"One question is that we are still blind about some vital aspects of HIV/AIDS control," said Wang Longde, vice-minister of health.

China officially has an estimated 840,000 HIV carriers -- a figure disputed by many independent observers -- and the government has precise knowledge of only a small percentage even of that conservative number of patients.

A mere 12.7 percent were registered with the health authorities, and disease control centers only had detailed records of 4.2 percent, according to Xinhua.

The draft of China's first HIV/AIDS prevention and control regulation had almost been completed and would be given to the State Council for further discussion this May, the agency said.

The regulation would mainly set out the rights and duties of regional governments and residents in controlling the deadly disease, according to Xinhua.

To identify more HIV/AIDS cases, every province wouldl offer free, voluntary tests for the HIV virus this year, Wang said.

In a sign of future policies, southwestern Yunnan province, one of the most seriously affected areas of the country, recently finished testing 410,000 high-risk people.

While China is groping in the dark as it tries to cope with its looming AIDS disaster, it is also hampered by a lack of resources.

Hao Yang, vice-director of the health ministry's Disease Control Department, told Xinhua there were only about 200 professional health workers engaged in HIV/AIDS treatment and prevention at the moment.

Many doctors who are employed in this field have not been well trained in taking care of HIV/AIDS patients, he said.

The United Nations has predicted 10 million cases in China in five years' time if the epidemic goes unchecked.

HIV/AIDS is already moving from high-risk groups to the general public in China, the coalition said.

The primary transmission route in China is through drug injection, but the proportion of sexually transmitted HIV infections and mother-to-child transmissions has rapidly increased in recent years.

Many others were infected through insanitary blood-buying schemes in the early 1990s.

"AIDS prevention is a important responsibility of the Chinese government, and is also a responsibility that must be shared by society, including the business enterprises," she told a conference of health officials here.

"I hope our entrepreneurs, while they are developing their businesses, would also participate broadly in public welfare at the same time."

She said the government also wants international businesses to bring their experience in participating in public welfare to China.

In the past, China has been criticised for being slow to recognise the AIDS problem, although high-profile visits in recent years by the country's top leaders to patients have signalled a more urgent approach.

China estimated it had 840,000 HIV/AIDS sufferers by the end of 2003, although many cases go undetected or unreported. The United Nations has predicted 10 million cases by 2010 if the epidemic goes unchecked.

Richard Holbrooke, president of New York-based Global Business Coalition on HIV/AIDS, said the actual number of AIDS cases in China was likely to be much higher and more people must be tested to prevent the disease from exploding.

"Without testing, the disease will spread and spread and spread," he said.

HIV/AIDS is already moving from high-risk groups to the general public in China, the coalition said.

The primary transmission route in China is through drug injection, but the proportion of sexually transmitted HIV infections and mother-to-child transmissions has rapidly increased in recent years.

Many others were infected through insanitary blood-buying schemes in the early 1990s.

Testing key to curbing AIDS

Fri Mar 18, 2005 09:41 AM ET

BEIJING (Reuters) - Better testing is the key to fighting the global AIDS pandemic, Richard Holbrooke has said in Beijing, where he was in town to encourage Chinese businesses to play a role in stopping the spread of the disease.

The former ambassador to the United Nations who now heads the Global Business Coalition on HIV/AIDS also had harsh words for the World Health Organisation, saying its emphasis on providing anti-retrovirals was misplaced when most of those with the disease did not know they were infected.

"The failure to test is the weakest link in the policy. If testing is not encouraged, AIDS will become, worldwide, the ultimate weapon of mass destruction," he told a news conference on Friday.

Holbrooke praised China's efforts to fight AIDS, saying the SARS outbreak in 2003 had been critical to changing central government's attitudes toward the disease by highlighting the economic consequences of allowing its spread.

He had harsher words for the WHO's "3 by 5" initiative to provide anti-retroviral therapy to 3 million people with HIV/AIDS by 2005, saying it was an advertising slogan that could not be fulfilled and that just 800,000 had been reached to date.

"Even if they did get to 3 by 5, they wouldn't catch up with the spread. The only way to get there is with testing," he said.

POLITICAL SENSITIVITY

WHO officials in Beijing were not immediately available for comment.

But Holbrooke's emphasis on testing highlights the problems remaining in China, where, despite high-level shows of support, prevention is still hampered by social stigma and political sensitivity.

Holbrooke said testing should be carried out routinely for patients undergoing operations, couples getting married and for pregnant women, but he acknowledged compliance with such a policy would be difficult without guarantees of confidentiality.

That presents a challenge for China, where the government was slow to acknowledge the epidemic and says it has fewer than 1 million cases -- a figure many AIDS organisations say is a gross underestimate.

At the highest levels, the government's attitude has changed.

"The government will further enhance legislation on prevention and treatment and invest additional resources in this work," Health Minister and Vice-Premier Wu Yi said.

