Far from over

Despite great progress, China must do more to fight HIV/AIDS

By Bernhard Schwartländer, WHO Representative in China

As the 2014 International AIDS Conference is underway in Melbourne this week, now is a good time to take stock of the state of HIV/AIDS in China.

Two things can be said about China’s fight against HIV/AIDS. First, progress has been impressive by anyone’s standards. Second, there is much more work to be done.

Let’s start with the progress. Over the past five years, China has tripled the number of its sentinel sites. These surveillance sites have helped to ensure we have a better understanding of the HIV epidemic in China.

Great strides have also been made in helping intravenous (IV) drug users – a key population at risk. China has gone from just eight methadone clinics a decade ago to about 700 today.

The number of Chinese HIV/AIDS patients receiving anti-retroviral therapy (ART) has more than doubled in the last three years, and HIV prevalence among the general population remains low.

Not over yet

These impressive accomplishments notwithstanding, much more can and should be done to protect those who are most at risk.

There is more sexual transmission of HIV in China than ever before, especially among men who have sex with men (MSM). The HIV infection rates amongst MSM in China tripled from 2% in 2007 to about 7% today, and are as high as 20% in some cities.

In the heterosexual population, sexual transmission has remained stubbornly constant despite efforts to lower it by educating men and women about the benefits of condom use.

Just as important, a large proportion of people with HIV in China are not tested, or are tested too late. Early testing and intervention can ensure that those who test positive get the treatment they need. This can slow the rate at which HIV progresses to AIDS, and sometimes can even check the progression entirely.

The greatest danger of all

At this point, the greatest danger facing China may well be complacency. With a low overall infection rate and exemplary progress over the last 10 years, the country’s leaders could easily be tempted to view HIV/AIDS as yesterday’s crisis.

It is anything but. The central problem now is that testing coverage remains low, particularly at village and township levels. Even among people who do get tested, there is often no follow-up after the initial screening. This is a serious issue among key affected populations such as MSM, IV drug users, sex workers, and their clients.

Greater efforts also must be made to engage community-based organizations in the fight against HIV/AIDS. This is because many people in the key affected populations will not go to regular hospitals.

Community-based organizations can close this gap in testing and treatment. But their current level of involvement is insufficient, and currently there is no mechanism for engaging them in the HIV/AIDS response.

UNAIDS is striving to end the AIDS epidemic as a public health threat by 2030, through reducing new global HIV infections, AIDS deaths, and HIV-related stigma and discrimination by 90% compared with 2010 levels. This is an ambitious target. Reaching it won’t be easy, and we are far from it now.

But the goal is attainable. The science is clear, and the tools work. What’s needed now are unwavering focus and concerted action.

We must focus on attaining a better understanding of where, and why, infections are taking place. And we must deliver the tools that we know to be effective: ART, methadone, condom use, and other behavioral changes.

As the International AIDS Conference convenes, we must sharpen our focus and renew our resolve to take the actions needed to meet our goals.

Great progress has been made, and we should celebrate it. But it is far too early to view China’s fight against HIV/AIDS as a battle already won.

For more information, please contact:

Ms WU Linlin
E-mail: wul@wpro.who.int
Office Tel: +86 10 6532 7191