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User:LUMINR/中国大陆艾滋病情况

< User:LUMINR
  关于中华民国控制下的台澎金马地区的艾滋病状况，请见「台灣愛滋病情況」。

目前，人类免疫缺陷病毒（HIV）在中华人民共和国最主要的传播途径是性传播[1]。中国受HIV影响的人数估计在43万到150万之间[2]，也有一些估计[3][4]要高得多。20世纪九十年代，以河南省为首的中国许多乡村地区，因为一些国营采血机构重复使用了被污染的设备，导致数十万的农民感染HIV[5][6][7]。

虽然从全球艾滋疫情来看，中国目前的艾滋病疫情相对不严重，但新感染率和发病率仍在急速增长。如果疫情在像中国这样的人口众多的国家爆发，将给全国乃至全世界的经济带来巨大影响。由此，目前政府对HIV和艾滋病主要对策为事前干预。

根据2009年2月的一份政府报告，2008年在中国艾滋病首次成为了死亡人数最多的传染病。2008年的前九个月，就有近7000人死于有关艾滋病和HIV感染的症状，而从80年代艾滋病进入中国到2005年的艾滋病相关的累计死亡则不到8000人。据美国中央情报局出版的《世界概况》，中国的成年人（15-49岁）HIV感染率为0.1％，和日本相当，且低于许多欧盟国家：英国（0.2％）、奥地利（0.3％）。[8]

历史 编辑

时间表 编辑

  • 1984年，中科院院士曾毅开始实行HIV血清检测，确认HIV病毒于1982年进入中国大陆，1983年第一次感染中国人。
  • 1985年6月，中国记录国内的首例艾滋病人死亡。病人是一名阿根廷遊客。 [9]
  • 1985年9月，中国禁止血液制品进口。
  • 1986年，4名中国血友病患者输血后检测出HIV阳性，证明受病毒污染的血液制品已经被进口 。
  • 1987年，一名接受输血后感染HIV的13岁中国血友病患者死于艾滋病。
  • 1989年12月，中国记录HIV感染第一次在物质滥用者中爆发。
  • 1990年， 中国卫生部设立预防艾滋病工作小组。
  • 1992年，中国健康教育研究所设立全国首个HIV和艾滋病咨询热线。
  • 1992年，中国政府确认11名艾滋病患者，并宣布防控HIV和艾滋病的中期计划。
  • 1995年1月，中国记录HIV感染第一次在血浆捐献者中爆发。
  • 1995年1月，中国设立HIV艾滋病定点检测系统。
  • 1995年5月，中国关闭了所有的采血站。
  • 1996年9月，中国首次试验安全套。
  • 1997年11月，中国第一次开办研讨会讨论有效的HIV和艾滋病干预策略。
  • 1998年7月，中国31个省首次发现HIV病毒。
  • 1998年10月1日，《中华人民共和国献血法》生效。法律要求卫生部门规范采血过程，同时禁止了血液的买卖。
  • 1998年11月30日，中国政府出台《中国预防与控制艾滋病中长期规划（1998-2010年）》，规划目标将HIV阳性人数控制在150万以下。
  • 1999年，卫生部发出行政指导，强调对HIV感染者合法权益的保护。
  • 1999年10月，中国试行其第一个针具交换（英语：Needle exchange programme）（NEP）项目。
  • 2001年6月，中国政府出台《中国遏制与防治艾滋病行动计划（2001-2005年）》。
  • 2002年8月，中国政府官员第一次正式承认，该国处于艾滋病疫情之中，并透露了中国的HIV感染率从2000年上半年至2001年上半年上涨67.4％。
  • 2002年12月，中国进行了第一例抗逆转录病毒疗法（ART）和HIV母婴阻断（PMTCT）试验。
  • 2003年9月，卫生部副部长高强在“第五十三次联合国大会关于艾滋病毒/艾滋病的特别会议”中，承诺一系列对HIV的遏制措施，扩大政府在防控艾滋病中承担的责任，其中包括对贫困的HIV感染者提供免费治疗机会、建立艾滋病防治中心、艾滋病相关立法和国际合作。
  • 2003年，国务院总理温家宝在北京一家医院看望艾滋病患者并与患者握手，力图消除社会歧视，成为了中国第一位公开与艾滋病患者握手的总理。
  • 2003年12月，中国启动了“四免一关怀”政策：免费提供抗逆转录病毒药物、免费提供HIV的母婴阻断、免费自愿咨询检测、艾滋病致孤儿童免费入学，以及对HIV感染者和艾滋病感染者的关怀。目前已经扩展到全国120多个地区。
  • 2003年12月1日，卫生部和联合国艾滋病中国专题组联合发布的评估报告，估计中国有84万人感染HIV，其中8万人患艾滋病。评估称尽管总患病率较低（成年人感染率小于0.1％），但疫情已蔓延至31个省份 。中国政府估计，2000年中国已有85万人感染HIV，且其中过半数是在1997年后感染。
  • 2004年2月，国务院防治艾滋病工作委员会成立。
  • 2004年3月，美沙酮维持疗法（MMT）的试验开始。
  • 2004年4月，国务院副总理吴仪在全国艾滋病防治工作会议中公开提倡直接行为干预（英语：Behavior modification）高危人群，标志着抗击艾滋病历程中新一步。
  • 2004年11月30日，国家主席胡锦涛在北京与艾滋病患者面对面会谈。
  • 2006年1月，卫生部、联合国艾滋病规划署和世界卫生组织在北京联合发布一份评估，将中国的HIV感染者、艾滋病例估计人数降低到65万，比2003年的估值少20万。并估计中国艾滋病患者为7万5千人。
  • 2006年3月1日，国务院出台的《艾滋病防治条例》《中国遏制与防治艾滋病行动计划（2006-2010年）》生效。

早期 编辑

最初，中国政府的防控艾滋病的措施着重于阻止HIV入境，艾滋病被描述为与西方国家接触的恶果。且“艾滋病”经常被双关成同音异字的“爱资病”，爱资本主义病[9]。中国相继出台法规，要求海归中国人和计划在中国居住一年以上的外国人接受HIV检测[10][11][12]。所有血液制品的进口都被禁止[13][14]。针对病毒在国内的传播，中国政府通过了打击物质滥用[15]和性交易[16]的法律，且允许直接隔离HIV感染者[12]。直到1994年HIV感染爆发在输血人群中，当局才认识到非法血站采集血液和血浆的危险，开始制定相应对策。和其他国家的HIV疫情相似，传统的公共卫生策略中用来控制传染病、隔离病例的做法都被证明无效[17]。当时的中国正处于经济快速增长的社会变革时期，物质滥用现象和性活动都有增加。这些早期的政策对阻止病毒传播几乎未起作用，还可能导致高危人群选择更隐蔽的活动方式，使这些群体的HIV感染难以发现[18][19][20]。


发展 编辑

政府内部合作 编辑

九十年代后半，科学证据显示中国人感染人数不断增长，与此同时外国不时传来艾滋病的负面消息，能有效降低HIV感染的针对性干预措施被发明，这些原因最终造成中国政府官员对HIV疫情的态度几次大幅转变。

