After taking nearly 15 years to acknowledge that AIDS even existed in China, government health officials have finally begun taking some effective measures emphasizing treatment, education, and prevention over draconian punishment. The turning point occurred in 2003 when President Hu Jingtao’s administration significantly stepped up measures to address the problem by increasing funding, from approximately 100 million yuan in 2002 to over 800 million by 2004, and by implementing a variety of health care policies. For example, under the 2003 “Four Free and One Care” policy, free HIV testing has been made available, expanding from 365 counties in 15 provinces in 2002 to over 2300 counties with 3039 clinics in all provinces by 2006. This active provider-initiated testing is one reason the number of reported HIV cases jumped from under 10,000 in 2002 to nearly 50,000 by 2004. The government also provides free antiretroviral drugs in 800 counties nationwide, treating more than 30,640 patients by 2006.

The government has also been attempting to reduce stigma and discrimination towards AIDS patients. In a series of grand gestures since 2003, President Hu Jintao, Premier Wen Jiabao and other senior leaders visited and embraced AIDS patients in urban hospitals as well as heavily hit rural counties, especially in Henan. Calling for an end to discrimination, the government enacted the AIDS Regulations making it illegal to discriminate against those with HIV and their families in terms of schooling, employment, health services, and community activities.

Daunting Challenges

Despite these measures, China still faces daunting challenges in controlling the epidemic. Especially in rural areas, staff and educators are still poorly informed and are unable to monitor patients’ CD4+ cell counts and viral load. Although substantial funds are going into building training centers and other physical infrastructure, health workers in rural areas, which are the most badly effected, rarely have any formal medical education. As general health services increasingly rely on patient fees, medical clinics in these areas often perform additional chargeable services that HIV patients cannot afford.

This emphasis on extra chargeable services reflects the general capitalist turn in China’s health care system that has placed even basic medical treatment out of reach for the majority of the population. According to UNICEF, drug sales account for over 60% of health care spending and half of hospital revenue to pay for doctors’ salaries. As a result, the once glorified “barefoot doctor” in the countryside has often become a drug salesperson, withholding medications for the top price. Far less than 10% of the 800 million who live in rural areas have any sort of medical coverage and cannot afford to see a doctor.

On top of these mounting problems, China is also quietly undergoing a sexual revolution. Yet, sex education is almost non-existent either for China’s youth or for the general adult population. Although the government has attempted to educate sex workers in some areas, it is highly dubious that any message is getting across clearly.