Nearly 40 million people live with HIV worldwide

Here are some key facts from the latest annual report by the two United Nations agencies:

*Two thirds of those infected -- 24.7 million people -- live in sub-Saharan Africa, which also accounts for almost 75 percent of deaths -- 2.1 million out of the global toll of 2.9 million.

*But the biggest infection increases were in east Asia and in central Asia/eastern Europe.

*In south and southeast Asia there are 7.8 million people living with HIV and there were 860,000 new infections in 2006. For eastern Europe and central Asia the combined figures were 1.7 million HIV cases and 270,000 new infections.

* High-risk behaviour (injecting drug use, unprotected paid sex and unsafe sex between men) is especially evident in the HIV epidemics of Asia, eastern Europe and Latin America.

* In China, with an estimated 650,000 people living with HIV, the virus is gradually spreading from high-risk groups to the general population. The HIV epidemic from drug use accounts for half of the cases and has reached "alarming proportions".

*More women than ever are living with HIV -- 17.7 million, up one million on 2004, the year the report uses for comparison.

*Less than 1 in five people at risk of catching HIV worldwide has access to basic prevention services. Only 1 in 8 of those wanting to be tested can be.

*More than 1.6 million people living with HIV are receiving anti-retroviral treatment in low and middle income countries, four times more than in Dec. 2003. But that is still just 24 percent of those in need of the life-extending drugs.

*Scaling up available prevention strategies in 125 low and middle income countries would avert 28 million new infections by 2015 and save $24 billion in treatment costs.

Can AIDS Virus Testing in China Be Done More Aggressively?

Luo Gang, Jiankang Bao (Beijing) 29 Aug 2006


"One of the difficulties in AIDS control and prevention in China is that the status of the disease is unclear. We have no idea how many patients are involved. Since a large number of HIV infected people do not know that they have been infected with the AIDS virus, they may still be engaged in high risk activities as before. Because
these infected people are hiding in the shadow, it is difficult for relevant authorities to identify them. Consequently, effective intervention is impossible." This is the comment made by Professor Jing Jun, Director of Center for AIDS Policy Research at Tsinghua University, during an educational news briefing held prior to the
16th International Conference on AIDS. He is very worried about the low discovery rate for HIV infection in China.

HIV Screening Is Consistent with Public Interest.

According to an estimate, approximately 650,000 people are carrying the AIDS virus in China as of the end of 2005. Nevertheless, only a little more than 100,000 cases of HIV infection were reported on a cumulative basis to date. "This is one of the major obstacles impeding any progress on AIDS control and prevention in China." This view is shared by research fellow Wu Zunyou, Director of Center of AIDS Control and Prevention of China Center of Disease Control and
Prevention, and Professor Jing Jun. "The experience gained in countries such as the United States, Zambia, Kenya, Tanzania, Trinidad-Tobago, Puerto Rico and India showed that people who are aware that they are infected are more inclined to curb high risk activities." Identifying more HIV infected people is good news to
AIDS control and prevention in China.

Wu Zunyou published an article in Science recently. He hopes that HIV screening can be done more aggressively to push AIDS control and prevention forward in China. As a matter of fact, a large scale HIV screening program was launched in Henan. People who sold blood in the past were tested. This HIV screening program sets a precedent for testing high risk population in China. In the same year, the Province of Yunnan also took a similar aggressive stance. Drug abusers, sex workers and sexually transmitted disease patients were tested for HIV infection. However, there are different opinions toward this approach. Despite the fact that HIV screening has forced more HIV infected people hiding in the shadow to "come to the surface," there are still some opposing views. They insist that aggressive HIV screening for the high risk population may violate their human rights because they may not be willing to be tested voluntarily. (The number of HIV infected people identified in a little more than three months in Henan is six times that identified cumulatively in the past 10 years. In Yunnan, the number of HIV infected people identified during the program is equal to the sum of all people identified in the past 18 years combined.)

To address this issue, Wu Zunyou points out that the United Nations Programme on HIV/AIDS and the World Health Organization hold the following position: HIV testing should be accompanied with informed consent, and the objective is to promote consulting service related to AIDS prevention. Theoretically speaking, this aggressive testing strategy should still obey the principle of voluntary testing. However, there will be some pressure from within the society to mobilize people targeted to take the test. In addition, consulting service is typically offered to those who are tested HIV positive. It usually covers knowledge related to disease progression, treatment and prevention. Therefore, this strategy does not contradict with the stance taken by these two international organizations.

Since the adoption of the policy of "four free and one care," aggressive HIV testing has been expanded as a part of the anti- retroviral treatment (ART). This signifies that HIV testing is no longer done solely for the purpose of information gathering and minimization of HIV transmission. It has become an effective way to provide consulting service to people who are confirmed to be HIV positive. Therefore, this strategy not only benefits those who are confirmed to be infected with HIV, but also those who are at risk of being infected with the AIDS virus.