早在九十年代中期，就有中国官员组织国外考察团，到其他国家学习防治艾滋病的成功和失败的经验，并带回这些经验。考察团成员包括卫生部、公安部、司法部、教育部、财政部、发改委、人口计生委员会的官员，以及国务院的立法者。目的地包括澳大利亚、美国、巴西、泰国、欧洲、非洲等。这些考察活动让官员们有机会去学习国外同行的经验，也增进了参加考察的政府各部门间的合作关系。

相关政府部门也在国内举办了研讨会，商讨加强跨部门沟通的策略。传统上中国政府的结构组织等级制度森严，各部门各自为政，跨部门不允许直接合作，导致当时艾滋病防控方案难以做到面面俱到。联合国艾滋病联合规划署和一些其他在亚太地区的联合国机构——如联合国药物管制规划署（现在的联合国毒品和犯罪问题办公室 ）——为推动中国政府各部门对话做出了极大贡献。

1997年，中国预防医学科学院（2002年改名中国疾病预防控制中心）和加州大学洛杉矶分校共同举办了一次重要的研讨会，研讨会主题关于针对高危人群的支持政策。研讨会吸引了来自社会学、伦理学、公共健康教育等领域的学者，以及一些政府官员和来自世界卫生组织、联合国、世界银行等国际机构的代表。此次研讨会首次公开讨论了一些对高危人群（如性工作者、注射毒品使用者、男男性接触人群）的干预措施。其中一些措施虽然得到科学证据支持，但在传统道德观念上仍存在争议。最终，政府意识到这些措施的有利之处，达成共识并决定实施。

这些研讨会和考察团的成员负责为中国最先端的HIV防控找到有效的措施，并参与制定规划文件，包括《中国预防与控制艾滋病中长期规划（1998-2010年）》[21]、《中国遏制与防治艾滋病行动计划（2001-2005年）》[22]、《艾滋病防治条例》[23]等。 这些重要文件中警告若疫情在中国爆发的后果，被认为影响了后来官员制定政策的态度。联合国2002年的报告（China's Titanic Peril）[24]中一个数据预测：2010年中国的HIV感染人数将达到一千万人，后来该数据被发现证据不足，但仍被反复误用。国务院防治艾滋病工作委员会办公室和联合国中国艾滋病专题组2004年发布的《中国艾滋病防治联合评估报告》[25]估计中国的HIV感染者和艾滋病患者达到84万。2005年，改进数据收集手段和估计方法后，这个数据被修正为65万。[26] 尽管新估计的传染率仅为0.05％，但也大大超出1998年政府估计的30万人[21]，让政府立刻加强了政策的实施。

科学新政策 编辑

一方面，官员经历了培训、建立了人际关系网。与此同时，中国的研究者识别了高危人群，开始有能力记录和预测疫情的传播路线。观摩了国外的成功案例后，在国内进行了行为干涉法有效性的测试。艾滋病病毒有关的研究计划主要由大学、医院、和地区机构(community agencies)来完成，并与国内外的机构有合作。中国政府命令下大部分的疾病研究和监控由中国疾病预防控制中心性病艾滋病预防控制中心主导。地区级别的防控工作，无论是否由全国疾控中心发起，几乎完全由省市疾控中心、区县医院、乡村医务工作者完成。中国疾控中心发起的尤其是卫生部下令的研究项目，通常比政府外的机构的研究项目更快被部署执行。

2000年后 编辑

政府换届 编辑

2003年，由国家主席胡锦涛、总理温家宝以及卫生部长吴仪带领的新一届中央政府作出承诺，大大加快了新防控政策的部署的进度。一系列行动包括：设立127个高感染率艾滋病综合防治示范区，为HIV携带者提供服务；四免一关怀政策；成立国务院防治艾滋病工作委员会，组织动员有关部门和社会各方面力量参与艾滋病防治工作[25]。新政策增加了财政预算，保证了防治、检测项目的进一步推进。

中国政府的艾滋病“四免一关怀”政策指：

  • 免费为农村居民和未参加医疗保障制度的城镇居民艾滋病病人提供抗病毒药物；
  • 免费为有意愿参加的人员提供咨询和艾滋病病毒抗体初筛检测；
  • 免费为感染艾滋病病毒的孕妇提供母婴阻断药物和婴儿检测试剂；
  • 免费为艾滋病遗孤提供心理康复和义务教育；
  • 关怀艾滋病患者及其家属的经济状况，给予其中经济困难者生活补助，或扶持增加工作中的收入。

立法 编辑

2006年3月，中华人民共和国国务院正式出台了中国第一部针对艾滋病防控的法规《艾滋病防治条例》[23]。该条例和随后推出的《中国遏制与防治艾滋病行动计划（2006-2010年）》[27]是政府在有关艾滋病防治的立法上迈出重大的一步。尽管距离发现第一例国内HIV感染已经过去二十年，一些条例还是被指过于超前。新政策的制定过程漫长又混乱，经过大量国内外的经验学习讨论和失败尝试，才得出一个前后一致的结果。新的法规使得政府官员、医疗机关、维权活动人士、政客和立法者等一系列机构开始协同工作。

2009年官方报告 编辑

2009年2月的一份中国官方报告中指出，艾滋病于2008年首次成为了造成死亡人数最多的传染病。中国国营媒体报道，2008年的前9个月中，就有近7000人死于HIV和艾滋病[28]。相比较，結核和狂犬病造成的死亡人数分别退至第二和第三[28]。中国卫生部确认，近年来有关HIV和艾滋病的死亡案例急剧增加。直到2005年，中国因HIV和艾滋病的死亡总数不到8000人[28]，而到2008年这个数字翻了五倍。[28]

流行病学 编辑

中国政府被指未能够对HIV和艾滋病的威胁做出及时反应且有意隐瞒疫情的严重性，受到了广泛的批判。[29][30]

感染人数 编辑

The Ministry of Health has said there are 650,000 HIV/AIDS cases, half of them among intravenous drug users, out of a nation of 1.3 billion people.[31] (Although this overall estimate of HIV and AIDS cases was lowered in January 2006 – in a report put together by the Chinese government, the World Health Organisation and the Joint United Nations Programme on HIV/AIDS (UNAIDS) – from 840,000 to 650,000, officials say this reflected the use of different statistical methodology rather than a drop in the incidence.) Epidemiology experts have said that 1.5 million is closer to the true figure.

 
2005年省别HIV报告病例

According to China's health ministry, there are now 264,302 registered cases of HIV/AIDS in September 2008, up from 183,733 in 2006, with 34,864 deaths.[32] But the real figures are likely to be much higher as testing and surveillance techniques are limited, especially in the countryside, and entrenched discrimination may have discouraged many from reporting.

