跳至內容

使用者:LUMINR/中國大陸愛滋病情況

維基百科，自由的百科全書
  關於中華民國控制下的台澎金馬地區的愛滋病狀況，請見「台灣愛滋病情況」。

目前，人類免疫缺陷病毒（HIV）在中華人民共和國最主要的傳播途徑是性傳播[1]。中國受HIV影響的人數估計在43萬到150萬之間[2]，也有一些估計[3][4]要高得多。20世紀九十年代，以河南省為首的中國許多鄉村地區，因為一些國營採血機構重複使用了被污染的設備，導致數十萬的農民感染HIV[5][6][7]。

雖然從全球愛滋疫情來看，中國目前的愛滋病疫情相對不嚴重，但新感染率和發病率仍在急速增長。如果疫情在像中國這樣的人口眾多的國家爆發，將給全國乃至全世界的經濟帶來巨大影響。由此，目前政府對HIV和愛滋病主要對策為事前干預。

根據2009年2月的一份政府報告，2008年在中國愛滋病首次成為了死亡人數最多的傳染病。2008年的前九個月，就有近7000人死於有關愛滋病和HIV感染的症狀，而從80年代愛滋病進入中國到2005年的愛滋病相關的累計死亡則不到8000人。據美國中央情報局出版的《世界概況》，中國的成年人（15-49歲）HIV感染率為0.1％，和日本相當，且低於許多歐盟國家：英國（0.2％）、奧地利（0.3％）。[8]

歷史

時間表

  • 1984年，中科院院士曾毅開始實行HIV血清檢測，確認HIV病毒於1982年進入中國大陸，1983年第一次感染中國人。
  • 1985年6月，中國記錄國內的首例愛滋病人死亡。病人是一名阿根廷遊客。 [9]
  • 1985年9月，中國禁止血液製品進口。
  • 1986年，4名中國血友病患者輸血後檢測出HIV陽性，證明受病毒污染的血液製品已經被進口 。
  • 1987年，一名接受輸血後感染HIV的13歲中國血友病患者死於愛滋病。
  • 1989年12月，中國記錄HIV感染第一次在物質濫用者中爆發。
  • 1990年， 中國衛生部設立預防愛滋病工作小組。
  • 1992年，中國健康教育研究所設立全國首個HIV和愛滋病諮詢熱線。
  • 1992年，中國政府確認11名愛滋病患者，並宣布防控HIV和愛滋病的中期計劃。
  • 1995年1月，中國記錄HIV感染第一次在血漿捐獻者中爆發。
  • 1995年1月，中國設立HIV愛滋病定點檢測系統。
  • 1995年5月，中國關閉了所有的採血站。
  • 1996年9月，中國首次試驗安全套。
  • 1997年11月，中國第一次開辦研討會討論有效的HIV和愛滋病干預策略。
  • 1998年7月，中國31個省首次發現HIV病毒。
  • 1998年10月1日，《中華人民共和國獻血法》生效。法律要求衛生部門規範採血過程，同時禁止了血液的買賣。
  • 1998年11月30日，中國政府出台《中國預防與控制愛滋病中長期規劃（1998-2010年）》，規劃目標將HIV陽性人數控制在150萬以下。
  • 1999年，衛生部發出行政指導，強調對HIV感染者合法權益的保護。
  • 1999年10月，中國試行其第一個針具交換（英語：Needle exchange programme）（NEP）項目。
  • 2001年6月，中國政府出台《中國遏制與防治愛滋病行動計劃（2001-2005年）》。
  • 2002年8月，中國政府官員第一次正式承認，該國處於愛滋病疫情之中，並透露了中國的HIV感染率從2000年上半年至2001年上半年上漲67.4％。
  • 2002年12月，中國進行了第一例抗逆轉錄病毒療法（ART）和HIV母嬰阻斷（PMTCT）試驗。
  • 2003年9月，衛生部副部長高強在「第五十三次聯合國大會關於愛滋病毒/愛滋病的特別會議」中，承諾一系列對HIV的遏制措施，擴大政府在防控愛滋病中承擔的責任，其中包括對貧困的HIV感染者提供免費治療機會、建立愛滋病防治中心、愛滋病相關立法和國際合作。
  • 2003年，國務院總理溫家寶在北京一家醫院看望愛滋病患者並與患者握手，力圖消除社會歧視，成為了中國第一位公開與愛滋病患者握手的總理。
  • 2003年12月，中國啟動了「四免一關懷」政策：免費提供抗逆轉錄病毒藥物、免費提供HIV的母嬰阻斷、免費自願諮詢檢測、愛滋病致孤兒童免費入學，以及對HIV感染者和愛滋病感染者的關懷。目前已經擴展到全國120多個地區。
  • 2003年12月1日，衛生部和聯合國愛滋病中國專題組聯合發布的評估報告，估計中國有84萬人感染HIV，其中8萬人患愛滋病。評估稱儘管總患病率較低（成年人感染率小於0.1％），但疫情已蔓延至31個省份 。中國政府估計，2000年中國已有85萬人感染HIV，且其中過半數是在1997年後感染。
  • 2004年2月，國務院防治愛滋病工作委員會成立。
  • 2004年3月，美沙酮維持療法（MMT）的試驗開始。
  • 2004年4月，國務院副總理吳儀在全國愛滋病防治工作會議中公開提倡直接行為干預（英語：Behavior modification）高危人群，標誌著抗擊愛滋病歷程中新一步。
  • 2004年11月30日，國家主席胡錦濤在北京與愛滋病患者面對面會談。
  • 2006年1月，衛生部、聯合國愛滋病規劃署和世界衛生組織在北京聯合發布一份評估，將中國的HIV感染者、愛滋病例估計人數降低到65萬，比2003年的估值少20萬。並估計中國愛滋病患者為7萬5千人。
  • 2006年3月1日，國務院出台的《愛滋病防治條例》《中國遏制與防治愛滋病行動計劃（2006-2010年）》生效。

早期

最初，中國政府的防控愛滋病的措施著重於阻止HIV入境，愛滋病被描述為與西方國家接觸的惡果。且「愛滋病」經常被雙關成同音異字的「愛資病」，愛資本主義病[9]。中國相繼出台法規，要求海歸中國人和計劃在中國居住一年以上的外國人接受HIV檢測[10][11][12]。所有血液製品的進口都被禁止[13][14]。針對病毒在國內的傳播，中國政府通過了打擊物質濫用[15]和性交易[16]的法律，且允許直接隔離HIV感染者[12]。直到1994年HIV感染爆發在輸血人群中，當局才認識到非法血站採集血液和血漿的危險，開始制定相應對策。和其他國家的HIV疫情相似，傳統的公共衛生策略中用來控制傳染病、隔離病例的做法都被證明無效[17]。當時的中國正處於經濟快速增長的社會變革時期，物質濫用現象和性活動都有增加。這些早期的政策對阻止病毒傳播幾乎未起作用，還可能導致高危人群選擇更隱蔽的活動方式，使這些群體的HIV感染難以發現[18][19][20]。


發展

政府內部合作

九十年代後半，科學證據顯示中國人感染人數不斷增長，與此同時外國不時傳來愛滋病的負面消息，能有效降低HIV感染的針對性干預措施被發明，這些原因最終造成中國政府官員對HIV疫情的態度幾次大幅轉變。

