China's Health Ministry is finally ready to fight AIDS. That alone won't be good enough.
Cuizi'en, the first openly gay man in China, came out in 1990.
By Duncan Hewitt
Government officials in China, a nation where the response to HIV has long been hampered by a reticence to discuss sexual matters in public, are finally getting real about AIDS. The Ministry of Health's announcement last week that "sexual transmission is now the main cause of new HIV cases" made headlines around the country, and was underlined by new TV public-awareness ads repeating the message. The French-educated health minister, Chen Zhu, broke another major taboo when he announced publicly that almost one third of new infections were among male homosexuals. It's a big shift from the government's traditional attitude that HIV mainly affects drug users and people who sell blood at illegal "blood-collecting stations."
But while the government may finally have apprehended the scope of the problem, plenty of ordinary Chinese people haven't caught on yet. Local police crackdowns on drug users and prostitutes work at cross-purposes with health workers and activists, and the public remains resistant to overt promotion of the use of condoms. Discrimination against gays and ignorance about STDs remain ingrained, and the government is still skittish about working with NGOs it can't control, even if they have better data and reach more people. A determined Health Ministry may not be enough to counter enduring attitudes.
Beijing's more enlightened outlook springs from a realization that HIV is increasingly threatening the mainstream population. A prediction made by the U.N. a decade ago that China could have 10 million cases by 2010 has not come to pass, but the country registered 48,000 new cases over the past year, and official estimates put the number of people now living with HIV at 740,000. And with surveys showing a 5 percent infection rate among prostitutes in some parts of the country, UNAIDS fears that "between 20 million and 50 million people are at risk," particularly among China's poorly educated migrant workers, many of whom are single men living far away from their families.
Meanwhile, the rapid growth of China's gay scene (following the decriminalizing of homosexuality in 1997 and the delisting of homosexuality as a psychiatric disorder in 2001) has led to what Dr. Bernhard Schwartländer, head of UNAIDS in China, calls "a massive epidemic among men who have sex with men." Gay or bisexual men accounted for 32 percent of new infections this year, and the Ministry of Health's first-ever survey of China's gay community recently found infection rates of 15 to 18 percent in a number of cities. Schwartländer sees "a huge gap between the information available and the opening up of the society," with the result that "HIV is hitting a fairly unprepared upcoming population, which is now at very, very high risk."
The Ministry of Health insists that it is ready to tackle the problem. Hao Yang, deputy director of its Department of Disease Control, says, "We've recently taken measures so that the government would not discriminate" against gay groups. Yet he acknowledges that changing ingrained attitudes, particularly among local governments, remains a challenge. Schwartländer says that sporadic police crackdowns on prostitution and drug use often set back attempts to work with these high-risk groups: "We have seen very good examples where the police work very closely with the health authorities," he acknowledges. "But problems still exist, such as campaigns against sex work where they check women, and if they find a condom they put them in jail—so it's more dangerous for them to carry condoms, which is a real issue." Crackdowns on gay bars, he adds, still take place in some smaller cities, and similarly risk driving the gay population underground.
And other forms of discrimination, says Schwartländer, remain "enormously high" in Chinese society: one U.N. survey showed that half of respondents would not want to work with someone who was HIV-positive, while one quarter would not shake hands with them. Such attitudes, he says, along with a lack of free access to health care for rural migrants in China's cities, discourage many people from even having an HIV test. Campaigns to change the attitudes "within families, where there is often still a very conservative environment," are also necessary, he adds. Continuing reluctance to promote the use of condoms in AIDS-related public-service announcements on prime-time, mainstream TV is another sign of China's awkwardness in discussing sex—a throwback not only to traditional decorum but also the puritanical decades of the early communist era.
Thomas Cai, founder of the NGO AIDS Care China, meanwhile, notes that those who are diagnosed often do not dare to tell friends or even family for fear of being ostracized. Cai's organization has now set up more than 20 "Red Ribbon" care centers at hospitals around China to offer "psychological and social support" to such people. It's something he says the authorities seem unable to provide—even though they do now promise free antiretroviral treatment to all those diagnosed with HIV. "Their approach is primarily medical," says Cai. "We need more civil-society organizations to do the work of raising public awareness and advocacy to combat stigmatization."
But this is another sensitive area: the Chinese government remains suspicious about the role of civil society and NGOs, and tight rules mean that many remain unregistered and hence technically illegal, or can register only as businesses, which hampers their ability to raise funds and work with official bodies. Hao Yang of the Ministry of Health says his department is now "very open" on the matter, and is encouraging officially registered organizations to "help NGOs which are not legally registered to gain registration and provide them with funding." Indeed, some 20 percent of a major grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria will, he says, be earmarked for NGOs in the coming years, in the belief that they can do more effective outreach work to groups such as the gay community.
Recognizing the hurdles that face the government's fight against AIDS, Cai says NGOs also need to share research with the authorities, and do more than simply criticize. Otherwise HIV will continue to spread rapidly. But Cai says he's concerned that official support and funding will still go mainly to government-affiliated bodies such as labor unions and Communist Party Youth League branches, rather than to real grassroots organizations. There are still more taboos to be overcome in China's fight against AIDS.
source: Newsweek.com
Cuizi'en, the first openly gay man in China, came out in 1990. 