Out of the 840,000 HIV carriers in the mainland, the health ministry estimates in early 2004 that there are 80,000 suffering from AIDS. HIV cases have been reported in all the Chinese mainland's 31 provinces, autonomous regions and municipalities.[33]

疫情的开端 编辑

1985年，中国发现国内第一例艾滋病例，一名病危的外国游客。[34]1989年，处中国西南边境的云南省的146名海洛因使用者被报感染，为HIV第一次在中国本土传播。[35]1989年至90年代中期，HIV从云南沿着主要的贩毒路径不断传播到邻近区域，再由注射毒品使用者（IDU）传播给其性伴侣和子女。随之，90年代中期，中原各省有偿血浆捐赠者间的感染率急速攀升。[36]为防止贫血，血浆捐赠者抽血后，血浆被取出，红细胞被输回体内。反复使用针管再加上血液回输，造成上千人感染。[37][38] 与此同时，HIV也在通过性传播传染。到1998年，受HIV影响的31个省份的感染人数不断上升。[25]到2005年，累计感染人数已达到65万人。[26]

Growth rate 编辑

The potential risks are very high. The most recent data showed that the number of new cases in China rose by 70,000 in 2005, which led to some health officials to raise concerns that infections were moving from high-risk groups into the broader population. The ministry attributes 37% of the new cases to drug use and 28% to unprotected sex.

Health officials are also mindful of the experience in Africa in the 1990s – for instance, the quick rise in South Africa's incidence from 1 percent at the start of the decade to about 20 percent in 2003 – which underlines the strong case for an early and aggressive policy response.

An increase in diagnoses might mean that HIV testing has become more easily available than in preceding years, or that the stigma associated with HIV has declined, encouraging more to get tested.

HIV subtypes 编辑

The subtypes of HIV-1 found in China include B, Thai B, A, C, D, E, F, G, and BC and BB recombinants. However, the epidemiological distribution and relative importance of these subtypes need further study.

Transmission 编辑

China's HIV/AIDS epidemic can be divided into three phases.

  • The first phase, in 1985–88, involved a small number of imported cases in coastal cities — mostly foreigners and overseas Chinese. Four people with haemophilia from Zhejiang province also became infected with HIV after using imported factor VIII.
  • The second phase, from 1989 to 1993, began with finding HIV infection in 146 drug users among minority communities in Yunnan province in the southwest, adjacent to the "Golden Triangle" bordering Myanmar, Laos, and Vietnam.
  • The third phase began in 1994, when a number of infections were reported among drug users and commercial plasma donors. In the 1990s, HIV gained a foothold in China largely due to tainted blood transfusions in hospitals and schemes to buy blood plasma, where it was collected using unsanitary means. Although the government today acknowledges responsibility in the transfusion cases, many victims still have trouble receiving compensation. By 1998 HIV infection had been reported from all 31 provinces, autonomous regions, and municipalities under control of the central government. Though drug users accounted for 60%–70% of reported HIV infections, the number of infections through heterosexual transmission had increased steadily to 7%.

High risk groups 编辑

  • Sex workers/prostitutes
Chinese authorities estimate there are 3 million to 4 million women working as prostitutes in so-called karaoke bars, hair salons, massage parlors and truck stops.
  • Intravenous drug users
  • Migrant workers (the "floating population"), are invariably single, poorly paid and from less progressive regions of China where sex education remains taboo, are immediately exposed to the high-risk groups. Workers travel between work and home for the periodic visit with spouses—the virus is virtually guaranteed to affect a broad geographic range. Now the United Nations, through the World Health Organization (WHO) said on Friday the importance of providing sex education in schools from 12 years to become familiar with the use of contraceptives.[39]
  • Blood donors
  • Healthcare workers.
  • Men who have sex with men
recent data shows HIV epidemic has been rapidly spread in China's MSM population. In 2011, NCAIDS estimated there were 780,000 people living with HIV/AIDS in China and 32.5% were MSM.

HIV and syphilis co-infection among MSM 编辑

Co-infection of HIV and syphilis is probably a major reason behind resurgence in syphilis prevalence among men who have sex with men in China. It is hypothesized that the association observed between syphilis and HIV among MSM is probably due to similar risks associated with both infections. Analysis of data from a survey among MSM in seven Chinese cities reveal that the factors significantly associated with co-infection are older age, education up to senior high school, unprotected anal intercourse, recent STD symptoms, and incorrect knowledge about routes of transmission.[40]

A meta-analysis has shown that the HIV-syphilis co-infection among MSM in China increased from 1.4% in 2005-2006 to 2.7% in 2007-2008.[41]

Predictions 编辑

Predictions of the size of the HIV/AIDS epidemic in China have been made by several expert bodies. Notable examples include:

  • In 2002, a UN-commissioned report, emotively entitled China's Titanic peril ,[42] estimated that China had about 1 million cases of HIV, and that it was on the brink of an "explosive HIV/AIDS epidemic... with an imminent risk to widespread dissemination to the general population". The report continued: "a potential HIV/AIDS disaster of unimaginable proportion now lies in wait."
  • In September 2002, the US National Intelligence Council estimated that 1–2 million people were living with HIV in China, and predicted 10–15 million cases by 2010.[3] The National Intelligence Council claimed that these figures were more reliable than previous estimates because they did not rely on official Chinese sources, which the National Intelligence Council asserted "systematically understate the actual figures", but rather incorporated assessments by academics and non-governmental organizations working in the field.
  • In November 2002, the American Enterprise Institute referred to the situation as the "AIDS typhoon".[4] This report emphasized the probable damage to the economy because HIV would spread among young educated urban people.
  • In April 2004, HIV/AIDS was referred to as China's timebomb by the Center for Strategic and International Studies (Washington, DC, USA).[43]
  • The number of people infected with HIV/AIDS in China "could rise to 10 million in the next six years unless the government acts urgently and effectively to prevent an epidemic", the Joint United Nations Programme on HIV/AIDS said in its 2004 biennial report on the global AIDS epidemic. The virus has spread to all provinces of China but with no distinct pattern of infection, and there are "extremely serious" epidemics in parts of the country despite a low rate of the disease nationwide of about 0.1 percent, the report said.

These estimates assumed substantial spread of the virus from high-risk groups to the general population. Yet, trends from sentinel surveillance of pregnant women in high-risk areas might indicate that such spread may not have occurred.[44][45] Another study showed, however, that 43% of the tested infected people were from low-risk groups.[46] More recently, China Aids Info reported that "HIV infection has caused a 75% increase in the worldwide mortality rate for newborns" and quoted a case in China.[47] It is discussed, whether these predictions may have been made on unfounded assumptions. Some have argued that the effect of the high predictions have drawn attention and resources away from areas of greater need. For example, China's burden of disease from tobacco use is enormous.[48] Others argue that due to the large number of cases of undiagnosed infections HIV testing must be introduced via "anonymous surveillance and voluntary counselling and testing in order to reduce transmission".[46]

HIV/AIDS surveillance system 编辑

The national surveillance system in China has three components:

  1. National disease reporting programme for 35 notifiable communicable diseases that covers the entire population.
  2. 845 national disease surveillance points covering 1% of China's population in 31 provinces, regions, and municipalities.
  3. Several disease specific surveillance systems including one for HIV infection and AIDS.

Additionally, 42 national HIV/AIDS sentinel surveillance points have been established in 23 provinces since 1995.

