It is rare for a foreign doctor to get to China's rural areas, where its AIDS epidemic was born and takes a horrible toll. But recently, two nurses and I ventured into a poor farming area, Nizui in Hubei Province, as part of a Medecins Sans Frontieres (MSF) team to visit the Liu family and evaluate their 7-month-old baby. The child was the size of a two month old, but his eyes held the gaze of an 80-year-old man long acquainted with extreme suffering. The baby was dying of AIDS. His parents, aunts, and uncles were also HIV-positive.
The Liu family is one of thousands of poor farming families in China's interior who contracted HIV through contaminated blood donations during the 1990s, when under-regulated for-profit blood banking companies reused needles and transferred blood from infected donors to clean donors after extracting the plasma.
The Chinese Health Ministry recently put the total number of HIV/AIDS cases at 840,000, although most experts believe that the true number is much higher. Some believe that by 2010, the number of infected Chinese may reach 10 million.
After years of taking a passive, low-profile approach to the epidemic, health officials have stepped up their anti-HIV campaign. Since 80 percent of HIV/AIDS patients reside in the countryside, greater access to health care in these areas has become a priority. This past July, during the highly publicized 15th International AIDS Conference in Bangkok, Premier Wen Jiabao (
This new anti-HIV/AIDS campaign, which the international community has lauded, is more open and proactive than before. But it must still operate in the context of a closed society, where government control over the media limits the flow of information necessary to deal with any public health epidemic. Moreover, it is unclear how care will be delivered to the rural front lines, where the old system of clinics based in Peoples' Communes collapsed with the de-collectivization of agriculture.
To be effective, clinics in areas where HIV/AIDS is prevalent must provide patients with the same standard of care that is offered for other health conditions. Unfortunately, the door to such access remains largely closed, partly because China was initially reluctant to allow overseas groups into their hinterlands to assist. Nonetheless, local and foreign NGOs are now starting to play a role in filling the gap between government policies and front-line healthcare delivery. In May last year, MSF was authorized to set up an HIV/AIDS clinic in Xiangfan, Hubei Province.
On my recent visit, I met Du, a thin-framed, HIV-positive farmer who lost his wife to AIDS last year and was desperate to prevent his infected seven-year-old son from meeting the same fate. He had been taking the boy all over China by train, bus, and truck in search of help. Last month alone, they visited five large cities without success. The chance that Du, and those like him, will find help in China is slim; at present, most clinics and hospitals are not adequately prepared to treat HIV-infected patients.
Treatment is extremely limited where it is available. For example, Xiangfan's Infectious Diseases Hospital is the prefecture's only health facility where HIV/AIDS patients can be admitted. On paper, the hospital appears well staffed and adequately equipped, but on my rounds there, I found the halls and wards deserted and barren. Few therapeutic and diagnostic options were available. Even a basic test like a CAT scan would require transport to another regional hospital.