According to Wu Zunyou, although there is some controversy in aggressively screening of high risk groups for HIV infection, it is still consistent with public interest. The foremost obligation in public health is to control the spreading of diseases to protect the uninfected public.

Discrimination Remains to Be the Biggest Obstacle.

Professor Qiu Renzong, a famous expert on bioethics at the Chinese Academy of Social Sciences, also expressed his view on HIV testing. He realizes that people are unwilling to be subjected to testing because they are afraid of discrimination after they are tested positive. He quoted some references. In Beijing, 62.8% of HIV infected people faced discriminated against them; and 80.7% of the discrimination came from medical facilities. Specifically, discriminatory actions includes refusal to provide therapy or unfair treatment, and restriction of movement or isolation. In some cases, test results were directly disclosed to partners, relatives and friends. In some occasions, a list of HIV infected people was provided to other organizations. In addition, other people were allowed access to confidential medical records of HIV infected patients. Consequently, it constitutes an invasion of personal privacy.

According to Wu Zunyou, although the newly released regulation on AIDS control and prevention stipulates that legal rights of HIV infected patients, such as marriage, employment, medical care and education must be protected, discrimination in real life still remains a major problem. To this end, people are reluctant to volunteer for consulting and testing. However, in areas where aggressive HIV screening is done on high risk groups, such as in Henan, researchers notice that the number of people who voluntarily subject themselves to consulting and testing increases as HIV testing penetrates to a deeper level.

Professor Qiu Renzong points out that in order to ease the concern of some people in high risk groups, anti-discriminatory measures must be incorporated as a part of the AIDS control and prevention strategy, including HIV testing. These people are afraid that they may lose their jobs, their marriages may fall apart, their families may be broken up and their rights to participate in social activities may be infringed. By doing so, they may be willing to walk out of the shadow to take a test. At the present moment, the most urgent task is to make sure that anti-discrimination provisions in laws and regulations are enforced in real life.

A Recommended Consulting and Testing System Is Emerging.

Since voluntary consulting and testing is ineffective as far as its scale is concerned, in addition to protecting the privacy of those who are being tested, Professor Jing Jun also suggests that a "recommended consulting and testing system" should be designed, tested and expanded. The so-called "recommended consulting and
testing system" may be summarized in the following. People in high risk groups are persuaded to be tested for HIV infection through a variety of means, including government notification, media promotion, community urging, companion education and administrative control and even pressure. In order to achieve this objective, the
confidentiality of consulting and testing must be emphasized by the relevant authority. Compared to voluntary consulting and testing, recommended consulting and testing can avoid the pitfall of lack of scale. Compared to mandatory consulting and testing, it can avoid letting the government bear all the liability and burden on AIDS
treatment.

According to Professor Jing Jun, this recommended confidential consulting and testing system should first target high risk groups (prostitutes, drug addicts and male homosexuals) and people who come in close contact with those in such high risk groups (people who pay for prostitutes, sex partners, spouses and children). Nevertheless, in order to minimize social discrimination created by expanding HIV testing to address special groups of people, it is also necessary for the government to initiate recommended confidential consulting and testing for HIV infection for people the general population. Medical professionals and public health officials should lead the way. Other relevant government officials in areas such as public security, family planning, education and propaganda should also offer themselves to be tested in order to advance AIDS testing in China. If TV and movie stars can also take part in HIV screening, the impact would be tremendous.

AIDS in China

Yu Fengwei, Kexue Shibao (Beijing) 1 September 2006


The Trend of Spreading Appears Grim.

Since the AIDS virus was first identified in the 1980s, people always believe that AIDS is a disease that will eventually be conquered. Nevertheless, more than 20 years have passed. A great deal of progress has been made in the diagnosis and treatment of AIDS. But, it is still impossible to completely eliminate HIV from the human
body. There is no breakthrough in the development of a vaccine against AIDS either. The disease continues to spread gradually into the general population.

According to a report entitled "Status of Sexually Transmitted Diseases in China" presented by Professor Zhang Guocheng, Deputy Director of Center for Control and Prevention of Sexually Transmitted Diseases of China Center for Disease Control and Prevention, in the Third National Symposium of Control and Prevention of Sexually Transmitted Diseases, cumulatively a total of 703,000 cases of 7 different sexually transmitted diseases were reported in 2005. Syphilis has increased by 28.74%. It is the fastest rising sexually transmitted disease in China. It is estimated that a total of 10 million people are infected with sexually transmitted diseases in
China. In China, the rate of sexual transmission of the AIDS virus is as high as 3.6%. It is gradually spreading from high risk groups into the general population.

