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SARS and AIDS: What the people don't know
By Christopher Horton

BANGKOK - Last October in the eastern Chinese city of Hangzhou, United Nations Secretary General Kofi Annan visited Zhejiang University to receive an honorary doctorate from the school. When he spoke at the presentation of his degree, he had a dire warning for the students, faculty and all of China. China was on the verge of a massive epidemic, Annan said, and immediate action must be taken in order to stem the spread of this deadly virus. He was not talking about severe acute respiratory syndrome (SARS), which would be first identified in Guangdong province the following month. He was talking about the human immunodeficiency virus (HIV), which causes AIDS.

"There is no time to lose if China is to prevent a massive further spread of HIV/AIDS," Annan said, "China is facing a decisive moment." Annan may have been spoiling the celebratory atmosphere for the gathering of 500 students who came to honor him, but he did not relent in his message. "For the truth is that today, China stands on brink of an explosive AIDS epidemic," he said.

Henan province: China's HIV hub
Central China's Henan province is a specter that haunts the new leadership in Beijing. Henan became the focus of global attention in 2001, when overseas media reported an HIV epidemic in the rural province of more than 95 million. Henan's HIV epidemic, unlike SARS, was in essence spread by local officials of the Chinese Communist Party (CCP), who were making heaps of cash from illegal blood banks in the late 1980s and early '90s. They were making so much money from these unregulated and unsanitary "clinics" that they dubbed blood banks Henan's "third industry". In poor rural areas in Henan, locals were encouraged to sell their plasma to the numerous operations throughout the province. Unfortunately, employees at the blood banks either didn't know or didn't care about spreading HIV, as evidenced by the repeated use of individual needles on donor after donor. The inevitable result of such actions was an HIV explosion among people who could not afford health care even if they were lucky enough to have access to it.

The head of China's AIDS foundation, Zeng Yi, said last year that local authorities became aware of the Henan problem back in 1995. Blood banks were closed, but locals were not told they might carry the virus. Now Henan has more than 100 "AIDS villages", as they are called in China. The HIV infection rates for these bleak towns range from 60-84 percent. Economics were the impetus for silence from local officials regarding the rapid spread of HIV. "They are afraid the economy will suffer if the situation is revealed. Maybe investors would no longer be interested in the region. And they wish to assume no responsibility - their way of thinking is false," Zeng said.

Such intense, but initially localized, spread of HIV might not have been a problem for Beijing if it had occurred in a more remote area, such as sparsely populated western China, and if the Chinese government had been honest and open in dealing with AIDS. Unfortunately, provincial capital Zhengzhou, a city of 6 million people, is the main hub for China's extensive railway system. China's major north-south highway also passes through Henan. Throughout all of China - and particularly in poorer places such as Henan - poor, uneducated women choose prostitution as a last resort for earning a living. Because of years of silence regarding the transmission of HIV, most of China's prostitutes almost never use condoms, which are predominantly viewed by Chinese as only being useful in preventing pregnancy. The Chinese word for condom, biyuntao, literally "avoid-pregnancy glove", can be seen as contributing to this large-scale ignorance, but the blame should rest squarely on the CCP.

The few HIV information campaigns in China have usually painted the picture that as long as one is not homosexual, an intravenous drug user or a prostitute, one is not at risk for HIV. Today many Chinese believe that if someone feels and looks fine, they could not have HIV because the only pictures they see of HIV/AIDS patients are images of people in very advanced stages of AIDS that are designed to shock the viewer. Last year in a Chinese poll of university students, far fewer than half of those polled knew how HIV was transmitted. Most of the people in Henan's AIDS villages had not heard the word "AIDS" until the past couple of years. It is this countrywide lack of information that makes a nationwide spread of HIV all too likely.

The histories of both HIV and SARS in China have one striking shared characteristic - Beijing's knee-jerk suppression of all relevant information out of fear of damaging China's economic growth. In the face of AIDS and now SARS, the Chinese government has spared no effort to suppress information regarding either illness. In both cases, the Chinese population is paying the price. The Chinese government said that by 2003 there would be a million cases of HIV on the mainland, roughly the same number of infections as in the United States. While a million infections in a population of 1.3 billion is only 0.08 percent of the population, it is still a disturbingly large number of people in a country whose government, even after Annan's visit, has made next to no efforts to inform its people about the virus. Last summer a UN report warned that if the Chinese government did not radically change its HIV policy, the number would reach 10 million by 2010.

