HIV/Aids finally on China's agenda

PU CUNXIN, one of China's top actors, is shown cycling through a Chinese city, and as he passes young lovers on the street, he…

PU CUNXIN, one of China's top actors, is shown cycling through a Chinese city, and as he passes young lovers on the street, he says: "Condoms reduce risk. Please protect yourself."

Similar sentiments from leading soprano Peng Liyuan, who congratulates young graduates celebrating their last day of school but warns them to play safe. Meanwhile, legendary action film star Jackie Chan, getting ready for a tricky stunt, says you need danger to make a good film, but in real life "we need to be safe".

This never would have happened in chairman Mao Zedong's day. The scenes come from a series of ads about using condoms to protect against HIV/Aids, produced by the Oscar-winning Aids documentary maker Ruby Yang, and her partner Thomas Lennon, whose previous film was about the Irish in America.

The frankness in the TV ads marks a significant advance in a country where talking about sex remains taboo and builds on a changing message from the higher ranks of the Communist party about the illness.

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In 2003, premier Wen Jiabao became China's first senior leader to publicly shake hands with Aids patients. Not long after, president Hu Jintao was photographed embracing patients, undoing years of suspicion and prejudice about the disease.

The question for China's health authorities became translating this new openness about HIV/Aids into some kind of meaningful policy.

Yang and Lennon's ads are a very positive development and there are more signs that Chinese authorities are taking these policies a step further.

The government had said late last year that 700,000 people were living with the virus, an increase from an earlier estimate of 650,000.

The year before, China lowered its estimate to 650,000 from 840,000, despite warnings from international experts that the disease was spreading due to ignorance and because many people were too afraid or too poor to seek help.

Health ministry data late in February showed that new cases of HIV/Aids in China soared by 45 per cent last year, compared with 2006. The ministry attributed this remarkable increase to changing social attitudes and an improvement in data collection.

Even though the rise was significant, the ministry gave few details about the surge in sexually transmitted diseases or those passed through the blood. There was also a sharp rise of 24 per cent in syphilis cases.

"It's been hard over the years to discover the number of Aids patients because of the stigma," a ministry spokesman said.

Chinese attitudes to sex are traditionally conservative, but now the disease is spreading fast in a country where information about Aids has long been suppressed and the government is serious about aiming to educate and help the segments of society most at risk, especially the growing number of sex workers and, for the first time, homosexual men.

Until very recently in China, HIV/Aids was viewed as a disease that really only affected foreigners, and could be passed through shaking hands or sharing chopsticks. The disease is now mainly sexually transmitted; before, it had been mostly caused by intravenous drug use.

The Beijing-based team leader of the Joint UN Programme on HIV/Aids, Dr Wiwat Rojanapithayakorn, says there has been a significant change in the proportion of sexual transmission of HIV/Aids, although research had not shown a massive increase in the absolute number.

Rojanapithayakorn believes the statistics could refer to more cases being reported, following the principle that if you test more, you will find more. Or it could be a misinterpretation referring to the proportion of cases which are transmitted by sex.

"In terms of sexually transmitted illnesses (STIs) we saw a gradual increase in the last 15 years and it is something the government has to control," said Rojanapithayakorn.

In the old days in China, sexually transmitted diseases were officially eradicated - the Communist party's grip on behaviour, and statistics gathering, was absolute.

But economic liberalisation has led to looser social mores - brothels and massage parlours have opened up and the number of sex workers is increasing.

China adopted a policy of encouraging 100 per cent condom use in 2002 but it is still concentrated in the cities. This needs to expand to include the provinces - the UN has warned that China could have 10 million cases of HIV by 2010 unless it takes steps to fight the epidemic.

China can learn from other Asian countries. Condom campaigns in Asia have been particularly successful in Thailand, where a programme encouraging the widespread use of condoms was introduced in 1989 and has stopped the spread of HIV/Aids among some five million people, and in Cambodia, which adopted the Thai policy.

"Both have demonstrated the effectiveness of the condom approach," said Rojanapithayakorn. As well as the traditional routes of spreading HIV/Aids, such as prostitution and intravenous drug use, the disease in China has been spread by unsanitary, uncontrolled blood banks that travelled rural areas buying blood. About 70,000 people had been infected by contaminated transfusions.

The health ministry survey also showed that even among better-educated city dwellers, nearly 60 per cent were "nervous" to have public contact with HIV-positive people.

China's 200 million migrant workers are among the high-risk groups. Building workers can now attend lectures on the ways HIV/Aids is spread and the importance of condom use.

"I came to know that Aids was not a disease exclusively belonging to sexually active Westerners," Chen Wei, 28, told the People's Daily after a session in the training school in Changsha in Hunan province.

In 2006, the government issued new rules. Now no organisation or individual is allowed to discriminate against Aids patients or their families, and Aids patients will be entitled to free treatment.

Homosexuality remains a real taboo and data is sketchy, but there are between five million and 10 million male homosexuals in China. Because of overwhelming social stigma about homosexuality, gay men are often married and risk passing it on to their wives.

In February, medical authorities began a bold move to reach the country's homosexuals with the first nationwide programme, in efforts to control the spread of Aids among them.

"By learning more about gay people, we can better protect them," said Wang Weizhen, deputy head of the HIV/Aids prevention department at the health ministry, adding that studies were under way in several cities to collect information on gay men, such as their distribution and behavioural patterns.

Xiong Lei, a council member of China Society for Human Rights Studies, sounded a positive note about changing attitudes in China. Xiong wrote in the China Daily how there was evidence of a more practical approach to dealing with HIV, with the use of methadone as a substitute to drug addicts using needles, and peer education is promoted among drug addicts, sex workers and gay men.

"All these groups, vulnerable to infection and subject to discrimination, have remained invisible in Chinese society. As the importance of their participation in the battle against Aids is being recognised, the attitude toward these groups is also changing," said Lei.

Clifford Coonan

Clifford Coonan

Clifford Coonan, an Irish Times contributor, spent 15 years reporting from Beijing