An analysis of sexually transmitted diseases in 2005 shows the following. The rate of incidence for sexually transmitted diseases is 53.87 per 100,000 last year. The male to female ratio is 1.16:1. Compared to 2004, syphilis increased by 28.74% last year. Significant increases in the number of cases for tertiary syphilis, latent syphilis and congenital syphilis were observed. The increases are 86.23%, 84.26% and 56.36%, respectively. Among the seven sexually transmitted diseases reported nationwide, the top ranking disease is non-gonococcal urethritis. It accounts for 36.78% of all reported cases. It is followed by gonorrhea, venereal wards
(Condyloma acuminatum), syphilis and genital herpes. The top five provinces reporting most cases of sexually transmitted diseases are Guangdong, Zhejiang, Jiangsu, Shanghai and Jiangxi. Jiangsu Province reported the highest number of gonorrhea cases; i.e., 22,430 cases.

Testing Is Being Optimized.

More than 20 years worth of research shows that the AIDS virus is a highly destructive virus that is unmatched by anything else. Although breakthroughs in AIDS research have never stopped, it will take a long time to conquer the AIDS virus that has 9,700 base pairs. Presently, people will have to mainly rely on prevention to
stop AIDS from spreading.

According to the physician in charge of the AIDS ward at Beijing Ditan Hospital, the AIDS virus is transmitted via three well defined routes; i.e., sexual intercourse, blood contact and mother to child transmission. Other than these three routes, the AIDS virus cannot be transmitted any other way. Any behavior related to these three
routes of transmission should be considered high risk. Ordinarily, such behaviors include sexual promiscuity, drug abuse and homosexuality. Presently, HIV testing may be done mainly in two different ways. One approach is to take a blood sample. The other is to use a urine sample. In addition, it may also be detected in the saliva. Urine and saliva samples can be obtained more conveniently. It is non-invasive as far as the test subject is concerned. However, its sensitivity and specificity are slightly lower than those with a blood sample. At the present sample, blood is still the most commonly used sample and either an ELISA assay or a rapid colloidal gold diagnostic technique is used to complete the test. Both methods are extremely accurate. Generally speaking, HIV test kit has gone through four development stages so far. The test kits sold in the market in China are third and fourth generation test kits. It can detect the presence of HIV antibodies in less than two weeks. Progress made in HIV detection has made it extremely easy to diagnose AIDS early.

Further Exploration

In light of discouraging results in the treatment of AIDS, it is obvious that we must intensify our effort on AIDS virus detection in order to fortify AIDS control and prevention. So far, a total of 2,850 free HIV voluntary consulting and testing clinics have been established across China. China Family Planning Association has
grown to become the largest non-government organization in AIDS control and prevention.

According to a report released by the Ministry of Health entitled "AIDS in China in 2005 and Its Control and Prevention," in order to effectively control and prevent AIDS, all 31 provinces, autonomous regions and directly governed cities and 88% of all local and city authorities have established an agency to coordinate AIDS control and prevention work at the leadership level. AIDS control and prevention has been included as a key public health project in the "11th Five Year Program." Funding for AIDS control and prevention has been incorporated in the budget of every level of government. In addition, a comprehensive national surveillance network for HIV infection will also be established in order to identify HIV infected people and AIDS patients as early as possible. Furthermore, according to a reliable source at China Family Planning Association, the membership at China Family Planning Association has grown to nearly 100,000,000. It has 1,000,000 networking organizations, and plans to launch an "AIDS prevention campaign" in 500 counties and cities this year. The purpose is to educate the public on AIDS prevention. Moreover, it is also collaborating with the United Nations Population Fund to launch an AIDS control and prevention campaign in some high schools and universities in Beijing and Shanghai.

Editor's Comment

Since it was initially reported, AIDS has behaved like a "dark phantom." It is running rampant everywhere. So far, it has taken nearly 3 million lives worldwide. It has affected a large number of people and created serious social consequences. Nevertheless, most importantly, never has there been a pathogenic microorganism that is
so difficult to deal with by scientists like HIV.

This summer, HIV testing has been included as a part of a routine physical examination in the newly released protocol for physical examination in the United States. In 2006, a new "regulation on AIDS control and prevention" was put into effect in China. It stipulates that an AIDS voluntary consulting and testing system shall be
implemented in China. AIDS is spreading in China. People are desperately looking forward to a cure. We can't help but ask the following question. Can HIV testing be done routinely as a part of a physical examination in China?

