HIV/AIDS epidemic in rural China

As many as half a million people may be infected with HIV/AIDS in the rural Chinese province of Henan. Tens of thousands of poor peasants, struggling to survive on incomes of a few hundred dollars a year, became infected while selling their blood to profit-making, blood-collecting agencies and have spread the disease due to ignorance.

According to the July issue of the Chinese-language magazine Cheng Ming, the Henan provincial health council decided in 1993 to establish blood collection networks among rural communities. A government official declared in a report: “We must develop ‘third industry’ such as blood stations. Henan has a population of nearly 90 million, of whom 80 percent are peasants. Even if there are only one to three percent of these 70 million peasants willing to sell blood once or twice a year, we will be able to collect this blood for biomedical companies, and can create millions in value.”

Over subsequent years, at least 200 legal blood stations and an unknown number of illegal stations were set up under this official policy. The operators were generally government bodies, such as hospitals, or private entrepreneurs connected with government officials. Peasants were encouraged to sell blood for around $US5 per 400cc. Blood plasma was sold on to biomedical companies operating in Shanghai and other major cities, which utilised it to manufacture medicines.

With ample evidence already existing internationally as to how HIV/AIDS was transmitted, the methods employed in the blood stations were nothing less than criminal. According to a June 20 account in the Japan Times, they “collected at one time from a number of donors who share the same blood type. Afterward, the blood is pooled, the components needed for medical use are separated and the remaining blood is divided up and re-infused into the original donors. This unsafe procedure exposes people to the blood of six to 12 other donors every time they donate, facilitating the spread of not only HIV but hepatitis and other serious diseases.” There are recorded cases of people giving blood several times in a single month.

By 1996 the first evidence was surfacing of severe rates of HIV infection in the rural areas where blood sale was prevalent. It was not until 1998, however, that the central government in Beijing banned the practice. By that time it was too late for thousands of villagers across Henan.

Both Chinese and international news services have exposed the situation in the village of Wenlou, in the Henan county of Shangchai, where blood donation became a major source of income in the mid-1990s. According to an Agence France Presse report last November, 30 villagers had died of AIDS in the previous two years, and 10 more were dying, out of a population of just 800. A test of 155 villagers found that 95 were HIV-positive—a calamitous infection rate of 65 percent.

A Wenlou woman told Reuters that villagers sold their blood to a local hospital. “They told us it was harmless to sell blood, so we believed [them]. If they told us that it could cause AIDS, nobody would ever sell their blood. We don’t have any hope, we don’t have any money or medicine. We are waiting to die. We hope the person who is responsible for this tragedy, the blood collector, will be arrested.”

Another woman, whose daughter had already died and whose son was dying of AIDS, told AFP: “My daughter and son began donating blood when they were 15 and 16 years old. My son didn’t want me to do it because my health was poor. For each time he donated blood, we bought a large wooden beam to build the roof.” Other villagers relied on the sale of their blood to pay taxes or their children’s school fees or simply to make ends meet.

In May, the New York Times ran an investigative report on the crisis in the Henan village of Donghu, in the county of Xincai. Three blood-collecting agencies operated in the county, including one run by a military-owned business. During December alone, 14 villagers died of AIDS. The infection rate among Donghu’s 4,500 residents was estimated to be 80 percent. Other villages in the region were believed to be similarly afflicted. A Henan doctor told the newspaper: “I’ve been a doctor for many decades, but I never cried until I saw these villages.”

Aggravating the health risks was the lack of understanding throughout rural China that HIV could be spread by sexual intercourse, breast-feeding or used syringes. The steady flow of infected persons to other villages, towns and cities ensured that the HIV crisis in rural Henan did not remain localised.

By the late 1990s, doctors and medical experts were making sustained efforts to alert government authorities about the AIDS epidemic and calling for a concerted campaign of education and treatment. They universally confronted obstruction. A report to the national government by a committee of medical experts damned the regime for its inaction at the beginning of this year. It declared: “Owing to government indifference, AIDS prevention and control is gravely ineffective.”

From its beginnings in 1949, the Chinese Stalinist state has reinforced ideological and cultural backwardness. Homosexuality was outlawed and deemed a mental disorder. Its response to HIV/AIDS has been the same combination of reactionary moralising and bureaucratic edicts.

No sustained nation-wide education program has been conducted to explain the nature of HIV. Rather, the regime has promoted popular prejudices that it is caused by immoral living. Such is the narrow conservatism of the ruling elite that the first national advertisement promoting the use of condoms to prevent HIV was banned within two days for illegally promoting sex products.

Instead of education to prevent the spread of HIV/AIDS, authorities have responded with almost medieval superstition and persecution. According to Wall Street Journal of March 23, the Beijing city government adopted a law that “stipulates that bodies of people who died from AIDS must be cremated immediately and not moved out of the city”.

The Hebei provincial government introduced legislation decreeing: “Those with sexually transmitted diseases who have not been cured cannot join the military, enter school, recruit workers or get married, cannot obtain permission to have a child, cannot work in child care, food-related or service industries, etc., and those already in those fields must be transferred.”

The result is an appalling degree of ignorance. A survey conducted by the Guangming Daily showed that, even in a relatively developed area of China, 45 percent of persons aged 20-64 did not think using a condom could help prevent AIDS. More than 50 percent of respondents thought that they could be infected if they used the chopsticks and bowls that an HIV person had used, or that it could be contracting through sneezing and even hand shaking.

The situation in Henan and the plight of thousands of poor peasants dying without access to even basic medicines has forced Beijing to finally acknowledge the dimensions of China’s AIDS crisis. In late June the Health Ministry increased its estimate of HIV-positive cases 15-fold, from 22,517 to over 600,000. It has since admitted that two-thirds live in rural areas and that 71.2 percent contracted the virus through blood transmission. The United Nations is predicting China will have at least 10 million HIV cases by 2010.

Even so, the government is not implementing any serious measures to combat its spread or alleviate the suffering. An “AIDS Control and Prevention Program” launched on August 3 is so conservative in its scope that by 2003 a quarter of major hospitals will still not be able to diagnose HIV or provide treatment. Just $US14 million will be spent per year for the next five years to finance increased AIDS education—or 85 cents per person in China. This compares with the estimated $US20 billion to be spent on infrastructure for the 2008 Beijing Olympic Games.