HIV/AIDS, luckily for Beijing, has still been relatively easy to cover up, at least domestically. It appears that SARS is about to change things very quickly. As of Wednesday, Henan province - again, a poor province of more than 95 million - was referred to by Chinese state media as one of the provinces hit hardest by SARS, this despite having only officially reported two confirmed cases as of Wednesday. Henan is next to Shanxi province, which as Asia Times Online reported on location (SARS wreaks havoc in Shanxi province, April 18) has been suffering from its own SARS outbreak for weeks already. Just as China's links to the world have fueled the international spread of SARS, China's massive web of domestic air, rail, bus and boat links combined with the world's largest population indicate that SARS will soon be in every province, city, and town soon, if it isn't already.

Beijing: Mass exodus, mass infection
Making things worse is the recent cancellation of school for Beijing's 1.7 million students, which has prompted a massive train and bus exodus out of the SARS-ravaged capital by students and migrant workers. These students and workers literally come from every part of China. They will be riding packed trains and buses out of the capital and to every corner of the country.

A typical Chinese train can hold more than 600 passengers. Restrooms are less than sanitary: the floors are usually covered with urine, and toilets are non-flushing holes that usually hold some residual fecal matter. Fecal matter is a suspected culprit in the spread of SARS. As the rapid spread of SARS among more than 300 residents of the Amoy Gardens residential complex in Hong Kong suggests, it could also be spread through the air or environment. Chinese trains typically have three passenger classes: "hard seat", "hard sleeper" and "soft sleeper". Hard-seat cars are in essence train cars filled with as many seats as possible, and in which seatless ticket holders sometimes sleep in aisles or even under seats. Hard-sleeper cars are divided into several small doorless compartments that hold six beds per compartment. Soft-sleeper cars are divided into compartments, each of which has a door, that contain four bunks.

If just one person infected with SARS is on any of the countless trains now leaving Beijing, these trains could significantly increase the speed of the spread of SARS throughout China's interior. The tragic irony of this exodus is that everyone leaving Beijing hopes to avoid getting SARS there, but they will in all likelihood contract and spread it throughout the country, to strangers, friends and family. Which brings us back to HIV/AIDS.

Beijing has admitted to covering up SARS statistics in order to preserve the image of normalcy. This seriously hurts the CCP's credibility. When one considers the HIV cover-up in Henan, combined with Henan's location at the center of the Chinese transportation nexus, it is also quite plausible that Beijing was fudging its numbers when it said last summer that there would be a million HIV cases in China by the start of this year. This was the number given long before Beijing came clean about its SARS cover-up. It is obvious that the highest levels of government in China are not averse to lying to its constituency or the world in order to maintain an image as a safe, stable environment for foreign direct investment.

Assuming that SARS makes its way to every populated area of China, it is quite plausible that China's SARS deaths could experience a ferocious increase. SARS is an atypical pneumonia caused by a coronavirus. AIDS sufferers are particularly susceptible to pneumonias. Indeed, the most common serious infection among AIDS patients in the United States is a type of pneumonia called Pneumocystis carinii pneumonia (PCP), which is typically fatal if not identified and treated quickly. Identification requires a laboratory test of fluid or tissue from a patient's lungs. Unfortunately, most of the people with AIDS, in Henan in particular, do not have access to laboratories, nor the money to pay for tests and treatment.

A bleak future gets bleaker
Unfortunately, because of Beijing's foolish handling of HIV, and now SARS, many Chinese are going to die. The question is how many.

It seems apparent from the government's reaction to either epidemic that the economy is its top priority. Therefore it is reasonable to conclude that Beijing will do little to protect China's impoverished hinterland. This makes it quite plausible that SARS could kill tens or hundreds of thousands of people in China alone. The majority of these deaths would likely be either elderly people who succumb to SARS more readily than young, previously healthy SARS patients - and China's AIDS sufferers. The world may find out just how serious China's AIDS situation really is as a result of the SARS epidemic.

When the Chinese people ask Beijing to explain why there were so many people with AIDS, the new leadership under President Hu Jintao and Premier Wen Jiabao will have two options. One option is to continue the state-sanctioned disinformation campaign regarding AIDS and its origins in China. This is unlikely, as not only has Beijing pledged to be more open with SARS, but nobody inside or outside of China is likely to believe Beijing's deceptive dismissals and denials. The other option is to throw the closet door wide and bring out the skeletons for all to see: the Chinese would have to be told that just as they had been duped regarding SARS, they had previously been deliberately kept in the dark regarding members of the CCP collecting profits as they spread the seeds of HIV in Henan.

How will the Chinese people react to either of these strategies?

(©2003 Asia Times Online Co, Ltd. All rights reserved. Please contact for information on our sales and syndication policies.)
Apr 24, 2003

China's atypical politics

SARS: Beijing's lesson may be too late
(Apr 23, '03)

China's bureaucracy: A virus's best friend
(Apr 22, '03)

Beijing loses big on SARS gamble (Apr 8, '03)


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