AIDS is likely to cause nearly 40 billion dollars in losses for China's economy over the next five years, mostly because of lost labor as patients die or fall sick, state media has warned.

The economic loss to the total national pool of workers is expected to reach 285.6 billion yuan (36 billion dollars) between 2006 and 2010, the Xinhua news agency reported on Wednesday, citing a senior health ministry official.

Another 16.5 billion yuan is likely to be lost as a result of reduced productivity in the agricultural sector, Xinhua said, quoting ministry statistics.

While in absolute terms the figures seem large, it accounts for less than 0.3 percent of China's expected accumulated gross domestic product for the coming five years.

An estimated 650,000 people had the HIV virus in China at the end of last year, according to a study carried out by the health ministry, the World Health Organization and UNAIDS that was released in January.

The study said there were between 60,000 and 80,000 new HIV/AIDS cases in 2005. An estimated 25,000 people died from AIDS in 2005, 10,000 of whom were poor farmers who sold blood in unsafe government-approved schemes in the 1990s.

The study was the first jointly conducted between the three groups.

UNAIDS said on May 30 as it released its biennial snapshot of the global pandemic that China was emerging from the shadows of AIDS by improving its accounting of the number of cases within the country.

"Not only is more data available, but the analysis of that data has also improved and has allowed us to come to an estimate that we are quite comfortable with," said Peter Ghys, manager of epidemic and impact monitoring at UNAIDS.

Critics had previously feared China could be a black hole in the global prevention and treatment effort, and had accused authorities of failing to acknowledge a spiralling epidemic driven by illicit drug use.

In those days, a diagnosis was a death sentence. No one knew how you got it, this mysterious ailment that savaged the human body with almost medieval cruelty.

Baffled doctors threw everything they had at skin cancers, brain infections, intestinal parasites and other horrific symptoms. Nothing worked.

Twenty-five years after federal health officials first recognized the disease that would become known as Acquired Immune Deficiency Syndrome, AIDS no longer is synonymous with terminal illness.

But like other wars, the early years of the AIDS epidemic produced survivors, people whose lives bear the contours of having crossed so malignant an enemy. Cameron Siemers, Lonnie Payne and Lisa Capaldini are three of them.

Three faces of AIDS, one message for a country where more than half a million people have died: 25 years is not such a long time.

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Cameron Siemers, 24, infected during a blood transfusion as a toddler

LOS ALAMITOS, Calif. (AP) — Cameron Siemers had a big secret until he was 18. When he decided to give it up, he did so in spectacular fashion, telling his entire high school graduating class that he had AIDS.

"It was hard because I knew all these people," Siemers said of the commencement speech. "I just wanted to give them something because we were graduating. ... And just to get it off my chest, to let them know."

The revelation explained why Cameron was small for his age and missed long stretches of school in this Los Angeles suburb. When friends wondered why he could never have sleepovers at their houses, he always had said he had hemophilia, which was true. That's how he got HIV.

His doctors think Siemers got tainted blood in a transfusion when he was 3 years old, but he wasn't diagnosed until he was 7. His mother gave him the news while they were playing Legos.

"I knew what it was and I knew what it meant, but I didn't think of it as a death sentence," he said.

As he's gotten older, it's gotten harder to hold onto his innocence. Siemers is among the minority of patients whose AIDS has proven resistant to the drug "cocktails" that changed the course of the disease. So even as treatment options have improved, he has gotten sicker.

He almost died two years ago after his inflamed pancreas started bleeding uncontrollably, a chronic condition associated with HIV. Recently, he was on a new drug that looked promising, but he had to stop taking it because the medication exacerbated the abdominal pain from his pancreatitis. His doctor is trying to get him enrolled in a study for another drug.

Looking back, it's easy to regret the things he hasn't been able to do that other guys his age take for granted. Asked for an example, he doesn't skip a beat: "Dating."

Siemers isn't sure why he grew up thinking AIDS was something he had to conceal from all but a few trusted friends. After he revealed his secret, he felt blessed by all the support he received.

While Siemers has contempt for infected people who conceal their HIV status from sex partners, he doesn't think of himself as morally superior to those who acquired the virus through unprotected sex or intravenous drug use.

"I've met a lot of people with this disease and they range from every ethnicity and every gender and they are just people trying to get though it," he said. "AIDS is not prejudiced. It will attack anybody."

