China's first ever national conference on HIV opens in Beijing today against a background of an estimated one million infections, virtually no access to antiretrovirals and widespread ignorance and prejudice.
Peter Piot, head of UNAIDS has warned that "China is on the verge of a major epidemic if business as usual continues" adding that China could be facing up to 10 million cases of HIV unless the Chinese authorities take immediate action.
Nevertheless, the very fact that an officially sanctioned conference is being held at all in Beijing, has been hailed as a major breakthrough. Until recently the Chinese authorities had denied that there was an Aids crisis in the country and had blamed HIV on either prostitutes or foreigners.
It has become clear, however, that hundreds of thousands of cases of HIV were caused by blood transfusions or by inadequate or nonexistent infection control procedures during the collection of blood for sale, mainly in remote rural areas gripped by poverty. In Wenlou, a village in the Henan province, 295 of 300 men who sold their blood to a commercial company were thought to have been infected with HIV in this way.
For those with HIV there is no realistic chance of obtaining access to antiretrovirals, even though a generic version of AZT is manufactured by a Chinese pharmaceutical company for export. According to the New York Times, there are currently only 74 people receiving antiretroviral treatment in China. Despite recent successes in driving down the cost of treatments in other developing countries, an effective combination of HIV drugs in China would still cost the same as in the US: $10,000 per patient per year. As few Chinese families earn more than a few hundred dollars a month, antiretroviral treatments are well beyond their reach. What's more, HIV-positive pregnant women are currently unable to obtain nevirapine to prevent their babies becoming infected with the virus because of the cost of the drug, even though it has recently become widely available in other developing countries through a combination of activism, government action and drug company pricing.
Fear of jeopardising its new relationship with the World Trade Organisation, which China joined last week, is thought to be a major obstacle to making cheaper treatments available. The Chinese authorities have proved unwilling to sanction the use of the generic AZT made in the country for domestic use, or to import generic versions of other HIV drugs. Such a move would drive down the cost of treatments to $350 per patient per year and put them within reach of many Chinese.
There is little availability of medication to treat HIV related opportunistic infections and widespread ignorance amongst rural doctors and local medical workers about HIV.
The opening of today's conference is therefore being viewed as significant, particularly as it is opening in blaze of publicity, designed, say the organisers to, "combat public ignorance and misunderstanding." However, much of the prejudice the conference is designed to address comes from Chinese authorities, with those individuals lobbying the government for care or compensation as a consequence of infection from blood products or via blood collection facing official harassment or imprisonment. Sex, particularly homosexuality, is viewed as a "taboo subject." Some Chinese disease control specialists are fearful that the country is heading for a sexually transmitted explosion of HIV, and as blood supplies will not be safe until 2005 and public health officials are saying that "years" of HIV prevention education are needed, the task facing China is awesome.