SCMP Wednesday, April 11, 2001

Risking Aids on Romance Street


"Come on, for just 50 yuan she will do whatever you like," a middle-aged beauty-salon owner said to me outside his establishment in Puzhai - a 10-minute walk from the border with Vietnam in southwestern China's Guangxi Zhuang Autonomous Region.
He tugged at my arm. "It's still afternoon, the perfect time to enjoy it without anyone else waiting. You won't be so lucky at night when it's crowded."
The Vietnamese girl in her 20s smiled when I asked if a condom was required. "They're free. It's up to you."
Nearby, a long-distance truck driver from the Yulin prefecture in Guangxi was waiting for goods to be unloaded. "Some of us used to frequent that street, but after we heard the girls weren't so clean, we were hesitant. We eventually go back home to our wives and children; for their sake, we should act responsibly."
A few doors down, seven Vietnamese women in their 20s were cracking melon seeds in front of a two-storey massage parlour and waving at passing men. Women such as these, along with others from inland China's Sichuan or Hunan provinces, are the sole demographic of a place locals call "Romance Street".
The Public Security Bureau office is a stone's throw from the brothels, and the deputy director sitting inside initially dismissed any suggestion of wrongdoing in the bustling zone. "These Vietnamese girls waving to you . . . it may just be a gesture of friendship," Wei Wen said. Then he sighed. "What would you expect us to do with these foreign massage girls if we arrested them? Drive them back home? They will return, and then complicated diplomatic issues will arise."
Pingxiang, like Puzhai, is regarded as an important and convenient land passage between China and Vietnam. The city of 100,000 is also the meeting point for two international drug-trafficking routes, from the opium-growing areas of the Golden Triangle and Vietnam.
Located in the southwest of Guangxi, Pingxiang was approved by China's State Council as an open border city in 1992. In 1996, the province reported its first HIV-infection case.
Once a scene of fierce fighting during China's border war with Vietnam in 1979, Pingxiang is now battling rising incidences of HIV and Aids. By mid-1999, the number of HIV and Aids cases had reached 132, more than 95 per cent of which were drug users aged 15 to 30. Among China's reported 20,711 HIV and Aids cases, 72.1 per cent are drug users.
Huang Yi, 26, was once certain of a promising future. Now he is one of 62 addicts confined to Pingxiang Drug Rehabilitation Centre. A graduate of a vocational medical school in Guangxi's capital city of Nanning, Mr Huang was encouraged by friends to inject heroin in 1996. He even bought disposable syringes for one yuan apiece to fill with heroin whenever he wanted a fix. Under the warm winter sun typical of southern China, he shivered when recalling drug buddies who used filthy water to dilute heroin.
Zhang Zhouning, a skinny, doe-eyed 14-year old, is the youngest recovering addict at the centre. "I was told not to share needles with others, but what if it's midnight and you're desperate for a shot and there is nowhere to buy syringes?"
Zhouning has appeared several times in documentaries produced by mainland TV stations. He leaves out nothing when discussing the virus and how it is transmitted. The threat of Aids doesn't scare him as much as his drug addiction. After his fourth stay in compulsory drug rehabilitation, he told a visiting American social worker: "I'd be willing to sacrifice even half my lifetime just for one magic pill that would kick my habit once and for all."
Zhouning learned how to prevent HIV and Aids thanks to an educational campaign launched jointly by Pingxiang government departments to target vulnerable groups. The United Nations Programme on HIV and Aids (UNAids), the UN children's fund (Unicef), the World Bank and the Australian Government are supporting the campaign.
Outside the confines of the drug rehab centre and the influence of health workers, the risk of Aids is prevalent. Although most beauty parlours which operated as brothels in Pingxiang were shut down this year, between 20,000 and 30,000 businessmen from inland China and bordering countries visit the city daily. A substantial number stop by at places such as Romance Street.
The future of most of the Vietnamese women working on the street is in the hands of their bosses, who pocket 20 yuan (about HK$18) out of the original 50 yuan per client. Brothel owners also urge the women not to use condoms. "In their minds, to survive for today is much more important than shunning possible threats from an epidemic tomorrow," comments Ho Huifang, the president of Pingxiang Women's Federation.