早在九十年代中期，就有中國官員組織國外考察團，到其他國家學習防治愛滋病的成功和失敗的經驗，並帶回這些經驗。考察團成員包括衛生部、公安部、司法部、教育部、財政部、發改委、人口計生委員會的官員，以及國務院的立法者。目的地包括澳大利亞、美國、巴西、泰國、歐洲、非洲等。這些考察活動讓官員們有機會去學習國外同行的經驗，也增進了參加考察的政府各部門間的合作關係。

相關政府部門也在國內舉辦了研討會，商討加強跨部門溝通的策略。傳統上中國政府的結構組織等級制度森嚴，各部門各自為政，跨部門不允許直接合作，導致當時愛滋病防控方案難以做到面面俱到。聯合國愛滋病聯合規劃署和一些其他在亞太地區的聯合國機構——如聯合國藥物管制規劃署（現在的聯合國毒品和犯罪問題辦公室 ）——為推動中國政府各部門對話做出了極大貢獻。

1997年，中國預防醫學科學院（2002年改名中國疾病預防控制中心）和加州大學洛杉磯分校共同舉辦了一次重要的研討會，研討會主題關於針對高危人群的支持政策。研討會吸引了來自社會學、倫理學、公共健康教育等領域的學者，以及一些政府官員和來自世界衛生組織、聯合國、世界銀行等國際機構的代表。此次研討會首次公開討論了一些對高危人群（如性工作者、注射毒品使用者、男男性接觸人群）的干預措施。其中一些措施雖然得到科學證據支持，但在傳統道德觀念上仍存在爭議。最終，政府意識到這些措施的有利之處，達成共識並決定實施。

這些研討會和考察團的成員負責為中國最先端的HIV防控找到有效的措施，並參與制定規劃文件，包括《中國預防與控制愛滋病中長期規劃（1998-2010年）》[21]、《中國遏制與防治愛滋病行動計劃（2001-2005年）》[22]、《愛滋病防治條例》[23]等。 這些重要文件中警告若疫情在中國爆發的後果，被認為影響了後來官員制定政策的態度。聯合國2002年的報告（China's Titanic Peril）[24]中一個數據預測：2010年中國的HIV感染人數將達到一千萬人，後來該數據被發現證據不足，但仍被反覆誤用。國務院防治愛滋病工作委員會辦公室和聯合國中國愛滋病專題組2004年發布的《中國愛滋病防治聯合評估報告》[25]估計中國的HIV感染者和愛滋病患者達到84萬。2005年，改進數據收集手段和估計方法後，這個數據被修正為65萬。[26] 儘管新估計的傳染率僅為0.05％，但也大大超出1998年政府估計的30萬人[21]，讓政府立刻加強了政策的實施。

科學新政策

一方面，官員經歷了培訓、建立了人際關係網。與此同時，中國的研究者識別了高危人群，開始有能力記錄和預測疫情的傳播路線。觀摩了國外的成功案例後，在國內進行了行為干涉法有效性的測試。愛滋病病毒有關的研究計劃主要由大學、醫院、和地區機構(community agencies)來完成，並與國內外的機構有合作。中國政府命令下大部分的疾病研究和監控由中國疾病預防控制中心性病愛滋病預防控制中心主導。地區級別的防控工作，無論是否由全國疾控中心發起，幾乎完全由省市疾控中心、區縣醫院、鄉村醫務工作者完成。中國疾控中心發起的尤其是衛生部下令的研究項目，通常比政府外的機構的研究項目更快被部署執行。

2000年後

政府換屆

2003年，由國家主席胡錦濤、總理溫家寶以及衛生部長吳儀帶領的新一屆中央政府作出承諾，大大加快了新防控政策的部署的進度。一系列行動包括：設立127個高感染率愛滋病綜合防治示範區，為HIV攜帶者提供服務；四免一關懷政策；成立國務院防治愛滋病工作委員會，組織動員有關部門和社會各方面力量參與愛滋病防治工作[25]。新政策增加了財政預算，保證了防治、檢測項目的進一步推進。

中國政府的愛滋病「四免一關懷」政策指：

  • 免費為農村居民和未參加醫療保障制度的城鎮居民愛滋病病人提供抗病毒藥物；
  • 免費為有意願參加的人員提供諮詢和愛滋病病毒抗體初篩檢測；
  • 免費為感染愛滋病病毒的孕婦提供母嬰阻斷藥物和嬰兒檢測試劑；
  • 免費為愛滋病遺孤提供心理康復和義務教育；
  • 關懷愛滋病患者及其家屬的經濟狀況，給予其中經濟困難者生活補助，或扶持增加工作中的收入。

立法

2006年3月，中華人民共和國國務院正式出台了中國第一部針對愛滋病防控的法規《愛滋病防治條例》[23]。該條例和隨後推出的《中國遏制與防治愛滋病行動計劃（2006-2010年）》[27]是政府在有關愛滋病防治的立法上邁出重大的一步。儘管距離發現第一例國內HIV感染已經過去二十年，一些條例還是被指過於超前。新政策的制定過程漫長又混亂，經過大量國內外的經驗學習討論和失敗嘗試，才得出一個前後一致的結果。新的法規使得政府官員、醫療機關、維權活動人士、政客和立法者等一系列機構開始協同工作。

2009年官方報告

2009年2月的一份中國官方報告中指出，愛滋病於2008年首次成為了造成死亡人數最多的傳染病。中國國營媒體報道，2008年的前9個月中，就有近7000人死於HIV和愛滋病[28]。相比較，結核和狂犬病造成的死亡人數分別退至第二和第三[28]。中國衛生部確認，近年來有關HIV和愛滋病的死亡案例急劇增加。直到2005年，中國因HIV和愛滋病的死亡總數不到8000人[28]，而到2008年這個數字翻了五倍。[28]

流行病學

中國政府被指未能夠對HIV和愛滋病的威脅做出及時反應且有意隱瞞疫情的嚴重性，受到了廣泛的批判。[29][30]

感染人數

The Ministry of Health has said there are 650,000 HIV/AIDS cases, half of them among intravenous drug users, out of a nation of 1.3 billion people.[31] (Although this overall estimate of HIV and AIDS cases was lowered in January 2006 – in a report put together by the Chinese government, the World Health Organisation and the Joint United Nations Programme on HIV/AIDS (UNAIDS) – from 840,000 to 650,000, officials say this reflected the use of different statistical methodology rather than a drop in the incidence.) Epidemiology experts have said that 1.5 million is closer to the true figure.

2005年省別HIV報告病例

According to China's health ministry, there are now 264,302 registered cases of HIV/AIDS in September 2008, up from 183,733 in 2006, with 34,864 deaths.[32] But the real figures are likely to be much higher as testing and surveillance techniques are limited, especially in the countryside, and entrenched discrimination may have discouraged many from reporting.

Out of the 840,000 HIV carriers in the mainland, the health ministry estimates in early 2004 that there are 80,000 suffering from AIDS. HIV cases have been reported in all the Chinese mainland's 31 provinces, autonomous regions and municipalities.[33]

疫情的開端

1985年，中國發現國內第一例愛滋病例，一名病危的外國遊客。[34]1989年，處中國西南邊境的雲南省的146名海洛因使用者被報感染，為HIV第一次在中國本土傳播。[35]1989年至90年代中期，HIV從雲南沿著主要的販毒路徑不斷傳播到鄰近區域，再由注射毒品使用者（IDU）傳播給其性伴侶和子女。隨之，90年代中期，中原各省有償血漿捐贈者間的感染率急速攀升。[36]為防止貧血，血漿捐贈者抽血後，血漿被取出，紅血球被輸回體內。反覆使用針管再加上血液回輸，造成上千人感染。[37][38] 與此同時，HIV也在通過性傳播傳染。到1998年，受HIV影響的31個省份的感染人數不斷上升。[25]到2005年，累計感染人數已達到65萬人。[26]

Growth rate

The potential risks are very high. The most recent data showed that the number of new cases in China rose by 70,000 in 2005, which led to some health officials to raise concerns that infections were moving from high-risk groups into the broader population. The ministry attributes 37% of the new cases to drug use and 28% to unprotected sex.

