SCMP Tuesday, August 28, 2001

Containing Aids

There is no need to look further than the row over the Richland Gardens clinic to see the problem the mainland faces in trying to warn its people about an impending Aids epidemic. It took six years, and eventually the threat of legal action by the Equal Opportunities Commission, to stop a blockade of the clinic by residents ignorant about Aids and HIV, and so bigoted they even menaced and threatened the facility's medical staff.
When so much fear and prejudice can flourish in an open and informed society like the SAR, how much worse it must be in rural areas where local officials worry that admitting to the infection rate in their provinces will get them in trouble with the central Government for not doing enough to curb drug addiction, prostitution and illegal blood donation.
Fortunately, events like the Community Forum on Aids at the Convention Centre help to highlight the scale of the problem. Publicity heightens community awareness while it exerts pressure on the authorities to take action, both here and across the border. Cross-border activity increases markedly every year; if the present trend of more than one in two local truck drivers having sex with mainland prostitutes continues, Hong Kong could quickly develop a serious epidemic of its own.
As yet the situation here is contained and manageable, thanks to a relatively small population and first-class medical facilities. But at $100,000 a year to keep HIV sufferers active and working, treatment is costly and it would only take a modest increase in the 600 patients currently receiving this life-prolonging drugs cocktail, to impose a severe strain on the SAR's medical budget.
Funding and treatment on that level is out of the question on the mainland. If Beijing is to avert an epidemic of catastrophic proportions, it has to begin with a nationwide campaign to try to ensure that every far-flung village has heard of Aids, knows how it is spread, and how to prevent it. In Henan's Wenlou county alone, the infection rate is 65 per cent, and unless blood collection clinics are closely scrutinised and rigorously controlled, that statistic will be mirrored in every impoverished region of the country.
Experts working on the ground believe the true figure is much greater than the official 600,000 HIV carriers assessed by the central Government and the World Health Organisation.
But if today's talks in Beijing with the Director of the Centre for Disease Control and Prevention in the US can be built on, there is real grounds for optimism that HIV can be contained, and that China can benefit from the 20 years of experience that the US has had in treating the disease and controlling its spread.
But differences in living standards, mass communication and the political system means the US approach must be radically changed to suit the mainland system. The community involvement strategy which has worked so well in America will not easily translate to those provinces where corruption and vested interests still hold sway.
But Beijing should be able to tailor the system to suit mainland conditions. If barefoot doctors could transform rural community health in the 1960s, it should be possible to devise a successful strategy for modern China.