HIV/AIDS in Yunnan

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Reported HIV cases in all Chinese provinces, 2005. ChinaHIVAIDSmap.svg
Reported HIV cases in all Chinese provinces, 2005.

The People's Republic of China's first reported AIDS case was identified in 1985 in a dying tourist. [1] In 1989, the first indigenous cases were reported as an outbreak in 146 infected heroin users in Yunnan province, near China's southwest border. [2]

Contents

Yunnan is the area most affected by HIV/AIDS in China. In 1989 first infections appeared among needle sharing drug users near the Burmese border. Up until 1993, the disease had remained a problem in the border areas before mobile people (truck drivers, construction and migrant workers and travelers) brought the virus further into the country. In 1995, the provinces of Sichuan and Xinjiang reported their first HIV cases, and by 1998, the virus had spread all over China.

Low awareness of the disease among China's general population appears to be a major culprit. Most Chinese consider HIV/AIDS as a foreign issue[ citation needed ], and even educated people are less knowledgeable of the virus, its transmission and prevention, than people in other countries. Until recently,[ when? ] the use of condoms was not very common, even among sex workers and their clients. As a result, the epidemic has spread from high-risk groups (drug users, sex workers, unsafe blood donors) to the general population.

Heroin flow

Heroin flows into Yunnan Province from neighboring Vietnam, Laos, and Myanmar, bringing with it HIV. The province's first cases were reported in 1989. With a population of 44 million, Yunnan now has only 200 health workers trained for the disease. Officials estimate that the province has 80,000 infected people, most of them intravenous drug users who have spread the disease by sharing needles. In Gejiu, a city of 310,000 people on a route favored by drug traffickers, initial rounds of AIDS testing in recent years found more than 1,000 people with HIV, nearly all drug users or prostitutes. Unlike some other provinces, Yunnan has welcomed international nonprofit groups and support from Britain, Australia, and more recently the United States. [3]

'3 Needles'

Dr. Gao Yaojie, a gynecologist and AIDS activist from Henan province. GaoYaojie2-70 percent.jpg
Dr. Gao Yaojie, a gynecologist and AIDS activist from Henan province.

3 Needles is a 2005 dramatic film depicting the lives of people in Yunnan during the HIV/AIDS epidemic. One of the film's protagonists, a pregnant black-market operative played by Lucy Liu, makes her living as a blood smuggler. But when several blood donors begin to get sick and die, she realizes that she may have jeopardized the health of the village's safety and beyond. 3 Needles is an attempt to visualize the profound experience of Gao Yaojie and many others as we can read in The New York Times sequel. [4]

Needle exchange

Since 2001, the State Council of the People's Republic of China has officially advocated needle social marketing as an HIV prevention measure. [5] Evidence from research and study tours to countries such as Australia, [6] which runs successful needle exchange programmes, prompted the Ministry of Health (China) to support the first such programme in Yunnan province and Guangxi Zhuang Autonomous Region in 1999. On the basis of the successes of the pilot, the programme was expanded in 2004, and plans are in place to open an additional 1500 methadone maintenance treatment clinics for about 300 000 heroin users by 2008. A National Training Centre for methadone maintenance treatment has been established in Yunnan to provide clinical and technical support.[ citation needed ]

Commercial sex

Commercial sex work is illegal in the People's Republic of China; hence, brothels are illegal and commercial sex workers operate out of places of entertainment (e.g., karaoke bars), hotels, hair-dressing salons, or on the street. [7] The traditional strategy for controlling HIV transmission through commercial sex workers has been the development of stricter laws to prevent risky behaviours, [8] accompanied by raids on suspected sex establishments by public security officials. [9] [10] In 1996–97, following the success of prevention interventions in neighbouring Thailand, [11] the Chinese Center for Disease Control and Prevention launched the first intervention projects to promote safer sex behaviours to prevent HIV and other sexually transmitted diseases in commercial sex workers working at entertainment establishments in Yunnan. [12] [13]

