Publication: China Brief Volume: 2 Issue: 17

“To them we are like bubbles,” says Xie Yan, referring to officials in her village. “They know if they turn away and ignore us, we will soon pop and be gone.” The mother of three lost her husband recently. Suffering from severe headaches and nausea and showing signs of meningitis, he died of ai zi bing, the Chinese term for AIDS. She was tested a few months later and then told that she would be dead within a couple years. She is 35 now. Her children will become orphans, but government in her hamlet, the New York Times reports, won’t help.

Xie Yan’s plain words tell us why AIDS will ravage China in the years ahead: Local cadres do not care. As they ignored the problem, HIV spread. And it’s not hard to see why, especially in Xie’s Henan Province, which is south of the capital city of Beijing. Dealers there wanted to buy plasma, an ingredient in medicines. Donated blood was pooled, and the plasma was extracted in centrifuges. The remainder, mostly red blood cells, was then reinjected into the donors to prevent anemia. HIV has spread to entire villages in Henan this way.

Blood sales have been illegal in China since 1998, but state-run blood collection centers, not to mention others, are still involved in this trade. Local officials have been involved, and now they try to suppress news of what happened. Last December health officials in Henan admitted to only 1,495 cases, but experts say that there are 1 million infected citizens in that province.

And there are millions more in the rest of the People’s Republic, but just how many is anyone’s guess. Data collected in 2001 showed that there were 30,736 HIV-positive citizens in China and that 1,594 had AIDS. A total of 684 had died from AIDS-related diseases. The government, however, estimates that there were in reality 80,000 to 100,000 cases of AIDS at the end of last year. The penetration of infection was much higher, of course. Public health officials believe that at that time there were 850,000 HIV cases in China, up from 600,000 the year before.

Foreign numbers are higher still. The United Nations publicly says that as many as 1.5 million in China have HIV. Yet it is reported that UN officials privately say that there might be as many as 6 million cases now, with 20 million by the end of this decade, especially if the Chinese government does not promptly, and effectively, address this situation.

It’s not fair to say that nothing is being done to contain AIDS in China, but officials have yet to come to terms with the crisis they face. The People’s Republic reported its first case in 1985, but the government essentially ignored the problem until last August, when it announced its five-year plan against the disease. Beijing admits that there is a problem among drug users, but it is loath to deal with the blood collection fiasco, presumably because the situation reflects so poorly on officials of all levels. The result of this institutional embarrassment is that the government’s five-year plan is pathetic–even if it is fully implemented.

The inadequacy of China’s efforts is visible, even to the United Nations. Most of the time, the health officials of that organization pretend to be diplomats as they go out of their way to avoid stating the obvious. Yet the Chinese government has challenged the patience even of these UN health bureaucrats, who in June issued eighty-nine pages of stinging criticism of the People’s Republic under the title “China’s Titanic Peril.” Public release of the report is sign of frustration with Beijing, The New York Times says. AIDS is the deadliest epidemic in history, but officials in the Chinese capital seem not to have noticed–they are slow to cooperate in efforts to contain the disease even in their own country.

“At the dawn of the third millennium,” the UN report says, “China is on the verge of a catastrophe that could result in unimaginable human suffering, economic loss and social devastation. We are now witnessing the unfolding of an HIV/AIDS epidemic of proportions beyond belief, an epidemic that calls for an urgent and proper but as yet unanswered quintessential response.”

And what is the Chinese government doing about this? The report says that China’s efforts to contain AIDS have had an “infinitesimally small impact.” “We recognize what has been done, but we’re saying that it’s not enough,” says Kerstin Leitner, the UN resident coordinator in China.

Chinese officials, predictably, reject the UN’s conclusions. As in all matters involving criticism from the outside, the first line of defense is that foreigners do not understand China. “I think the information they have is not sufficient and cannot be fully trusted,” said Sun Xinhua, division chief of the Ministry of Health’s disease-control program. The second reflexive defense is to blame the motives of critics. “The situation of AIDS control in China should be analyzed and understood from different angles,” said Wang Liji, division chief of the Ministry of Health’s department of international cooperation. “Unfortunately, UN officials saw this issue only from their own angle.”

Although Sun and Wang appear a bit irritable, in many ways they are absolutely correct in their assessments. Wang is certainly right when he says that the UN did not have all the facts. The fact is that no organization–not even the Chinese government–knows the truth about AIDS and HIV in China. Yet Wang undoubtedly knows where blame lies. Beijing, through inaction or inattention or callousness, has let the epidemic spread. Now, no one knows how deep in the population it has reached.

It didn’t have to be this way, as analysts and common sense tell us. At one time, it was easy to keep track of HIV in China: It was once confined to intravenous drug users in the areas bordering Burma. By now, however, the virus has spread across the country primarily by drug use, prostitution, and blood sales. The recently released UN report notes that a 1997 report written by four UN agencies and the World Health Organization said China had an “unparalleled opportunity to neutralize the danger” of this epidemic. Since then, the new UN report notes, China has squandered the opportunity. The new report cites many reasons for this failure, including the general collapse of health care in the countryside. Now infection has spread to the four corners of China. No wonder the UN can’t adequately describe the problem, as Sun helpfully reminds us.

Wang Liji’s “angle” criticism also has merit, at least from Beijing’s perspective. The “angle” pursued by the United Nations is helping the Chinese people contain the spread of HIV and alleviate suffering. Government officials, on the other hand, view the AIDS problem as just one of many public health crises they face. Of course, the possibility that AIDS, as serious as it is in China’s rural areas, is a relatively unimportant problem shows the gravity of the situation in the country today. In the race to build a modern society, senior Chinese leaders have built highways, dams and railroads, but they have let the health care system lapse, especially in the countryside.

Today the state has essentially abandoned peasants when it comes to medical needs. In a way, the spread of AIDS highlights how little regard Beijing has for the welfare of its own citizens. That’s not rhetoric: It’s an inescapable conclusion. Senior leaders in the Chinese capital are ultimately responsible for the breakdown of health care in their country. Who else can be responsible? The UN report “is not written to assign blame,” says Kerstin Leitner. Yet we all know who should be held accountable.

Recent comments show that Beijing is also capable of a more considered response to the United Nations report. “We indeed understand how serious China’s HIV/AIDS situation is, as the report says,” said Shen Jie, director of the National Center for AIDS Prevention and Control, as quoted in People’s Daily, the Communist Party’s newspaper. Those words sound fine, but they are essentially meaningless. If the Party really believed what it said, it wouldn’t be sitting on its hands today.

Gordon G. Chang is the author of The Coming Collapse of China, published by Random House.

COMING SOON: Beijing fights AIDS activists and imprisons the infected.