Dr Chen Jie, who works with HIV and Aids cases in Guangxi, said: "Infection from drug use is just a prelude; the sexual spread of the virus is just ahead."
Towards the end of November, Guangxi had reported 2,038 HIV and Aids cases, an increase of more than 35 per cent over the previous year. The actual number is estimated at more than 50,000, out of a total population of 47 million. Two-thirds of Guangxi's 95 counties and cities have reported HIV and Aids cases, and the infection rate has exceeded 50 per cent among tested drug users in four or five counties, according to the centre.
"There is probably going to be another peak in the spread of the epidemic within one or two years," warns Dr Chen. "What worries us most is the accelerating speed at which the epidemic is spreading."
The priority for health workers such as Dr Chen is "to control the spread of HIV and Aids among drug users and to slow down the spread of the virus from drug users to sexually-active people".
Pingxiang has been praised by UNAids and Unicef as a model for HIV- and Aids-intervention projects, partly because it has helped keep the infection rate to less than 20 per cent among tested drug users. Though funding for the work comes mostly from international organisations, Zhao Shaoji, the director of the Pingxiang Health Bureau, is glad to see there has been "no obstacle from the municipal Government".
Mr Zhao's counterparts in some other regions in Guangxi are not so lucky. Wei Nianshen, the deputy director of the health bureau in Lingshan County, said local TV did not dare to broadcast public-service announcements on condom use at prime time, as Pingxiang had done.
The HIV- and Aids-infection rate among tested drug users in Lingshan rocketed to nearly 50 per cent in 2000 from just 0.7 per cent in 1997. Yet the issue is scarcely mentioned except on rare occasions, such as Worlds Aids Day, said a local health official.
"Of course we know how urgent the situation is, and we need to join hands with other government departments in monitoring drug users and prostitutes," said the official. "But without funding and a political 'yes' from above, the plans are just words."
Another problem for the Lingshan health bureau is the tough task of persuading prostitutes and drug users to take blood tests. First, they must overcome fears the testing will lead to apprehension by the police.
Some people in Lingshan who test positive vanish, leaving only false identities behind. Yang Shengming, director of the Lingshan Anti-epidemic and Health Centre, is often reluctant to reveal the truth to people who have tested positive. "What if they are so desperate they decide to retaliate on society?" asked Mr Yang. "But our silence means we have deprived them of their right to know the truth, even if it is a death sentence."
So far, only about 10 per cent of more than 100 people with HIV in Pingxiang have been told they have the virus. "All we can do now is offer psychological counselling for these people living with HIV, as a sort of spiritual remedy," said Ho Bo, the deputy director of the Pingxiang Anti-epidemic and Health Centre. All of the informed infected people are jobless drug users, and the only significant lifestyle change they make after diagnosis is to cut back on needle sharing.
Discrimination against people with the virus is also a problem. One solution is to set up community-care centres, such as those in Thailand and Hong Kong. "At least these Aids patients can laugh and cry together, and release their daily frustrations," said Mr Ho.
But as Pingxiang has no single mobilising force and no funding, and, most importantly, a public that is still Aids-phobic, Mr Ho doesn't know if an HIV and Aids community centre could survive in Pingxiang.
Guangxi's most acute HIV- and Aids-infection rate is found in Baise prefecture, where at least four counties have a rate of more than 50 per cent among tested intravenous-drug users, and its political centre, Baise, has reported a stunning infection rate of 70 per cent among tested users. But just a few of the carriers have been told the truth, according to the Guangxi Aids centre.
Apart from deliberate cover-ups, ignorance among decision-makers can be damaging. A 1997 survey in Pingxiang indicated people such as farmers or vendors were more knowledgeable about the general facts of HIV and Aids than some local officials.
On a more optimistic note, top authorities in Pingxiang have given the go-ahead for a comprehensive public-awareness campaign, which has been ridiculed by some other regions as "clear proof of the shameful HIV and Aids record" in the city, said Mr Ho.
Pingxiang was among the few danger areas in China where the large-scale intervention work was yet to start, said a Beijing-based UN official. "In some parts of China, the increasing rate of HIV and Aids is one of the most rapid in the world, comparable to Africa," the UN official said. "It's as if we're holding a time bomb or sitting at the mouth of a volcano."
Lin Gu is a Beijing-based writer for China Features.