Civil society can do more to fight AIDS

The spread of HIV/AIDS may have been arrested for now, but the disease always poses a threat. UNAIDS China coordinator Dr Bernhard Schwartlander shares his views on the disease and the situation in the country with Shan Juan of China Daily. Excerpts from the interview follow:

How do you see the current HIV/AIDS situation in China?

Overall, HIV prevalence in China remains low - less than 0.1 percent of the population. But the epidemic is growing nationwide. HIV transmission associated with the sale of blood and blood plasma in central China in the 1990s appears to be largely contained, and the majority of new HIV infections were caused by syringe sharing among drug users or sexual transmission.

Since 1985, about 223,000 HIV cases, including 63,000 AIDS cases, have been reported. The 2007 estimate of the number of people living with HIV was 700,000 and the estimated number with AIDS, 85,000. The number of people who have a high HIV exposure risk could be 30-50 million - mainly intravenous drug users and their sexual partners, and prostitutes and their clients.

What are the major challenges facing China in the fight against HIV/AIDS?

I think the top challenge is to bring leadership commitment and good policies down to community levels and groups like MSM (men who have sex with men). It is true that the HIV/AIDS risk level is different among different groups, but identification of high-risk groups should go hand in hand with general education, particularly for young people.

Besides, the rapidly changing Chinese society is also creating new and different risks for HIV infection. For example in all major Chinese cities, a vibrant culture is developing like the emergence of MSM, which didn't exist 15 years ago. They seek partners and have sex in bars and parks, which is a new thing for the government. So for intervention, authorities need to adjust to rapidly changing situations.

Furthermore, many of the 200 million migrant workers visit prostitutes. Despite that HIV/AIDS cases remain low in China. But vulnerability is expanding to more people in general. Given that the high-risk groups like migrant workers, MSM and prostitutes are hard to reach, these are also big challenges.

Do you see discrimination against HIV/AIDS patients in China? And why doing away with discrimination is important for an effective response?

Discrimination is still serious. Recent surveys show more than half of the people don't want to work with HIV/AIDS patients and a quarter of them don't want to even shake hands with them.

China has taken great steps to fight discrimination, like enacting the anti-AIDS discrimination law, which many other countries don't have. State leaders have been visiting AIDS patients every year since 2003, which shows the strong commitment of the top leadership to prevent sufferers from being left in the corner.

But this is not enough. Risk behaviors are not seen in the great halls of the people, but in bars, parks and villages. The government needs to show commitment from the top and issue good regulations to reach everybody across the country.

Only without the discrimination, and with a change in attitude and behavior, and acquiring of knowledge can people be well protected against HIV. With strong discrimination against people with HIV/AIDS, it's hard to reach them because they hide from wider society. For example, MSM can't talk about it with their wives or use condoms naturally. They engage in risk behaviors because of their nature and expose themselves to HIV/AIDS risk. So it's important to create an environment where we can talk about these issues openly and honestly.

What is the level of HIV/AIDS awareness among the Chinese officials you work with?

I'm quite impressed by my Chinese colleagues in central administrations like the Ministry of Health and the Center for Disease Control and Prevention. They are smart and caring people. Sometimes we have a debate over difficult issues. But overall I think it's good mutual trust. Officials at local levels, who are not on the same level as their counterparts in central administrations, are my challenge. But if I talk with them patiently and candidly, I get the feeling that they are willing to listen. I have traveled to many provinces and talked a lot to local health officials. There is openness in the dialogues and I will keep trying. Change doesn't come overnight.

What kind of role should civil society play in China's response to HIV/AIDS?

It is fascinating that China has a huge scope for civil society. But much of that has not been tapped.

There are many things civil society can do as a part of the general HIV/AIDS response, like going to bars and parks for peer education where high-risk behaviors take place. Organizations, especially those formed by HIV-positive people, are better than the government in reaching the people with behaviors that are not in line with accepted social norms.

For treatment, civil society is better at encouraging HIV-positive people to come forward for timely tests and proper treatment, which is also protection for the healthy.

But most members of such help organizations are not well organized. A lot of them remain unregistered given the law limitation. They don't have independent bank accounts to accept donations and don't know how to maximize the use of the resources at their disposal. They need to get salaries to make civil society operation sustainable.

We're working closely with health officials and civil society to work out a system that can make organizations well organized. With overseas money flowing in, some groups of civil society could misuse it instead of spending it to raise awareness.

What are the major obstacles you've faced in your work here?

The bureaucracy is strong. Given the huge territory and population, the administration is big. I'm happy dealing with administrative leaders but it's difficult to work through the entire administration. It takes long to convince people at all levels, particularly those at the grassroots level, who actually translate policies into action. Given the size of the administration and the number of people you have to work with and make them change, sometimes it's tiring and frustrating.

What has been your most memorable moment in China?

I have so many good memories here. I think the last World's AIDS Day was the highest point when we had the huge red AIDS ribbon on the Bird's Nest (National Stadium) as a part of a program to mark the special day. Thousands of people were present - all carrying small red AIDS ribbons. It was a strong commitment from the government and the people both to combat the disease. The use of the most iconic building to raise HIV/AIDS awareness was a great moment, and I was touched by the commitment and energy. Luckily enough, my granddaughter was born on the day, too.

(China Daily 07/31/2009 page9)