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Foreign Affairs
China's HIV Crisis
By Bates Gill, Jennifer Chang, and Sarah Palmer
Bates Gill is Senior Fellow in Foreign Policy Studies at the Brookings Institution. Jennifer Chang is a Research Assistant in the Foreign Policy Studies Program at the Brookings Institution. Sarah Palmer is a virologist at the HIV Drug Resistance Program, National Cancer Institute, National Institutes of Health.
The Price of Prosperity
"To get rich is glorious," the late Chinese leader Deng Xiaoping once exhorted his people. Defending this reformist vision, he added, "If you open the window for fresh air, you have to expect some flies to blow in." In the two decades of breakneck economic development since China's embrace of gaige kaifang (reform and opening), both the promise and the peril of Deng's two maxims have become abundantly clear. Although China enjoys growing wealth, increasing per capita incomes, and rising living standards, it also suffers from environmental degradation and a host of social ills including political unrest, increased crime, and a fraying social safety net. China, like other developing nations, faces tough choices between the benefits and the costs of modernity.
Unfortunately for China, however, the very nature of its particular political, social, and economic systems exacerbates the dangers of opening up. The growing problem of HIV/AIDS in China is a glaring example of this phenomenon, and one with enormous implications. Once dismissed by Chinese officialdom as a Western problem, the spread of HIV/AIDS has only recently gained serious attention from Beijing. But it may be too late: China now faces a major epidemic, one that the government will find extremely difficult to combat.
A Rising Tide
After years of neglect, the Chinese government has now begun to recognize the enormity of the country's HIV/AIDS problem. In June 2001, the Chinese health minister, Zhang Wenkang, made a stunning announcement while attending the United Nations General Assembly Special Session on HIV/AIDS: China could have as many as 600,000 cases of HIV. This admission stands in stark contrast to previous official statistics, which in 2000 counted only 22,517 registered cases. Even the higher numbers are suspect, for both practical and political reasons. The U.N. AIDS program (UNAIDS) estimates that there are more than one million people infected with HIV in China — and this figure might be even two or three times larger. Among mainland China's 22 provinces, serious HIV epidemics are already raging in 7, and threatening to break out in another 9. UNAIDS warns that the disease, if left unchecked, could afflict 20 million Chinese by 2010.
In certain parts of China the problem is already particularly acute. Along China's southern borders with the opium-growing regions of Burma, Thailand, and Laos, widespread intravenous (IV) drug use was an early source of HIV infection. Drug use — and with it the spread of HIV — has also extended along drug trafficking routes into China's northwestern province of Xinjiang. And it appears that the central province of Henan, China's second most populous, has been hit the hardest. According to some experts in international nongovernmental organizations (NGOs), as many as 1.2 million people in Henan are HIV-positive, largely owing to an unsafe blood collection system. Chinese and Western news media reports have focused in particular on "HIV/AIDS villages" in Henan where up to 80 percent of inhabitants have contracted the virus, and more than 60 percent already suffer from AIDS.
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