A Poor Ethnic Enclave in China Is Shadowed by Drugs and HIV

Butuo, China, is a place populated by China's large but impoverished Yi ethnic minority, an ethnic backwater made up of red mud houses and the trappings of rural farming. But Butuo, a town of 10,000 in the Liangshan Yi Autonomous Prefecture, and other towns near it have become centers of intravenous drug use and HIV. Butuo is located on the drug-trafficking route that connects Myanmar with China's northern cities, and its residents increasingly engage in intravenous drug use and trafficking.

Officials have estimated that up to 20 deaths each year result from heroin overdoses, and hundreds of residents have HIV. "The spread of HIV here is worse every year," said Zhang Se'er of the Butuo anti-epidemic station. "When we first saw it, in the mid-to late-90s, it used to be just from drugs, but now there's sexual transmission as well"

Initially, officials in Liangshan tried to ignore HIV. But in 1999, with the virus rolling through their population, officials decided to admit that they had an AIDS problem and call in Doctors Without Borders to set up prevention programs. "At first, we didn't want to talk about it -- we were filled with worries -- and we certainly didn't want to check to see how bad it was," said Liu Yan, deputy commissioner of Liangshan prefecture. "But then we realized that if we didn't do anything, 300 people could quickly become 3,000. AIDS is a global problem. These places are poor. They need help."

Scientists have been able to document the quick spread of AIDS along drug routes in China, since the subtype of AIDS found at the Burmese border is somewhat unusual. "You can actually map it year by year as it follows the route north skirting Tibet, arriving first in Chengdu and then north to Xinjiang," said Chris Beyrer of the Johns Hopkins School of Hygiene and Public Health, who has studied the spread of HIV in Asia.

Like all rural migrants to Chinese cities, Yi workers are at the bottom of the pecking order. Many of the poor, desperate people who take up work as low-level couriers eventually become addicts and many then take up trafficking to support their habit. Eventually police send them home and they bring their addiction and diseases with them. Some workers come home after working in Kunming -- a city where studies have found that 40 percent of addicts have HIV.

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