Workers

HIV/AIDS in China: A workers issue

In the initial years following the identification of the HIV/AIDS virus, the illness was associated with homosexuality – especially in the West, where it was often referred to as the ‘gay cancer’. This assumption contributed to widespread ignorance, discrimination and a lack of resources invested into its treatment. As the epidemic grew, governments began to realise HIV/AIDS threatened the whole of the population, regardless of sexuality. Even as civil society organisations have forced HIV/AIDS to the top of mainstream political agendas, avoidable early death and discrimination remains a fact of life in many countries.

The capacity of HIV to affect the workforce – and therefore productivity and profits – began to dawn on companies and governments as HIV/AIDS engulfed parts of Africa in the nineties. The impact on workers was obvious and some trade unions, especially in hard hit African countries, began to regard their role as crucial in the fight against HIV. For example, Zimbabwe and South Africa now possess a range of anti-discrimination and preventative regulations often fostered by union initiatives. Many unions and union federations, as well as the ILO, now see HIV/AIDS as a key labour issue and moreover a challenge that directly impacts labour and trade union rights. Indeed, the ICFTU believes that “trade unions are uniquely placed to fight the pandemic as the work place could be a major “entry point” for information, prevention and rights campaigns. Among the measures proposed by unions are prevention and protective clauses in collective agreement and partnership with employers.”

HIV affects workers in a myriad of way; from the occupational risks of infection for health workers, the discrimination against HIV people in recruitment or company insurance policies, to the more general economic threats posed by large numbers of sick men and women of working age. Almost all national governments have been slow to see the need for the inclusion of HIV/AIDS related concerns in the language and practice of labour laws and labour protection. In countries where freedom of association and information is restricted, the problem of forcing authorities to face up to the problem has been even more difficult.

Low Prevalence?

It has been officially (and hence conservatively) estimated that somewhere between 840,000 to one million people in China are currently living with HIV/AIDS and that this figure is rising rapidly. Despite this increase, HIV/AIDS in China is regarded as highly unlikely to have the same kind of devastating economic impact that the disease has had in sub-Saharan Africa. Even in the worst case scenarios, which point to as many as 10 million people infected with HIV in China by 2010, the rate of infection as a proportion of the total working population comes nowhere near the 30 percent - and counting - that has blighted the African continent. However, facing up to HIV/AIDS is vital to China’s development. Young people between the ages of 10 and 24, who make up one sixth of the total population and who are traditionally the healthiest sector of the population and the next working generation are increasingly at risk of HIV. It is their awareness and understanding of HIV/AIDS, safe sexual practice and health in general that is crucial in halting the creation of a pandemic in China.

At the same time, we should point out that the notion of ‘low prevalence’ in China, referred to above, is somewhat disingenuous given the population size of China – a million infections in China is in fact less than 0.1 percent of the population – and serves to hide the fact that China is teetering on the edge of an appalling human tragedy that has been gradually unfolding over the last 20 years. It should also be noted that the ‘low prevalence’ school of thought is only useful insofar that it keeps us from panicking and giving support to the kind of draconian measures that the Chinese government has shown itself to be keen on when faced with a major social problem. It is imperative to remember that as well as being a public health, social, and economic issue, HIV/AIDS is also a human rights issue. A worker who admits he or she is HIV positive faces dismissal, social isolation, and increased poverty as well as the often overwhelming medical cost implications.

Seen as a ‘foreign problem’ throughout most of the 1990s, most Chinese who had heard of the disease considered it far away from their own lives. Until very recently, official statistics referred to AIDS patients in the thousands and sufferers as confined to drug smuggling areas such as Yunnan province in southwest China. Local health departments were reluctant to admit that they were facing a growing problem and this set the pace for a culture of concealment and blame. Even today, many people believe that the disease doesn’t concern them and is somehow the result of ‘immoral’ or illegal behaviour; drug users, sex workers, and homosexuals etc. HIV/AIDS activists in other countries will be all too familiar with this kind of scapegoating. They point to government policy and active education programmes that are not weighed down with moral judgements as vital components of efforts to limit infection.