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Lonnie Payne, 53, diagnosed with AIDS in 1986

SAN FRANCISCO (AP) — The same month Cameron was conceived, Lonnie Payne moved from Chicago to San Francisco with his lover, Joel Swandby.

In April 1981, the city was "the gay Mecca of the United States," and Payne and Swandby reveled in the freedom of living in a place where men could love other men with abandon.

Although Payne remembers hearing about a strange illness that surfaced in the gay community that year, it took time before "the rumor started getting longer" and reality set in. Once-beautiful men walked the predominantly gay Castro District like living skeletons, their sunken cheeks bearing the telltale lesions of Kaposi's sarcoma.

Not long after the first HIV tests became available, Payne, Swandby, Payne's twin brother, Lawrence, and the brother's partner, Timothy Bollinger, decided to get tested together, "as a family."

"In those days, there was this fear of being identified, so I remember not even using our real names."

All four men tested positive.

"In '86, that was a death sentence. We didn't know how long we had to live," he said.

"On one level we were like, 'OK, we have this bug. We are going to do the right things and stay healthy.' On the other hand, there was this fatalistic effect happening, where it was like, 'If I'm going to die, why should I worry about following some regimen?'"

The signs surfaced soon enough. Infection after infection broke through the men's weakened immune systems, and the drugs they were taking had debilitating side-effects. Those years are a blur for Payne, who was taking care of Joel while coping with his own illness. In 1994, Lawrence Payne died, followed by Bollinger in 1995. Swandby succumbed in 1996.

"It's hard to think back through that darkness for me at times," Payne said. "I never thought I would be in a world without my twin brother. ... It was like everything I knew that was comfort was eroding."

For reasons that remain a mystery, Lonnie Payne stayed strong long enough to benefit from a new class of drugs that hit the market around the time Swandby died. He thinks he'd be dead, too, were it not for the protease inhibitors that ushered in the era of so-called "cocktails."

"They were horrible and they were nasty. The side effects were everything you have ever heard — the diarrhea, the neuropathy," Payne said. "But for me, the reality is that they were working, and it changed my outlook on life.

"I started with an attitude of, 'I will try to see if I can make these drugs work because I'm really not ready to check out yet. There's a reason why I'm alive and the other guys aren't, and I just need to find out what it is."

Another decade has passed. To look at Payne, one would never know how sick he was. He retired in 1996 from his marketing job with a telephone company and volunteers as a director for two AIDS organizations. He is 53 years old when he never expected to see 40.

"I love the fact that we consider ourselves long-term survivors of AIDS and not people living with HIV and AIDS," he said. "Because we are survivors, and whatever has come up we have navigated through it, sometimes with great success and sometimes with just passable success."

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Dr. Lisa Capaldini, nationally recognized HIV expert

SAN FRANCISCO (AP) — In her solo medical practice in the Castro District, Lisa Capaldini sees a lot of HIV patients. She once treated Lonnie Payne's late brother and partner.

Some suffer from a sense of spiritual ennui she calls the "Lazarus Phenomenon," after the figure whom Jesus brought back from the dead in the biblical story. Well enough to know their limitations but too sick to work full-time, they are the epidemic's walking wounded, Capaldini said.

"They are a little bit lost souls," she said. "They may have sold a business or never finished school because they didn't think they would be around. Now what they are dealing with is, 'I may live another 20 or 30 years. What does surviving this mean?'"

Capaldini first encountered HIV on a medical school fellowship in 1981. Her first AIDS patient two years later was an intravenous drug user who was going blind from the disease. She remembers her tears of impotence when she sent him home to die.

San Francisco General was one of the first hospitals to have a dedicated AIDS ward, and as a lesbian herself, she gravitated to the epidemic that was hitting gay men. Even as a new doctor, she became a nationally recognized expert in treating an illness with which no one was experienced.

These days, the type of care she provides is different. A decade ago, her waiting room was full of people getting ready to die.

"I have more patients with HIV in my practice than I ever have, but I am spending less time with them than I ever have," she said.

The challenge today is not to get complacent about HIV, she said. Patients must adhere closely to their drug regimens to avoid developing an immunity. That can be difficult.

There are complex psychological and sociological reasons why HIV patients fall off their meds, such as domestic and economic problems.