Numbers

In 2002, a United Nations-commissioned report, entitled China's Titanic peril, [14] estimating that the People's Republic of China had about 1 million cases of HIV, and that it was on the brink of an "explosive HIV/AIDS epidemic…with an imminent risk to widespread dissemination to the general population". The report continued: "a potential HIV/AIDS disaster of unimaginable proportion now lies in wait." A few months later, the US National Intelligence Council estimated that 1-2 million people were living with HIV in People's Republic of China, and predicted 10–15 million cases by 2010. [15]

Other reports at this time were similarly pessimistic: from the Center for Strategic and International Studies (Washington, DC, USA), HIV/AIDS was referred to as China's time-bomb; [16] and from the American Enterprise Institute as the AIDS typhoon. [17] However, as Wu and colleagues note, by 2006 the number of people living with HIV/AIDS is estimated to be 650,000—a figure revised downwards by 200,000 from 2005. [18]

After a slow start and reluctance to recognise the existence of risk activities in its population and of the HIV epidemic, China has responded to international influences, media coverage, and scientific evidence to take bold steps to control the epidemic, using scientifically validated strategies. [19] A Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China (2004), [20] developed jointly by UNAIDS and the State Council of the People's Republic of China, estimated that the country had 840,000 people living with HIV/AIDS. This figure was revised down to 650,000 in 2005 in light of more representative data collection and more appropriate estimation methods. [21]

Yunnan ahead

Yunnan province has shown strong support for implementation and advocacy of harm-reduction strategies that reduce HIV transmission in its many drug users, whereas Henan province had been slower to respond to the needs of former plasma donors in the early stages of the epidemic. [22] The distribution of HIV in China is not even, and is concentrated in areas with high drug use (i.e. Yunnan, Guangxi, Xinjiang, and Sichuan) and in areas where people were infected through unsafe blood or plasma donation (i.e. Henan, Anhui, Hebei, Shanxi, and Hubei). The number of cases ranges dramatically between provinces (see the map of China on your right), with, for example, just 20 cases reported from Tibet but well over 40,000 in neighbouring Yunnan.[ citation needed ]

Yunnan Red Cross

The Yunnan Red Cross was one of the first non-government organizations fighting HIV/AIDS in China. It was established in 1994, as an adaptation of the Australian Red Cross, and is operating five projects in various locations throughout the province.[ citation needed ]

See also

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<span class="mw-page-title-main">HIV/AIDS in Asia</span>

In 2008, 4.7 million people in Asia were living with human immunodeficiency virus (HIV). Asia's epidemic peaked in the mid-1990s, and annual HIV incidence has declined since then by more than half. Regionally, the epidemic has remained somewhat stable since 2000.

The Caribbean is the second-most affected region in the world in terms of HIV prevalence rates. Based on 2009 data, about 1.0 percent of the adult population is living with the disease, which is higher than any other region except Sub-Saharan Africa. Several factors influence this epidemic, including poverty, gender, sex tourism, and stigma. HIV incidence in the Caribbean declined 49% between 2001 and 2012. Different countries have employed a variety of responses to the disease, with a range of challenges and successes.

HIV/AIDS in China can be traced to an initial outbreak of the human immunodeficiency virus (HIV) first recognized in 1989 among injecting drug users along China's southern border. Figures from the Chinese Center for Disease Control and Prevention, World Health Organization, and UNAIDS estimate that there were 1.25 million people living with HIV/AIDS in China at the end of 2018, with 135,000 new infections from 2017. The reported incidence of HIV/AIDS in China is relatively low, but the Chinese government anticipates that the number of individuals infected annually will continue to increase.

Human immunodeficiency virus and acquired immune deficiency syndrome in Burma is recognised as a disease of concern by the Ministry of Health and is a major social and health issue in the country. In 2005, the estimated adult HIV prevalence rate in Burma was 1.3%, according to UNAIDS, and early indicators show that the epidemic may be waning in the country, although the epidemic continues to expand in parts of the country. Four different strains of HIV are believed to have originated from Burma, along heroin trafficking routes in northern, eastern and western Burma.