While the situation in China remains grave, there are signs of hope. Thomas Cai is openly HIV positive and runs an HIV organisation, AIDS Care China in Guangzhou. He and his fellow workers promote HIV/AIDS related awareness and provide help to sufferers. Thomas has made use of an increasingly open media to argue that HIV/AIDS is an issue for everyone: “If society can come together and take AIDS seriously, we can beat this problem.” Just five years ago, it would have been more or less unthinkable for an individual who is openly HIV positive to get access to the media in order to make such an argument. From at best ignoring the problem and at worst encouraging ignorance, media outlets in China are at last beginning to play a more positive role in debunking common myths inside China. [ An Operation That Nobody Is Willing To Carry Out ]

There is still an enormous amount of work to do be done in China if we are to control the disease. The intimidation of outspoken of HIV activists continues as do reports of official suppression of protests by disenfranchised HIV carriers and AIDS patients, especially those whose illness was brought on by the practice of blood selling (see below). Problems of discrimination and even violence remain, as does their legacy in the villages of poor provinces.

Government policy – inching towards openness

In a sense foreshadowing initial government policy during SARS, the government and the Ministry of Health at local and national level got off to an extremely poor start in facing up to the spread of HIV/AIDS in China. Secrecy and concealment of the AIDS epidemic was a problem across China, although perhaps the worst illustration comes from Henan, China’s most populous province.

Estimates vary, but there could be as many as one million HIV positive people in Henan’s villages alone. After China banned the importation of blood products in the mid-1980s, a market opened up for local blood. Instead of enforcing safety regulations at the private blood donor stations that sprang up all over Henan, government officials colluded with people known as ‘blood heads’, directly profiting from the lucrative trade and tacitly encouraging low standards of hygiene and bad medical practices. A farmer could get up to 40 yuan (US1 = 8.2 yuan) per donation and this could be used to buy much needed farm fertiliser or pay for children’s education. The results were disastrous as HIV-tainted blood began to spread through the villages. Lack of access to medicine and poor living conditions had direct implications on the speed with which farmers began dying. The situation has been nothing short of appalling for most of the villagers:

“The first person in our village died of AIDS in 1999. At the time, we didn’t know what this disease was; we just knew that those who had it would have severe diarrhoea, low fever, and would get thinner and thinner. When they got near to death, they became skeleton-like. Some would have only 10 days between the onset of the sickness and death. And so people died one by one. We called the disease the plague, and we thought someone had put a curse on our village… We were terrified - what were we going to do? We could only watch as more people passed away.”

The scale of the disaster in rural Henan was finally dragged into the spotlight following courageous reporting by Chinese journalists, doctors, medical workers and activists such as Dr. Gao Yaojie whose work forced the Henan government to publicly address the situation. After many years of denials and downplay, the Henan Health Bureau issued a report in August 2002 in which it admitted the extent of the tragedy even while covering up its own role in creating it. An alternative report written under the alias of He Aigang and available on the Internet gives a much more thorough picture of just how involved Henan government officials were in profiting from the sale of infected blood. The Henan government has promised to scale up its measures to deal with HIV/AIDS including providing affordable drugs and allowing international organisations access to the so-called “AIDS villages”. At the national level, Gao Qiang, the Executive Vice Health Minister officially launched a nationwide campaign in May 2004 to shut down illegal blood stations, which he acknowledged were responsible for many people getting AIDS.

