong May Day holiday, the China advisory committee spent a donation of 400,000 yuan ($54,000) from eight companies on printing poker cards with information about HIV/AIDS, tuberculosis and malaria on the back. Chinese volunteers for GBC, mainly college students, distributed 10,000 sets of poker cards to migrant workers at a railway station in Beijing. The GBC China advisory committee donated the remaining 30,000 sets of poker cards to the Beijing Municipal Health Bureau, which promised to deliver these poker cards as education material to migrant workers at construction sites throughout the city.

Zheng Wenkai, an official from the Ministry of Agriculture, told the online discussion that since the beginning of the national campaign, over 20 million migrant workers had received basic vocational training before traveling to cities, which included information on AIDS prevention. Zheng said his ministry had also tried to educate the farming population on AIDS so that they can educate family members who work in cities when they come back for family reunions.

Despite the progress, it is too early for China to be conceited. Zhang said his commission had conducted polls on migrant workers on their knowledge of HIV/AIDS, which showed that it remains insufficient in general and less than that of farmers. He proposed a solution that migrant workers should be given more holidays to meet their families.

Although the Chinese Government has been promoting the use of condoms as a vital means to prevent HIV/AIDS transmission, programs of distributing free condoms in entertainment venues in many Chinese cities have been aborted by public criticism that it is an unspoken confirmation of prostitution.

Until recently, police departments at all levels had taken condoms as proof of illegal sex activity in entertainment venues, which dampened the use of condoms in the sex trade. According to national surveillance figures, the rate of regular condom use among China's prostitutes rose from 14.7 percent in 2001 to 41.4 percent in 2006.

Affordable medication

At the end of 2003, the Central Government adopted a "four exemptions, one care" policy as a long-term strategy to fight HIV/AIDS.

This policy states that rural and urban AIDS patients who are not covered by basic medical insurance and are in financial difficulty can receive free antiretroviral drugs and treatment from designated hospitals; people can get free counseling and HIV antibody tests at local disease control centers or designated medical institutions; pregnant women who carry the HIV virus can get counseling, prenatal guidance and delivery service at designated hospitals and free medication to cut mother-to-child HIV transmission; local governments are obliged to pay for the cost of psychological therapy and nine-year education for children orphaned by HIV/AIDS; and governments at all levels should earmark money for funds to support AIDS patients and their families who are in financial difficulty.

The Chinese Government has also started to provide free prevention and treatment of HIV-related opportunistic infections in some provinces to protect people with advanced HIV against infections and malignancies due to their weakened immune system. Non-governmental organizations are also contributing to the cause. According to the latest AIDS report, over 36,000 HIV carriers and AIDS patients in China had received treatment sponsored by programs of the Global Fund to Fight AIDS, Tuberculosis and Malaria by the end of June.

China's top food and drug agency is streamlining approval procedures for importing drugs to treat the estimated 85,000 patients in the country suffering from full-blown AIDS. Zhang Wei, Director with the Drug Registration Department of the State Food and Drug Administration (SFDA), said a streamlined approval method has been adopted for imports of drugs that show significant clinical effects in treating diseases such as AIDS and cancer.

A regulation on drug approval was also amended in July, making procedures more transparent and efficient, which could see certain procedures going faster in special cases.

It costs 120 working days to register an AIDS drug compared with 150 for most others, Zhang said.

Approval for the import of TDF, a key drug in the second line of anti-retroviral treatment also known as the cocktail therapy for AIDS, is currently under way and is expected to be completed in time, he said.

The United States-based Gliead, the drug's developer, filed the required application in August, said Zhang.

So far, only seven kinds of AIDS drugs mainly prescribed for first-line anti-retroviral treatment are available in China.

About 10 percent of patients on first-line treatment, however, develop resistance after taking the drugs for one year and have to switch to second-line drugs to survive, said Hao Yao, Deputy Director with the Disease Control Department of the Health Ministry.

To reduce the drug resistance also faced by AIDS patients in other countries, Hao strongly urged Chinese patients to stick to their treatment as many kinds of drugs in the second-line cocktail treatment such as TDF are still unavailable here and have to be imported from foreign countries.

"We are aware of the pressing issues and are considering further measures and policies," Zhang said.