Yunnan, Province of China
HIV/AIDS profile
Growing economic prosperity has been the single most important shift in the past three decades in China. In this country of more than 1.3 billion people, per capita gross national income in 2005 stood at US$ 1100 and per capita government expenditure on health was US$ 101.
Many of China’s reforms have created new challenges - in reforms linked with decentralization, for example, where an uneven burden in financing exists between the central and lower levels of government, particularly in poor counties and townships in the west. As a result, significant gaps remain in the availability of health services throughout the country, which limits China’s capacity to comprehensively address HIV/AIDS - a critical public health challenge that is increasingly recognized as an issue pertinent to the quality and prosperity of China by its leaders.
Located in South-West China, Yunnan, a poor interior province bordered by Lao PDR, Myanmar and Viet Nam, has been particularly hard-hit by the HIV/AIDS epidemic. The first group of 146 HIV carriers were found in Yunnan in 1989 and the province is considered the "birthplace" of HIV/AIDS in China.
In the early 1990s, the HIV epidemic was predominantly found among intravenous drug users (IDUs) along the Myanmar-Yunnan border. Since 1995, HIV has spread along truck routes to most parts of Yunnan and the rest of China. In 2004, HIV was detected in 48% of China’s counties but was observed in all 31 provinces, autonomous regions and municipalities.
In 2001, a total of 8,317 HIV/AIDS cases were documented in Yunnan, and 326 AIDS deaths were reported. In 1999, the number of HIV carriers in Yunnan accounted for 43.6% of the national total. This dropped to 32% in 2002.
In 2003, it was estimated that there were 840,000 people living with HIV/AIDS in China. Since then, the Chinese government has collected more representative data on HIV/AIDS, better estimates of the most at-risk populations have been generated, and improved estimation methods have become available. In the 2005 update on the epidemic in China, the WHO, which released the report in January 2006, has put the figure of people living with HIV/AIDS in China, at 650,000. However, other estimates placed the number of people living with HIV in China at over one million and the WHO warns that by all evidence the epidemic seems to be spreading from high-risk groups to the general population.
It is also suspected that a large number of HIV infected people in China do not know their HIV status. The 2005 update notes that approximately 141,000 people living with HIV were detected through testing. With an estimated 650,000 living with the infection, this meant that approximately 510,000 people were living with AIDS did not know their HIV status, highlighting the need for increased coverage of marketing and access to HIV testing services as an entry point to prevention, treatment and care.
At present, the majority of detected HIV infections are found in Yunnan and Henan provinces and in Guangxi autonomous region. By the end of November 2005, Henan and Yunnan Provinces each reported over 30,000 cumulative HIV cases. Least affected at the moment are Qinghai province and Tibet autonomous region.
Currently, injection drug use and sexual contact are the dominant modes of HIV transmission. Although former commercial blood and plasma donors account for a significant proportion of people living with HIV and AIDS, transmission in this group occurred primarily before 1996. The most serious HIV epidemics in China to date are clustered among specific population groups and in certain geographic areas, especially in the south and west of the country, including Yunnan Province. The estimated 70,000 new HIV infections in 2005 primarily occurred among high-risk groups, including drug users, sex workers, clients of sex workers, men who have sex with men, and partners of people living with HIV/AIDS.
Sentinel surveillance showed that HIV prevalence continues to rise among high-risk groups: from 1.95% in 1996 to 6.48% in 2004 among drug users, and from 0.02% in 1996 to 0.93% in 2004 among sex workers. In 2005, HIV prevalence among sex workers was found to be over 1% in some parts of Yunnan, Chongqing, Hunan, Guangdong, Guangxi, Sichuan and other provinces,
Estimated data indicated a focused spread of infections among IDUs. In 2005, there were an estimated 288,000 drug users living with HIV/AIDS, accounting for 44.3% of the total number of estimated HIV cases. In 2003, just over 20% of injectors tested positive for HIV in Yunnan Province. In 2005, seven provinces – Guangxi, Xinjiang, Yunnan, Guangdong, Guizhou, Sichuan, and Hunan account for 89.5% of the infected drug users estimated.
However, surveillance data indicates that HIV is spreading from drug users, sex workers and their clients and other high-risk populations to the general population, and increasingly among women. In some areas of Yunnan, Henan, Xinjiang and other provinces, HIV prevalence already exceeds 1% among pregnant women and those receiving premarital and clinical HIV testing, thereby meeting UNAIDS criteria for a generalized epidemic. In 2003, HIV prevalence among pregnant women in Yunnan Province was 1.3%.
A poor understanding of HIV/AIDS is still one of the primary reasons for the increasing number of people infected and affected by HIV/AIDS. HIV/AIDS awareness remains unacceptably low, and many people still do not know enough about how to protect oneself against HIV. This provides a volatile mix when combined with an increase in risky sexual behavior, increasing (domestic) mobility, and unsafe injection practices.
Stigma and discrimination is a key barrier to addressing HIV/AIDS in China. As a result, take-up of HIV testing and counselling services remains low. Stigma and discrimination also hinders access to care and treatment services, where available. This is a critical issue in a country where more people are now developing clinical AIDS, and AIDS-related deaths are on the rise.
