Bill & Melinda Gates Foundation

China Perspective: How We're Turning the Tide on AIDS

July 24, 2012

Talking about the spread of HIV/AIDS, almost everyone knows that this disease spreads through three channels: blood, sex, and mother to child transmission. The HIV/AIDS story of China follows this same path, but with it's own unique pattern. 

The first HIV/AIDS case in China was reported in 1985. The patient was an American visitor to China.

In 1989, China's first HIV/AIDS epidemic broke out in Yunnan Province because of needle sharing amongst intravenous drug users. For many years, intravenous drug users were the primary source of new HIV infections in China.

In 1993, HIV/AIDS was found among blood givers in China's central areas, but was effectively controlled through strong government intervention.

Since the beginning of the 21st century, China's new HIV infections have mainly been transmitted through sexual relationships, with infections among men who have sex with men rapidly trending upward. According to the official estimates, the number of MSM in China is only 3 million within the total population of 1.34 billion.

It’s clear that you can’t fully confront HIV/AIDS without confronting fear, stigma, and ignorance. Chinese society must understand there should be no discrimination in HIV testing and that infection does not mean the end of life.
A New Partnership in China 

In order to change the upward trend of HIV/AIDS spread in China, the foundation and the Ministry of Health of China have joined efforts to explore a "three-in-one" collaboration model, under which the government, medical institutions, and grassroots organizations have joined hands to effectively prevent and control HIV infections in China. The partnership has focused particularly on men who have sex with men, a high-risk group for HIV that has been overlooked in the past.

The project has shown exciting results over the first four years: the average HIV testing rate of MSM in the 15 pilot cities has increased from 3% to 14.4%, while the rate in some cities has even exceeded 50%.

Increasing HIV Testing Rates

Studies have shown that testing is an important strategy for changing high-risk behaviors of people living with HIV while also reducing the spread. HIV-infected people reduce high-risk behaviors by 60% after learning their status. And if the infection is discovered at an early stage and treatment begins immediately, the risk of disease transmission through sex will be reduced by 96%.

Based on these research results, the foundation and Ministry of Health project put forward two core philosophies:

  • testing is an important measure for intervention
  • treatment is an important means of prevention and control

To control the HIV spread among high-risk populations, the HIV testing rate in MSM groups must reach 60%. The goal is clear: to reduce the probability the spread of HIV among MSM by means of early testing, early discovery, and early treatment.

There primary goals for our partnership are to  increase the HIV testing rate among MSM to over 60%; and ensure that 60% of HIV-infected people receive appropriate treatment.

A New Model For Success

When our partnership launched in 2008 the HIV testing rate among Chinese MSM was below 3%. Increasing this is a great challenge because MSM in China tend to keep their sexual identities secret and segregate into their own communities. It is very difficult for disease control centers or medical institutions to reach them or get into their communities to mobilize testing. The three-in-one model of our project works to join the efforts of the national CDC, medical institutions, and social groups to reach these populations.

The project provides MSM with integrated services, including testing, care, and treatment from local, trusted social groups to increase the HIV testing rates and work together to provide those who test positive with care services and quality treatment, further reducing HIV transmission.

The project has carried out pilot programs in 15 large cities in China where testing of 196,000 MSM uncovered 7,704 cases of HIV. Trusted grassroots social groups found 51.7% these cases. Meanwhile, HIV testing coverage in MSM groups increased from 3% to 14.4% and is to rise above 20% in 2012.

Challenges For the Future

Five major issues still stop China's MSM from getting tested:

  • privacy protection and fear of discrimination
  • scared of HIV positive test result
  • Lack of sense of self-protection, feeling that they are very healthy;
  • Lack of relevant knowledge, believing that nothing can help HIV-infected persons and HIV testing is useless;
  • There are not enough testing stations and service quality still needs to be improved.

It’s clear that you can’t fully confront HIV/AIDS without confronting fear, stigma, and ignorance. Chinese society must understand there should be no discrimination in HIV testing and that HIV infection does not mean the end of life.

Early testing, early diagnosis and early treatment will help HIV-infected people and patients enjoy lives as normal people, while also contributing to further spread of the disease.  

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