China has lowered its estimate of the number of people with HIV/AIDS to 650,000 from 840,000, but international experts have warned the disease may be spreading due to ignorance and because many people are too afraid or too poor to seek help.

The new policy guidelines were approved by the State Council, China's cabinet, and signed by Premier Wen Jiabao, who in 2003 became China's first senior leader to publicly shake hands with AIDS patients.

Wen also made a point of visiting villages in central Henan province, where thousands were infected after donating blood in unsanitary clinics.

No organisation or individual is allowed to discriminate against AIDS patients or their families and AIDS patients will be entitled to free treatment, according to the guidelines published by the official Xinhua news agency.

"This indicates good progress," Joel Rehnstrom, country coordinator of the UNAIDS China office, told Xinhua.

AIDS activist Hu Jia said the new rules did not go far beyond grouping existing regulations under a single heading.

"The problem in China is not the lack of laws but whether these laws will be implemented by local governments," he said.

Images of Chinese President Hu Jintao shaking hands with AIDS patients, intended to dispel discrimination, instead brought mockery for their now-shunned families, a state newspaper reported recently.

Even among better-educated urban residents, nearly 60 percent said they would be "nervous" to have public contact with HIV positive people, a Health Ministry survey has found.

NO ROOM FOR COMPLACENCY

Patients in rural areas and poor urban patients must receive free anti HIV/AIDS drugs, the guidelines stipulate. They take effect on March 1.

Consultations on preventing infection from mother to baby as well as free treatment must be made available, while children orphaned by AIDS will receive free schooling.

Any official who causes the disease to spread will be punished. Under the new guidelines it also becomes illegal to reveal the identity of someone infected, or their families.

The United Nations had warned that China could have 10 million cases of HIV by 2010 unless it takes steps to educate the public and fight the epidemic.

The WHO says that figure is probably out of date now that the estimate of the number of infections has been lowered.

Still, experts say China cannot afford to be complacent about AIDS given the risk of rising infections through drug injection and sexual contact within an increasingly mobile population.

Political sensitivity and social stigma still surround AIDS in China, and the government's slowness to acknowledge the epidemic contributed to its spread.

Hu, the AIDS activist, said many patients in poor areas of Henan had long been entitled to free medical treatment, but this had been slow to arrive.

"It's important that the government should involve civil, non-government organisations because patients are less afraid of dealing with them," Hu said.

The new guidelines state a need to encourage and support organisations and individuals who promote AIDS-prevention awareness. However, they do not identify the most active NGOs.

Gay culture takes root in China

Beijing, Feb 12: China has teamed up with Ford Foundation to publish its first-ever comprehensive report on the sexual behaviours of the nation's gay population. The report, 'MSM (men having sex with men) in China: Surveying sex and self-identity', probes into the sexual behaviours of the country's male homosexuals with 400 detailed interviews and case studies. "It offers a look into the feelings, identity and expression of the gay group amid different social and cultural backgrounds," Director of Sexual Sociology Institute in People's University of China, Pan Shiming said in the report's preface. The 650,000-word report, written by scholar and writer Tong GE, is comprised of 15 chapters, including a comparison of attitudes towards MSM between Chinese and western societies, aesthetics in MSM, and MSM group & marriage between opposite sex, the 'Beijing News' reported. Chinese society has developed a more open attitude towards homosexuality, as prestigious Fudan University in Shanghai began to offer the country's first course on homosexuality last September and the first homosexual cultural festival was held in Beijing last December. But men who have sex with men have been a high risk group contributing to China's 75,000 new HIV infections last year, a report jointly released by the Ministry of Health, UNAIDS and the World Health Organisation said last month.

A Kenyan girl with HIV/AIDS lies in bed at Mbagathi hospital, Nairobi. July 23, 2005.

They called for pharmaceutical giants to bring down the cost of children's anti-retrovirals (ARVs), the drugs used to treat HIV, and develop better paediatric medication.

While the cost of ARVs for adults has tumbled in recent years, companies are still not producing cheap drugs specifically tailored for children.

At the moment those looking after children with HIV often have to break up adult formulations, risking under or overdosing.

"Today, in the poorest countries of Africa one year's treatment for an adult can be as low as $150 or even a bit lower," said Dr Peter Piot, executive director of UNAIDS, the U.N.'s HIV/AIDS programme.

"For a child it would be at least six times more, but in general you can't get these low prices. You are talking about thousands of dollars and the differences between countries are enormous - it can be $15,000 in some cases."