However, despite the tacit acknowledgement of the responsibility of illegal blood stations in the HIV crisis, there has been no mention of bringing to justice those involved. Indeed, despite positive acknowledgement of the problem and some steps towards the provision of more adequate supplies, HIV sufferers, activists and medical staff in the province continue to face beatings and arrest for speaking out about the situation and for protesting against the poor standards of health care. Even the former Deputy Director of the Henan Centre for Disease Control, Ma Shiwen, was detained in August 2003 on charges of revealing state secrets and later released without standing trial. According to Wan Yanhai, a well-known activist, the situation has developed to such an extent that special HIV positive prisons have been built to house protesting HIV patients in Henan.

Tackling HIV at work

Recent economic reforms in China have had a dramatic effect on employment structures and have led to large-scale internal migration in search of work, chiefly from farm jobs in the countryside to off-farm jobs in rural towns and urban centres. Membership of the World Trade Organisation (WTO) and a consequent rise in the import of cheaper cereals and grain from abroad will eventually drive more farmers off the land while the recent – and welcome – relaxation of residential regulations will remove more formal barriers against internal migration. Such mass migrations of young and predominantly male workers often create environments that facilitate and encourage the spread of HIV. The refusal of the government to consider implementing Chinese workers’ constitutional right to freedom of association and of expression will only serve to handicap measures to stop the spread of HIV/AIDS among migrant and local workers.

Yet migration does not have to lead to the potential pandemic that UNAIDS and Chinese specialists warn of. China has a long experience in education campaigns – the literacy campaign of the 1950s is perhaps the most successful ever undertaken anywhere. Government departments and medical officials are beginning to realise that HIV is spreading rapidly among the mobile working population as single men and women travel in search of employment and there is a corresponding growth in the rise of sex workers and extramarital liaisons. Migrant women too face a disproportionate risk of contracting HIV from their partners, a fact compounded by the almost total lack of health care and educational opportunities available to them in the urban areas.

Several non-governmental initiatives are already underway which aim to reach out to migrant workers and rural workers. One scheme, run by the China Youth Development Foundation has been concentrating on teaching HIV awareness to new migrant workers from the rural areas. Such work is urgently needed; a recent survey by the organisation amongst workers in various fields including security personnel, sales people, rubbish collectors and drivers showed that only 19 percent of the workers could identify the three means of HIV transmission.

HIV and health education stations – ideally combined with labour rights education – could be set up at bus stops and train stations where migrants congregate. The mass education programmes promoted after the government admitted the extent of SARS in spring 2003 clearly shows the continuing capacity of the central authorities to galvanise and oversee large-scale civic education projects. Hostels for migrants are dotted all over Chinese cities and could also serve as a distribution point for educational material and the promotion of safe sex. Within the factories themselves there are real opportunities for education and training on HIV awareness and tactics for avoidance, especially given the continued widespread use of factory dormitories and canteens that allow for extensive opportunities for education and communication at the workplace.

The labour press is currently full of articles praising the new labour and legal advice centres that are being set up in many cities, some run by the official All China Federation of Trade Unions, others by NGOs or concerned law students. These too would be ideal centres for HIV/AIDS education. In fact the Guangzhou Federation of Trade Unions (GFTU) undertook a pilot project to hand out free condoms to migrant workers. While this approach should be welcomed, it is clearly sensitive work that needs to be carried out with skill. A GFTU official told the writer that the project ran into difficulties when migrant workers expressed anger at the fact that they alone had been singled out for free condoms. The implication drawn was that outside workers were more promiscuous than local workers.

In Urumqi, the capital of the northwestern Xinjiang Uighur Autonomous Region, it has recently been announced that all employees in “entertainment venues” such as saunas (i.e. sex workers) will be required to obtain health certificates. While this initiative may signal the start of a more open attitude to sex workers and a de-facto legalisation of the commercial sex, it remains to be seen if the requirement is not used to further discriminate against HIV positive people and what complimentary measures the local government has planned. Legalisation of sex work would be a much more effective policy, although this would probably meet with public opposition.