Case finding 编辑

The first step in understanding the extent of an epidemic was to be able to identify cases. National sentinel surveillance has been implemented since 1995, but was initially restricted to high-risk areas and to attendees at sexually transmitted disease clinics, female sex workers, drug users, and long-distance truck drivers. Surveillance has gradually been expanded to 845 national sites and now also includes pregnant women and men who have sex with men.

Around the same time, voluntary testing and counseling was made available in some communities, but, even where available, was rarely used. Reluctance to seek HIV testing was probably due to a number of causes – e.g., cost, inaccessibility of services, absence of any treatment, scant publicity or advocacy for testing, low or no perceived risk, and stigma associated with the use of testing services.[49][50][51][52] Since 2004, the government has addressed the environmental barriers. The high cost was addressed in 2003 by making free HIV testing available for the poor,[53] and later, under the 'Four Free and One Care' policy, antiretroviral therapy was made freely available for all through the Chinese health system. The number of screening laboratories has been expanded to 5500, and there are now 99 laboratories able to do confirmatory HIV tests. Free HIV testing has been made available, and expanded from 365 counties in 15 provinces in 2002 to over 2300 counties, with 3037 sites, in all provinces in 2006. The AIDS Regulations have introduced penalties for health units that do not provide free testing on request.

The rapid expansion of testing infrastructure has been largely prompted by the introduction of provider-initiated routine testing campaigns to identify infected individuals and put them in contact with treatment services. Client-initiated testing was failing to identify most infected individuals, so campaigns to screen high-risk groups, including drug users, commercial sex workers, prisoners, and former plasma donors, were commissioned to link patients to treatment services.[54] The campaigns have resulted in a substantial increase in the number of individuals who know their HIV status, with an additional 60,000 people living with HIV/AIDS identified. This increased identification explains, at least in part, the rapid rise in reported HIV cases in the early 21st century. However, even with this effort, only about 22% of the estimated 650,000 HIV-infected individuals living in China at the end of 2005 have been identified.[26] Routine testing in high-risk groups continues.

Control and prevention 编辑

Overview 编辑

Early efforts to control the HIV/AIDS epidemic emphasized enforcement of laws against high-risk behavior. Later lessons from effective interventions in pilot programs and in other countries (e.g., needle exchange programs in Australia and condom campaigns for sex workers in Thailand) have led to a more evidence-based approach.[55]

The process of policy development have not been tidy because of tensions arising particularly from those between public health officials and the police and those within public security over the management of illegal drug use and prostitution. However, the 2006 AIDS Prevention and Control Regulations[56] are an example of evidence-based policy, even if their implementation is highly variable across China.

In 2003, in response to the ever growing spread of HIV/AIDS, the Chinese government declared a strong commitment to its prevention. Long- and medium-term plans for controlling and preventing HIV/AIDS have been developed, and a central government coordinating committee has been formed among 33 ministries.

Four main factors have driven China's response to the HIV/AIDS pandemic:

  • existing government structures and networks of relationships;
  • increasing scientific information;
  • external influences that underscored the potential consequences of an HIV/AIDS pandemic and thus accelerated strategic planning; and
  • increasing political commitment at the highest levels.

China's response culminated in legislation to control HIV/AIDS — the AIDS Prevention and Control Regulations.

Three major initiatives are being scaled up concurrently.

  • First, the government has prioritized interventions to control the epidemic in injection drug users, sex workers, men who have sex with men, and plasma donors.
  • Second, routine HIV testing is being implemented in populations at high risk of infection.
  • Third, the government is providing treatment for infected individuals.

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 — leading to decisive action.

Treatment programs 编辑

Current treatment plan 编辑

The government now provides free AIDS drugs to rural residents and city-dwellers without insurance. Other measures include:

  • Free voluntary counseling and testing.
  • Free drugs to HIV-infected pregnant women to prevent mother-to-child transmission, and HIV testing of newborn babies.
  • Free schooling for AIDS orphans.
  • Care and economic assistance to the households of people living with HIV/AIDS.
Antiretroviral treatment for people with HIV/AIDS 编辑

In 2001 and 2002, the number of patients living with HIV/AIDS being identified through treatment services began to increase. As many as 69,000 of these people were the rural poor who had been infected when they sold their blood and plasma in the mid-1990s and who were unable to access or afford much-needed antiretroviral treatment.[26] On the basis of the successes of programmes in other nations, such as Brazil,[57] a free antiretroviral therapy programme was piloted in late 2002 in Shangcai county, Henan province, one of the most severely affected areas.[58] Patients were provided with a combination of 齐多夫定 or didanosine plus 拉米夫定 and nevirapine. On the basis of the improved health status and survival of the initial cohort, the programme was scaled up in early 2003, mainly through the China CARES programme.[58]


The provision of free antiretroviral therapy to rural residents and the urban poor became policy in 2003 under the 'Four Free and One Care' policy.[59] The National HIV/AIDS Clinical Taskforce took the lead in establishing the programme, and set up a database to monitor it.[58] As of the end of 2006, more than 30,640 patients have been treated in 800 counties in all 31 provinces. Research to inform further expansion and improvement of the programme is ongoing. Initial reports indicate that the current treatment regimen has a high drop-out rate (at least 8%), mainly due to side-effects, drug resistance, difficulty with adherence, and progression of disease.[58] Therefore, the government is currently exploring options within the pharmaceutical industry to make additional regimens available,[60] which will address both the issues of compliance, by making regimens with fewer side-effects available, and resistance, by making available additional lines of treatment.

Pilot programs 编辑

The government has recently approved a series of pilot programs, such as:

  • a needle exchange program for drug users who have gone through detoxification
  • a methadone maintenance treatment program
  • vending machines selling condoms have been set up in public places.

Reduction of transmission via injecting drug use 编辑

Intravenous drug use represents the largest single cause of HIV transmission in China, accounting for 44.3% of infections at the end of 2005.[26] Ministry of Public Security data suggests that the number of registered drug users has risen steadily at a rate of about 122% per year, from 70,000 in 1990 to 1.16 million in 2005. The total number, including unregistered drug users, is thought to be much higher, with one estimate placing the figure at 3.5 million;[61] the UNODC World Drug Report estimated that in 2003, 0.2% of 16–64-year-olds (i.e., 1.7 million people) were opiate abusers.[62] The most commonly used drug is heroin, which accounts for 85% of total reported drug use, although amphetamines are becoming more common, especially in urban areas.[63] Many drug users begin heroin use by smoking, but later find it more cost effective to inject because of the stronger effect gained from injecting a smaller amount. Sharing injection equipment is common.[64]

National policymakers have recently shifted their position and publicly acknowledged the extent and pattern of increasing drug use, which has led to a rapid increase in treatment options for drug users. According to the regulations on the prohibition of narcotics,[15] drug users identified by authorities for the first time are fined or sent to a voluntary detoxification center run by the health system, which might include short-term use of methadone, buprenorphine, or traditional Chinese medicine. Detoxification costs 2000–5000 yuan (about US$250–625) for one phase of treatment.[65][66] If, as often happens, the treatment is not successful, relapsing patients identified by authorities are sent to a compulsory rehabilitation center, administered by the Ministry of Public Security, for 3–6 months. Those with multiple relapses are detained in a re-education-through-labor center, managed by the Ministry of Justice, for 1–3 years. In reality, internment procedures and durations vary enormously between administrative units. In general, centers focus on detoxification. Although some health education or treatment is provided, the relapse rate is extremely high..[67][68][69]

Cooperative actions by politicians, policymakers, government officials, and scientific researchers have resulted in the introduction of new strategies for drug control over the past 6 years. For example, the government is working with neighboring countries to prevent drug smuggling, and is increasing anti-drug education for the general population and in schools.[66] The government has also commissioned research on harm reduction strategies, such as methadone maintenance treatment and needle exchange programmes.

