A Prescription for Change

September 16, 2006

It can take a long time to wake a sleeping giant. For years, China ignored the growing devastation AIDS wreaked among its people. Then came the frightening SARS outbreak in 2002, an unequivocal wake-up call to the nation's leaders. This year a prescriptive book edited by Heller senior scientist Joan Kaufman is showing China the way to start confronting the gathering storm of AIDS. The book advises China's leaders to pay more attention to social and behavioral determinants and change the approach to treatment and testing.

After the SARS scare, the Chinese government acknowledged the growing AIDS epidemic and began implementing some international best practices to prevent the transmission of AIDS. However, many controversial interventions including clean needle and drug substitution programs for injecting drug users, putting condoms in every hotel room in some badly affected areas, and providing sex education for young people were not adopted.

Kaufman's book says further social science and behavioral research is needed. AIDS and Social Policy in China is the first English language book on China's AIDS epidemic. It was published electronically by Harvard University Asia Center Publications in July (http://www.fas.harvard.edu/~asiactr/publications/pubs.htm).

Chinese officials have begun acting on some of the book's recommendations, particularly in the areas of AIDS testing and treatment, in harm reduction (clean needles and drug substitution) for drug users, for condom promotion for sex workers, and sex education for young people. For example, Chinese authorities improved AIDS drugs' availability after one chapter in the book criticized China's national AIDS treatment program for using only generic drugs. Similarly, the book offers a rationale for routine HIV testing, as recommended by the Centers for Disease Control and Prevention. As a result, the head of China's National Center for AIDS Prevention and Control has called for routine HIV testing similar to the CDC guidelines.

The book consists of papers originally presented at a workshop on China's social policies on HIV/AIDS at Harvard University. As international recognition that Asia is the next wave of the HIV/AIDS epidemic has grown, the book's influence has burgeoned. Countries like China, with large, young populations and a dearth of effective programs to combat HIV and AIDS, are at particular risk due to their size. "Even if only one percent of the population is infected, it's a large number of people," Kaufman says.

"There are probably already as many people living with HIV in China as in the United States, where the epidemic began decades ago," writes Paul Farmer, an internationally-known medical anthropologist, in his preface to the book.

AIDS began spreading in the 1990s through the heroin trade and intravenous drug use, spilling over the Burmese border to China. In the early days of the epidemic, the Chinese thought AIDS could only be transmitted by drug use, sex with sex industry workers, or gay male sex. But since Chinese society deeply stigmatizes all of these behaviors and the people who engage in them, it was easy for the country's leaders to ignore the growing impact of AIDS.

A second epidemic also started in the 1990s in central China. AIDS spread there because many poor farmers who donated blood for money were subjected to unsafe blood donation processes and became infected. By the time this epidemic came to light in 2000, the Chinese were also becoming aware of the urgent need to address the behavioral sources of transmission that were fueling the epidemic's spread in south and southwest China.

"The book has provided a forum and an opportunity to get the issue on the table and has been part of the mix in articulating the debates and discussion," says Kaufman. "I'm proud to be part of the solution to this enormous problem."

It can take a long time to wake a sleeping giant. For years, China ignored the growing devastation AIDS wreaked among its people. Then came the frightening SARS outbreak in 2002, an unequivocal wake-up call to the nation's leaders. This year a prescriptive book edited by Heller senior scientist Joan Kaufman is showing China the way to start confronting the gathering storm of AIDS. The book advises China's leaders to pay more attention to social and behavioral determinants and change the approach to treatment and testing.

After the SARS scare, the Chinese government acknowledged the growing AIDS epidemic and began implementing some international best practices to prevent the transmission of AIDS. However, many controversial interventions including clean needle and drug substitution programs for injecting drug users, putting condoms in every hotel room in some badly affected areas, and providing sex education for young people were not adopted.

Kaufman's book says further social science and behavioral research is needed. AIDS and Social Policy in China is the first English language book on China's AIDS epidemic. It was published electronically by Harvard University Asia Center Publications in July (http://www.fas.harvard.edu/~asiactr/publications/pubs.htm).

Chinese officials have begun acting on some of the book's recommendations, particularly in the areas of AIDS testing and treatment, in harm reduction (clean needles and drug substitution) for drug users, for condom promotion for sex workers, and sex education for young people. For example, Chinese authorities improved AIDS drugs' availability after one chapter in the book criticized China's national AIDS treatment program for using only generic drugs. Similarly, the book offers a rationale for routine HIV testing, as recommended by the Centers for Disease Control and Prevention. As a result, the head of China's National Center for AIDS Prevention and Control has called for routine HIV testing similar to the CDC guidelines.

The book consists of papers originally presented at a workshop on China's social policies on HIV/AIDS at Harvard University. As international recognition that Asia is the next wave of the HIV/AIDS epidemic has grown, the book's influence has burgeoned. Countries like China, with large, young populations and a dearth of effective programs to combat HIV and AIDS, are at particular risk due to their size. "Even if only one percent of the population is infected, it's a large number of people," Kaufman says.

"There are probably already as many people living with HIV in China as in the United States, where the epidemic began decades ago," writes Paul Farmer, an internationally-known medical anthropologist, in his preface to the book.

AIDS began spreading in the 1990s through the heroin trade and intravenous drug use, spilling over the Burmese border to China. In the early days of the epidemic, the Chinese thought AIDS could only be transmitted by drug use, sex with sex industry workers, or gay male sex. But since Chinese society deeply stigmatizes all of these behaviors and the people who engage in them, it was easy for the country's leaders to ignore the growing impact of AIDS.

A second epidemic also started in the 1990s in central China. AIDS spread there because many poor farmers who donated blood for money were subjected to unsafe blood donation processes and became infected. By the time this epidemic came to light in 2000, the Chinese were also becoming aware of the urgent need to address the behavioral sources of transmission that were fueling the epidemic's spread in south and southwest China.

"The book has provided a forum and an opportunity to get the issue on the table and has been part of the mix in articulating the debates and discussion," says Kaufman. "I'm proud to be part of the solution to this enormous problem."

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