Since the first HIV/AIDS case in the Lao People's Democratic Republic (PDR) was identified in 1990, the number of infections has continued to grow. In 2005, UNAIDS estimated that 3,700 people in Lao PDR were living with HIV.

Kenya has a severe, generalized HIV epidemic, but in recent years, the country has experienced a notable decline in HIV prevalence, attributed in part to significant behavioral change and increased access to ARV. Adult HIV prevalence is estimated to have fallen from 10 percent in the late 1990s to about 4.8 percent in 2017. Women face considerably higher risk of HIV infection than men but have longer life expectancies than men when on ART. The 7th edition of AIDS in Kenya reports an HIV prevalence rate of eight percent in adult women and four percent in adult men. Populations in Kenya that are especially at risk include injecting drug users and people in prostitution, whose prevalence rates are estimated at 53 percent and 27 percent, respectively. Men who have sex with men (MSM) are also at risk at a prevalence of 18.2%. Other groups also include discordant couples however successful ARV-treatment will prevent transmission. Other groups at risk are prison communities, uniformed forces, and truck drivers.

With less than 0.1 percent of the population estimated to be HIV-positive, Bangladesh is a low HIV-prevalence country.

UNAIDS has said that HIV/AIDS in Indonesia is one of Asia's fastest growing epidemics. In 2010, it is expected that 5 million Indonesians will have HIV/AIDS. In 2007, Indonesia was ranked 99th in the world by prevalence rate, but because of low understanding of the symptoms of the disease and high social stigma attached to it, only 5-10% of HIV/AIDS sufferers actually get diagnosed and treated. According to the a census conducted in 2019, it is counted that 640,443 people in the country are living with HIV. The adult prevalence for HIV/ AIDS in the country is 0.4%. Indonesia is the country in Southeast Asia to have the most number of recorded people living with HIV while Thailand has the highest adult prevalence.

<span class="mw-page-title-main">HIV/AIDS in Nepal</span>

The first HIV/AIDS cases in Nepal were reported in 1988. The HIV epidemic is largely attributed to sexual transmissions and account for more than 85% of the total new HIV infections. Coinciding with the outbreak of civil unrest, there was a drastic increase in the new cases in 1996. The infection rate of HIV/AIDS in Nepal among the adult population is estimated to be below the 1 percent threshold which is considered "generalized and severe". However, the prevalence rate masks a concentrated epidemic among at-risk populations such as female sex workers (FSWs), male sex workers (MSWs), injecting drug users (IDUs), men who have sex with men (MSM), Transgender Groups (TG), migrants and male labor migrants (MLMs) as well as their spouses. Socio-Cultural taboos and stigmas that pose an issue for open discussion concerning sex education and sex habits to practice has manifest crucial role in spread of HIV/AIDS in Nepal. With this, factors such as poverty, illiteracy, political instability combined with gender inequality make the tasks challenging.

The Philippines has one of the lowest rates of infection of HIV/AIDS, yet has one of the fastest growing number of cases worldwide. The Philippines is one of seven countries with growth in number of cases of over 25%, from 2001 to 2009.

Since HIV/AIDS was first reported in Thailand in 1984, 1,115,415 adults had been infected as of 2008, with 585,830 having died since 1984. 532,522 Thais were living with HIV/AIDS in 2008. In 2009 the adult prevalence of HIV was 1.3%. As of 2016, Thailand had the highest prevalence of HIV in Southeast Asia at 1.1 percent, the 40th highest prevalence of 109 nations.

The Dominican Republic has a 0.7 percent prevalence rate of HIV/AIDS, among the lowest percentage-wise in the Caribbean region. However, it has the second most cases in the Caribbean region in total web|url=http://www.avert.org/caribbean-hiv-aids-statistics.htm |title=Caribbean HIV & AIDS Statistics|date=21 July 2015}}</ref> with an estimated 46,000 HIV/AIDS-positive Dominicans as of 2013.