针具交换项目 编辑

针具交换项目（英语：Needle exchange programme）最初卫生部未被正式批准，因为易被理解成容忍吸毒行为。因此，该项目一开始被称为针具社会营销，名为推广商业针具，扩展销售渠道、普及大众的使用，顺带安全使用注射器的健康教育，再有时候提供免费针具。[64] 2001年，国务院正式提倡将针具社会营销作为HIV干预手段。[22] 考察团了解到澳大利亚等国家[70]针具交换项目的成果和其显著成果，促使卫生部支持了1999年在云南省和广西壮族自治区的第一个针具交换项目。2000年至2002年，一个规模更大的针具交换项目在广东和广西的四个县试行。[71][72]后续调查的数据显示实行针具交换项目的实验组比控制组在过去一个月内共用针具的概率小三倍（OR 0.36，95% CI，0.25–0.52）。此外，实验组的丙型肝炎（51.1%对83.6%, p=0.001）和HIV感染率都显著低于控制组，不过这个结果只出现在广东（p=0.011），从广西（p=0.2）或总体数据（18.1% vs 23.6%, p=0.391）上看都不为显著。

此次试行的结果被用于制作2002年的全国行动纲领，针具交换项目也被包括在了第二个五年行动计划中。[73] 该项目在2006年显著扩大规模，由93个城市至年底扩张至729个，主要为乡村地区。其中很多地方提供的服务不止针对注射吸毒者，还包括分发安全套、自愿咨询和检测、抗病毒治疗、关于物质滥用和HIV的普及教育等。[74]

Methadone maintenance treatment programmes 编辑

A large body of international research has shown the efficacy of methadone maintenance treatment programmes for the treatment of drug addiction and subsequent reduction in HIV risk behaviors.[75][76][77][78] In acknowledgment of this evidence, in 2004 the Chinese government called for the use of such practices to mitigate HIV transmission.[60] Immediately, under the governance of the Ministries of Health and Public Security and the State Food and Drug Administration, a pilot study of eight clinics in five provinces was done.[79][80] Inclusion in the programme required: (1) several failed attempts to quit the use of heroin, (2) at least two terms in a detoxification centre, (3) age at least 20 years, (4) being a registered local resident of the area in which the clinic is located, and (5) being of good civil character. Those testing HIV positive need only fulfill criteria 4 and 5. To monitor the progress of the clinics, a database was established to gather data on demographics, medical issues, drug use, and other information about the patients. These data were assessed at 3, 6, and 12 months, and indicated reductions in heroin use, drug-related crime, and unemployment in those who received methadone maintenance treatment.

On the basis of the successes of the pilot, the programme began scale-up in 2004 and plans are in place to open an additional 1500 methadone maintenance treatment clinics for about 300,000 heroin users by 2008. A National Training Center for methadone maintenance treatment has been established in Yunnan to provide clinical and technical support. The services offered at such clinics have been broadened and provide access to other services, including HIV and hepatitis testing, antiretroviral therapy for eligible AIDS patients, group activities, and skills training for employment. The use of methadone maintenance therapy has been incorporated into the AIDS Regulations as a treatment for heroin addiction. Additionally, the requirements for entrance into methadone maintenance treatment programmes have been relaxed to encourage greater access. For example, patients are no longer required to have local residency or a previous history of internment in a detoxification centre. The programme is not without problems, however, and retaining drug users in the programme remains a critical challenge.

Sexual transmission 编辑

Although most HIV-infected individuals in China are drug users, patients infected through sexual transmission are the fastest growing group, accounting for close to 50% of new infections in 2005.[26] Overall, they represent 43.6% of total HIV/AIDS cases, including commercial sex workers or their clients (19.6%), partners of HIV-infected individuals (16.7%), and men who have sex with men (7.3%).[26] As with drug use, sexuality is not openly discussed in Chinese society and is therefore neither easily targeted by health promotion campaigns, nor has it traditionally been taught in schools. Even among university students, levels of AIDS knowledge and risk perception are alarmingly low.[81][82] On the other hand, attitudes towards sex are becoming increasingly more liberal and, as a result, premarital and extramarital sex are more commonly practiced.[83][84] Although they are widely available, condoms are rarely used.[85]

Commercial sex work 编辑

Commercial sex work is illegal in China; hence, brothels are illegal and commercial sex workers operate out of places of entertainment (e.g., karaoke bars), hotels, hair-dressing salons, or on the street.[86] The traditional strategy for controlling HIV transmission through commercial sex workers has been the development of stricter laws to prevent risky behaviors,[16] accompanied by raids on suspected sex establishments by public security officials.[20][86] Those apprehended are subject to compulsory education on law and morality, testing and treatment for sexually transmitted diseases,[86] and forced participation in productive labor.[20] Under the Frontier Health and Quarantine Law,[12] those knowingly infected with HIV who continue to practice prostitution are subject to more severe penalties and criminal liability for creating a risk of spreading a quarantinable disease.[12][86] Detention ranges from 6 months to 2 years. Until recently, health education in this system was uncommon.

In 1996–97, following the success of prevention interventions in neighboring Thailand,[87] the Chinese CDC launched the first intervention projects to promote safer sex behaviors to prevent HIV and other sexually transmitted diseases in commercial sex workers working at entertainment establishments in Yunnan.[88][89] These projects showed the feasibility of such programmes, which included condom use to control the spread of HIV and other sexually transmitted diseases in commercial sex workers, and have been officially promoted since 1998.[21] Between 1999 and 2001, the World AIDS Foundation supported a five-site trial of a behavioral intervention in commercial sex workers who worked in entertainment establishments.[90][91] The intervention included condom promotion, establishment of clinics for sexually transmitted diseases to provide check-ups, and outreach for health education and counseling. HIV-related knowledge improved substantially, and the rate of bacterial sexually transmitted diseases fell. The rate of condom use at last intercourse increased from around 55% to 68%, and fewer commercial sex workers agreed to sex without a condom when requested by a client who offered more money. The prevalence of gonorrhea fell from about 26% at baseline to 4% after intervention, and the prevalence of chlamydia fell from about 41% to 26%.