Other than medical workers, sex workers are the other main group of workers to suffer from HIV as an occupational hazard. Worldwide, sex workers are often blamed for spreading HIV and STDS, despite the fact that sex workers around the globe know more about the prevention and transmission of HIV and other STDs than most people, including their clients. The majority would, if their clients agreed, take preventative measures. In a recent survey in Shenzhen reported by the UNDP, it was found that while 71% of sex workers used condoms, only 47% of clients reported using them. Most clients do not use condoms with their regular partners or spouses. In the Shenzhen study most clients believed that condoms did not help stop the transmission of HIV. There needs to be a great deal of practical and positive measures to help halt the occupational spread of HIV among sex workers. Such measures must not simply penalise the workers and should also include client education.

Discrimination at work

Discrimination of employment opportunities and at work is a major problem at a number of different levels including race, gender and age. HIV/AIDS has added another aspect to discrimination. It is still legal – despite a recent smattering of legal challenges by individuals – for the government to allow local recruitment regulations for civil servants to specify how tall or how ‘regular-featured’ (a euphemism for female beauty) a recruit should be in addition to specifying that a recruit should not be Hepatitis B positive. Recently added to some lists of disqualifiers has been HIV. At the same time however, the government has been active in reducing discrimination amongst private sector workers by calling upon provincial and local authorities to draft anti-discrimination legislation, which specifically includes provisions against HIV discrimination and in particular provides against the dismissal of HIV positive staff. On 20 August 2004, the Jiangsu People’s Congress passed the “Jiangsu Province AIDS Prevention Legislation”. This is the first local level legislation specifically aimed at AIDS prevention to be introduced in the country. Preventative measures such as the promotion of condoms and clean needles for drug users – through sales, not free distribution – are included in the legislation. According to a Xinhua report it also requires that:

“No work unit or individual may discriminate against AIDS sufferers and their family members; they must not violate their lawful rights to enjoy medical services or their rights to employment, education and participation in social activities. AIDS patients and people with HIV have the right to marry but they must fulfill their obligation to disclose their illness to their partner and receive medical guidance from medical health bodies. The legislation clearly states the legal responsibilities any AIDS patient or HIV carrier has to shoulder if they violate these regulations.”

Beginning 1 March 2004, Zhejiang Province has required that all staff working in “hotels, inns, beauty salons, music halls, saunas, massage and bath parlours, swimming pools and other places of business will be required to have regular health exams, including HIV tests, and be required to have health certificates…Those infected with HIV and STD will not be permitted to work in service jobs.” For workers outside the service sector “whose jobs risk transmission of HIV or STDs, their work units will be notified and must take measures within one month to adjust the person’s employment. However, it is not permitted to dismiss the person or cancel their work contract, and confidentiality must be ensured.”

One major problem in overcoming discrimination are many current local or provincial laws on infectious diseases which conflict with emerging regulations encouraging confidentiality and state that if local health departments discover a worker to be HIV positive, they must inform his or her employers often leading to dismissal. Given the lack of knowledge of the disease and the amount of myth surrounding infection, it is not surprising that many HIV positive workers have reported being removed from their rented housing or denied access to basic medical care once news has got out at the work place – which it invariably does. The national law on Infectious Diseases (1989) classified HIV as disease that allows for the forcible detention of the patient for isolation and treatment if the patient is unwilling to be treated. It also requires the local health authorities to inform the central bodies of new cases. It was only in the most recent 2004 NPC Congress that a draft amendment to the law was passed removing HIV/AIDS from the list of such diseases and removing the right of the security forces to forcibly quarantine HIV/AIDS sufferers. Recent surveys have shown that an increasing, not decreasing, number of people are unwilling to work with HIV positive people and a deceasing number of people reported that they would care for an HIV positive family member. Not only does this not bode well for enforcing and maintaining anti-discrimination laws, it also sends a warning for the future care of HIV positive patients as a lack of public facilities force more reliance on family support for patients.

