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AIDS at 25

Heroin, ignorance boost spread of AIDS in Chinese province

Clarification: This story about AIDS in China should have said that, while there are 140,000 Chinese with confirmed HIV infections, the Chinese health ministry, World Health Organization, and the United Nations HIV/AIDS program estimate that 650,000 HIV-infected people lived in China at the end of 2005.

KUNMING, China -- This scenic capital of China's southern Yunnan Province has earned itself a more unsavory sobriquet -- China's AIDS capital.

Historically, this multi-ethnic region of stunning valleys and gorges, including a site locals say is the fabled region of Shangri-La, stood out in mostly Han China for its uniquely diverse culture and beauty.

Now the province, where China's first HIV cases were discovered in the early 1990s, is home to about 30,000 of the 140,000 Chinese who are HIV-positive, according to official reports. And that's almost certainly an underestimate, said Yang Maobin, director of Daytop, a HIV/AIDS care center in Kunming.

Experts say that in reality there could be as many as 200,000 HIV cases in Yunnan and 300,000 more in neighboring Guangxi Province and western Xinjiang Province.

Part of the reason almost half of China's HIV cases are concentrated in these areas is their proximity to the world's largest heroin-producing areas -- Afghanistan in the case of Xinjiang and the ``Golden Triangle" countries of Thailand, Myanmar, and Laos in the case of Yunnan and Guangxi.

Starting in the 1980s when China's economic reforms began to take hold, relentless social change and growing inequalities led many disaffected youth to experiment with the heroin being brought into China by smugglers in cahoots with corrupt local officials.

That, combined with an almost total lack of AIDS awareness, has ``burnt a hole into our society," said Yang.

Yunnan's heroin addicts soon began sharing needles -- the surest way of contracting HIV. While the risk of HIV transmission during unprotected sex is less than 1 percent, anyone sharing a needle with an HIV-infected person is almost certain to contract the disease, Yang said.

Zhu Jian, 29, a grim-faced HIV-positive heroin addict who frequents Yang's clinic, said he and those in his circle of heroin addicts had no knowledge about this.

``Nobody told us what was going on," Zhu said. ``At first we didn't know the risks" of needle-sharing. ``We didn't even really know what AIDS was. Then, when we knew, we just didn't care."

A lack of public AIDS education and alienation among hardened heroin users is common in most countries. But in Yunnan and other western provinces the problem is compounded by the preexisting feeling of social dislocation within the region, which is China's poorest. Minority groups make up about 35 percent of the local population and often feel excluded from mainstream life in predominantly Han China.

``In China there's a clear correlation between ethnicity, poverty, and HIV," said Joel Rehnstrom, country coordinator with the UNAIDS program in Beijing. ``However, it's a very sensitive issue, and the causality has not been well understood because of a lack of data and studies."

Rehnstrom said that problem manifests itself in simple ways, such as local governments that don't create communication and education messages tailored to ethnic minorities, who often speak only halting Mandarin, and don't create HIV testing facilities that are truly confidential. As a result, he said, large swathes of the population remained ignorant about HIV and are hesitant to test themselves for the disease.

Most health experts agree that China's HIV rates are unlikely to rise as high as those in sub-Saharan Africa -- which has more then half of the world's 40 million HIV-positive people -- mainly because of its better healthcare system and less-risky patterns of sexual activity.

Though the Chinese government has needle exchange programs as well as a program to provide AIDS patients with free medications, their effectiveness is flawed, Yang said. Many heroin addicts stay away from the official centers where they can get free needles, and the bureaucratic processes HIV patients need to follow to receive medications are so cumbersome that fewer than 10,000 people are receiving medicine.

So Yang worries that in Yunnan the problem could soon burst out of control.

``On one hand, our advantage is that for now HIV is spreading mostly between drug users," said Yang. ``On the other, this is a huge problem because if we don't intervene into this problem now it could break out into the general population" because ``most female addicts have to prostitute themselves" to support their habit.

Ma Chun Mei, 32, a snack food operator and heroin addict, said she enrolled herself into Yang's clinic because she realized she was just a step away from doing that.

``I know I would have become a prostitute because I was earning" about $300 a month, she said quietly, ``but spending all of it on drugs and borrowing more." ``Many of my friends can't bring themselves to face their demons, so many are going the wrong way and selling themselves." If HIV-infected sex workers spur a wider wave of HIV/AIDS in China as they have in India, about 5 million Chinese could get infected with the virus, the World Health Organization has warned.

Yunnan reported last year that in some areas the HIV infection rate among pregnant women was already 1 percent, but China continues to underspend on all public health issues, including on AIDS, according to Henk Bekedam, the chief World Health Organization representative in Beijing.

The greater problem, Yang said, is that the fight against HIV/AIDS in China is crippled by the entrenched prejudices that government officials, healthcare practitioners, and the general population have against the disease and the people it afflicts.

Zhu said when he was diagnosed with HIV, his family and friends immediately rejected him.

``They wouldn't even let me drink water from the same glass as them," said Zhu. ``Overnight I became something else, not fully human."

Alienated and diminished, Zhu said he left home and took to a life of petty crime to support his habit. So far he's been arrested nine times for botched robberies. Each time, he said, local police sent him to compulsory six-month detoxification programs at government rehabilitation centers, where inmates are routinely beaten, intimidated, and humiliated.

Zhu has become fatalistic, saying the dearth of effective medications in China means AIDS will probably kill him before heroin does.

``I come by here every day and sit around with people," said Zhu gesturing at the group of fellow heroin addicts playing board games in Daytop's recreation room. ``But in my heart I know no one is interested in helping me. I'm not a good person, I know. I steal and I bully people. I'm a person. But that doesn't mean anything to anyone. This is the dark side of Chinese society today."

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