The findings from this trial were used to draft national guidelines for interventions among sex workers in China. The provision of condoms at entertainment establishments is now an official requirement under the AIDS Regulations. Condom vending machines are being installed in venues such as university campuses and hotels, and condom promotion and HIV education campaigns that target youth and migrant workers are gradually being scaled up.[91][92]

Prevention of mother-to-child transmission 编辑

After reports of successful intervention in other developing countries,[93] a feasibility trial of the prevention of mother-to-child transmission was piloted in late 2002 concurrent with the antiretroviral therapy pilot, with financial and technical support from UNICEF. Mothers who tested HIV positive were offered counseling, the option of abortion or antiretroviral therapy and, where available, caesarean delivery, to reduce the likelihood of mother-to-child transmission. Free formula milk for 12 months was provided for infants.[94]

On the basis of this pilot programme, national guidelines were developed to guide the prevention of mother-to-child transmission in the country. The provision of such services has been ratified by the AIDS Regulations. Services are being scaled up to cover at least 85% of infected pregnant women by 2007, and to reach at least 90% by 2010.[73] Scale-up is being prioritized to the most heavily affected areas first. As of the end of 2005, more than 500,000 pregnant women in high-risk groups or in high-prevalence areas had been tested for HIV in 271 counties in 28 provinces. The overall participation rate in HIV testing in these pregnant women was 92%, and the HIV infection rate ranged from 0.3% to 0.7%. Among those who tested positive, 80% received antiretroviral therapy, and more than 90% accepted formula milk for the prevention of mother-to-child transmission.[95]

Health promotion 编辑

A national program has been launched to combat the stigma and discrimination against people with HIV/AIDS.

  • In 2006, 5,000 Beijing taxi drivers handed out HIV/AIDS information leaflets to passengers in the first 10 days of December.
  • Officials in the southwestern province of Yunnan announced in 2006 that, starting on January 1, 2007, Yunnan residents will be required by law to take an HIV test before marriage. There would be no charge for the test, the results of which are to be shared with prospective spouses. Yunnan, home to 25% of the country's HIV cases, borders the opium-rich Golden Triangle of Vietnam, Laos and Myanmar. The virus has been found in 128 of its 129 counties, the provincial government has said.

Future treatment options 编辑

In China, a distant hope for HIV prevention is the development of an effective vaccine that can offer long-term protection against the wide spectrum of HIV variants that exist. Despite the fact that there are now more than 30 vaccine candidates in clinical trials (in the world), and three of these are in advance stage testing (phase IIb and phase III), many obstacles still lie in the way of the development of a truly effective HIV preventive vaccine.

The genetic diversity of HIV presents an enormous challenge for researchers. And, because the virus has the ability to evade neutralizing antibodies produced by natural immunity, the standard vaccine strategy of mimicking natural infection to induce antibodies has so far proved impossible. Strengthening cell-mediated immunity offers another possible route to success. About 90% of candidate HIV vaccines in development use this approach. These products will not prevent infection. But it is hoped that they will lower viral load and therefore progression to AIDS and secondary transmissions. Some observers believe that a vaccine to prevent HIV will never be achieved. Ultimately, even if an HIV preventive vaccine were to be developed, they are unlikely to be 100% effective. It has come to be realised that no single approach alone will be able to stem the spread of HIV. The future of HIV prevention will most likely involve combining new methods with existing approaches, such as condom use.

Newer approaches to HIV prevention 编辑

Planned programmes 编辑

Unlike prostitution and drug use, homosexuality has never been banned in China, but it was listed as a psychiatric disorder until 2001, and public acts of homosexual sex are punishable as hooliganism.[96] Although increasingly tolerated in the cities, in general, homosexuality is highly stigmatised and men who have sex with men are under considerable pressure to conceal their sexual orientation.[97] As a result, most homosexuals are married, or will be in the future, and form a bridge between the high-risk men who have sex with men group to their low-risk wives and other partners.[96][98][99] The government has initiated few interventions for men who have sex with men, leaving such programmes to advocacy groups, non-governmental organizations (NGOs), and researchers.[100] However, the government recently estimated that there were 5–10 million men who have sex with men living in China, of whom 1.35% are thought to be HIV positive.[101] This information, in addition to studies indicating low levels of HIV knowledge, perceived risk, and testing, and high rates of sexually transmitted diseases,[51][102][103] has prompted the Ministry of Health to now include men who have sex with men in the high-risk groups and to call for the development of novel interventions to target them.[104]

Funding 编辑

Private sector and NGO involvement 编辑

Since 2003, the central government showed an increasing openness on AIDS issues, making several public statements encouraging the participation of the private sector and, to some extent, NGOs. This was due, in part, to the SARS epidemic, which helped change the way in which government dealt with public health issues. For a prolonged period, the authorities did not admit to having a serious outbreak of SARS until it was a devastating problem and only then did they decide to come forward and acknowledge the real scale of the epidemic. The new-found frankness helped the government win back some credibility before the international community.

Currently, there are dozens of different projects sponsored by the private sector targeting the problem around the country, from education and awareness programmes to increasing the capacity of local NGOs. Notable cases include:

  • Merck, a US pharmaceutical company, is spending about US$30m over a period of five years. The program involves training for healthcare professionals, condom distribution and identifying high-risk groups.
  • Bayer, a German pharmaceutical company, has set up a training course in HIV/AIDS issues for journalists. About 300 reporters have completed the course so far at Tsinghua University in Beijing.
  • Standard Chartered Bank has introduced some of the approaches it has learned from its operations in southern Africa, including awareness programs for new employees and encouraging staff to be tested.

AIDS vaccine trials 编辑

China is currently seeking volunteers to participate in its second clinical trial of a new AIDS vaccine for early 2007, Shao Yiming, chief expert for the National Center for AIDS/STD Control and Prevention. The center is looking for men and women to participate in the trials which will take place in Beijing. He revealed the plan at a conference on Sino-U.S. AIDS vaccine research and development held on the 17 December 2006 without indicating how many participants will be involved in the trial. The vaccine was approved for clinical trials by Chinese drug authorities in November 2006. Trials on Rhesus Monkeys indicate that the vaccine is safe and effective in preventing HIV infections, Shao said.

In March 2005 China began its first human clinical trials on an AIDS vaccine in southwestern Guangxi Zhuang Autonomous Region. The volunteers, 33 men and 16 women aged from 18 to 50, have been vaccinated and none have had adverse side effects.

According to a recent report released in 2006, there are 120 clinical trials of AIDS vaccines being conducted on humans throughout the world.