Health officials are also mindful of the experience in Africa in the 1990s – for instance, the quick rise in South Africa's incidence from 1 percent at the start of the decade to about 20 percent in 2003 – which underlines the strong case for an early and aggressive policy response.

An increase in diagnoses might mean that HIV testing has become more easily available than in preceding years, or that the stigma associated with HIV has declined, encouraging more to get tested.

HIV subtypes

The subtypes of HIV-1 found in China include B, Thai B, A, C, D, E, F, G, and BC and BB recombinants. However, the epidemiological distribution and relative importance of these subtypes need further study.

Transmission

China's HIV/AIDS epidemic can be divided into three phases.

  • The first phase, in 1985–88, involved a small number of imported cases in coastal cities — mostly foreigners and overseas Chinese. Four people with haemophilia from Zhejiang province also became infected with HIV after using imported factor VIII.
  • The second phase, from 1989 to 1993, began with finding HIV infection in 146 drug users among minority communities in Yunnan province in the southwest, adjacent to the "Golden Triangle" bordering Myanmar, Laos, and Vietnam.
  • The third phase began in 1994, when a number of infections were reported among drug users and commercial plasma donors. In the 1990s, HIV gained a foothold in China largely due to tainted blood transfusions in hospitals and schemes to buy blood plasma, where it was collected using unsanitary means. Although the government today acknowledges responsibility in the transfusion cases, many victims still have trouble receiving compensation. By 1998 HIV infection had been reported from all 31 provinces, autonomous regions, and municipalities under control of the central government. Though drug users accounted for 60%–70% of reported HIV infections, the number of infections through heterosexual transmission had increased steadily to 7%.

High risk groups

  • Sex workers/prostitutes
Chinese authorities estimate there are 3 million to 4 million women working as prostitutes in so-called karaoke bars, hair salons, massage parlors and truck stops.
  • Intravenous drug users
  • Migrant workers (the "floating population"), are invariably single, poorly paid and from less progressive regions of China where sex education remains taboo, are immediately exposed to the high-risk groups. Workers travel between work and home for the periodic visit with spouses—the virus is virtually guaranteed to affect a broad geographic range. Now the United Nations, through the World Health Organization (WHO) said on Friday the importance of providing sex education in schools from 12 years to become familiar with the use of contraceptives.[39]
  • Blood donors
  • Healthcare workers.
  • Men who have sex with men
recent data shows HIV epidemic has been rapidly spread in China's MSM population. In 2011, NCAIDS estimated there were 780,000 people living with HIV/AIDS in China and 32.5% were MSM.

HIV and syphilis co-infection among MSM

Co-infection of HIV and syphilis is probably a major reason behind resurgence in syphilis prevalence among men who have sex with men in China. It is hypothesized that the association observed between syphilis and HIV among MSM is probably due to similar risks associated with both infections. Analysis of data from a survey among MSM in seven Chinese cities reveal that the factors significantly associated with co-infection are older age, education up to senior high school, unprotected anal intercourse, recent STD symptoms, and incorrect knowledge about routes of transmission.[40]

A meta-analysis has shown that the HIV-syphilis co-infection among MSM in China increased from 1.4% in 2005-2006 to 2.7% in 2007-2008.[41]

Predictions

Predictions of the size of the HIV/AIDS epidemic in China have been made by several expert bodies. Notable examples include:

  • In 2002, a UN-commissioned report, emotively entitled China's Titanic peril ,[42] estimated that China had about 1 million cases of HIV, and that it was on the brink of an "explosive HIV/AIDS epidemic... with an imminent risk to widespread dissemination to the general population". The report continued: "a potential HIV/AIDS disaster of unimaginable proportion now lies in wait."
  • In September 2002, the US National Intelligence Council estimated that 1–2 million people were living with HIV in China, and predicted 10–15 million cases by 2010.[3] The National Intelligence Council claimed that these figures were more reliable than previous estimates because they did not rely on official Chinese sources, which the National Intelligence Council asserted "systematically understate the actual figures", but rather incorporated assessments by academics and non-governmental organizations working in the field.
  • In November 2002, the American Enterprise Institute referred to the situation as the "AIDS typhoon".[4] This report emphasized the probable damage to the economy because HIV would spread among young educated urban people.
  • In April 2004, HIV/AIDS was referred to as China's timebomb by the Center for Strategic and International Studies (Washington, DC, USA).[43]
  • The number of people infected with HIV/AIDS in China "could rise to 10 million in the next six years unless the government acts urgently and effectively to prevent an epidemic", the Joint United Nations Programme on HIV/AIDS said in its 2004 biennial report on the global AIDS epidemic. The virus has spread to all provinces of China but with no distinct pattern of infection, and there are "extremely serious" epidemics in parts of the country despite a low rate of the disease nationwide of about 0.1 percent, the report said.

These estimates assumed substantial spread of the virus from high-risk groups to the general population. Yet, trends from sentinel surveillance of pregnant women in high-risk areas might indicate that such spread may not have occurred.[44][45] Another study showed, however, that 43% of the tested infected people were from low-risk groups.[46] More recently, China Aids Info reported that "HIV infection has caused a 75% increase in the worldwide mortality rate for newborns" and quoted a case in China.[47] It is discussed, whether these predictions may have been made on unfounded assumptions. Some have argued that the effect of the high predictions have drawn attention and resources away from areas of greater need. For example, China's burden of disease from tobacco use is enormous.[48] Others argue that due to the large number of cases of undiagnosed infections HIV testing must be introduced via "anonymous surveillance and voluntary counselling and testing in order to reduce transmission".[46]

HIV/AIDS surveillance system

The national surveillance system in China has three components:

  1. National disease reporting programme for 35 notifiable communicable diseases that covers the entire population.
  2. 845 national disease surveillance points covering 1% of China's population in 31 provinces, regions, and municipalities.
  3. Several disease specific surveillance systems including one for HIV infection and AIDS.

Additionally, 42 national HIV/AIDS sentinel surveillance points have been established in 23 provinces since 1995.

Case finding

The first step in understanding the extent of an epidemic was to be able to identify cases. National sentinel surveillance has been implemented since 1995, but was initially restricted to high-risk areas and to attendees at sexually transmitted disease clinics, female sex workers, drug users, and long-distance truck drivers. Surveillance has gradually been expanded to 845 national sites and now also includes pregnant women and men who have sex with men.

Around the same time, voluntary testing and counseling was made available in some communities, but, even where available, was rarely used. Reluctance to seek HIV testing was probably due to a number of causes – e.g., cost, inaccessibility of services, absence of any treatment, scant publicity or advocacy for testing, low or no perceived risk, and stigma associated with the use of testing services.[49][50][51][52] Since 2004, the government has addressed the environmental barriers. The high cost was addressed in 2003 by making free HIV testing available for the poor,[53] and later, under the 'Four Free and One Care' policy, antiretroviral therapy was made freely available for all through the Chinese health system. The number of screening laboratories has been expanded to 5500, and there are now 99 laboratories able to do confirmatory HIV tests. Free HIV testing has been made available, and expanded from 365 counties in 15 provinces in 2002 to over 2300 counties, with 3037 sites, in all provinces in 2006. The AIDS Regulations have introduced penalties for health units that do not provide free testing on request.