In Yunnan Province, trafficking of women and girls, high cross-border mobility and the difficulty in reaching mobile populations and the ethnic minorities in the region are also main contributing factors to the spread of HIV/AIDS.
National Strategic Framework
China has developed and adopted a strategic framework in the form of the nationwide National Medium- and Long- Term Plan for AIDS Prevention and Control (1998-2010), and the Plan of Action (2001-2005) for immediate intervention. Areas for priority action under the 2002 – 2005 plan included timely implementation of AIDS prevention; strategic planning; improvement of STI care system; investment of human and financial resources for AIDS prevention; and expanding AIDS response at all levels and in all sectors.
In 2005, the Chinese government has taken steps to further strengthen its leadership in the response to HIV/AIDS. The State Council convened an executive meeting and a national videoconference was held on multisectoral work in HIV/AIDS prevention, treatment and care to clarify roles and responsibilities, to strengthen HIV/AIDS prevention, treatment and care legislation, and to include HIV/AIDS in the 11th National Five-Year Plan. In addition, new HIV/AIDS prevention and care regulations, and the 2006-2010 Action Plan for HIV/AIDS Containment, Prevention and Care in China provide the overall framework for the current and future response.
The central government has continued to increase its investment in HIV/AIDS prevention and care. The national budget for HIV/AIDS prevention and care has increased from 390 million RMB (US$ 48.75 million) in 2003 to 800 million RMB (US$ 100 million) in 2005. Local investment has risen from less than 100 million RMB (US$ 12.5 million) in 2003 to 280 million RMB (US$ 34.7 million) in 2005.
Across the country, a range of activities have been instituted to raise awareness and reduce stigma related to AIDS. Information, education and communication materials have been distributed widely. The Ministry of Health, the Publicity Department of the Central Committee of the Communist Party of China, the Ministry of Education, the All China Federation of Trade Unions, the Chinese Communist Youth League, the All China Women’s Federation, and other ministries and organizations have initiated mass media education activities. According to incomplete statistics, over 120 million IEC materials have been distributed, and 34.9 million people have so far received HIV/AIDS information and face-to-face education.
There has been some scaling up of condom promotion, prevention of mother-to-child transmission and harm reduction—targeting injecting drug users with methadone maintenance treatment and needle and syringe exchange. Six ministries, including the Ministry of Health and the National Population and Family Planning Commission, have formulated methods for implementing condom promotion for HIV prevention. Yunnan Province is one of the provinces that have already begun to implement 100% condom use programs on a large scale.
Treatment and care are increasingly being provided to AIDS patients, and steps have been taken to address problems around domestic production and supply of antiretroviral drugs. In 2003, tariffs on imported antiretroviral (ARV) drugs were waived to facilitate access to care. However, China has made slow progress in realizing its 2003 pledge to provide free antiretroviral treatment to all who need it; by June 2005, about 20 000 people were receiving the drugs in the 28 provinces and autonomous regions where antiretroviral treatment had been introduced.
China's Health Ministry has also launched a nationwide system to collect AIDS data from county health authorities directly via the Internet instead of via paper reports passed through a hierarchy of officials. In addition, the ministry has stipulated the responsibilities of local disease prevention authorities who will now be required to visit HIV patients twice a year and AIDS patients four times a year, writing a record of each visit
The Chinese government also has a ‘Four Frees and One Care’ nationwide policy to provide the following services:
- Free ARV drugs to HIV patients who are rural residents or people with financial difficulties living in urban areas;
- Free Voluntary Counseling and Testing (VCT);
- Free drugs to HIV infected pregnant women to prevent parent-to-child transmission, and HIV testing of newborn babies;
- Free schooling for children orphaned by AIDS; and
- Care and economic assistance to the households of people living with HIV/AIDS.
The China Comprehensive AIDS Response (China CARES) program is an ambitious program to expand access to comprehensive HIV/AIDS treatment and care services that covers 127 sites in priority provinces most affected by HIV/AIDS
Challenges and issues to be addressed in 2006 include the need to:
- Introduce and implement recent policies and regulations related to HIV prevention, treatment and care at all levels of government;
- Strengthen HIV-related training for local leaders in formulating workplans, implementing activities and ensuring accountability;
- Expand existing media and other efforts to raise HIV awareness and eliminate discrimination against people living with HIV;
- Strengthen and expand targeted interventions among vulnerable populations—injecting drug users and sex workers—and improve management of blood collection and donation;
- Improve the implementation of the “Four Frees and One Care” policy—a commitment made to provide free treatment and care for rural and poor urban residents with HIV, but often not implemented by local governments;
- Disseminate lessons learnt/good practices from existing projects in China, to guide expansion of HIV prevention, treatment and care interventions; and
- Expand and improve international cooperation and coordination, and remove barriers that hinder comprehensive participation of nongovernmental organizations, including people living with HIV.
The information presented in the HIV/AIDS country watch originated from the web site of the Joint United Nations Programme on AIDS (UNAIDS) – www.unaids.org (November 2006).
For more information please visit:
http://www.unchina.org/unaids/
