Shanghai plans responses to AIDS

The Lancet 2005; 365:1524-1525 [DOI:10.1016/S0140-6736(05)66435-5]

Scott Burris a, Joanne Csete b, Xia Goumei c, Zhou Dan d
and Bebe Loff e

On Dec 15, 2004, a meeting was convened in Shanghai, China, to
discuss options for laws dealing with HIV/AIDS at the provincial and
municipal levels. The primary agencies responsible were the Shanghai
Academy of Social Sciences, the Shanghai Law Society, and the
Institute of Legislation and Temple University in the USA. With a
population of some 13 million, Shanghai is China's largest city and
enjoys a legal status equivalent to a province, enabling it to
create its own law. Participants in the meeting were mainly leaders
of the municipal government (including members of the Municipal
People's Congress and the health department), and researchers from
the Shanghai Academy of Social Sciences and other research
institutions. The meeting showed Shanghai's commitment to effective
HIV/AIDS legislation and the challenge of steering HIV/AIDS policy
through the shoals of fear and moral disapproval of drug use and
prostitution.

Both the content and process of law reform were addressed. A law-
reform exercise in Australia in the early 1980s was offered as an
example of a consultative process in which affected populations were
encouraged to share their experiences. Over 2 years, non-
governmental organisations were encouraged to come forward to help
shape the law, law that in turn supported an environment of
partnership between government and community.

At the Shanghai meeting, three important areas of concern were
identified, each tied to a different legal strategy for HIV/AIDS
control. First, there remains a great deal of anxiety in some of
those in the legislative process about low-risk exposures and
attempts to intentionally transmit HIV. Speakers and participants
offered anecdotes about vengeful people with HIV deliberately trying
to infect others, and robbers using infected needles to intimidate
victims. Similarly, some speakers alluded to the necessity of
testing hospital patients to protect medical staff, and disclosing
HIV test-results to employers to allow safety-related job
reassignment.

Fears about deliberate exposure to HIV have elsewhere come to be
regarded as exaggerated. Mandatory testing and disclosure as a means
of protecting individuals from exposure to HIV is elsewhere seen as
unnecessary and even counterproductive.1 The universal precautions
approach, in which workers are trained and equipped to manage
occupational exposure to blood or infectious body fluids, is now
well established. The Chinese Centres for Disease Control plans to
promote this approach, but it does not yet appear in Chinese
HIV/AIDS legislation. Including a universal precautions approach in
Shanghai's legislation, and providing the support for the necessary
training and equipment, could set a valuable example.

A second important theme was the need to enhance the involvement of
non-governmental organisations in HIV/AIDS prevention and care in
China. People in vulnerable populations, such as drug users and sex
workers, have begun to organise in China to advocate for policy and
law that respects their rights. The Shanghai meeting was notable for
the participation of an openly gay lawyer, Zhou Dan. Although
Chinese law formally contemplates a vital role for non-governmental
organisations in HIV/AIDS prevention and response, there are many
legal and social barriers to the development of a vigorous sector
for non-governmental organisations in China.2 The requirements for
establishing non-governmental organisations are set for the most
part at the national level, and include provisions requiring such
organisations to have a government or official sponsor, and that
allow only one non-governmental organisation on a topic for each
jurisdiction.3 Partnerships between Chinese non-governmental
organisations and non-Chinese funders and providers of technical
assistance are also limited. Whilst eliminating these barriers would
require national legislation, local governments can encourage the
participation of non-governmental organisations by providing greater
funding to these organisations and actively involving them in
planning and evaluation of HIV policies and programmes, including
the development of good law. Creative legal work might identify ways
in which provinces and municipalities can reduce bureaucratic
barriers to non-governmental organisations in the absence of reform
at the national level. Representatives of the Shanghai
administration reported that the problem of non-governmental
organisations will be addressed in the municipal legislation.

Finally, the meeting also highlighted the importance of policy
implementation. The approval of needle-exchange and drug-treatment
programmes on paper, or the passage of privacy and discrimination
protections, is not sufficient to assure that services are actually
delivered in a way that meets policy goals. Legislative planning
must include funding for training and monitoring of performance. The
implementation problem is particularly great in the area of privacy
and antidiscrimination law. Vitally, there was no disagreement that
people with HIV should be protected from discrimination and from the
inappropriate release of their medical information. At the same
time, however, it was also widely accepted that China lacks an
effective system for the enforcement of these basic human rights. An
enforcement mechanism, such as a Human Rights Commission charged
with investigating discrimination cases and promoting compliance, as
well as legal services, will be necessary to provide real protection
that people with HIV can rely on.

We declare that we have no conflict of interest.

References

1. World Health Organization. UNAIDS/WHO policy statement on HIV
testing.
http://www.who.int/hiv/pub/vct/statement/en
June, 2004 (accessed March 14, 2005)(accessed March 14, 2005)

2. State Council of China. Chinese national medium-and long-term
strategic plan for HIV/AIDS prevention and control (1998–2010).
State Council Document GF (1998) 38.
http://www.usembassy-china.org.cn/sandt/hivpolicypr98-2010.h...
Nov, 12, 1998 (unofficial translation, accessed March 8, 2005)
(unofficial translation, accessed March 8, 2005)

3. State Council of China. Regulations for registration and
management of social organizations. Order number 250.
http://www.humanrights-china.org/zt/NGOs/..%5CNGOs/200412004...
Sept, 25, 1998 (unofficial translation, accessed March 8, 2005)
(unofficial translation, accessed March 8, 2005)


Affiliations

a Temple University Beasley School of Law, Philadelphia,
Pennsylvania, PA19122, USA; Johns Hopkins School of Hygiene and
Public Health, Baltimore, Maryland, USA; and Center for Law and the
Public's Health, Johns Hopkins School of Hygiene and Public Health,
Baltimore, Maryland, USA

b Canadian HIV/AIDS Legal Network, Montreal, Quebec, Canada

c Centre for Public Policy Study of HIV/AIDS, Shanghai Academy of
Social Science, Shanghai, China

d Richard Wang & Co, Shanghai, China

e Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Victoria, Australia

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