"I hope Chinese businesses will take advantage of the growth of their companies to ... take steps to harness and develop workers' enthusiasm for this cause," she told Friday's forum, aimed at harnessing business resources and skills to fight AIDS.

Her comments followed the lead of President Hu Jintao and Premier Wen Jiabao, who have both visited hospitals to shake hands and chat with AIDS patients.

But China has also been criticised for not holding any local officials accountable for a blood-selling scandal involving state-run health clinics, and journalists who travel to the countryside to report on the disease are routinely detained.

"China is at a crossroads in the fight against AIDS," Holbrooke said. "They're either going to stop it and strangle it, or it's going to spread."

Despite assurances from New Delhi that the legislation will not prevent Indian drug firms from and supplying generic anti-AIDS drugs to developing nations, the group urged that the bill be dropped or significantly amended.

The Nairobi-based Network of African People Living with HIV/AIDS said it was deeply concerned that the proposed law could have a disastrous affect on the millions of Africans suffering from the deadly disease.

"We fear the proposed patent bill might have a negative impact in Africa, as millions of lives hang in the balance," it said in a letter delivered to the Indian High Commission here.

The group said its primary concern was that the law could bar Indian firms from producing the so-called "three-in-one" fixed dose combination of anti-retroviral drugs that are "easiest to use."

The pills "revolutionized AIDS treatment in Africa and providing this user-friendly form of treatment has only been possible because there are no patent constraints in India on putting these medicines together in one tablet," it said.

"These generic medications are a life line for (people with AIDS) in Kenya and the rest of Africa," the group said.

Until now, Indian firms have been able to make cheaper versions of patented drugs as India's patent laws protect the process of manufacture rather than the medicines themselves. By putting together the drug in a different way, pharmaceutical firms have been able to produce generics of all well-known products.

Indian officials defend the new law as necessary to comply with World Trade Organization rules but have stressed that HIV-AIDS patients will not suffer as under WTO regulations Indian firms will be able to continue to supply drugs to countries that do not have manufacturing facilities of their own.

Africa is home to almost two-thirds of the world's HIV and full-blown AIDS sufferers, according to the United Nations, which reported that in 2004, 3.1 million Africans contracted the infection and 2.3 million died of AIDS.

The Nairobi-based network said Africa's grim statistics made it imperative for the Indian government to drop the law, or at least significantly amend it, to save lives.

Only 33,000 people with full-blown AIDS were receiving free drugs at the end of January, according to the health department's new

"The biggest challenge I would say is getting the human resource capacity up to the level where it needs to be," says Xundu.

"In the category of pharmacists, doctors and dieticians, we are struggling," Xundu told AFP.

he health department set a goal of hiring 220 doctors by March this year but only 111 have been found, she said.

Out of the 271 pharmacists needed to help roll out the world's most comprehensive anti-retroviral treatment program, only 90 were hired and 64 out of the 136 wanted dieticians were hired, she added.

"There are not that many sitting and waiting to work in the public health system," says Xundu. "The working conditions are not very attractive" with the average annual salary for doctors at some 190,000 rand (32,000 US dollars/ 24,000 euros).

The government recently allocated 4.3 billion rand over the next three years to enable the rollout of free anti-retrovirals and provide comprehensive treatment.

South Africa has the world's highest AIDS caseload, with 5.3 million people, or an estimated one out of five adults living with HIV and AIDS, according to UN figures.

While she laments the lack of credible figures, Xundu says the health department estimates that 5.6 million people are living with HIV and AIDS in South Africa, with the highest prevalence rate -- at 30 percent -- among young people between the ages of 21 and 29, especially women.

The government is looking at incentives to attract more health care professionals, offering for instance housing benefits for doctors who take up posts in rural areas where there are fewer medical facilities.

It is also trying to recruit doctors and other professionals from abroad, notably from Cuba and Iran.

"We are looking for foreign professionals but we shouldn't be bleeding the African states because they are in the same situation," says Xundu.

For AIDS activists however, the missed targets are rooted in a lack of political will from a government whose leader, Mbeki, has in the past openly shown his skepticism over the need to make the fight against AIDS a priority.

"The evidence is that there is plenty of people needing the program. Instead of filling the gaps, the politicians are content to allow things to proceed at a snail's pace," says Mark Heywood, spokesman for the Treatment Action Campaign (TAC) which two years ago won court rulings forcing the government to offer free ARVs.

TAC has launched a campaign to demand that 200,000 South Africans be put on anti-retrovirals by next year and that at least 10 percent of these patients be children.

A non-governmental organisation, Health Systems Trust, which has been monitoring the AIDS treatment program since its launch in 2003, also concurs that the number one problem is human resources.

"We don't have the staff, the expertise to actually run the sites", says Rob Stewart, who runs the monitoring project for the Durban-based organisation.

"But we are developing it quite rapidly," he says.