Pubdate: Mon, 05 Jun 2006
Source: Boston Globe (MA)
Copyright: 2006 Globe Newspaper Company
Contact:  http://www.boston.com/globe/
Details: http://www.mapinc.org/media/52
Author: Jehangir S. Pocha, Globe Correspondent
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/find?137 (Needle Exchange)

HEROIN, IGNORANCE BOOST SPREAD OF AIDS IN CHINESE PROVINCE

KUNMING, China -- This scenic capital of China's southern Yunnan 
Province has earned itself a more unsavory sobriquet -- China's AIDS capital.

Historically, this multi-ethnic region of stunning valleys and 
gorges, including a site locals say is the fabled region of 
Shangri-La, stood out in mostly Han China for its uniquely diverse 
culture and beauty.

Now the province, where China's first HIV cases were discovered in 
the early 1990s, is home to about 30,000 of the 140,000 Chinese who 
are HIV-positive, according to official reports. And that's almost 
certainly an underestimate, said Yang Maobin, director of Daytop, a 
HIV/AIDS care center in Kunming.

Experts say that in reality there could be as many as 200,000 HIV 
cases in Yunnan and 300,000 more in neighboring Guangxi Province and 
western Xinjiang Province.

Part of the reason almost half of China's HIV cases are concentrated 
in these areas is their proximity to the world's largest 
heroin-producing areas -- Afghanistan in the case of Xinjiang and the 
"Golden Triangle" countries of Thailand, Myanmar, and Laos in the 
case of Yunnan and Guangxi.

Starting in the 1980s when China's economic reforms began to take 
hold, relentless social change and growing inequalities led many 
disaffected youth to experiment with the heroin being brought into 
China by smugglers in cahoots with corrupt local officials.

That, combined with an almost total lack of AIDS awareness, has 
"burnt a hole into our society," said Yang.

Yunnan's heroin addicts soon began sharing needles -- the surest way 
of contracting HIV. While the risk of HIV transmission during 
unprotected sex is less than 1 percent, anyone sharing a needle with 
an HIV-infected person is almost certain to contract the disease, Yang said.

Zhu Jian, 29, a grim-faced HIV-positive heroin addict who frequents 
Yang's clinic, said he and those in his circle of heroin addicts had 
no knowledge about this.

"Nobody told us what was going on," Zhu said. "At first we didn't 
know the risks" of needle-sharing. "We didn't even really know what 
AIDS was. Then, when we knew, we just didn't care."

A lack of public AIDS education and alienation among hardened heroin 
users is common in most countries. But in Yunnan and other western 
provinces the problem is compounded by the preexisting feeling of 
social dislocation within the region, which is China's poorest. 
Minority groups make up about 35 percent of the local population and 
often feel excluded from mainstream life in predominantly Han China.

"In China there's a clear correlation between ethnicity, poverty, and 
HIV," said Joel Rehnstrom, country coordinator with the UNAIDS 
program in Beijing. "However, it's a very sensitive issue, and the 
causality has not been well understood because of a lack of data and studies."

Rehnstrom said that problem manifests itself in simple ways, such as 
local governments that don't create communication and education 
messages tailored to ethnic minorities, who often speak only halting 
Mandarin, and don't create HIV testing facilities that are truly 
confidential. As a result, he said, large swathes of the population 
remained ignorant about HIV and are hesitant to test themselves for 
the disease.

Most health experts agree that China's HIV rates are unlikely to rise 
as high as those in sub-Saharan Africa -- which has more then half of 
the world's 40 million HIV-positive people -- mainly because of its 
better healthcare system and less-risky patterns of sexual activity.

Though the Chinese government has needle exchange programs as well as 
a program to provide AIDS patients with free medications, their 
effectiveness is flawed, Yang said. Many heroin addicts stay away 
from the official centers where they can get free needles, and the 
bureaucratic processes HIV patients need to follow to receive 
medications are so cumbersome that fewer than 10,000 people are 
receiving medicine.

So Yang worries that in Yunnan the problem could soon burst out of control.

"On one hand, our advantage is that for now HIV is spreading mostly 
between drug users," said Yang. "On the other, this is a huge problem 
because if we don't intervene into this problem now it could break 
out into the general population" because "most female addicts have to 
prostitute themselves" to support their habit.

Ma Chun Mei, 32, a snack food operator and heroin addict, said she 
enrolled herself into Yang's clinic because she realized she was just 
a step away from doing that.

"I know I would have become a prostitute because I was earning" about 
$300 a month, she said quietly, "but spending all of it on drugs and 
borrowing more." "Many of my friends can't bring themselves to face 
their demons, so many are going the wrong way and selling 
themselves." If HIV-infected sex workers spur a wider wave of 
HIV/AIDS in China as they have in India, about 5 million Chinese 
could get infected with the virus, the World Health Organization has warned.

Yunnan reported last year that in some areas the HIV infection rate 
among pregnant women was already 1 percent, but China continues to 
underspend on all public health issues, including on AIDS, according 
to Henk Bekedam, the chief World Health Organization representative in Beijing.

The greater problem, Yang said, is that the fight against HIV/AIDS in 
China is crippled by the entrenched prejudices that government 
officials, healthcare practitioners, and the general population have 
against the disease and the people it afflicts.

Zhu said when he was diagnosed with HIV, his family and friends 
immediately rejected him.

"They wouldn't even let me drink water from the same glass as them," 
said Zhu. "Overnight I became something else, not fully human."

Alienated and diminished, Zhu said he left home and took to a life of 
petty crime to support his habit. So far he's been arrested nine 
times for botched robberies. Each time, he said, local police sent 
him to compulsory six-month detoxification programs at government 
rehabilitation centers, where inmates are routinely beaten, 
intimidated, and humiliated.

Zhu has become fatalistic, saying the dearth of effective medications 
in China means AIDS will probably kill him before heroin does.

"I come by here every day and sit around with people," said Zhu 
gesturing at the group of fellow heroin addicts playing board games 
in Daytop's recreation room. "But in my heart I know no one is 
interested in helping me. I'm not a good person, I know. I steal and 
I bully people. I'm a person. But that doesn't mean anything to 
anyone. This is the dark side of Chinese society today."
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MAP posted-by: Beth Wehrman