In 2016, the prevalence rate of HIV/AIDS in adults aged 15–49 was 0.3%, relatively low for a developing country. This low prevalence has been maintained, as in 2006, the HIV prevalence in Mexico was estimated at around 0.3% as well. The infected population is remains mainly concentrated among high risk populations, men who have sex with other men, intravenous drug users, and commercial sex workers. This low national prevalence is not reflected in the high-risk populations. The prison population in Mexico, faces a fairly similar low rate of around 0.7%. Among the population of prisoners, around 2% are known to be infected with HIV. Sex workers, male and female, face an HIV prevalence of around 7%. Identifying gay men and men who have sex with other men have a prevalence of 17.4%. The highest risk-factor group is identifying transgender people; about 17.4% of this population is known to be infected with HIV. Around 90% of new infections occur by sex-related methods of transmission. Of these known infected populations, around 60% of living infected people are known to be on anti-retroviral therapy (ART).

Nicaragua has 0.2 percent of the adult population estimated to be HIV-positive. Nicaragua has one of the lowest HIV prevalence rates in Central America.

With less than 1 percent of the population estimated to be HIV-positive, Egypt is a low-HIV-prevalence country. However, between the years 2006 and 2011, HIV prevalence rates in Egypt increased tenfold. Until 2011, the average number of new cases of HIV in Egypt was 400 per year, but in 2012 and 2013, it increased to about 600 new cases, and in 2014, it reached 880 new cases per year. According to 2016 statistics from UNAIDS, there are about 11,000 people currently living with HIV in Egypt. The Ministry of Health and Population reported in 2020 over 13,000 Egyptians are living with HIV/AIDS. However, unsafe behaviors among most-at-risk populations and limited condom usage among the general population place Egypt at risk of a broader epidemic.

The HIV/AIDS epidemic in Ukraine is one of the fastest-growing epidemics in the world. Ukraine has one of the highest rates of increase of HIV/AIDS cases in Eastern Europe and highest HIV prevalence outside Africa. Experts estimated in August 2010 that 1.3 percent of the adult population of Ukraine was infected with HIV, the highest in all of Europe. Late 2011 Ukraine numbered 360,000 HIV-positive persons. Between 1987 and late 2012 27,800 Ukrainians died of AIDS. In 2012 tests revealed 57 new cases of HIV positive Ukrainians each day and 11 daily AIDS-related deaths.

Vietnam faces a concentrated HIV epidemic among high-risk groups, including sex workers, and intravenous drug users. There are cases of HIV/AIDS in all provinces of Vietnam, though low testing rates make it difficult to estimate how prevalent the disease is. The known rates among high-risk groups are high enough that there is a risk of HIV/AIDS rates increasing among the general population as well. People who are HIV+ face intense discrimination in Vietnam, which does not offer legal protections to those living with the condition. Stigma, along with limited funding and human research, make the epidemic difficult to control.

