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Here's a dilemma for the authorities: Prostitution is banned by law in China, but prostitutes are among those at the greatest risk of contracting HIV/AIDS.
So how do the health authorities test or treat people who are technically criminals?
By being innovative.
"Obviously, intervention work with prostitutes is more difficult compared with drug addicts who are more easily identifiable because they often gather together and only a certain group of people take drugs," said Wang Longde, vice-minister of the Ministry of Health, in a recent exclusive interview with China Daily. Wang is also the director of the Office of the Working Committee for HIV/AIDS Prevention and Control under the State Council.
Globally, HIV/AIDS is spreading fastest among women, mainly through commercial and casual sex, according to various reports in the media.
Commercial sex, which is illegal in China, is an underground phenomenon and widespread among different sections of society -- making the intervention work more difficult than in other cases, Wang said.
"That is why centres of disease control and prevention (CDCPs) at various levels have their own working teams to deal with the issue," he said.
The working groups, usually with five to seven experts, focus only on people involved with commercial sex, and work at night when commercial sex or homosexual contact are more common, he explained.
"The CDCP experts are encouraged to do intervention work along with non-governmental organizations (NGOs), which are playing a more active role in HIV/AIDS prevention."
And the health authorities and CDCPs are also encouraging people to set up NGOs specifically devoted to fighting the disease, Wang said.
For example, he had written a letter to the Chinese Medical Association, the biggest NGO of doctors in the country, encouraging public-health experts who had retired but are still keen on contribution to set up NGOs.
Governments will provide financial and technical support for them, Wang said, and they will work with the special CDCP teams.
The task for the working teams this year is to make a thorough check of entertainment places in the regions they are located, trying their best to familiarize themselves with prostitutes and their habits.
Based on their understanding, the teams will spread condom and HIV/AIDS prevention knowledge in entertainment places or parks where high-risk people gather.
They will also train volunteers from high-risk group who will spread the awareness wider among their peers, he added.
Gay sex and drug abuse will also be a target of intervention work, Wang said.
Experts estimate the number of male homosexuals in the country is 5-12.5 million, accounting for 2 to 4 per cent of the adult male population.
The prevalence of HIV among gays is 1 to 5 per cent, experts say.
For drug users, measures which have proved effective overseas, such as clean syringe exchange, methadone replacement and voluntary HIV tests among the public, have been implemented in recent years.
For example, last year, the Ministry of Health set up eight sites for providing addicts with methadone, which helps them kick the habit gradually.
"In terms of disease control itself, we have entered a very critical period because China has a comparatively small number of HIV carriers; and progress can be made in prevention," he says.
Although the HIV prevalence among the adult population is less than 0.1 per cent, the number of HIV carriers is increasing at a rate about 3.2 per cent annually.
Some experts have predicted that China could have more than 10 million HIV carriers by 2010 but Wang counters that the forecast is based on a premise that no prevention measures will be taken from now.
"In fact, from the central government to individuals, all are playing an active role and taking every possible measures in prevention. We are establishing a national database of HIV/AIDS sufferers in the Chinese Centre for Disease Control and Prevention to make treatment more efficient," said Wang.
All HIV registered carriers, who number about 15,000 now, are given regular medical examinations.
Victims' right
Another key policy measure is protecting the rights of victims, and draft legislation has been submitted to the State Council soon for further discussion, Wang revealed.
The regulation stresses that medical institutes must keep all the data on HIV carriers confidential, and inform the carriers when they test positive appropriately and be sensitive to their feelings.
Carriers are also required to inform their spouses within a certain time to protect the latter's health rights. If they don't, hospitals have the right to inform the wives or husbands.
HIV/AIDs sufferers who intentionally transmit the virus to others face tough punishment.
"Right now, we badly need training in treatment, prevention and control management," he says.
Training is urgent for grass-roots medical workers because 70 per cent of China's HIV carriers are in rural and remote areas.
China has too few people who have professional education in AIDS treatment and follow-up procedures.
For example, in Southwest China's Yunnan Province which is one the worst affected, there are only 40 professionals to handle treatment.
To improve treatment and follow-up tests, the Ministry of Health has sent two State-level medical team of five members each to Yunnan and Henan provinces.
The teams will be sent abroad after they finish their work in the two provinces for further study, after which they will help train local doctors.
International help
China also needs international support in medicines and test reagents, says Wang.
Chinese patients have only five choices of anti-virus medicines produced by domestic enterprises. These medicines have more side effects than those produced by developed countries. Also, reagents are all produced by local companies and do not work well all the time, Wang said.
China is also considering production of advanced medicines which are still under patent protection, said Wang.
At home, Wang says he wants to thank two groups of people: State leaders like President Hu Jintao, Premier Wen Jiabao and Vice-Premier Wu Yi; and NGO pioneers like Gao Yaojie and Gui Xi'en.
"National leaders have contributed a lot to China's HIV/AIDS control. For example, President Hu visited an HIV/AIDS patient on last World AIDS Day at the Beijing You'an Hospital," Wang said.
Gao Yaojie, a Henan-based woman who has consistently appealed to the society and the governments to pay more attention to HIV carriers, and Gui Xi'en, a Hubei-based medical expert who was the first doctor to reveal the AIDS situation in some Henan villages to the public, deserve people's respect, Wang said.
However, Wang admits one major problem is many local governments, especially those at county level and townships, do not fully understand the importance of HIV/AIDS prevention and control.
For instance, some officials still regard the epidemic as a shame which may affect the reputation of their regions, and worry about social stability, economic development and investment, Wang said.
(China Daily June 2, 2005)
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