A group of drug users gather at the Center of Disease Control (CDC) in Jiele, a small township in Ruili City, southwest China's Yunnan Province. A doctor is teaching them how to do artificial respiration.

The class offered by the local CDC to intravenous drug users (IDUs), in Mandarin and in languages of several ethnic minorities inhabiting the area, is part of a program to promote condom use and other methods to prevent the spreading of HIV/AIDS and reduce the hazard of drug using.

Jiele Township is an epitome of areas in southwest China bordering with the notorious "Golden Triangle" in international drug trafficking, where local residents could easily get drugs at low costs from Myanmar and other countries across the border. For an average addict, 30 yuan would be enough to cover his daily consumption, says a middle-aged trainee of the class.

"Our aim for the time being is not to have them quit the drug, but to prevent them from contracting HIV/AIDS," says Duan Yijuan, a doctor at the CDC branch.

She says that in the past, the local government was not so keen on providing such training for fear it might encourage people to use drugs. "But now, we have full support from the provincial government, " she says.

"The government even supports our programs of clean needle exchange and methadone replacement," says Wang Yunsheng, deputy-director of the HIV/AIDS prevention office of the province's Health Bureau, "which is a big progress from the past."

The local governments' conception change actually reflects a major turn of the central government's attitudes toward the control and prevention of the infectious disease. That is to confront the reality more positively and open.

The recognized turning point came in December 2003, when Premier Wen Jiabao and Vice Premier Wu Yi shook hands with AIDS patients in a Beijing hospital, signaling that the central government has put the combat with the disease on top of the agenda.

Meanwhile, the central government's gesture, as a climax among all government and non-government organizations' efforts to eliminate fear and discrimination against HIV-infected people, has made a great impact on the public's thoughts about HIV/AIDS.

Just from May to August this year, Beijing alone witnessed a training workshop for patients of HIV/AIDS on their rights to information and treatment, and a camp for children orphaned by AIDS.

"Today, what the government is doing is probably more than 500 percent what it was doing a year ago," says epidemiologist Ray Yip, director for the Global AIDS Program of the US Centers for Disease Control and Prevention (CDC) in China.

He says that the outbreak of SARS in the Spring of 2003, as a fatal infectious disease, sounded an alarm that any infectious disease should be treated with serious attention.

In China, there are about 500,000 registered IDUs, who constitute 60 percent of the estimated 840,000 people infected with HIV throughout the country, where the first AIDS case was detected in 1985.

In Yunnan Province alone, where the largest number of HIV-infected people was reported, the reported HIV-infected cases are 15,000, while experts estimate 75,000 people have been infected. Another high-risk group are sex workers.

But due to the social stigma and pressure that the two groups are facing, it is not easy to trace all of them and provide knowledge and medical care, says Wang Yunsheng.

Alarming to experts, about 95 percent of the estimated 840,000 people living with HIV do not know about their infection, according to Prof. Jing Jun, director of the HIV/AIDS Policy Research Center at Qinghua University. Their ignorance can be disastrous, as they can pass the virus to their sexual partners and children.

The HIV/AIDS epidemic in China also features the highest prevalence in some remote areas of minority-inhabited areas. The population of ethnic minorities barely accounts for 10 percent of the nation's total, but among the HIV-infected people, 36 percent are from ethnic minorities, according to Jing.

The underdevelopment of these areas and their geographical inaccessibility handicap the communication of information about prevention and control of HIV/AIDS.

Realizing that most patients of HIV/AIDS are poor, the Ministry of Health announced last April that the government would give free, anonymous testing and counseling to HIV carriers who have financial difficulties.

Hubei and Henan provinces in central China have pledged to offer free AIDS-related medication to all HIV-carriers in addition to dispatching officials to areas most seriously hit by the epidemic.

In 2001, the central government increased its budget for HIV/AIDS prevention and control from 15 million yuan (US$1.8 million) to 100 million yuan (US$12 million) annually, and the figure reached 390 million yuan (US$47 million) last year.

Another 2.5 billion yuan (US$300 million) has been earmarked to improve the construction of public blood banks in central and western China to prevent transmission through sub-standard blood collection and transfusion.

Actually, Yunnan is a pioneer in China to start the free anti-virus treatment. The provincial government is now preparing a standard anti-virus treatment program.

Chen Juemin, director of Yunnan's Health Bureau, says they have invited foreign experts to work out a treatment program in accordance with international standards.

In Central China's Henan Province, which has a large number of rural residents infected with HIV from tainted plasma donation, the anti-virus treatment was provided on a large scale, says Wang Zhe, deputy-director of Henan CDC, in order "to save more lives."

But experts say this anti-virus treatment still has its own flaws due to the limitation of anti-HIV drugs currently available in China. The four AIDS drugs in the program--ddI, d4T, AZT, and nevirapine, not only have serious toxicity, but could easily develop resistance among HIV patients if they fail to adhere.

A survey conducted by the Chinese CDC in Beijing shows among 500 former blood donors receiving treatment: after about nine months, nearly 20 percent of them dropped out, and 20 to 30 percent had become resistant to nevirapine.

"This means that we need to introduce new anti-HIV drugs to our treatment plan while trying to train more qualified doctors to monitor the whole process of treatment," says Zhang Fujie, a clinician at China's Center for Disease Control and Prevention (CDC) who heads the national effort. "We still have a long way to go."
 
(Xinhua News Agency October 4, 2004)