The rapid expansion of testing infrastructure has been largely prompted by the introduction of provider-initiated routine testing campaigns to identify infected individuals and put them in contact with treatment services. Client-initiated testing was failing to identify most infected individuals, so campaigns to screen high-risk groups, including drug users, commercial sex workers, prisoners, and former plasma donors, were commissioned to link patients to treatment services.[54] The campaigns have resulted in a substantial increase in the number of individuals who know their HIV status, with an additional 60,000 people living with HIV/AIDS identified. This increased identification explains, at least in part, the rapid rise in reported HIV cases in the early 21st century. However, even with this effort, only about 22% of the estimated 650,000 HIV-infected individuals living in China at the end of 2005 have been identified.[26] Routine testing in high-risk groups continues.

Control and prevention

Overview

Early efforts to control the HIV/AIDS epidemic emphasized enforcement of laws against high-risk behavior. Later lessons from effective interventions in pilot programs and in other countries (e.g., needle exchange programs in Australia and condom campaigns for sex workers in Thailand) have led to a more evidence-based approach.[55]

The process of policy development have not been tidy because of tensions arising particularly from those between public health officials and the police and those within public security over the management of illegal drug use and prostitution. However, the 2006 AIDS Prevention and Control Regulations[56] are an example of evidence-based policy, even if their implementation is highly variable across China.

In 2003, in response to the ever growing spread of HIV/AIDS, the Chinese government declared a strong commitment to its prevention. Long- and medium-term plans for controlling and preventing HIV/AIDS have been developed, and a central government coordinating committee has been formed among 33 ministries.

Four main factors have driven China's response to the HIV/AIDS pandemic:

  • existing government structures and networks of relationships;
  • increasing scientific information;
  • external influences that underscored the potential consequences of an HIV/AIDS pandemic and thus accelerated strategic planning; and
  • increasing political commitment at the highest levels.

China's response culminated in legislation to control HIV/AIDS — the AIDS Prevention and Control Regulations.

Three major initiatives are being scaled up concurrently.

  • First, the government has prioritized interventions to control the epidemic in injection drug users, sex workers, men who have sex with men, and plasma donors.
  • Second, routine HIV testing is being implemented in populations at high risk of infection.
  • Third, the government is providing treatment for infected individuals.

These bold programs have emerged from a process of gradual and prolonged dialogue and collaboration between officials at every level of government, researchers, service providers, policymakers, and politicians — leading to decisive action.

Treatment programs

Current treatment plan

The government now provides free AIDS drugs to rural residents and city-dwellers without insurance. Other measures include:

  • Free voluntary counseling and testing.
  • Free drugs to HIV-infected pregnant women to prevent mother-to-child transmission, and HIV testing of newborn babies.
  • Free schooling for AIDS orphans.
  • Care and economic assistance to the households of people living with HIV/AIDS.
Antiretroviral treatment for people with HIV/AIDS

In 2001 and 2002, the number of patients living with HIV/AIDS being identified through treatment services began to increase. As many as 69,000 of these people were the rural poor who had been infected when they sold their blood and plasma in the mid-1990s and who were unable to access or afford much-needed antiretroviral treatment.[26] On the basis of the successes of programmes in other nations, such as Brazil,[57] a free antiretroviral therapy programme was piloted in late 2002 in Shangcai county, Henan province, one of the most severely affected areas.[58] Patients were provided with a combination of 齊多夫定 or didanosine plus 拉米夫定 and nevirapine. On the basis of the improved health status and survival of the initial cohort, the programme was scaled up in early 2003, mainly through the China CARES programme.[58]


The provision of free antiretroviral therapy to rural residents and the urban poor became policy in 2003 under the 'Four Free and One Care' policy.[59] The National HIV/AIDS Clinical Taskforce took the lead in establishing the programme, and set up a database to monitor it.[58] As of the end of 2006, more than 30,640 patients have been treated in 800 counties in all 31 provinces. Research to inform further expansion and improvement of the programme is ongoing. Initial reports indicate that the current treatment regimen has a high drop-out rate (at least 8%), mainly due to side-effects, drug resistance, difficulty with adherence, and progression of disease.[58] Therefore, the government is currently exploring options within the pharmaceutical industry to make additional regimens available,[60] which will address both the issues of compliance, by making regimens with fewer side-effects available, and resistance, by making available additional lines of treatment.

Pilot programs

The government has recently approved a series of pilot programs, such as:

  • a needle exchange program for drug users who have gone through detoxification
  • a methadone maintenance treatment program
  • vending machines selling condoms have been set up in public places.

Reduction of transmission via injecting drug use

Intravenous drug use represents the largest single cause of HIV transmission in China, accounting for 44.3% of infections at the end of 2005.[26] Ministry of Public Security data suggests that the number of registered drug users has risen steadily at a rate of about 122% per year, from 70,000 in 1990 to 1.16 million in 2005. The total number, including unregistered drug users, is thought to be much higher, with one estimate placing the figure at 3.5 million;[61] the UNODC World Drug Report estimated that in 2003, 0.2% of 16–64-year-olds (i.e., 1.7 million people) were opiate abusers.[62] The most commonly used drug is heroin, which accounts for 85% of total reported drug use, although amphetamines are becoming more common, especially in urban areas.[63] Many drug users begin heroin use by smoking, but later find it more cost effective to inject because of the stronger effect gained from injecting a smaller amount. Sharing injection equipment is common.[64]

National policymakers have recently shifted their position and publicly acknowledged the extent and pattern of increasing drug use, which has led to a rapid increase in treatment options for drug users. According to the regulations on the prohibition of narcotics,[15] drug users identified by authorities for the first time are fined or sent to a voluntary detoxification center run by the health system, which might include short-term use of methadone, buprenorphine, or traditional Chinese medicine. Detoxification costs 2000–5000 yuan (about US$250–625) for one phase of treatment.[65][66] If, as often happens, the treatment is not successful, relapsing patients identified by authorities are sent to a compulsory rehabilitation center, administered by the Ministry of Public Security, for 3–6 months. Those with multiple relapses are detained in a re-education-through-labor center, managed by the Ministry of Justice, for 1–3 years. In reality, internment procedures and durations vary enormously between administrative units. In general, centers focus on detoxification. Although some health education or treatment is provided, the relapse rate is extremely high..[67][68][69]

Cooperative actions by politicians, policymakers, government officials, and scientific researchers have resulted in the introduction of new strategies for drug control over the past 6 years. For example, the government is working with neighboring countries to prevent drug smuggling, and is increasing anti-drug education for the general population and in schools.[66] The government has also commissioned research on harm reduction strategies, such as methadone maintenance treatment and needle exchange programmes.

