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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.
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