中国传统医学 编辑

  维基百科中的醫學内容仅供参考，並不能視作專業意見。如需獲取醫療幫助或意見，请咨询专业人士。詳見醫學聲明。

有证据显示中医药可能有助缓解艾滋病症状，但没有证据表明其能有效控制HIV感染 [105]。

公众认识和科普 编辑

公众普遍对艾滋病缺乏正确认识是中国艾滋病疫情中一大难题。2001年一份调查显示，五分之一的中国民众从未听说过此病。[106]

科普 编辑

HIV檢測以及基层宣传项目帮助增加人们对艾滋病的认识，消除有关艾滋病的偏见。法律规定，所有乡级以上地方政府以及教育机构、企业、医疗机关、海关、边检和媒体都有义务参与HIV和艾滋病的科普教育和宣传活动。有学校向学生开展了专题为性、物质滥用和HIV特别课程，尤其是在感染多发的云南、广西、广东等省份。

An important part of HIV education is targeting behavior to reduce stigma towards people with HIV/AIDS. Stigma is well recognized as a major barrier to HIV control, because it prevents people from seeking services for testing and treatment, and discourages people from practicing safer behaviors.[49][107][108] To address this issue, senior political figures have been involved in anti-discrimination campaigns, and have publicly shown that HIV cannot be transmitted through casual contact. For example, on World AIDS Day, Dec 1, 2003, Premier 温家宝 publicly shook hands with AIDS patients in Beijing Ditan Hospital.[59] The day before the 2004 World AIDS Day, President Hu Jintao and other senior government leaders visited patients living with HIV/AIDS and called for the elimination of bias against this group.[109] During the Chinese New Year celebrations in 2005, Premier Wen Jiabao visited the homes of HIV-infected villagers in Henan province. These actions had a tremendous effect on the general community, and have now been backed up by policy changes. The AIDS Regulations have made it illegal to discriminate against people living with HIV/AIDS and their families in terms of their rights to schooling, employment, health services, and participation in community activities. Furthermore, the AIDS Regulations and the 2004 revision of the Law on the Prevention and Treatment of Infectious Disease [110] include language to protect the identity and disease status of those with an infectious disease, with disciplinary action recommended for those individuals or institutions that violate these laws. Although there had been language in previous regulations to protect the rights of people living with HIV/AIDS, these new laws give such individuals and their families a stronger basis from which to defend their rights.

Criticisms and control problems 编辑

Government policies 编辑

Health officials say there are plenty of problems in China's approach to AIDS. There are frequent reports of police crack-downs on local NGOs involved in AIDS prevention. There have also been reports of police using the presence of a condom in a sex worker's handbag to justify detention. This has been partially blamed on policy incoordination, and contradictions and conflicts between laws and regulations.

In addition, there are concerns that provincial governments have enough autonomy to sometimes stall the implementation of central government-set guidelines and some officials say there has been a reluctance from many state-owned companies to get involved in AIDS programs.

Discrimination and stigma 编辑

Many Chinese businesses have been reluctant to make voluntary commitments to non-discriminatory treatment of HIV-positive employees, often because they fear lawsuits and because they are unable to recoup the cost of HIV/AIDS related health care from company insurance policies.

Population movement and urban-rural inequality 编辑

Challenges ahead 编辑

China has made impressive progress in the development and implementation of effective intervention strategies, especially since 2004. The country is currently in a transition stage in its HIV policy development. It is increasingly adopting approaches that are based on scientific evidence and has encouraged the pilot testing of controversial methods of risk reduction (e.g., methadone maintenance treatment, needle exchange programmes, and the targeting of men who have sex with men and sex workers).

Failures in scaling-up HIV prevention programmes have not been caused by an absence of policy, but rather, as with other countries, by there being no policy enforcement and timely scale-up. Although China has a strong central government, provincial and lower levels of government enjoy a great deal of autonomy, which has resulted in a mixed response and inconsistent enforcement of HIV/AIDS policy. For example, Yunnan province has shown strong support for implementation and advocacy of harm-reduction strategies that reduce HIV transmission in its many drug users, whereas Henan province had been slower to respond to the needs of former plasma donors in the early stages of the epidemic.[111] Moreover, the distribution of HIV in China is not even, and is concentrated in areas with high drug use (e.g., Yunnan, Guangxi, Xinjiang, and Sichuan) and in areas where people were infected through unsafe blood or plasma donation (e.g., Henan, Anhui, Hebei, Shanxi, and Hubei). The number of cases ranges dramatically between provinces, with, for example, just 20 cases reported from Tibet but well over 40,000 in neighboring Yunnan. In provinces with an extremely low prevalence, it can be difficult for officials to see the need for HIV prevention and control.

Conflicts of interest between departments, such as those responsible for health and public security, have also made coordination of services to reach high-risk groups that engage in illegal behavior difficult.[112] The central government has called for greater cooperation between relevant departments – including Public Security, Justice, Education, Civil Affairs, and Health – but implementation of this policy at the local level varies.

The problem is further exacerbated by inadequate resources and trained personnel. Many rural areas – where most of China's HIV-positive population resides – do not have the capacity to monitor patients' CD4+ cell counts and viral load. In some cases, the physical infrastructure exists, but staff do not have the skills or reagents to use it. Human resource capacity is a major constraint on China's ability to deliver HIV prevention and care. Many health workers and educators have poor knowledge of HIV and hold their own biases and stigmas towards those at risk or infected with HIV.[113][114][115] A substantial proportion of the funds allocated to HIV prevention and control is being spent on establishing training centers and in building the capacity of health workers so that they can deliver better services. But many of those willing to work in rural areas do not have formal medical qualifications to begin with, which limits their abilities to understand the complexities of treating HIV patients.[116] Furthermore, health services rely heavily on user fees, which often encourages health workers to do additional, chargeable services that many people living with HIV/AIDS cannot afford.[117]

With an estimated 650,000 people living with HIV/AIDS and an ever greater number of people at risk of infection, the government has embarked upon a formidable task. The provision of accessible testing and treatment services not only requires financial resources, but also, in many cases, reorganization and supplementary funding of existing local health services infrastructure, especially in rural areas where most of Chinese HIV-positive individuals reside.[118] In particular, rural areas do not have adequately trained staff capable of providing effective treatment and prevention services, as well as the laboratory and clinical infrastructure necessary to monitor treatment.[58] The problem of inadequate human resources is not restricted to health departments – in rural areas, there are few adequately trained technical and management personnel at all levels and across all sectors. The combination of insufficiently trained staff, inadequate technical resources, and a largely remote, poorly educated, rural population represents a challenge to the implementation of effective programmes.

A major step has been the government's promotion of NGOs,[119] which are a new concept in China.[120] Many of the larger domestic groups are actually government funded, and those not affiliated with the government are required to go through a complicated registration procedure to be officially endorsed, although there might be a relaxation of these policies in the future.[121] The presence of international NGOs is also increasing. The ability of NGOs to work with high-risk groups, especially those that engage in behaviors deemed to be illegal or immoral, and to provide care and outreach where overstretched health services cannot, is recognized.[122] The private sector is also being encouraged to undertake prevention and education activities.[123]

The mobilization of multiple sectors within China occurred over a 15-year period when there was a long series of educational workshops, conferences, collaborative projects, and networking between members at a number of levels of the government and administrative structural hierarchies. At local, national, and international forums, officials from many sectors were able to meet one another, share a common knowledge base, and debate the appropriateness of different interventions. Personal relationships were formed that facilitated the consideration and examination of previously unrecognised policy options for detection, prevention, and care. In a non-linear process, a consensus slowly evolved, identifying policy options.

Political officials, policymakers, administrators, and service providers were increasingly willing to recognize the relevance of a substantial body of scientific research that suggested effective intervention strategies that could change the course of the epidemic. Also, major policy recommendations with regard to behavioral interventions were preceded by small pilot projects that showed feasibility or efficacy in those populations at highest risk. Once the evidence base was documented, both the policymakers and politicians publicly showed their support for HIV prevention and care, as well as passing legislation to enforce and broadly disseminate health practices (e.g., routine HIV testing and access to care).