針具交換項目

針具交換項目（英語：Needle exchange programme）最初衛生部未被正式批准，因為易被理解成容忍吸毒行為。因此，該項目一開始被稱為針具社會營銷，名為推廣商業針具，擴展銷售渠道、普及大眾的使用，順帶安全使用注射器的健康教育，再有時候提供免費針具。[64] 2001年，國務院正式提倡將針具社會營銷作為HIV干預手段。[22] 考察團了解到澳大利亞等國家[70]針具交換項目的成果和其顯著成果，促使衛生部支持了1999年在雲南省和廣西壯族自治區的第一個針具交換項目。2000年至2002年，一個規模更大的針具交換項目在廣東和廣西的四個縣試行。[71][72]後續調查的數據顯示實行針具交換項目的實驗組比控制組在過去一個月內共用針具的概率小三倍（OR 0.36，95% CI，0.25–0.52）。此外，實驗組的C型肝炎（51.1%對83.6%, p=0.001）和HIV感染率都顯著低於控制組，不過這個結果只出現在廣東（p=0.011），從廣西（p=0.2）或總體數據（18.1% vs 23.6%, p=0.391）上看都不為顯著。

此次試行的結果被用於製作2002年的全國行動綱領，針具交換項目也被包括在了第二個五年行動計劃中。[73] 該項目在2006年顯著擴大規模，由93個城市至年底擴張至729個，主要為鄉村地區。其中很多地方提供的服務不止針對注射吸毒者，還包括分發安全套、自願諮詢和檢測、抗病毒治療、關於物質濫用和HIV的普及教育等。[74]

Methadone maintenance treatment programmes

A large body of international research has shown the efficacy of methadone maintenance treatment programmes for the treatment of drug addiction and subsequent reduction in HIV risk behaviors.[75][76][77][78] In acknowledgment of this evidence, in 2004 the Chinese government called for the use of such practices to mitigate HIV transmission.[60] Immediately, under the governance of the Ministries of Health and Public Security and the State Food and Drug Administration, a pilot study of eight clinics in five provinces was done.[79][80] Inclusion in the programme required: (1) several failed attempts to quit the use of heroin, (2) at least two terms in a detoxification centre, (3) age at least 20 years, (4) being a registered local resident of the area in which the clinic is located, and (5) being of good civil character. Those testing HIV positive need only fulfill criteria 4 and 5. To monitor the progress of the clinics, a database was established to gather data on demographics, medical issues, drug use, and other information about the patients. These data were assessed at 3, 6, and 12 months, and indicated reductions in heroin use, drug-related crime, and unemployment in those who received methadone maintenance treatment.

On the basis of the successes of the pilot, the programme began scale-up in 2004 and plans are in place to open an additional 1500 methadone maintenance treatment clinics for about 300,000 heroin users by 2008. A National Training Center for methadone maintenance treatment has been established in Yunnan to provide clinical and technical support. The services offered at such clinics have been broadened and provide access to other services, including HIV and hepatitis testing, antiretroviral therapy for eligible AIDS patients, group activities, and skills training for employment. The use of methadone maintenance therapy has been incorporated into the AIDS Regulations as a treatment for heroin addiction. Additionally, the requirements for entrance into methadone maintenance treatment programmes have been relaxed to encourage greater access. For example, patients are no longer required to have local residency or a previous history of internment in a detoxification centre. The programme is not without problems, however, and retaining drug users in the programme remains a critical challenge.

Sexual transmission

Although most HIV-infected individuals in China are drug users, patients infected through sexual transmission are the fastest growing group, accounting for close to 50% of new infections in 2005.[26] Overall, they represent 43.6% of total HIV/AIDS cases, including commercial sex workers or their clients (19.6%), partners of HIV-infected individuals (16.7%), and men who have sex with men (7.3%).[26] As with drug use, sexuality is not openly discussed in Chinese society and is therefore neither easily targeted by health promotion campaigns, nor has it traditionally been taught in schools. Even among university students, levels of AIDS knowledge and risk perception are alarmingly low.[81][82] On the other hand, attitudes towards sex are becoming increasingly more liberal and, as a result, premarital and extramarital sex are more commonly practiced.[83][84] Although they are widely available, condoms are rarely used.[85]

Commercial sex work

Commercial sex work is illegal in China; hence, brothels are illegal and commercial sex workers operate out of places of entertainment (e.g., karaoke bars), hotels, hair-dressing salons, or on the street.[86] The traditional strategy for controlling HIV transmission through commercial sex workers has been the development of stricter laws to prevent risky behaviors,[16] accompanied by raids on suspected sex establishments by public security officials.[20][86] Those apprehended are subject to compulsory education on law and morality, testing and treatment for sexually transmitted diseases,[86] and forced participation in productive labor.[20] Under the Frontier Health and Quarantine Law,[12] those knowingly infected with HIV who continue to practice prostitution are subject to more severe penalties and criminal liability for creating a risk of spreading a quarantinable disease.[12][86] Detention ranges from 6 months to 2 years. Until recently, health education in this system was uncommon.

In 1996–97, following the success of prevention interventions in neighboring Thailand,[87] the Chinese CDC launched the first intervention projects to promote safer sex behaviors to prevent HIV and other sexually transmitted diseases in commercial sex workers working at entertainment establishments in Yunnan.[88][89] These projects showed the feasibility of such programmes, which included condom use to control the spread of HIV and other sexually transmitted diseases in commercial sex workers, and have been officially promoted since 1998.[21] Between 1999 and 2001, the World AIDS Foundation supported a five-site trial of a behavioral intervention in commercial sex workers who worked in entertainment establishments.[90][91] The intervention included condom promotion, establishment of clinics for sexually transmitted diseases to provide check-ups, and outreach for health education and counseling. HIV-related knowledge improved substantially, and the rate of bacterial sexually transmitted diseases fell. The rate of condom use at last intercourse increased from around 55% to 68%, and fewer commercial sex workers agreed to sex without a condom when requested by a client who offered more money. The prevalence of gonorrhea fell from about 26% at baseline to 4% after intervention, and the prevalence of chlamydia fell from about 41% to 26%.

The findings from this trial were used to draft national guidelines for interventions among sex workers in China. The provision of condoms at entertainment establishments is now an official requirement under the AIDS Regulations. Condom vending machines are being installed in venues such as university campuses and hotels, and condom promotion and HIV education campaigns that target youth and migrant workers are gradually being scaled up.[91][92]

Prevention of mother-to-child transmission

After reports of successful intervention in other developing countries,[93] a feasibility trial of the prevention of mother-to-child transmission was piloted in late 2002 concurrent with the antiretroviral therapy pilot, with financial and technical support from UNICEF. Mothers who tested HIV positive were offered counseling, the option of abortion or antiretroviral therapy and, where available, caesarean delivery, to reduce the likelihood of mother-to-child transmission. Free formula milk for 12 months was provided for infants.[94]

On the basis of this pilot programme, national guidelines were developed to guide the prevention of mother-to-child transmission in the country. The provision of such services has been ratified by the AIDS Regulations. Services are being scaled up to cover at least 85% of infected pregnant women by 2007, and to reach at least 90% by 2010.[73] Scale-up is being prioritized to the most heavily affected areas first. As of the end of 2005, more than 500,000 pregnant women in high-risk groups or in high-prevalence areas had been tested for HIV in 271 counties in 28 provinces. The overall participation rate in HIV testing in these pregnant women was 92%, and the HIV infection rate ranged from 0.3% to 0.7%. Among those who tested positive, 80% received antiretroviral therapy, and more than 90% accepted formula milk for the prevention of mother-to-child transmission.[95]

Health promotion

A national program has been launched to combat the stigma and discrimination against people with HIV/AIDS.

