Guest article by Dr Bernhard Schwartländer, World Health Organization (WHO) Representative in China
I first came to China more than 15 years ago. At that time, China was just starting to come to terms with the HIV epidemic, and scale up its response. Not long after that, the first methadone clinics were opened. The early days of China’s HIV response were filled with hard and bitter lessons. But they showed me firsthand what China can achieve when it sets its mind to overcoming a challenge.
The HIV epidemic in China was driven by initially by injecting drug use. China’s response: set up a massive national network of needle exchanges and methadone centres. There are now 763 clinics across the country. China is a world leader in this. The result? A marked reduction of HIV prevalence among people who inject drugs.
I am heartened by the incredible progress China has made since the first outbreaks of AIDS. Compared to my early days, China is now much better placed to prevent HIV infection, and doing better at caring for those living with HIV. Yet as we recognise World AIDS Day, I know there is much more China needs to do.
It is time to bring the same spirit of pragmatism and innovation which created a world’s best practice methadone treatment program to the challenges with HIV that we confront in China today. Chief among these is the fact that the HIV epidemic in China is now largely driven by sexual transmission – in particular among men who have sex with men, where HIV infections are on the rise. But the heterosexual population is not immune: HIV infections are not decreasing in this population either.
We must do better than this, starting with making safe sex “sexy”! We need to find new, interesting, innovative, effective ways of promoting safe sex in China, especially including condom use. Because every new HIV infection is one too many; every new infection is one that could have been avoided.
There are other areas of the HIV response where China is doing well, but can do better. Take antiretroviral drugs. These drugs were a major breakthrough in the AIDS response, because they defer HIV infection progressing to full-blown AIDS. China is a leader in ‘Treatment as Prevention’ using antiretrovirals: for instance, these drugs are provided free of cost to couples when one partner is HIV positive and the other is HIV negative. This is good for the health of people living with HIV, and it will prevent transmission of HIV to their sexual partners.
But the antiretroviral treatment regime must be made much simpler, to improve uptake and adherence. People taking antiretroviral drugs in China have to take 5 or 6 pills every day. In most parts of Africa and the rest of Asia – including some of the poorest countries in the world – people on antiretrovirals need to take just one pill per day, in a fixed dose combination. By not making this fixed dose combination available here, China is falling behind the pack.
More also needs to be done to improve HIV testing. Many people with HIV actually don’t know their status, and therefore miss out completely on treatment. There are now self-test kits, and rapid HIV tests that give results in 20 minutes. Through innovations like this, we can bring HIV testing to the people – and they can benefit from treatment as they need it.
Perhaps most importantly, we must eliminate stigma and discrimination towards people living with HIV, and at-risk populations such as men who have sex with men, sex workers, and injecting drug users. I’ve seen some of my own colleagues in the medical profession turn patients away because they disapproved of the person’s sexual orientation. That is simply unacceptable, and it has to stop.
“Close the Gap” is the global theme of this year’s World AIDS Day. This means we have to work harder, and smarter – to close the gaps in access to prevention and treatment, as well as the gaps we know exist in education, awareness and action, in order to end the HIV epidemic.
This World AIDS Day is special: 30 years have passed since the virus was first discovered. We have a wealth of experience, and evidence of what works and does not work. We have the science and the tools – we just need to take them out of the toolbox. And we have the power and resources of a great nation that has proven, again and again, that it can be done. The China of today has made much progress from the China I first knew. On World AIDS Day, I want China to “close the gap”, so that the China of tomorrow ends the HIV epidemic for good.