Asia Owns Up to AIDS, Slowly

DECEMBER 2, 2005 •
By Bruce Einhorn

Long in denial over the problem, Chinese officials are allowing some
outside help into the country. But India's leaders are dragging

With "Chindia" having captured the attention of so many people in
the world of business this year, it's no surprise that China and
India took center stage on World AIDS Day 2005. On Dec. 1, as public-
health experts worldwide assessed the battle against the virus, many
were worrying about whether the governments of Asia's giants can
prevent their HIV/AIDS problems from spiraling out of control among
their 2 billion-plus people -- and threatening China's and India's
ability to become 21st century economic powers

In China, the question is whether a communist regime can cope with
the kind of openness needed when tackling HIV/AIDS. Jeff Busch, a 47-
year-old former investment banker, knows from first-hand experience
how far China has come -- and how much officials there still need to
do. Busch runs the Safe Blood International Foundation, a nonprofit
that in the spring formed a joint venture with the Chinese Health
Ministry to help cope with the problem of HIV-tainted blood (see BW
Online, 5/10/05, "China Wakes Up to the AIDS Threat").

In late November, Busch traveled to China to attend the opening of
Safe Blood's first facility, a training center for health workers in
central Henan province. This was a big deal, a milestone not just
for Busch and his nongovernment organization (NGO) but for China
too, since it would be the first time the country had worked with
foreigners to overcome Chinese shortcomings in protecting its
citizens from the deadly virus.

CHANGE OF ATTITUDE. To mark the occasion, Busch was to travel to
Zhengzhou, the capital of Henan, with a top Health Ministry
official. The media would be there, to give people in China and the
rest of the world an indication of China's new, more open attitude
toward HIV/AIDS.

But just a few days before the opening, that attitude gave way. New
rules stipulated no reporters. "We had it as an open event, and then
we were just told that it wasn't," says Busch. Local officials were
nervous about letting in the media and calling too much attention to
the facility and the HIV/AIDS problem in Henan, which has some of
the highest infection rates in the country. The official figure is
25,000 cases, but many people think that the real number is much,
much higher.

While Busch says he's very impressed with the attitude of Health
Ministry officials in Beijing, getting the locals on board is
another matter. "The provinces are slower in moving," he says.

The good news is that at least officials at the national level are
moving speedily. Safe Blood isn't the only NGO from abroad that's
making progress in China. The Clinton Foundation, run by the former
U.S. President, has started working in the country, and the Global
Business Coalition on HIV/AIDS (GBC), run by Clinton's former U.N.
Ambassador Richard Holbrooke, is active, too. In November, the
Baylor International Pediatric AIDS Initiative, part of the Texas
university's medical school, signed an agreement to open a treatment
center for HIV-positive children in the city of Kunming, in
southwestern Yunnan province, another place where infections are
high.

TWO APPROACHES. Both India and China have serious problems (see BW,
8/22/05, "Crouching Tigers, Hidden Dragons"). With over 5 million
people with HIV/AIDS, India has more residents with the virus than
any place outside of Africa. No reliable statistics exist on the
number of people with the virus in China. Estimates range from
840,000 to several million. And for a long time, the Chinese were in
denial about their HIV/AIDS problem, with the government starting to
face up to the magnitude of the mess only after the SARS debacle in
2003 illustrated the consequences of ignoring or covering up a
public-health crisis.

You might think that India, as a democracy, would be better able to
deal with the virus than China's communist cadres. China has a
history of locking up AIDS activists, for instance. But GBC
Executive Director Trevor Neilson says, now that the Chinese
government has gotten past the denial stage, he's seeing a lot more
progress in China than in India. "India is largely sitting around
talking about this [problem]," he says (see BW Online,
3/14/05, "India: Success Tainted by AIDS").

The Chinese, on the other hand, have mobilized the bureaucracy, with
top officials in each ministry now responsible for HIV/AIDS
prevention and awareness work. (According to the Indian press, on
World AIDS Day the Indian Prime Minister, Manmohan Singh, called for
a major effort to fight HIV/AIDS. Singh is chairman of India's
National AIDS Council. He announced plans to revamp the health-care
system to improve the treatment people with HIV/AIDS receive.)

Certainly, the Chinese aren't where they need to be yet, as Safe
Blood's Busch can testify. The central government in Beijing may
have recognized the importance of tackling HIV/AIDS, but that
message still hasn't quite made it down to the provincial
level. "The Health Ministry needs the cooperation of the provinces
to put together programs for HIV prevention," he says. "It's not [a
matter of] ordering them but working with them."

"WE HAD TO BREAK THROUGH." Busch and his colleagues had to spend
months reassuring officials in Zhengzhou that they should adopt Safe
Blood's American-style methods for training workers to handle blood
that might carry HIV. "It took quite a bit of convincing," he
says, "and lots of visits." Busch reckons that people from Safe
Blood made the trip from Beijing to Zhenghou every week for about
six months. "There has never been hostility, " he say, "but they've
been used to doing things a certain way for so many years, and we
were changing them. We had to break through the resistance."

Now that he has managed to do that, Busch is hopeful that Safe Blood
will be able to open more centers -- in Yunnan and the other in
Beijing -- next year. If he and other NGOs make more progress, then
the gap between China and India might be even bigger by next year's
World AIDS Day.

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