While Capaldini thinks the early years of the epidemic helped "humanize" gay men in America, HIV still carries a stigma, especially for heterosexual women.

"If you are a woman and you have HIV in 2006, you are either a slut or a druggy. People want to know how you got it," she said. "Having HIV remains a stigmatizing thing. It's not ever going to be a chronic condition like emphysema or diabetes."

More than 100,000 New York City residents have HIV, and 20 percent don't know it. Many sicken and die without learning their status.

New York City health officials want to reverse the trend by making it easier for doctors to administer HIV tests and to monitor the care of people who have the virus. But the issue has drawn outrage from AIDS service providers.

The dispute coincides with the 25th anniversary of the AIDS epidemic. On June 5, 1981, federal health authorities found that five gay men in California had contracted a rare kind of pneumonia, the first recognized cases of what later became known as AIDS.

At issue in 2006 in New York is whether it is time to start treating AIDS more like other communicable diseases or whether AIDS still carries so much stigma that issues of privacy and confidentiality must remain paramount.

The changes would abolish a requirement in New York for separate written consent for an HIV test and permit public health authorities to share information about matters such as viral load and drug resistance with an HIV patient's doctor — information which can help doctors treat their patients effectively.

New York City Health Commissioner Dr. Thomas Frieden made his case for the changes at a series of public meetings this spring.

"As long as HIV testing is different from all other testing in the medical care system it's not going to be part of routine medical care," he said at a Harlem Hospital forum.

His audience largely disagreed; it included representatives of civil liberties groups and organizations that serve people with AIDS.

"To imagine that it's just like every other disease — like cancer or diabetes — is false," said Tracy Welsh, executive director of the HIV Law Project. "Getting a positive test result is something that turns somebody's life upside down."

"How will we ensure that those individuals who test positive will not be criminalized in an effort to contain the epidemic?" asked Ofelia Barrios, a staff member with the Harlem Directors Group, a consortium of AIDS services organizations.

Frieden said he was not proposing mandatory HIV testing or breaching confidentiality. But following his plan, he said, could halve the number of people "who find out that they're HIV positive when they're already sick with AIDS."

HIV testing policies differ around the nation. California does not require separate written consent for an HIV test, and the San Francisco Department of Public Health on May 16 amended city policy to eliminate the need for written consent there.

New York's HIV laws were written at a time when there was no effective treatment for AIDS and the disease was associated with a group, gay men, already facing discrimination. People with AIDS feared that if they disclosed their diagnosis they would lose jobs, homes, families.

There is still no cure for AIDS, but antiretroviral medications can make it a manageable condition for many patients — if they learn their HIV status and take the drugs.

State Sen. Tom Duane, the New York State Legislature's only openly HIV-positive member, said Frieden underestimates the persistence of AIDS stigma.

"People do not lose their jobs if their employer finds out that they have high cholesterol," he said. "Dr. Frieden may live in a world where the stigma's less. ... He needs to come visit a trailer park with me, where people with HIV are living, to find out what their lives are like."

Frieden's proposed changes will face an uphill fight in the Legislature, where he expects them to be formally introduced in the next few weeks. Assemblyman Richard Gottfried, chairman of the Health Committee, said he would be surprised if there is action taken on the bill this session.

Assemblywoman Nettie Mayersohn, a veteran of past HIV battles, said, "My point was always, let's treat it as we treat any other disease. When the patient goes into the office for a routine checkup, let HIV be included in the test without any extra forms to fill out, without going through the hassle."

In 1996, Mayersohn authored the Baby AIDS bill, which required that either a pregnant woman get tested or that her baby be tested at birth. Prior to its enactment, newborns in New York were tested for HIV exposure but only for statistical purposes. Their parents were not given the results. Now, HIV-exposed infants are offered medical care.

Many groups opposing Frieden's plan fought the newborn bill, arguing it amounted to an involuntary HIV test on the mother, since a positive result meant that the mother had the virus, too.

Dennis deLeon, the president of the Latino Commission on AIDS, said he regrets his earlier opposition.

"We have to rethink how we approach testing," he said. "There is stigma around TB. There is stigma around gonorrhea. ... The way you address stigma is to make the testing routine and integrate it across the board. I just don't want to make the same mistake again."

By Tatum Anderson Kampala