With the familiarity of a long-married couple, Leng Zhijin lifts his wife Wang Xiangying's ragged blouse to show raw rashes and she grasps his shoulder, gaunt after 20 days of diarrhea.

Like an estimated 300,000 farmers across central China's rural Henan province, including some 100 in their brick-and-mud Leng Village of 800, they caught the HIV virus through state-promoted schemes offering poor farmers easy money for their blood.

"I'm glad we have medicine so we don't die, but living is also hard," said Leng, 43 and haggard beyond his years.

"Look at us. Is this really called living?"

Since 2003, a flow of state-funded drugs has driven back the tide of AIDS deaths that engulfed rural Henan from the 1990s, making it the center of China's HIV epidemic, which the United Nations estimated last year has killed about 31,000 Chinese.

But in afflicted places like Leng Village, which means "Cold Village" after its main surname, the survival of HIV-infected farmers has itself brought adversities for which they and the government have been ill-equipped.

About 40 villagers here have died of AIDS, including five last year, leaving about two dozen children without one parent or both, residents said.

Those reprieved from death face poverty and threadbare medical care, forcing many to eke out lives that distil all the hardships of China's poor farmers.

"These problems ultimately reflect the problems of the rural medical system and countryside in general," said Zhang Ke, an AIDS doctor at Beijing's You'an Hospital who has studied Henan's epidemic. "Treatment often isn't available or is flawed, education is inadequate and illness and poverty are inseparable."

Many of the farmers, weakened by their illness, are unable to farm effectively and must subsist on meager crops and incomes far lower than those earned by healthy farmers.

BLOOD HARVEST

Things are nevertheless better here than they were.

Until four or so years ago, thousands of AIDS-stricken Henan farmers died in agony, lacking all but the crudest care as province officials refused to acknowledge the epidemic.

Many local officials had reason to want silence.

They and their kin held stakes in the deadly commercial "blood stations" that thrived across Henan in the mid-1990s, Gao Yaojie, one of the first doctors to expose the epidemic, said in a recent interview.

The farmers sold blood by volume and -- to squeeze payments and speed their recovery to sell more -- the stations took the valuable plasma from the blood and transfused donors back with a brew of left-over corpuscles, mixed together with the corpuscles of other donors in batches that were too often infected with HIV.

"There's never been pursuit of culpability for what happened. It was a crime pure and simple," said Gao.

Now the mass blood-harvest has stopped and 253 state-funded village clinics across Henan give HIV-infected residents free drugs to keep the retrovirus at bay.

The spartan clinics also stock aspirin and other simple medicines to fight the effects of AIDS, but villagers such as Leng and Wang said those often did not help against the complicated disease.

"WHAT HELP DO WE GET?"

The help that is available appears to be skewed by politics.

Henan named 38 villages as "key" ones to receive more drugs and help. The most famous Wenlou Village is a tightly guarded showcase, visited by leaders including Premier Wen Jiabao in 2005.

But other villages across Henan with many AIDS patients have been left off the list, leaving residents in deeper poverty and often beyond the reach of newer treatments.

In Ruanlou Village, Sui County, an hour's drive from Leng Village, Han Fujiang hunkered in his tumble-down hut. He sold blood and contracted HIV, and the free medicines he has been taking seem to be losing their grip.

Complaining of rashes and constant tiredness, Han, 34, said he wanted the better drugs. But his village is not a key one, so they are out of reach.

"What help do we get? Bad medicine and that's all. That and a bag of flour for Spring Festival." He used the flour to make steamed bread, hardening and graying in a pile on his table. "They'll last a long time," he said.

Many AIDS sufferers in Henan now endure destitution and poor diets, saying they lack the strength to farm.

Over 60 percent of HIV-infected farmers in Henan surveyed by Zhang last year said they ate meat twice a year at most.

"I think the pressure from poverty is bigger than the pressure from illness," said Zhang.