The shocking difference in price was highlighted at a conference which gathered delegates from 50 countries to discuss how to help children affected by HIV, including millions of orphans and others caring for dying parents.

Some 570,000 children under 15 are dying a year due to AIDS, yet less than 5 percent of children who need treatment receive it.

Antibiotics

The lack of ARVs is not the only problem. Many children die from illnesses that attack them because HIV has reduced their immune system. But a lot of these illnesses could be easily treated with cheap antibiotics.

Research in Zambia shows that the antibiotic cotrimoxazole can reduce mortality rates in children by as much as 43 percent.

But 4 million children thought to be infected or at risk of HIV do not have access to the drug.

"Twenty five years into the epidemic, considerable progress has been made in mobilising the world against AIDS," Piot said.

"But when it comes to accessing HIV prevention and treatment services, children and young people continue to be left behind."

Peter McDermott, head of the HIV/AIDS section at the U.N.'s children's agency UNICEF, said his message to pharmaceutical companies was "cheaper, better drugs as quickly as possible".

The cost of ARVs for adults plummeted after the pharmaceutical industry bowed to pressure to offer concessionary rates in developing countries and firms in places like India and Brazil started producing cheap non-brandname drugs.

McDermott told the conference that in 1998 it cost $1,300 to $1,800 a month to treat someone with HIV in Zambia. It now costs around $200 a year.

Pregnant women

Children need drugs in different doses and different forms to adults. Syrups are more suitable but are more expensive to produce, have a shorter shelf life and are often unpalatable.

UNICEF and UNAIDS said they were hopeful prices would drop shortly.

"We are seeing some positive movements by some drug companies and we would expect some price reductions in the near term," McDermott said.

Generic drugs for children are also just starting to become available.

Another way of reducing the death toll in children is by treating HIV positive pregnant women to prevent them passing the virus onto their babies.

Although this is highly effective, UNICEF said very few women were being reached at the moment – just over one percent in West Africa.

McDermott said drug companies had not focussed on making medicines for children, partly because the market was very small. They are also loath to go ahead unless they know the market is guaranteed and can predict demand, but it has been difficult to forecast how many children might need ARVs over the coming years.

He also pointed out that companies were aware that if projects to prevent mothers passing HIV to their babies were successful demand for children’s ARVs would shrink.

Britain’s Department for International Development (DFID), which is hosting the two-day London conference with UNICEF, said it would organise a meeting with the pharmaceutical industry to look at how to speed up development of cheaper, better paediatric treatments.

International Development Minister Gareth Thomas said the lack of suitable drugs could partly be explained by the fact only 1 percent of the world’s pharmaceutical market was concentrated on Africa compared to 50 percent on the Americas.

"While pharmaceutical companies have done much to help improve access to treatment for HIV, more effort must be made to help provide effective and affordable treatment for children - especially for those in developing countries," he said.

"Tackling HIV and AIDS in children is not simply a political choice, it is an obligation."

AIDS orphans wait for their free breakfast provided by Islamic charity Jamra in Dakar, Senegal

In sub-Saharan Africa alone an estimated 18 million children will have lost one or both parents to AIDS by 2010 – an increase of six million in just four years, according to U.N. forecasts.

“Despite progress in some areas, children are still the missing face of AIDS in the global response to the pandemic,” said Ann Veneman, executive director of the U.N. children’s fund UNICEF.

“The world must act now, urgently and decisively, to ensure that the next generation is AIDS-free.”

The conference in London will bring together 90 international organisations, governments and non-governmental organisations to look at how to improve the plight of children affected by AIDS, including those who are HIV positive themselves and those looking after sick or dying parents.

“Less than 10 per cent of the children who have been orphaned or made vulnerable by AIDS receive public support or services,” Veneman said.

Millions of children infected with HIV do not have access to appropriate treatment, according to UNICEF, which is co-hosting the meeting with Britain’s Department for International Development.

“Twenty five years into the epidemic, considerable progress has been made in mobilising the world against AIDS,” said Dr Peter Piot, executive director of UNAIDS, the U.N.’s HIV/AIDS programme.

“But when it comes to accessing HIV prevention and treatment services, children and young people continue to be left behind. If we are to break the cycle of HIV infection, children and young people must know how to protect themselves from HIV.”

The third annual Global Partners Forum on Children Affected by HIV and AIDS will focus on ways to:

• Strengthen families’ capacity to care for orphans and other children affected by HIV
• Mobilise community-based support for affected families
• Guarantee access to HIV treatment
• Reduce stigma for children affected by AIDS
• Ensure access to education

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