Beijing, November 2003.

Until recently, there was little evidence that the government of China was serious about AIDS, despite its own forecast that today’s one million people with HIV could reach at least 10 million by 2010. However, the Ministry of Health now appears willing to take some hesitant steps forward – although there is as yet little evidence that other ministries, or local government outside Beijing, are ready to act decisively.

The first signs of a change in spirit by the Ministry of Health came with China’s Round 3 proposal to the Global Fund. (See www.aidspan.org/globalfund/grants/round3/data-china.htm) The CCM proposed a program costing $98 million over 5 years to provide care and treatment for 40,000 “former plasma donors” in rural provinces. In the mid-1990s, these people supplemented meager incomes by repeatedly selling plasma at blood collection points which, it turned out, were practicing unsafe procedures, causing the blood sellers to become HIV-infected.

These people have been treated shamelessly. Local officials who profited from the plasma-selling operations took far too long to bring them to an end. Many of these officials remain in office to this day, sometimes promoting police crackdowns on HIV-infected villagers who protest at their dire plight. The central government wrings its hands and says that health and police activities have been delegated to local authorities and cannot be controlled from Beijing.

The government has at last led an initiative by the CCM to obtain Global Fund support for the provision of treatment to former plasma donors. The proposal was approved by the Fund’s board last month.

Prominently placed on the first page of the proposal was a statement that “the Ministry of Health is currently evaluating the potential financial and other consequences of providing universal free HIV/AIDS treatment to all those in China who cannot afford it.” Then on September 22, speaking at the UN, China’s acting Minister of Health, Gao Qiang, stated that the government has decided that it will indeed provide free treatment to all rural HIV/AIDS patients and poor urban patients.

This promise was repeated at several AIDS-related events in Beijing during early November. There was, on the one hand, an impressive spirit of openness. But on the other hand, there was little discussion by government officials of the enormous hurdles that have to be surmounted if the government’s desire to tackle HIV/AIDS is to be successful. As one speaker pointed out, the Ministry of Health – which has low status among government ministries – could not do all that is needed even if it tried to. Success will only occur if the desire for action moves *up* from the Ministry of Health to the nation’s top leadership; moves *down* from the MOH to autonomous provincial and county agencies; and moves *across* from the MOH to other ministries. Concern was also expressed regarding sub-optimal mixes of ARV drugs being used, and regarding high dropout rates from pilot treatment programs.

The culminating point in the week’s activities occurred on November 10, with a visit by Bill Clinton to an AIDS conference at TsinghuaUniversity. In the question and answer session, he was asked how physically close he has ever come to someone infected with HIV. Very close, he replied in a relaxed tone – handshakes, hugs, sometimes with patients who were close to death. After the Q and A session was over, one of the would-be questioners who had not been called upon jumped up and demanded to be heard. He said that he is twenty-one, and has been HIV-positive for the past six years. Clinton answered his questions, and congratulated him on his openness. He then beckoned to the young man to come up on the stage, affably draped his arm over the young man’s shoulders, and grinned at the flashing cameras as the audience applauded. The following morning, most of China’s major newspapers showed this incident as the main photograph on the front page. It was the ultimate media moment.

The young man in question, Song Pengfei, became HIV-positive through receiving infected blood in a hospital operation. He and his family were then completely ostracized by society, and lived in poverty. His father fought tenaciously to publicize his plight and to obtain ARVs for him from foreign charities. Some years ago, Song was the first person in China to publicly state that he is HIV-infected. After he asked tough questions of Chinese officials at a foreign conference, he was blacklisted by the government. So there was poetic justice when a beaming Clinton took Song by the arm and got him to shake hands, in front of the cameras, with three government ministers, whose smiles seemed a little less perky than Song’s.

The Global Fund grant is important because it represents a last-minute effort to help the former plasma donors before they die, and because it represents the first significant HIV care and treatment program in China. But the real test will be whether China builds on this and effectively tackles the flow of HIV infections from injecting drug users, via commercial sex workers, to the general population.

[Bernard Rivers (rivers@aidspan.org) is Executive Director of Aidspan and Editor of its GFO Newsletter. He visited China several times this year to serve as facilitator to the team developing China’s HIV proposal to the Global Fund.]