Freedom of Association and Civil Society

While better than nothing, the anti-discrimination regulations cited in the previous section still tacitly support some form of discrimination towards HIV positive workers. It is clear that most, if not all, of the new legislation has been developed without the involvement or influence of an open civil society - from trade union scrutiny to the input of the emerging HIV support groups. The official Zhejiang Federation of Trade Unions for example voiced no public objection to the discrimination against hotel workers that is explicit in the new Zhejiang regulations.

Despite constitutional assurances Chinese people do not enjoy freedom of association or the right to freedom of expression. Workers cannot form independent trade unions and citizens have to go through a complicated process to set up a non-governmental organisation (NGO) that must be registered and affiliated with a state institution or department. These restrictions have been and will remain a serious obstacle to the prevention and treatment of HIV and sustained pressure to lift them from within and outside China is essential.

IHLO believes that the lack of freedom of association and the total absence of worker friendly policies fostered by independent trade unions is a contributory factor to the apparent hardening of public attitudes to HIV/AIDS even as the government is attempting to open the issue up. In Shandong province for example, the provincial authorities passed a regulation in May 2004 which expressly forbids the dismissal of a worker or the breaking of a labour contract with an employee because that employee has HIV /AIDS or is an HIV carrier. However, according to China Daily reports, local people still reported that they would rather resign or leave work than remain at work with an HIV positive co-worker. In fact most believed that the company had a duty to dismiss employees who are HIV positive.

Despite the restrictions, semi-independent organisations have made great headway even in the face of police arrests and intimidation. Perhaps the most successful are the informal ‘tongzhi’ or ‘comrade’ groups which are springing up in most major cities. Inspired by the gay community, these groups aim to provide information on HIV/AIDS via the Internet, pamphlets, and safe houses. These initiatives are extremely welcome, but if they are to be effective they will have to be accompanied by effective and non-authoritarian government measures, regulations, laws, and policies, especially given the size and mobility of China’s population. At the moment many initiatives occupy the grey area between state sanctioned and semi-illegal activities. As stated earlier, intimidation of activists remains common and open media coverage of the HIV crisis (and the situation in Henan) remains potentially risky for the many Chinese journalists who are attempting to cover the issue.

Insurance and Compensation

The first health insurance scheme for medical workers at risk of infection with the HIV virus was set up in April 2003 in Mudanjiang City in the northeastern province of Heilongjiang. According to reports in the Chinese media the scheme was launched by a private insurance company, “New China Life Insurance Company”. The scheme in a sense reflects more generally the increasing privatisation of social insurance as state insurance schemes continue to falter at the first hurdle and remain woefully short of funds. Many doctors cite the risk of HIV infection, and the lack of insurance for such infection, as prime reasons for their unwillingness to treat HIV positive patients. It is a vicious circle of discrimination and inadequate policies.

Access to Medicine; TRIPS and the WTO

Current government spending on health care is clearly insufficient and the health sector is particularly corrupt. Many millions of people, especially in rural China, do not have medical insurance and do not have access to proper health care facilities and medical staff. For many of the poor in China, even a simple operation or illness can spell financial ruin due to the high cost of medicine and hospital case and the ubiquitous fees throughout the health care system. For many, contracting HIV still means a death sentence. Even with the proper prevention and education campaigns, the situation will not be ameliorated without other strategies regarding treatment. It is IHLO’s view that the current HIV/AIDS situation in China, as in much of the developing world, demands that the government issue compulsory licensing permitted by Article 31 of the Trade Related Intellectual Property Rights (TRIPS) Agreement. This would allow cheaper copies of the HIV drugs to be produced and sold at lower costs in China itself, and crucially, with no immediate obligation to negotiate with international pharmaceutical companies beforehand. The conditions for such an arrangement are a ‘national emergency’ which China is clearly facing, whichever way one defines the term.