  • In 2006, 5,000 Beijing taxi drivers handed out HIV/AIDS information leaflets to passengers in the first 10 days of December.
  • Officials in the southwestern province of Yunnan announced in 2006 that, starting on January 1, 2007, Yunnan residents will be required by law to take an HIV test before marriage. There would be no charge for the test, the results of which are to be shared with prospective spouses. Yunnan, home to 25% of the country's HIV cases, borders the opium-rich Golden Triangle of Vietnam, Laos and Myanmar. The virus has been found in 128 of its 129 counties, the provincial government has said.

Future treatment options

In China, a distant hope for HIV prevention is the development of an effective vaccine that can offer long-term protection against the wide spectrum of HIV variants that exist. Despite the fact that there are now more than 30 vaccine candidates in clinical trials (in the world), and three of these are in advance stage testing (phase IIb and phase III), many obstacles still lie in the way of the development of a truly effective HIV preventive vaccine.

The genetic diversity of HIV presents an enormous challenge for researchers. And, because the virus has the ability to evade neutralizing antibodies produced by natural immunity, the standard vaccine strategy of mimicking natural infection to induce antibodies has so far proved impossible. Strengthening cell-mediated immunity offers another possible route to success. About 90% of candidate HIV vaccines in development use this approach. These products will not prevent infection. But it is hoped that they will lower viral load and therefore progression to AIDS and secondary transmissions. Some observers believe that a vaccine to prevent HIV will never be achieved. Ultimately, even if an HIV preventive vaccine were to be developed, they are unlikely to be 100% effective. It has come to be realised that no single approach alone will be able to stem the spread of HIV. The future of HIV prevention will most likely involve combining new methods with existing approaches, such as condom use.

Newer approaches to HIV prevention

Planned programmes

Unlike prostitution and drug use, homosexuality has never been banned in China, but it was listed as a psychiatric disorder until 2001, and public acts of homosexual sex are punishable as hooliganism.[96] Although increasingly tolerated in the cities, in general, homosexuality is highly stigmatised and men who have sex with men are under considerable pressure to conceal their sexual orientation.[97] As a result, most homosexuals are married, or will be in the future, and form a bridge between the high-risk men who have sex with men group to their low-risk wives and other partners.[96][98][99] The government has initiated few interventions for men who have sex with men, leaving such programmes to advocacy groups, non-governmental organizations (NGOs), and researchers.[100] However, the government recently estimated that there were 5–10 million men who have sex with men living in China, of whom 1.35% are thought to be HIV positive.[101] This information, in addition to studies indicating low levels of HIV knowledge, perceived risk, and testing, and high rates of sexually transmitted diseases,[51][102][103] has prompted the Ministry of Health to now include men who have sex with men in the high-risk groups and to call for the development of novel interventions to target them.[104]

Funding

Private sector and NGO involvement

Since 2003, the central government showed an increasing openness on AIDS issues, making several public statements encouraging the participation of the private sector and, to some extent, NGOs. This was due, in part, to the SARS epidemic, which helped change the way in which government dealt with public health issues. For a prolonged period, the authorities did not admit to having a serious outbreak of SARS until it was a devastating problem and only then did they decide to come forward and acknowledge the real scale of the epidemic. The new-found frankness helped the government win back some credibility before the international community.

Currently, there are dozens of different projects sponsored by the private sector targeting the problem around the country, from education and awareness programmes to increasing the capacity of local NGOs. Notable cases include:

  • Merck, a US pharmaceutical company, is spending about US$30m over a period of five years. The program involves training for healthcare professionals, condom distribution and identifying high-risk groups.
  • Bayer, a German pharmaceutical company, has set up a training course in HIV/AIDS issues for journalists. About 300 reporters have completed the course so far at Tsinghua University in Beijing.
  • Standard Chartered Bank has introduced some of the approaches it has learned from its operations in southern Africa, including awareness programs for new employees and encouraging staff to be tested.

AIDS vaccine trials

China is currently seeking volunteers to participate in its second clinical trial of a new AIDS vaccine for early 2007, Shao Yiming, chief expert for the National Center for AIDS/STD Control and Prevention. The center is looking for men and women to participate in the trials which will take place in Beijing. He revealed the plan at a conference on Sino-U.S. AIDS vaccine research and development held on the 17 December 2006 without indicating how many participants will be involved in the trial. The vaccine was approved for clinical trials by Chinese drug authorities in November 2006. Trials on Rhesus Monkeys indicate that the vaccine is safe and effective in preventing HIV infections, Shao said.

In March 2005 China began its first human clinical trials on an AIDS vaccine in southwestern Guangxi Zhuang Autonomous Region. The volunteers, 33 men and 16 women aged from 18 to 50, have been vaccinated and none have had adverse side effects.

According to a recent report released in 2006, there are 120 clinical trials of AIDS vaccines being conducted on humans throughout the world.

中國傳統醫學

維基百科中的醫學內容僅供參考，並不能視作專業意見。如需獲取醫療幫助或意見，請諮詢專業人士。詳見醫學聲明。

有證據顯示中醫藥可能有助緩解愛滋病症狀，但沒有證據表明其能有效控制HIV感染 [105]。

公眾認識和科普

公眾普遍對愛滋病缺乏正確認識是中國愛滋病疫情中一大難題。2001年一份調查顯示，五分之一的中國民眾從未聽說過此病。[106]

科普

HIV檢測以及基層宣傳項目幫助增加人們對愛滋病的認識，消除有關愛滋病的偏見。法律規定，所有鄉級以上地方政府以及教育機構、企業、醫療機關、海關、邊檢和媒體都有義務參與HIV和愛滋病的科普教育和宣傳活動。有學校向學生開展了專題為性、物質濫用和HIV特別課程，尤其是在感染多發的雲南、廣西、廣東等省份。

An important part of HIV education is targeting behavior to reduce stigma towards people with HIV/AIDS. Stigma is well recognized as a major barrier to HIV control, because it prevents people from seeking services for testing and treatment, and discourages people from practicing safer behaviors.[49][107][108] To address this issue, senior political figures have been involved in anti-discrimination campaigns, and have publicly shown that HIV cannot be transmitted through casual contact. For example, on World AIDS Day, Dec 1, 2003, Premier 溫家寶 publicly shook hands with AIDS patients in Beijing Ditan Hospital.[59] The day before the 2004 World AIDS Day, President Hu Jintao and other senior government leaders visited patients living with HIV/AIDS and called for the elimination of bias against this group.[109] During the Chinese New Year celebrations in 2005, Premier Wen Jiabao visited the homes of HIV-infected villagers in Henan province. These actions had a tremendous effect on the general community, and have now been backed up by policy changes. The AIDS Regulations have made it illegal to discriminate against people living with HIV/AIDS and their families in terms of their rights to schooling, employment, health services, and participation in community activities. Furthermore, the AIDS Regulations and the 2004 revision of the Law on the Prevention and Treatment of Infectious Disease [110] include language to protect the identity and disease status of those with an infectious disease, with disciplinary action recommended for those individuals or institutions that violate these laws. Although there had been language in previous regulations to protect the rights of people living with HIV/AIDS, these new laws give such individuals and their families a stronger basis from which to defend their rights.

Criticisms and control problems

Government policies

Health officials say there are plenty of problems in China's approach to AIDS. There are frequent reports of police crack-downs on local NGOs involved in AIDS prevention. There have also been reports of police using the presence of a condom in a sex worker's handbag to justify detention. This has been partially blamed on policy incoordination, and contradictions and conflicts between laws and regulations.

In addition, there are concerns that provincial governments have enough autonomy to sometimes stall the implementation of central government-set guidelines and some officials say there has been a reluctance from many state-owned companies to get involved in AIDS programs.