References

  1. ↑ Settle E. AIDS in China: an annotated chronology: 1985–2003. Montreal: China AIDS Survey, 2003
  2. ↑ Ma Y, Li ZZ, Zhang KX. Identifi cation of HIV infection among drug users in China. Zhonghua Liu Xing Bing Xue Za Zhi 1990; 11:184–85 (in Chinese).
  3. ↑ Chinese City Emerges As Model in AIDS Fight (June 16) by JIM YARDLEY. The New York Times (2005)
  4. ↑ Detained AIDS Doctor Allowed to Visit U.S. Later, China Says (February 17); China Covers Up Detention of AIDS Doctor (February 16); China Places AIDS Activist Under House Arrest (February 6) by JIM YARDLEY. The New York Times (2007)
  5. ↑ State Council of the People's Republic of China. China's action plan on HIV/AIDS prevention and containment (2001–2005). State Council Document (2001) number 40. Beijing, 2001 (in Chinese)
  6. ↑ Bowtell W. Australia. In: Yamamoto T, Itoh S, eds. Fighting a rising tide: the response to AIDS in East Asia, 1st edn. Tokyo: Japan Center for International Exchange, 2006: 19–52
  7. ↑ Gil VE, Wang MS, Anderson AF, Lin GM, Wu ZO. Prostitutes, prostitution and Sexually transmitted disease/HIV transmission in mainland China. Soc Sci Med 1996; 42: 141–52.
  8. ↑ Standing Committee of the National People's Congress. Decision on the strict prohibition against prostitution and whoring. Beijing, 1991 (in Chinese)
  9. ↑ Husain L. Policing AIDS in China: official discourses, change, continuity, and unofficial voices. In: Christiansen F, Dosch J, Caroline R, Hamelman S, eds. Leeds East Asia Papers. Leeds: Department of East Asia Studies, University of Leeds, 2004
  10. ↑ Gil VE, Wang MS, Anderson AF, Lin GM, Wu ZO. Prostitutes, prostitution and STD/HIV transmission in mainland China. Soc Sci Med 1996; 42: 141–52.
  11. ↑ Anon. Thailand condom campaign reduced AIDS infections by fifty percent. AIDS Wkly Plus 1996; Aug 12, 19
  12. ↑ Wu Z. Final Report for Intervention on Female Prostitutes in Yunnan. Final Report to the World Bank. Beijing, China: Chinese Academy of Preventive Medicine, 1997
  13. ↑ Wu Z. Promoting condom use among female prostitutes in natural settings in Yunnan, China. 12th International AIDS Conference; Geneva, Switzerland; June 28–July 3, 1998.
  14. ↑ Eldis gateway. HIV/AIDS: China's Titanic peril: 2001 update of the AIDS situation and needs assessment report. UNAIDS, 2002. http://www.eldis.org/static/DOC9892.htm Archived 2006-05-18 at the Wayback Machine (accessed Oct 26, 2006).
  15. ↑ National Intelligence Council. The next wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India, China. ICA 2002-04 D. September, 2002: https://fas.org/irp/nic/hiv-aids.html (accessed Oct 26, 2006)
  16. ↑ Bates G, Morrison SJ, Thompson D, eds. Defusing China's time-bomb-sustaining the momentum of China's HIV/AIDS response. A report of the CSIS HIV/AIDS delegation to China, April 13–18, 2004. 2004: http://www.csis.org/media/csis/pubs/040413_china_aids.pdf (accessed Oct 26, 2006).
  17. ↑ American Enterprise Institute, Washington, D.C. Can Asia avoid the AIDS typhoon? Nov 11, 2002: ""Can Asia Avoid the AIDS Typhoon?" - Kaisernetwork.org". Archived from the original on 2007-09-27. Retrieved 2007-03-06. (accessed Oct 19, 2006)
  18. ↑ Ministry of Health, People's Republic of China, Joint United Nations Programme on HIV/AIDS, World Health Organization. Update on the HIV/AIDS epidemic and response in China. 2006: http://data.unaids.org/publications/External-Documents/RP_2005ChinaEstimation_25Jan06_en.pdf (accessed Oct 26, 2006).
  19. ↑ Wu Z, Sullivan SG, Wang Y, Rotheram-Borus MJ, Detels R. Lancet (2007) 369(9562):679-90
  20. ↑ State Council AIDS Working Committee Office, UN Theme Group on HIV/AIDS in the People's Republic of China. A joint assessment of HIV/AIDS prevention, treatment and care in China. Beijing: China Ministry of Health, 2004
  21. ↑ Ministry of Health of the People's Republic of China, UNAIDS, WHO. 2005 update on the HIV/AIDS epidemic and response in China. Beijing: Ministry of Health, 2006
  22. ↑ Watts J. AIDS in China: new legislation, old doubts. Lancet 2006; 367: 803–04
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