China over the past several years has responded to the challenges of fighting HIV/AIDS and should be applauded for its efforts to develop programs aimed at preventing and treating the disease, according to a report published in the Feb. 24 issue of the journal Lancet, Reuters reports. Some of China's HIV/AIDS prevention and control methods could serve as models for other countries, the report says, adding that the country has learned from its mistakes in dealing with SARS and is working to control the spread of HIV. According to Roger Detels, an epidemiologist at the University of California-Los Angeles, and colleagues, China's initial response to HIV/AIDS was to attempt to isolate and contain HIV cases, which likely encouraged HIV-positive people to conceal their status. Detels said that although China initially was "somewhat slow to respond" to HIV/AIDS, once the country responded, it "did it in a big way" (Fox, Reuters, 2/23). According to the authors, four factors have fueled China's response to HIV/AIDS: existing government infrastructures and networks; increased scientific data; international concerns that emphasized the potential consequences of an HIV/AIDS pandemic and resulted in expedited strategic planning; and strengthened political commitment among top government officials (Detels et al., Lancet, 2/24). The researchers highlighted government-funded programs and services that offer no-cost voluntary testing and counseling; no-cost antiretroviral drugs for individuals and pregnant women; no-cost education for AIDS orphans; and financial assistance for people living with HIV/AIDS (Reuters, 2/23). They also highlighted needle-exchange and methadone initiatives for injection drug users, as well as safer-sex awareness campaigns. "These bold programs have emerged from a process of gradual and prolonged dialogue and collaboration between officials at every level of government, researchers, service providers, policymakers and politicians and have led to decisive action," the authors wrote. The report also praised Chinese President Hu Jintao for stepping up his efforts to tackle HIV/AIDS, as well as Prime Minister Wen Jinbao, who in 2003 publicly shook hands with an HIV-positive person in an effort to reduce stigma and discrimination related to the disease. The report uses the country's official number of HIV/AIDS cases, which China said was 650,000 at the end of 2005. According to AFP/Yahoo! News, some experts say that this figure likely is an underestimate. The report also says that 30,640 people at the end of 2006 were receiving access to no-cost antiretrovirals. The researchers added that although China has made improvements, the country still faces "a formidable task" in translating central government policies to provincial and local levels and in mobilizing adequate resources and trained personnel (AFP/Yahoo! News, 2/22).

The report is available online.

Related Editorial, Commentary

• Lancet: The magnitude of HIV/AIDS, "particularly in Asia, warrant[s] an aggressive and committed approach to strengthening health systems and to facilitating international collaboration in disease control," a Lancet editorial says. "With the rising incidence of HIV/AIDS in many Chinese provinces," primarily among IDUs, "opportunities for collaboration across all borders must be taken," the editorial says, adding, "Strategies that work, such as needle-exchange or methadone-maintenance programs, need to be scaled up and consistently used along trafficking routes" (Lancet, 2/24).
  
  
• Therese Hesketh, Lancet: Some experts and agencies, including UNAIDS, have "substantially overestimated" China's HIV/AIDS epidemic in the last few years, Hesketh of the Institute of Child Health writes in a Lancet commentary. Some statistics released about HIV/AIDS in China, including from UNAIDS, have been "emotive and pessimistic," Hesketh writes, adding that as a result, a "disproportionate amount of funding is being given to a health problem for which the disease burden is low, drawing resources away from areas of greater need." Hesketh concludes that HIV/AIDS efforts in China should "focus on high-risk areas," adding, "For most of China, the prevalence of HIV remains low. Here, the focus on public health efforts should be on diseases with a higher burden" (Hesketh, Lancet, 2/24).

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