AIDS Alert International

China private partnership offers some new hope

SARS outbreak opened doors for HIV prevention

Until recently, there have been multiple barriers to initiating HIV prevention and education programs in China, where certain areas have high rates of HIV prevalence and concentrated epidemics.

Barriers included financial resources, cultural issues, and a lack of urgency since the nation’s overall HIV prevalence remains very low.

Then China had to deal with the severe acute respiratory syndrome (SARS) epidemic and the international criticism that surrounded how the government dealt with the epidemic, and the world’s most populated country was ready for some changes in its public health infrastructure.

"I basically believe SARS was quite a wake-up call for China," says David Ho, MD, executive director of the Aaron Diamond AIDS Research Center and professor at Rockefeller University, both in New York City.

"The SARS epidemic pointed out the importance of public health and how it could impact the whole society," he says. "Of course, China with its impressive growth over the past two decades is a success story; but in two months, the country saw Beijing come to a grinding halt, and Hong Kong suffered from the same."

Furthermore, SARS forced China’s leadership to re-examine the public health infrastructure and realize how it is inadequate, particularly in rural areas, Ho adds.

It is within the context of this change that the Chinese AIDS Initiative has been formed as a new partnership that involves the Aaron Diamond AIDS Research Center and other private organizations. The private groups will work with Chinese health officials on meeting a variety of goals that would enhance HIV testing, counseling, prevention, and treatment.

"What we want to do with this alliance is to scale up because we cannot continue to have small pilot projects in China," Ho says. "We have to go and make an impact now."

This approach will require training a critical mass of health care professionals and building clinical infrastructure, including labs, he adds.

While the alliance initially will pursue these changes in the areas most effected by HIV, the improvements could serve as models for other Chinese regions, as well, Ho says.

"Of course, China eventually would have to take on this effort on its own, but I think we certainly could help by not just making suggestions, but by leading the way with a few of these efforts," he says.

Ho outlines the challenges ahead in forging a lasting HIV program in China:

• First, China needs to have a national plan that defines the extent of the epidemic, he says. China has two major HIV epidemics that involve different modes of transmission.

One is in the South and Southwest, including Xinjiang where 35% to 80% of the area’s injection drug users (IDUs) are HIV-positive, according to data from UNAIDS of Geneva. China’s second epidemic is in the central provinces, where there is a separate epidemic that was caused by the sale of HIV-infected blood and plasma from 1992 to 1996, Ho explains.

"A lot of people are infected, but no one really knows the magnitude of the epidemic," he adds.

• Another challenge is to provide large-scale testing after properly training people and offering the public incentives for being tested.

For instance, if there was a treatment component to the testing and prevention-counseling program, then people would have an important incentive to being tested, Ho adds.

• Reducing stigma and cultural barriers also are challenges that need to be met.

There needs to be legislation that protects the rights of people who are HIV-infected, and there needs to be legal reform, Ho says.

• Both the U.S. government and nongovernmental organizations need to be included in the alliance.

"Our long-term vision is to have hundreds of staff on the ground in China," he points out. "Before we get to that level, we have to acquire substantial funding from the government and other private sources. We cannot scale out to that level without more financial support."

• The Aaron Diamond AIDS Research Center will continue with its vaccine program, which had its first vaccines administered in December, Ho says.

"Our vaccines have been tested in animals and re-tested in animals to assure safety, and we’ve gone through human subjects review and Food and Drug Administration (FDA) review, and now we’re doing the first phase of a study in the United States," he explains.

"Then we will take the vaccine to the Southwest province of Yunnan in China." The Chinese part of the vaccine program will be subject to a Chinese government review before it can begin, Ho adds.

• Prevention programs will be initiated. In the fall of 2003, the first public service announcements about HIV, initiated by the Aaron Diamond center, were aired, Ho says.

"The first ad primarily dealt with the issue of stigma and discrimination, but we’ll have a series of public service announcements that will address condoms, drug use, and so on," he adds.

"All of these things have to be linked to other efforts, and unless it’s a multipronged process, it won’t have the same level of impact," explains Ho.