A Henan official defended the province's record. "When Premier Wen praised efforts to control and prevent AIDS, that included Henan," Vice Governor Zhang Dawei told reporters last week at China's national parliament.

The province announced last week that it would give rural HIV patients a monthly payment of 30 yuan ($3.8). In Leng Village, patients said they now got a monthly payment of 18 yuan ($2.3).

The annual payments would add up to a tenth of the average income earned by non-HIV infected farmers in the region.

The exact extent of the HIV outbreak has never been determined. Zhang estimated that in Henan, with a population of 98 million, about 300,000 people caught HIV selling blood.

Last week, Henan said it had 35,232 confirmed cases of HIV at the end of 2006 -- a number widely disbelieved as too low by experts.

In Leng Village, Leng Changxian, 64, and doing well on HIV medicine, sat in his home before a portrait of a cheery Chairman Mao Zedong, the revolutionary he called a hero.

Leng said local officials rarely visited the village and his biggest hope was for a sealed road to its school and AIDS clinic as rain often turned the dirt path to impassable mud.

"If Chairman Mao was here, he would care about us, he'd come down here and help build the road himself," he said.

Poised to receive an award for fighting HIV/AIDS in rural China, Chinese activist Gao Yaojie said she feels like a failure.

Eighty years old, her face creased with wrinkles, Gao has spent the last decade of her life working to treat the sick, to slow the disease's spread and to expose official complicity in its dispersal in her home province of Henan in central China.

Thousands of poor farmers have become infected with the disease after selling their blood in the 1990s at unsanitary, often state-run clinics, making the province the center of China's AIDS epidemic.

Having handed out thousands of AIDS prevention pamphlets to passengers at bus depots, prostitutes in nightclubs and peasants in the countryside, the retired gynecologist said she felt she had not done enough.

"I constantly think that I am a failure because I have been at this work for more than 10 years and yet AIDS is still rampant," the doctor said in an interview on Monday in Washington, where she is to receive a "global leadership" award on Wednesday from Vital Voices, a nonprofit that recognizes women leaders.

That Gao came to Washington at all was something of a feat given that local Henan officials put her under house arrest for two weeks in February to prevent her from traveling.

They relented in the face of an international outcry, including a letter from Sen. Hillary Rodham Clinton, a New York Democrat and U.S. presidential candidate, to Chinese President Hu Jintao and Vice Premier Wu Yi urging them to intervene on her behalf.

"SOME SHAME"

Asked why the Henan authorities did not want her to travel, Gao chuckled and said: "Oh, that's really hard for me to say ... I have a feeling that my various criticisms have caused them some shame."

No senior official has been prosecuted or publicly punished for the blood-selling scandal in Henan, where such practices have now been banned.

"They are indifferent to the life and death of ordinary people and care only about their power, position and salaries and the country's reputation," she said of the local officials, while crediting the Beijing authorities with her release.

Her harshest words, however, were reserved for people who make money off the disease by pretending to have found a cure.

"What is more frightening are these charlatans who are peddling cures," she said, grimacing. "There have been people who have said they have family remedies that go back eight generations but of course AIDS has only been with us about 20 years. "

The doctor, whose feet were bound as a child according Chinese custom but were encased in black espadrilles on Monday, has seen the convulsions of Chinese history. She was purged and attempted suicide during the 1966-1976 Cultural Revolution.

Gao said she hoped to write two more books, one about her work since 1996 to fight AIDS and the other to give voice to AIDS patients.

"I want my readers to understand the truth about AIDS patients who are innocent but who endure miserable lives and especially children, who die before even before knowing what life is," she said.

She then spoke of a couple who contracted the disease from selling blood.

"The husband died and the wife hung herself from the ceiling. Her small child found the mother hanging and grabbed her feet and pulled her (saying) 'Come down, mother. Come down," she said, speaking in a child's soft voice and clawing at her own legs. "But the woman was already swinging, stiff and dead."