Until recently, the Chinese government has been keen to show adherence to TRIPS and chosen to negotiate with the transnational corporations (TNCs) producing the drugs rather than issue compulsory licensing. This tactic has extracted some price drops from the TNCs, but the current monthly cost of treatment is still US$361, which is way beyond the budget of most people who have contracted HIV. The Northeast China Pharmaceuticals Group Company has begun manufacturing a legal imitation of the AIDS drug AZT as the patent has already expired, and the Shanghai Desano company is producing another three drugs. These imitations will bring the cost down further to between US$30 and US$100 per month. Yet this is still way too expensive for most workers. Moreover, migrant workers are generally not included in employer health insurance schemes and, as already mentioned, there is no health cover or insurance for farmers at all.

At this juncture it is unclear whether China will actually take the plunge and allow large-scale production of generic AIDS drugs as Brazil and India have done, or whether it will use its rights under the TRIPS agreement to issue compulsory licensing against the objections of the international pharmaceutical industry. There is certainly pressure from the local media and many doctors inside the health system to do so. Indeed in October 2002, the Beijing Youth Daily encouraged the government to “… consider using the benefits that the TRIPS Agreement affords and establish the technical, market, and legal conditions that would facilitate compulsory licences”.

For their part, the pharmaceutical TNCs have hardly been co-operative and have used China’s partial reliance on foreign investment to drive economic development as leverage. An example of their attitude can be seen in their reaction to general drug purchasing measures in Shanghai. In 2002, the city issued a set of regulations aimed at reducing hospital drug budgets via centralised bidding and purchasing methods. Space precludes an explanation of these complex regulations in detail, but according to a recent report in the 21st Century Economic Herald, the net result was a substantial drop in the sales of pharmaceutical TNCs in Shanghai. The companies, represented by the Foreign Pharmaceutical Manufacturers Association in Beijing, responded with undisguised threats. On 28 April 2003, the association sent a fax to the Shanghai Department of Health demanding that the government “… reconsider the said policy”. The fax continued “… we originally planned to continue investment in Shanghai…but will change our thinking”.

The government has managed to negotiate a deal with GlaxoSmithKline for a reduced price for 3TC, an essential component of the most effective treatment for HIV/AIDS –combined triple therapy. Previously, 3TC had been missing from China’s domestically produced triple therapy and the lack of it had caused severe side effects in the patients. Although the process of negotiation has been a long and arduous one with numerous delays, the end result is that there will be improved access to an effective and cheap triple combination therapy.

In addition to willingness to extend the provision of therapeutic HIV drugs, some provinces, such as Liaoning, Guangdong, and Beijing have recently begun to add selected antiretroviral drugs (ARVs) onto the list of medicines that are available under the local medical insurance schemes. Despite the often limited nature of these schemes this development is welcome. A further sign of government’s moves to improve the provision of AIDS medicine throughout China is evident in the decision to add some 13 types of ARVs to the national health insurance list, along with drugs related to the treatment of AIDs related influenza and the treatment of active Hepatitis B.

Government projects to combat HIV

The United Nations’ ‘Titanic’ report on the spread of HIV/AIDS in China, which warned of a nationwide epidemic played a major role in dragging the issue out where it belongs – in the open. Despite an initially defensive government reaction, the UN report does seem to have concentrated minds in high places. On International AIDS Day in 2002, the state media was flooded with articles on HIV/AIDS, many addressing previously taboo topics such as blood selling, AIDS orphans, and sex work with some papers even suggesting that the latter be legalised in order to regulate the industry and promote safe sex – the reaction from the Ministry of Health was a flat ‘No’. The years following 2002 have seen an incremental increase in the open discussion of HIV problem and related issues.

And yet media coverage on AIDS Day is obviously not enough. Sustainable educational projects that reach the majority of those with HIV or at risk from it are urgently required. Approximately 71 percent of HIV positive persons live in the countryside, many in areas where newspapers are rarely seen. According to a survey conducted by the State Family Planning Commission in 2000, 23 percent of them had never heard of AIDS.

