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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 content@atimes.com
for information on our sales and syndication policies.)
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