Seven Rules for AIDS Prevention for Individuals

Have some self-respect, don't be sexually promiscuous. Don't share a razor and a toothbrush with others. Don't pierce your ears and tattoo your eyebrows with a piece of equipment that has not been disinfected. Insist on using a condom when you suspect that either you or your partner may be infected by HIV. If you are addicted to drugs, don't share a syringe with others before you kick the habit. Syringes and medical equipment used for examination and treatment must be rigorously sterilized.
When blood transfusion becomes necessary, use blood that was screened for HIV antibodies. HIV Detection - Let Us Hope that the "Taboo" Can be Broken.

Reporter: How is AIDS vaccine development progressing in China? How effective is AIDS control and prevention?

Lun Wenhui (Director of Center for Venereal Diseases and AIDS at Ditan Hospital in Beijing): AIDS is being spread at a faster rate year after year. Based on the figure acquired in Beijing, it is growing at a rate of 20% ~ 30% every year. In light of this grim picture, control and prevention of AIDS becomes the most urgent task on hand. Presently, AIDS vaccine research in China is still in phase I clinical trial. Some breakthroughs were achieved. There are two major objectives in AIDS vaccine research. One is to prevent HIV infection and the other is to delay the onset of AIDS. However, the effectiveness of the vaccine is still unclear. As for the development of an effective therapy for AIDS, it is a tough challenge that is urgently awaiting major breakthroughs.

Relative to how ignorant we were in the treatment of AIDS a decade ago, we are quite confident that AIDS can be treated medically. Since the introduction of the cocktail therapy, more than 20 drugs are available on the market. AIDS is no longer demonized. AIDS patients have the same life expectancy as ordinary people.
Currently, the government has invested more resources in AIDS treatment. AIDS patients are currently receiving treatment free of charge.

Reporter: The new "regulation on AIDS control and prevention" stipulates the implementation of a voluntary consulting and testing system in China. What is your view on this new policy?

Lun Wenhui: The new policy shows that the government is very concerned about HIV testing. It even established a system by policy and regulation. However, from the clinical perspective, HIV testing is always done on a voluntary basis. Of course, some high risk people refuse to take the test out of fear. They may also feel that
they can be spared out of luck. Or, they may be afraid that their privacy may be compromised. As far as these people are concerned, we hope they will change their mind in the future. Reporter: HIV testing has been included as a part of routine physical examination in the United States this summer. Will HIV testing be included as a part of a routine physical in China in the future?

Lun Wenhui: It is highly significant to include HIV screening as a part of a routine physical. In some countries, people in certain professions, such as surgeons, are required to be tested for HIV antibodies. As far as China is concerned, it is premature to include HIV screening as a part of a routine physical exam. As far as the
whole society is concerned, we must develop a social environment that is more tolerant to people who are infected with HIV. Furthermore, we must ensure that their rights are not infringed. Therefore, our consensus is that HIV testing must be done on a voluntary basis.  However, we hope that people working in certain professions are mandated to take a HIV test.

Reporter: When do you think that HIV screening can be included as a part of a routine physical exam?

Lun Wenhui: Currently, HIV screening is included as a part of a preoperative physical or a genetic health exam in China. Patients may elect to take the test on a voluntary basis. There is nothing wrong to include a HIV test as a part of a routine physical. Actually, periodic testing is necessary for people working in certain
professions. Nevertheless, it takes a long process to include HIV screening as a part of a routine physical. It needs a supportive social environment. A tolerant society that does not discriminate against AIDS patients is a necessary condition for us to include voluntary HIV screening as a part of a routine physical. In the absence of a tolerant social environment, it is detrimental to include HIV screening as a part of a routine physical. It may cause some AIDS patients to go into hiding. As for how and when HIV screening can be included in a routine physical, we look forward to a more tolerant social environment and government policy support.

Reporter's Notes

In the past decade, sexually transmitted diseases are growing at an annual rate of 20% ~ 30% in China. The risk of HIV infection is increased by a factor of 1.5 ~ 18.2 for people with venereal diseases. Venereal diseases are fueling the AIDS epidemic. Some experts are calling for everyone's help to control and prevent venereal diseases. We must educate the public about venereal diseases in order to raise public awareness of self-protection against venereal diseases. The public should be encouraged to be tested for HIV on a voluntary basis. In the war against AIDS, we firmly believe that mankind will be the victor.

The Province of Jiangxi recently issued a "method for discovery, reporting and management of HIV infected subjects and AIDS patients." The province intends to include HIV screening as a part of a routine and periodic physical exam to be administered to all service industry employees working in public places. Without a
health certificate, no one is allowed to be employed in the service industry. Furthermore, disease control officials will hold face-to- face meetings with AIDS patients once every three months. We are looking forward to the introduction of more AIDS control and prevention measures such as this one. We are also hoping that more
propaganda campaigns will be launched. In addition, other than by policy and regulation, we hope to elevate HIV screening from voluntary testing to self-conscious testing. We look forward to the day that HIV screening is included as a part of a routine physical examination.

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