In April 2003, the Chinese government began a politically sensitive pilot program called China Comprehensive AIDS Response (China CARES). This broad community-based treatment and care program aims to supply free domestically manufactured anti-retroviral (ARV) AIDS medication to HIV patients who contracted the AIDS virus through tainted blood transfusions. The initial phase of the plan called for the establishment of 124 treatment centres and for ARVs to be distributed to more than 3,000 people in 56 counties in 11 provinces, including the seven most affected provinces: Anhui, Henan, Hubei, Shanxi, Shaanxi and Sichuan. According to the Ministry of Health (MoH) the decision to target former blood sellers was made firstly because many were infected ten years ago and were now beginning to develop AIDS and secondly because they are primarily concentrated within 56 out of China’s 2,800 counties, and such concentrated grouping would allow health officials to better implement the community-based treatment and care program. The initial group of 56 counties has now been expanded to some 127 counties. As of July 2003, the program was reported to have distributed AIDS medication to an estimated 61 people in Sichuan, 200 in Anhui and 420 in Hubei. In Shangcai County, a badly affected area in Henan Province, 2,550 people were receiving medication, 200 in Xincai County and 120 in Queshan County. There are plans to expand the program to other groups such as intravenous drug users – still the main route of infection according to the government – and commercial sex workers once the China CARES pilot program has been established.

The focus on the health care system brought on by SARS has also led to other initiatives. For example, new measures include those announced in late 2003, which offer free medical care to all HIV carriers and AIDS patients in rural areas and to urban people in financial difficulties. Initially the scheme would cover some 5,000 HIV carriers and AIDS patients who would receive free treatment and would be extended to cover all “poor” HIV carriers and AIDS patients in 2004. Government plans also include the training of additional doctors and other medical staff in the care and treatment of HIV/AIDs.

In October 2003, China successfully applied for a US$98 million grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria which will be used to expand China CARES. Two previous applications were turned down as government policies were deemed to be too secretive. Combined with US$200 million provided by the Chinese government, the MoH intends to use this grant to increase the quality of care and significantly expand the number of HIV patients under treatment from 3,000 to 40,000 within the 127 counties. In five years China CARES anticipates having 300,000 people taking advantage of voluntary testing and counseling, with more than 90 percent of HIV patients in the selected counties having access to care, monitoring and basic health services. These health services include treatment for opportunistic HIV related infections and access to supervised ARV treatment. According to the MoH, intravenous drug users and prostitutes in the targeted counties will also be eligible for treatment and care.

Conclusion

This article has done no more than scratch the surface of HIV/AIDS in China. In many ways, the pattern of denial, concealment, corruption, lack of access to drugs, and social prejudice is no more unique to China than are the emerging signs of hope. These include the recent moves such as endorsing methadone and needle exchange for intravenous drug users and attempts to reduce discrimination as well as international grants. As well as US$98 million from the UN Global Fund, a second application for more than US$60 million, also from the Global Fund, has already been approved pending clarifications from the Chinese side and will be used mainly for projects addressing HIV/AIDS among sex workers and drug users. This signals a major step forward in investment in treatment and prevention.

But serious problems remain – not least the flawed dynamic between central government and local authorities that obstructs many of the more positive policies from Beijing and not just in the field of HIV/AIDS. Corruption, secrecy and even criminal behaviour will, if allowed to continue, further lock HIV/AIDS treatment and prevention into a cycle of lack of treatment, poor testing procedures, and an overall lack of balance in responses.

If the money from the Global Fund is not to be wasted, in addition to concrete practical measures we need to fight for a sea change in the political, social and medical environment in which government policies are implemented and activists operate. International NGOs and small local groups inside China are beginning to make progress. But they need the support of labour groups and trade unions outside China as well as the official state-run union inside China to move ahead.

HIV/AIDS is a workplace issue in China and we need to get it on the agenda of the labour movement as soon as possible.