China's national HIV/AIDS treatment program is facing a variety of problems, including patients halting antiretroviral treatment, researchers said on Monday at a symposium on HIV/AIDS and SARS at Tsinghua University
in Beijing, the Washington Post
reports. The government began offering free antiretroviral treatment to some HIV-positive people in April, but the "underfunded, sometimes corrupt health care system" is not "respond[ing] effectively," according to the Post
(Pan, Washington Post
, 11/11). Chinese authorities have begun distributing antiretroviral drugs through pilot programs in 51 counties for thousands of poor farmers who contracted HIV through a government-backed blood buying scheme in the 1990s. The government earlier this year allowed two Chinese pharmaceutical firms to begin producing four antiretroviral drugs and has plans to expand the pilot drug distribution program to 100 counties and 3,000 patients by the end of the year. However, international experts are concerned that the shortage of trained medical staff and the lack of follow-up care and counseling could result in low drug adherence rates. (Kaiser Daily HIV/AIDS Report
, 10/15). Without an infrastructure, patients could continue to "dro[p] out of treatment" and drug-resistant strains of HIV could emerge, the Post
reports. The government also is facing issues with local authorities and health care providers, according to the Post
, 11/11). Although the attitudes of health officials in the central government have shifted, many local officials still deny the existence of AIDS, and some have said they will deny treatment to anyone who complains or protests (Kaiser Daily HIV/AIDS Report
, 10/15). According to the Post
, some patients have said that local officials have charged them for the free drugs, and other patients have said that health care providers are "unavailable or refuse to treat them."
Aaron Diamond AIDS Research Center Executive Director Dr. David Ho said that the program's high dropout rate is "troubling" and called on the Chinese government to continue to provide free antiretrovirals and train health care providers, according to the Post. He added, "Do I worry? Yes. Is it a problem? It's a problem that's very difficult to solve. But I wouldn't recommend slowing anything down. ... I'd recommend speeding up the other aspects" of the program (Washington Post, 11/11). Ho also said, "Many committed and talented Chinese ... are anxiously awaiting a clear and unequivocal directive from the top," adding, "Until such a call to action comes, the response to AIDS will be muted" (Epstein, Baltimore Sun, 11/11). Hu Angang, director of Tsinghua University's Center for China Study, said, "The government has to transform from a developmental government to a public service government" (Hoo, AP/Newport News Daily Press, 11/10). Zeng Yi, a senior HIV/AIDS official from the Chinese Centre for Disease Control and Prevention, said that the government should create a national headquarters "with real powers" for HIV/AIDS prevention and control efforts in the country, Agence France-Presse reports (Agence France-Presse, 11/11). He added, "We should tell our people the true situation and take effective measures. We should try our best to find all the HIV carriers and AIDS patients and give them care and support" (AFP/Yahoo! News, 11/11). A survey conducted jointly by China, the World Health Organization and UNAIDS shows that there are 840,000 HIV-positive people and 80,000 people with AIDS living in the country, and about 150,000 people in China have died from AIDS-related diseases since 1985. Other experts estimate that more than one million HIV-positive people live in China (Kaiser Daily HIV/AIDS Report, 11/10).
Chinese legal experts said at the conference that the country's legal system needs "much improvemen[t]" to stop discrimination against HIV/AIDS patients and help curb the spread of the disease, Xinhua News Agency reports. Professor Li Dun, executive director of the Tsinghua Social Policy Research Institute, said that current Chinese law focuses on the detection and control of HIV-positive people, but that approach is "just the opposite to what one wished," Li said. He added that the law should focus on discrimination in health care, education and employment; testing donated blood before it is used in transfusions; and confidentiality for HIV-positive people, according to Xinhua News Agency (Xinhua News Agency, 11/11). The not-for-profit advocacy group Human Rights Watch supported China's decision to provide free antiretroviral therapy to people living with HIV in the country but also called for rights protections, Agence France-Presse reports (Agence France-Presse, 11/11). In a statement released on Tuesday, HRW's Asia Division Executive Director Brad Adams said that although "[p]roviding antiretroviral drugs to poor people is a great step forward ... draconian crackdowns against people at high risk of HIV will only drive them underground and make it less likely that they will come forward for testing and treatment" (HRW statement, 11/11). He added, "China urgently needs a national law barring discrimination against people with HIV/AIDS and should establish a mechanism through which victims of discrimination can file complaints" (Agence France-Presse, 11/11).
PRI's "The World" on Monday reported on the summit. The segment includes comments from Ho and former President Bill Clinton (Magistad, "The World," PRI, 11/10). The full segment is available online in Windows Media.
Additional information on AIDS in China is available online from kaisernetwork.org's Issue Spotlight on AIDS.
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Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of the Kaiser Family Foundation, by The Advisory Board Company. © 2003 by The Advisory Board Company and Kaiser Family Foundation. All rights reserved.