Discrimination and stigma

Many Chinese businesses have been reluctant to make voluntary commitments to non-discriminatory treatment of HIV-positive employees, often because they fear lawsuits and because they are unable to recoup the cost of HIV/AIDS related health care from company insurance policies.

Population movement and urban-rural inequality

Challenges ahead

China has made impressive progress in the development and implementation of effective intervention strategies, especially since 2004. The country is currently in a transition stage in its HIV policy development. It is increasingly adopting approaches that are based on scientific evidence and has encouraged the pilot testing of controversial methods of risk reduction (e.g., methadone maintenance treatment, needle exchange programmes, and the targeting of men who have sex with men and sex workers).

Failures in scaling-up HIV prevention programmes have not been caused by an absence of policy, but rather, as with other countries, by there being no policy enforcement and timely scale-up. Although China has a strong central government, provincial and lower levels of government enjoy a great deal of autonomy, which has resulted in a mixed response and inconsistent enforcement of HIV/AIDS policy. For example, Yunnan province has shown strong support for implementation and advocacy of harm-reduction strategies that reduce HIV transmission in its many drug users, whereas Henan province had been slower to respond to the needs of former plasma donors in the early stages of the epidemic.[111] Moreover, the distribution of HIV in China is not even, and is concentrated in areas with high drug use (e.g., Yunnan, Guangxi, Xinjiang, and Sichuan) and in areas where people were infected through unsafe blood or plasma donation (e.g., Henan, Anhui, Hebei, Shanxi, and Hubei). The number of cases ranges dramatically between provinces, with, for example, just 20 cases reported from Tibet but well over 40,000 in neighboring Yunnan. In provinces with an extremely low prevalence, it can be difficult for officials to see the need for HIV prevention and control.

Conflicts of interest between departments, such as those responsible for health and public security, have also made coordination of services to reach high-risk groups that engage in illegal behavior difficult.[112] The central government has called for greater cooperation between relevant departments – including Public Security, Justice, Education, Civil Affairs, and Health – but implementation of this policy at the local level varies.

The problem is further exacerbated by inadequate resources and trained personnel. Many rural areas – where most of China's HIV-positive population resides – do not have the capacity to monitor patients' CD4+ cell counts and viral load. In some cases, the physical infrastructure exists, but staff do not have the skills or reagents to use it. Human resource capacity is a major constraint on China's ability to deliver HIV prevention and care. Many health workers and educators have poor knowledge of HIV and hold their own biases and stigmas towards those at risk or infected with HIV.[113][114][115] A substantial proportion of the funds allocated to HIV prevention and control is being spent on establishing training centers and in building the capacity of health workers so that they can deliver better services. But many of those willing to work in rural areas do not have formal medical qualifications to begin with, which limits their abilities to understand the complexities of treating HIV patients.[116] Furthermore, health services rely heavily on user fees, which often encourages health workers to do additional, chargeable services that many people living with HIV/AIDS cannot afford.[117]

With an estimated 650,000 people living with HIV/AIDS and an ever greater number of people at risk of infection, the government has embarked upon a formidable task. The provision of accessible testing and treatment services not only requires financial resources, but also, in many cases, reorganization and supplementary funding of existing local health services infrastructure, especially in rural areas where most of Chinese HIV-positive individuals reside.[118] In particular, rural areas do not have adequately trained staff capable of providing effective treatment and prevention services, as well as the laboratory and clinical infrastructure necessary to monitor treatment.[58] The problem of inadequate human resources is not restricted to health departments – in rural areas, there are few adequately trained technical and management personnel at all levels and across all sectors. The combination of insufficiently trained staff, inadequate technical resources, and a largely remote, poorly educated, rural population represents a challenge to the implementation of effective programmes.

A major step has been the government's promotion of NGOs,[119] which are a new concept in China.[120] Many of the larger domestic groups are actually government funded, and those not affiliated with the government are required to go through a complicated registration procedure to be officially endorsed, although there might be a relaxation of these policies in the future.[121] The presence of international NGOs is also increasing. The ability of NGOs to work with high-risk groups, especially those that engage in behaviors deemed to be illegal or immoral, and to provide care and outreach where overstretched health services cannot, is recognized.[122] The private sector is also being encouraged to undertake prevention and education activities.[123]

The mobilization of multiple sectors within China occurred over a 15-year period when there was a long series of educational workshops, conferences, collaborative projects, and networking between members at a number of levels of the government and administrative structural hierarchies. At local, national, and international forums, officials from many sectors were able to meet one another, share a common knowledge base, and debate the appropriateness of different interventions. Personal relationships were formed that facilitated the consideration and examination of previously unrecognised policy options for detection, prevention, and care. In a non-linear process, a consensus slowly evolved, identifying policy options.

Political officials, policymakers, administrators, and service providers were increasingly willing to recognize the relevance of a substantial body of scientific research that suggested effective intervention strategies that could change the course of the epidemic. Also, major policy recommendations with regard to behavioral interventions were preceded by small pilot projects that showed feasibility or efficacy in those populations at highest risk. Once the evidence base was documented, both the policymakers and politicians publicly showed their support for HIV prevention and care, as well as passing legislation to enforce and broadly disseminate health practices (e.g., routine HIV testing and access to care).

These processes occurred in a context of ongoing influences from the media and international donor agencies, with some contribution from advocacy groups within China. The SARS epidemic showed the potentially disastrous effect of a fast-moving infectious disease and, simultaneously, allowed the HIV community to acquire new methods to fight the epidemic (e.g., real-time data collection of new cases). However, mobilisation of resources, scientific evidence, and administrative drive did not occur until there was enthusiastic political commitment. The pace of implementation of innovative strategies for HIV detection, prevention, and care, accelerated with the commitments made by the government of Hu Jintao, starting in 2003.

After a slow start and reluctance to recognize the existence of risk activities in its population and of the HIV epidemic, China has responded to international influences, media coverage, and scientific evidence to take bold steps to control the epidemic, using scientifically validated strategies. The country now faces the challenge of scaling up these programmes and of convincing all levels of government to implement these innovative strategies and policies. This vigorous response, incorporating research findings into policy formulation, can be informative to other countries that face similar challenges in responding to the HIV/AIDS epidemic.

Activism

In China, like elsewhere, HIV/AIDS activists have played and continue to play an essential role in promoting public awareness and education about the disease, helping to prevent discrimination against people living with HIV/AIDS and highlighting factors which may impede efforts to check the spread of the disease.

It has been claimed by some international human rights groups that HIV/AIDS activists in China continue to face serious obstacles in their work, including arbitrary detention, harassment and intimidation, and other human rights violations. Restrictions on travel by Dr. Gao Yaojie, a Henan activist, have been cited in news reports.[124]

The country's best-known AIDS activist, Wan Yanhai, believes China suffers 10 times the number of HIV cases – 650,000 – estimated by health officials.

