China's Fight Against AIDS Faces Uphill Battle

Officials in China, where the response to HIV has long been hampered by a reticence to discuss sexual matters in public, are finally getting real about AIDS. The Ministry of Health's announcement last month that "sexual transmission is now the main cause of new HIV cases" made headlines around the country and was underlined by new TV public-awareness ads repeating the message. The health minister broke another major taboo when he announced that almost one third of new infections were among male homosexuals. It's a big shift from the government's traditional attitude that HIV mainly affects drug users and people who sell blood at illegal "blood-collecting stations."

Beijing's more enlightened outlook springs from a realization that HIV is increasingly threatening the mainstream population. The country registered 48,000 new cases over the past year, and official estimates put the number of people living with HIV at 740,000. And with surveys showing a 5 percent infection rate among prostitutes in some parts of the country, the U.N.'s AIDS program (UNAIDS) fears that "between 20 million and 50 million people are at risk," particularly among China's poorly educated migrant workers, many of whom are single men living far away from their families.

Meanwhile, the rapid growth of China's gay scene has led to what Dr. Bernhard Schwartländer, head of UNAIDS in China, calls "a massive epidemic." Gay or bisexual men accounted for 32 percent of new infections this year, and the Ministry of Health's first-ever survey of China's gay community recently found infection rates of 15 to 18 percent in a number of cities. Schwartländer sees "a huge gap between the information available and the opening up of the society," with the result that "HIV is hitting a fairly unprepared upcoming population, which is now at very, very high risk."

The Ministry of Health insists that it is ready to tackle the problem. But plenty of ordinary Chinese haven't yet caught on to its scope. Police crackdowns on drug users and prostitutes work at cross-purposes with health workers and activists, and the public remains resistant to condom promotion. Other forms of discrimination also remain high: one U.N. survey showed that half of respondents would not want to work with someone who was HIV-positive, while one quarter would not shake hands with them. Such attitudes discourage many people from even having an HIV test and may prove difficult for even the most determined health ministry to counter.