Epidemiology of HIV in China
May 17, 2002
"The first case of AIDS in China was diagnosed in 1985, heralding the HIV epidemic in mainland China. As of 30 September 2001 the Chinese Ministry of Health reported a total of 28,133 people infected with HIV, of whom 1,208 had developed AIDS and 641 died. The actual number of HIV infected people in the mainland, however, is perhaps more than 600,000. UNAIDS says that China could have 10 million people with HIV or AIDS by 2010. China has been pushed into action after the number of people with HIV surged by 67.4 percent to 3,541 in the first half of 2001.
"...China's HIV/AIDS epidemic can be divided into three phases. The first phase, in 1985-8, involved a small number of imported cases in coastal cities -- mostly foreigners and overseas Chinese. ...The second phase, from 1989 to 1993, began with finding HIV infection in 146 drug users among minority communities in Yunnan province in the southwest, adjacent to the "Golden Triangle" bordering Myanmar, Laos, and Vietnam. The third phase began in 1994, when a number of infections were reported among drug users and commercial plasma donors. By 1998, HIV infection had been reported from all 31 provinces, autonomous regions, and municipalities under control of the central government.
"Though drug users account for 60 percent-70 percent of reported HIV infections, the number of infections through heterosexual transmission has increased steadily to 7 percent.
"HIV transmission in China has been mainly due to misuse of injectable drugs and unsafe sexual practices. Moreover, the current epidemic of sexually transmitted diseases is fuelling the AIDS epidemic. ...Heroin addiction began in the early 1980s.... The ministry of public security passed a regulation that required every drug user to be registered and undergo a detoxification program in an incarcerated setting for three to six months. Despite such extreme measures, the relapse rate has been very high -- around 90 percent.
"There were over 900,000 registered drug users in China in 2001. However, the real number of drug abusers is perhaps several times higher. ...The number of sex workers and their clients arrested in the late 1990s was around 700,000. ...The average usage rate of condoms among them is 30 percent.
"With the rapid modernization and economic development in China, movements of very large populations of rural people seeking work in urban areas have caused concern for potential increase in the sexual transmission of HIV in China. The large mobile populations, estimated to be about 100 million, have been identified as being at risk of HIV.
"Compared with many neighboring countries, China is still in an early phase of the epidemic. ...The HIV infection rate ranges from 0.1 percent to 5 percent among sex workers but is as high as 50 percent-70 percent in drug users. ...If the rate of contact between these two populations increases the present situation will become a greater disaster. About 0.5 percent of married urban Chinese and 2.3 percent in rural areas engage in homosexual activities. There are about two to eight million homosexual men in China. This population is at high risk of HIV infection as anal sex is practiced commonly.
"According to the report of the national system of surveillance for sexually transmitted diseases, the incidence of the eight mandatory notifiable diseases increased 4.2 times in women and 3.9 times in men in 1990-8. The number of patients with STDs has risen almost 30 percent.
"...Long and medium term plans for controlling and preventing HIV- AIDS have been developed, and a central government coordinating committee has been formed among 33 ministries. The government has recently approved a series of pilot programs, such as a methadone maintenance treatment program... (and) needle exchange.... Vending machines selling condoms have been set up in public places. The hazards related to uncontrolled illegal collection of blood and plasma were realized in 1994... and countermeasures were initiated. A program has been launched to deal with stigma and discrimination against people with HIV-AIDS. We hope that the current crisis can be controlled. However, the government and society must make immediate and unrestrained efforts for there is no time to lose."
Kong-lai Zhang is Professor in the Department of Epidemiology, School of Basic Medicine, Peking Union Medical College Shao-Jun Ma is Chief Physician, Gansu provincial CDC, Lanzhou, Gansu, China.
British Medical Journal
04.06.02; Vol. 324; P. 803-804; Editorial
This article was provided by U.S. Centers for Disease Control and Prevention. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update. Visit the CDC's website to find out more about their activities, publications and services.