Years after being infected with HIV from selling blood, poor farmers are finally getting life-saving drugs from the government, but many are shunning the free medication.
Unendurable side effects and fears of stigmatization caused about 20 percent of the more than 5,000 people from nine provinces on the pilot program to stop taking the anti-retroviral medication.
"Many stopped after one to two weeks because the side effects were too strong," said Hu Jia, a Beijing-based AIDS activist.
In some villages, such as Dongguan in Henan Province, farmers skip days when they cannot bear the painful side effects, including headaches and vomiting.
Elsewhere, farmers afraid of discrimination do not collect the medicine, which was first offered in July.
"Some patients prefer to die at home rather than admit they're AIDS sufferers," said Zhang Fujie, head of the program run by the National Center for AIDS-STD Control and Prevention under China's Center for Disease Control.
"They said their daughter won't be able to marry and their son won't be able to find a wife," Zhang said.
International experts fear a low compliance rate due to lower quality drugs, and that the lack of qualified doctors to help patients stay on the medication will create dangerous, drug-resistant HIV.
"The advent of poorly monitored anti-retroviral drug treatment virtually guarantees the emergence of a drug-resistant HIV `superinfection' likely to spread to other parts of China, Asia and the rest of the world," wrote Andrew Thompson, a researcher at the Center for Strategic and International Studies in Washington.
By 2008, China hopes to provide the drugs to 40,000 people.
The program comes following years of appeals for help by plasma donors who contracted HIV since the mid-1980s from selling blood in unsanitary, government-approved stations.
But it is being launched when China still cannot provide the best medicine or care.
Unable to afford the latest cocktail therapy drugs, China is manufacturing and distributing older versions with expired patents. But these drugs have stronger side effects, sometimes worse than the disease's symptoms.
Patients are also not getting follow-up care from doctors to help them change the course of the drugs and keep taking them, the experts said. Fewer than 100 doctors in the country are qualified to administer AIDS drugs and few work in the countryside.
"If nobody is there to say, `They will save your life. The side effects will go away in a few days,' people are going to say I'm not going to keep taking [them]," said an international AIDS specialist familiar with the program.
The drugs are the best China can offer for now and are still effective, Zhang said.
The cost of treating one patient on the Chinese version of the cocktail drug is about US$400 a year. The cost of treatment with imported drugs is more than 10 times this amount.
But Zhang acknowledged the risks.
"If patients develop a resistance to the drugs, that's a big worry for us," Zhang said.
In spite of the shortcomings, China seems to have little choice but to continue the program.
"It's better to start now than wait too long until they can do it right. Those people dying from AIDS cannot wait," the AIDS specialist said.
Up to a million plasma donors and their loved ones could be infected with HIV in just the worst affected province, Henan, experts said.