Li Ming goes to work every morning dressed in a white shirt, black trousers and shoes that his employer bought for him. If that seems like an assault on his self-confidence, he'll be the first to disagree. On the ladder of life, he's on the way up.

Li, 33, works at the People's Hospital of Pingxiang in south China's Guangxi Zhuang Autonomous Region, taking care of HIV patients. And he does the job from an unusual perspective.

He's an HIV carrier himself.

"My job makes me feel happy," Li said. " One thing I do here is trying to persuade newly hospitalized patients to receive medical treatment. HIV/AIDS sufferers usually will become quite depressed as they know they are infected and often refuse to see the doctor."

But because he has had the same experience as those sufferers, he said, "they prefer to believe what I say than what comes from the mouths of the doctors and nurses."

Pingxiang, a city of 100,000 population, has alarming numbers regarding HIV and AIDS: 347 HIV carriers are officially registered. Forty-nine people have died of AIDS there.

The central government began to provide free anti-virus medicines to all HIV/AIDS sufferers in 2003. Some HIV patients receive them at hospitals and take them at home under the supervision of community doctors. But those in the Pingxiang area who develop into AIDS patients and those whose conditions deteriorate suddenly are treated in the hospital where Li works.

Figures from the Ministry of Health in Beijing show that 70 percent of these sufferers in the city are farmers and jobless people living in the villages and towns near the border between China and Viet Nam. Pingxiang's border alone is 97 kilometres. The city's location makes it a major stop on the drug trafficking from Southeast Asian countries into China.

Drugs, needles and HIV

Sharing the same dirty syringes in drug consumption is the main channel of HIV/AIDS infection here, said He Bo, director of the Pingxiang Centre for Disease Control and Prevention (CDC).

Such was the case with Li.

"I cannot tell you the exact time when I was infected, but I can tell you it was the late 1990s as that was when I shared a syringe with other people," he said.

Li began to smoke opium and inject morphine in 1991 in Viet Nam. Four years later, he became a heroin addict. In those years of drug use, he was still quite rich and did not need to share the syringe, he said.

Many of his neighbours in his hometown earned money doing business with the Vietnamese.

At that time, he could annually earn about 40,000 yuan (US$5,000) by trading pigs, copper and other goods with the Vietnamese. Forty thousand yuan is a large sum of money, even for many urban residents in China today, Li said.

"I had so much money and didn't know how to spend it," he said. "Then I became bored and looked to taking drugs to have more fun."

As is often the case, drugs siphoned Li's money and business gradually. In the late 1990s, with little money, he began to share drugs using the same syringes with other people.

But Li didn't know he was infected with HIV until June 24, 2005, when he became seriously ill. Six days later, his test result came back positive.

"I put him on my back and took him to hospital; he was dying," He Bo said.

In the next several months, Li was hospitalized twice and was given free medical treatment with government support.

Last February 10, when he was discharged from hospital for the second time, he decided to stay there as a volunteer to care for other HIV/AIDS patients. Officials from the local CDC and the hospital agreed.

"We call him a volunteer because originally he did not ask for money for his work," He said. "We gave him some money because we thought he needed to cover his living expenses and can have the feeling that he is useful to society and that his work earns him respect."

Until his former six-month contract, which ended on August 10, he earned about 400 yuan (US$48) a month.

"How much money I earn here is not important to me," Li said. "The important thing is that it makes me feel that I am useful to society."

Zhao Xiaoji, director of the Pingxiang Bureau of Health, said Li would sign a new contract later this month.

'Psychologist for them'

Ten patients are receiving AIDS treatment in hospital, but there is only one nurse to tend to them, making Li's participation necessary.

"I have learnt and done a lot in the past several months," he said. "For example, I help doctors by taking test samples and results among different departments of the hospital."

But in Li's eyes, his most important role is to give loving care to the patients who share his fate.

"I am the psychologist for them, in a way," he said. "I talk to every patient here, helping them all fight off despair, fear and even thoughts of suicide."

One female patient, Chun Hua (not her real name), said: "I really wanted to kill myself when I was confirmed as an HIV carrier and sent here for treatment. It was Li who made me understand that I still have to lead my life for my parents and that I still have hope."

Li also helps with hospice care, providing services to patients who have no family or whose relatives refuse to take care of them on their deathbeds.

"I share the same room with them, chat with them and do everything I can to make them physically and mentally comfortable as they leave the world," Li said. "They have told me they really appreciate what I have done."

Each weekend, Li goes home to visit his parents. "Every time I go home, I always buy some gifts and food for them with the money I earn here," he said.

"My neighbours know that I had recovered from a very serious illness and was fortunate to get a job in the hospital. They all admire and respect me."

He hasn't told them which disease, though. He's still a bit concerned about what may happen if they knew he was an HIV/AIDS patient.

"We are considering his applying for a new contract, and we prefer to give it to him because he is really helpful during the medical treatment process," said Chen Jie, the Guangxi CDC's director.

Chen said Li has set a good example for HIV/AIDS sufferers by showing them they can participate in the war against the disease.

Fighting the battle

Across China, hundreds of HIV carriers have volunteered in the same way. They not only work in the hospitals, but also go to public education events and to gathering places for high-risk groups.

"The reason for me to show up here in public is that I want to use my own action and words to change something," said Da Wei, a young college student who became infected with HIV through unprotected homosexual sex. "I want to call on people to give more understanding and love to HIV/AIDS sufferers and homosexual groups."

Da made the remarks at the opening ceremony of a touring photo exhibition benefiting HIV/AIDS care programmes, held by the Ministry of Health last month in Nanning, Guangxi's capital. It was Da who, in August 2005, showed courage by doing an interview on a CCTV programme without hiding his face.

By sharing their own experiences, HIV/AIDS volunteers can educate the public better on the prevention and control work being done, Ministry of Health spokesman Mao Qun'an said in Beijing recently.

Governments at all levels have promised to take responsibility for HIV/AIDS control, but they also encourage non-governmental organizations and individuals to take part in the war, he said.

Many high-risk people, including drug users and prostitutes, are also being motivated to become volunteers in educating the public today in China, where the virus still spreads rapidly mainly through drug abuse and unprotected sex.

In Pingxiang, 660 addicts have registered, but it is estimated that nearly 500 more prostitutes are working in hotels, bars, and massage shops.

The first HIV case among addicts was reported in Pingxiang in 1996. The first case caused by unprotected sex was reported five years later. Although He Bo of the Pingxiang CDC said that addicts are still the main group of HIV carriers, an increasing number of cases have been reported among prostitutes and their partners since 2003.

The official number of registered HIV/AIDS cases in China last year was 141,000, but according to a joint report done by China and the United Nations, there were about 650,000 HIV/AIDS patients at the end of last year, of whom 44.3 percent were drug addicts and 43.6 percent were infected through unsafe sex.

Medical and government officials warn that both channels, but especially sexual contact, are hampering China's attempts to control the epidemic.

(China Daily September 16, 2006)