These processes occurred in a context of ongoing influences from the media and international donor agencies, with some contribution from advocacy groups within China. The SARS epidemic showed the potentially disastrous effect of a fast-moving infectious disease and, simultaneously, allowed the HIV community to acquire new methods to fight the epidemic (e.g., real-time data collection of new cases). However, mobilisation of resources, scientific evidence, and administrative drive did not occur until there was enthusiastic political commitment. The pace of implementation of innovative strategies for HIV detection, prevention, and care, accelerated with the commitments made by the government of Hu Jintao, starting in 2003.

After a slow start and reluctance to recognize the existence of risk activities in its population and of the HIV epidemic, China has responded to international influences, media coverage, and scientific evidence to take bold steps to control the epidemic, using scientifically validated strategies. The country now faces the challenge of scaling up these programmes and of convincing all levels of government to implement these innovative strategies and policies. This vigorous response, incorporating research findings into policy formulation, can be informative to other countries that face similar challenges in responding to the HIV/AIDS epidemic.

Activism 编辑

In China, like elsewhere, HIV/AIDS activists have played and continue to play an essential role in promoting public awareness and education about the disease, helping to prevent discrimination against people living with HIV/AIDS and highlighting factors which may impede efforts to check the spread of the disease.

It has been claimed by some international human rights groups that HIV/AIDS activists in China continue to face serious obstacles in their work, including arbitrary detention, harassment and intimidation, and other human rights violations. Restrictions on travel by Dr. Gao Yaojie, a Henan activist, have been cited in news reports.[124]

The country's best-known AIDS activist, Wan Yanhai, believes China suffers 10 times the number of HIV cases – 650,000 – estimated by health officials.

Blood transfusion controversy 编辑

Bloodhead scandal 编辑

From the early to mid-1990s a network of businessmen and government workers, known as "bloodheads", set up hundreds of official and unofficial blood donation stations in Henan Province to supply the market for blood plasma created by hospitals and manufacturers of health products. The common practice of reusing needles, not screening for diseases, sellers traveling from station to station with false records to maximize their income, and the mixing the blood prior to centrifuging and re-injecting the separated red blood cells back into the peasant blood-sellers guaranteed the rapid spread of blood-borne diseases such as HIV and Hepatitis B.[7]

Particularly in the province of Henan, tens of thousands of farmers and peasants were infected with HIV through participation in these programs. The blood stations began to be closed down in 1995 when the scale of the HIV outbreak began to become apparent. The ensuing coverup saw government officials take credit for dealing with the crisis which they caused, the harassment of journalists attempting to cover the story, and of whole villages dying of what was to them a mysterious disease because they had not been informed that they were likely to have been infected.[7] On August 23, 2001, the Chinese government admitted that 30,000-50,000 Chinese people could have been infected with HIV through illegal blood collections and sales.[6]

On August 24, 2002, the prominent HIV/AIDS activist, Wan Yanhai, was arrested in Beijing and detained for a month for leaking an internal government report on the Henan AIDS crisis.[7]

Compensation 编辑

In early December 2006, it was reported that a group of 19 people who contracted HIV from tainted blood transfusions at a hospital in the northeastern province of Heilongjiang were awarded 20 million yuan (US$2.5 million) in compensation. The landmark case involves the largest single group stricken by HIV in China. Eighteen of the victims will receive a one-off payment of $25,500 from the hospital and additional monthly payments of $380. Payment will go to the family of the one victim who has already died from AIDS.[125]

Socioeconomic impact 编辑

The process of the impact of HIV/AIDS can be described as having three key stages: first, the impact experienced at the micro level; second, at the sectoral level; and finally, at the macro level. The impact began to be observed in China at the micro, or household level, and will most certainly be observed in the future at the sectoral level. Individuals and families have been bearing both the economic and social costs of the disease, and the poverty of those affected have increased and will further increase substantially. Expenditures for the health sector will increase, for both treatment and prevention interventions. There has been almost no impact on the macro level. But if without effective preventive action, the HIV spread in the general population at large will have an impact on the macro level as have happened in some countries in sub-Saharan Africa.[126]

Severe acute respiratory syndrome 编辑

The challenge of managing the severe acute respiratory syndrome (SARS) epidemic (November 2002 to June 2003) is often credited with further motivating the government to take aggressive policy action on HIV-related issues. SARS showed not only how infectious diseases could threaten economic and social stability but also the effect of China's policies on international health problems.[19] Policymakers announced a change of focus from purely economic goals to increasing the focus on health and social wellbeing and, as a result, increased support for public health agencies. In controlling SARS, contact between the government and international agencies such as WHO, UN, and the US Centers for Disease Control and Prevention was essential and further stimulated stronger international collaboration for HIV/AIDS prevention and treatment. Intervention strategies necessary for SARS control have been translated into HIV/AIDS prevention – e.g., real-time electronic case reporting.

Media 编辑

The media have exerted substantial influence over the timing and course of HIV control in China by bringing news of HIV to the attention of the public, administrators, and policymakers. In 1996, the Southern Weekend newspaper ran a front-page story and devoted another two pages to AIDS in China. This coverage was the first time any comprehensive exposure of the HIV/AIDS epidemic in China had been published by the Chinese press. From 1999, the international and subsequently the national media reported on the thousands of infected plasma donors in Henan and neighbouring provinces who did not have access to services. Although the government had acted quickly when the tragedy became apparent in 1995 by shutting down collection stations and, later, introducing new laws and regulations on the collection and management of blood and blood products,[37][127][128] provision of HIV testing, prevention, and care for donors in the local areas was slower. Progress was stimulated by the media's attention to the plight of the infected plasma donors. Since these initial reports, the HIV/AIDS situation in China has received much attention from the local and international media.

 
维基共享资源上的相关多媒体资源：LUMINR/中国大陆艾滋病情况

Documentaries 编辑

Chinese-American director Ruby Yang has recently made a documentary about AIDS in rural China, which premiered on 14 June 2006, entitled The Blood of Yingzhou District .

An abridged version of Robert Bilheimer's acclaimed US-made 2003 documentary A Closer Walk was shown on China Central Television (CCTV) on World AIDS Day, December 1 (Friday), 2006, and was rerun Sunday and Monday. It was viewed by around 400 million people. The 75-minute length documentary narrated by actors Will Smith and Glenn Close, had premiered in the United States in 2003.

News coverage 编辑

AIDSPortal news summaries on China

On 25 November 2006, the Associated Press reported that a Chinese HIV/AIDS activist, Wan Yanhai, was apparently arrested shortly before an AIDS seminar was about to take place in Beijing.

See also 编辑


Template:艾滋病（英语：Template:AIDS） Template:中华人民共和国性与性别（英语：Template:SexGenderPRChina）

亚洲各国家和地區HIV/AIDS
聯合國會員國
聯合國观察员
未受国际普遍承认国家
属地和其他特殊政區
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