Blood transfusion controversy

Bloodhead scandal

From the early to mid-1990s a network of businessmen and government workers, known as "bloodheads", set up hundreds of official and unofficial blood donation stations in Henan Province to supply the market for blood plasma created by hospitals and manufacturers of health products. The common practice of reusing needles, not screening for diseases, sellers traveling from station to station with false records to maximize their income, and the mixing the blood prior to centrifuging and re-injecting the separated red blood cells back into the peasant blood-sellers guaranteed the rapid spread of blood-borne diseases such as HIV and Hepatitis B.[7]

Particularly in the province of Henan, tens of thousands of farmers and peasants were infected with HIV through participation in these programs. The blood stations began to be closed down in 1995 when the scale of the HIV outbreak began to become apparent. The ensuing coverup saw government officials take credit for dealing with the crisis which they caused, the harassment of journalists attempting to cover the story, and of whole villages dying of what was to them a mysterious disease because they had not been informed that they were likely to have been infected.[7] On August 23, 2001, the Chinese government admitted that 30,000-50,000 Chinese people could have been infected with HIV through illegal blood collections and sales.[6]

On August 24, 2002, the prominent HIV/AIDS activist, Wan Yanhai, was arrested in Beijing and detained for a month for leaking an internal government report on the Henan AIDS crisis.[7]

Compensation

In early December 2006, it was reported that a group of 19 people who contracted HIV from tainted blood transfusions at a hospital in the northeastern province of Heilongjiang were awarded 20 million yuan (US$2.5 million) in compensation. The landmark case involves the largest single group stricken by HIV in China. Eighteen of the victims will receive a one-off payment of $25,500 from the hospital and additional monthly payments of $380. Payment will go to the family of the one victim who has already died from AIDS.[125]

Socioeconomic impact

The process of the impact of HIV/AIDS can be described as having three key stages: first, the impact experienced at the micro level; second, at the sectoral level; and finally, at the macro level. The impact began to be observed in China at the micro, or household level, and will most certainly be observed in the future at the sectoral level. Individuals and families have been bearing both the economic and social costs of the disease, and the poverty of those affected have increased and will further increase substantially. Expenditures for the health sector will increase, for both treatment and prevention interventions. There has been almost no impact on the macro level. But if without effective preventive action, the HIV spread in the general population at large will have an impact on the macro level as have happened in some countries in sub-Saharan Africa.[126]

Severe acute respiratory syndrome

The challenge of managing the severe acute respiratory syndrome (SARS) epidemic (November 2002 to June 2003) is often credited with further motivating the government to take aggressive policy action on HIV-related issues. SARS showed not only how infectious diseases could threaten economic and social stability but also the effect of China's policies on international health problems.[19] Policymakers announced a change of focus from purely economic goals to increasing the focus on health and social wellbeing and, as a result, increased support for public health agencies. In controlling SARS, contact between the government and international agencies such as WHO, UN, and the US Centers for Disease Control and Prevention was essential and further stimulated stronger international collaboration for HIV/AIDS prevention and treatment. Intervention strategies necessary for SARS control have been translated into HIV/AIDS prevention – e.g., real-time electronic case reporting.

Media

The media have exerted substantial influence over the timing and course of HIV control in China by bringing news of HIV to the attention of the public, administrators, and policymakers. In 1996, the Southern Weekend newspaper ran a front-page story and devoted another two pages to AIDS in China. This coverage was the first time any comprehensive exposure of the HIV/AIDS epidemic in China had been published by the Chinese press. From 1999, the international and subsequently the national media reported on the thousands of infected plasma donors in Henan and neighbouring provinces who did not have access to services. Although the government had acted quickly when the tragedy became apparent in 1995 by shutting down collection stations and, later, introducing new laws and regulations on the collection and management of blood and blood products,[37][127][128] provision of HIV testing, prevention, and care for donors in the local areas was slower. Progress was stimulated by the media's attention to the plight of the infected plasma donors. Since these initial reports, the HIV/AIDS situation in China has received much attention from the local and international media.

維基共享資源上的相關多媒體資源：LUMINR/中國大陸愛滋病情況

Documentaries

Chinese-American director Ruby Yang has recently made a documentary about AIDS in rural China, which premiered on 14 June 2006, entitled The Blood of Yingzhou District .

An abridged version of Robert Bilheimer's acclaimed US-made 2003 documentary A Closer Walk was shown on China Central Television (CCTV) on World AIDS Day, December 1 (Friday), 2006, and was rerun Sunday and Monday. It was viewed by around 400 million people. The 75-minute length documentary narrated by actors Will Smith and Glenn Close, had premiered in the United States in 2003.

News coverage

AIDSPortal news summaries on China

On 25 November 2006, the Associated Press reported that a Chinese HIV/AIDS activist, Wan Yanhai, was apparently arrested shortly before an AIDS seminar was about to take place in Beijing.

See also


Template:愛滋病（英語：Template:AIDS） Template:中華人民共和國性與性別（英語：Template:SexGenderPRChina）

已隱藏部分未翻譯內容，歡迎參與翻譯。

Notes and references

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Further reading

  • Gill B and Okie S. China and HIV — A Window of Opportunity. N Engl J Med 2007; 356(18): 1801–05.（英文）
  • Chen HT, Liang S, Liao Q, Wang S, Schumacher JE, Creger TN, Wilson CM, Dong B, Vermund SH. HIV Voluntary Counseling and Testing among Injection Drug Users in South China: A Study of a Non-Government Organization Based Program. AIDS Behav Mar 9, 2007.（英文）
  • Wu Z, Sullivan S, Wang Y, Rotheram-Borus M, Detels R. Evolution of China's response to HIV/AIDS. Lancet 2007; 369:679–690.（英文）
  • Li X, Wang B, Fang X, Zhao R, Stanton B, Hong Y, Dong B, Liu W, Zhou Y, Liang S, Yang H. Short-Term Effect of a Cultural Adaptation of Voluntary Counseling and Testing Among Female Sex Workers in China: A Quasi-Experimental Trial. AIDS Educ Prev 2006 Oct; 18(5): 406–19.（英文）
  • Hong Y, Stanton B, Li X, Yang H, Lin D, Fang X, Wang J, Mao R. Rural-to-Urban Migrants and the HIV Epidemic in China. AIDS Behav 2006 Jul; 10(4): 421–30.（英文）
  • Wu Z. Sustainability of effective STD/HIV prevention intervention targeting female prostitutes and their clients at five different settings in China. Final Report to the World AIDS Foundation . Beijing, China: Chinese Academy of Preventive Medicine, 2002.（英文）
  • Su, L; Graf, M; Zhang, Y; von Briesen, H; Xing, H; Kostler, J; et al. Characterization of a virtually full-length human immunodeficiency virus type 1 genome of a prevalent intersubtype (C/B') recombinant strain in China. J Virol. 2000, 74: 11367–11376. doi:10.1128/jvi.74.23.11367-11376.2000. 
  • Zhang, K. AIDS. Beijing: PUMC Publishing House; 2000. pp. 1–4.（英文）
  • Cohen MS, Ping G, Fox K, Henderson GE. Sexually transmitted diseases in the People's Republic of China in Y2K; back to the future. Sex Transm Dis. 2000; 27: 143–145.（英文）
  • 廣西HIV-1首次流行的分子流行病學分析，陳杰。《中華流行病學雜誌》 1999; 20：74-77。
  • Liao SS. HIV in China: epidemiology and risk factors. AIDS. 1998; 12 (suppl B): s19–s25.（英文）
  • Chinese Ministry of Health; UN Theme Group on HIV/AIDS in the People's Republic of China. China responds to AIDS—HIV/AIDS situation and needs assessment report. Beijing: Chinese Ministry of Health; 1997.（英文）
  • Cohen MS, Henderson GE, Aiello P, Zheng H. Successful eradication of sexually transmitted diseases in the People's Republic of China: implications for the 21st century. J Infect Dis. 1996; 174(s2): s223–s229. （英文）

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