With HIV infection in China
on the rise, it is a cause of great concern that HIV-related stigma
remains an obstacle in access to testing and treatment. Last year, South
African Supreme Court Justice Edwin Cameron described HIV-related stigma
in China as a "tragedy" for preventing people living with
HIV from accessing what is otherwise a "very good treatment program."
According to his data, whilst between 35,000 and 40,000 HIV-positive
people in China are effectively receiving treatment, more than twice
that number are unwilling to be tested or receive test results because
of fear of stigma and remain untreated.
Justice Cameron is indeed correct
when he says that China has a very good treatment program. China’s Statute
on AIDS Prevention,
in force from March 2006 consists of 64 regulations, which require local
governments to provide anti-retrovirals at no cost to rural and low-income
urban HIV-positive people. Local governments also must provide treatment
to pregnant women at no cost and counselling and prevention information
about mother-to-child HIV transmission. In addition, the Statute also
requires that all HIV tests be given at no cost and bars officials from
disclosing the names or personal information of those who test positive.
According to UNAIDS, in 2007,
there were 700,000 people living with HIV/AIDS in China.
The figure, however, could in fact be 10
times higher given
the extent of under-reporting and since HIV-testing remains uncommon
throughout China. According to a report by the Chinese Ministry of Health, there were 22,299 new HIV/AIDS cases
reported in the mainland in the first half of 2008. Low rates of condom
use have been blamed for the steady
rise in the ratio
of sexually transmitted infections, a marked change from the pre-2003
situation, when intravenous drug use was the dominant means of HIV transmission.
The Ministry of Health reported that heterosexual and male homosexual
transmission climbed to 37.9 percent and 3.3 percent in 2007, respectively,
from 10.7 percent and 0.4 percent in 2005, respectively.
A study conducted by Beijing’s Renmin University
and supported by UNAIDS is particularly telling with regard to attitudes
to HIV-positive people. The study, released September 2008, which involved
interviews with 6,000 people in six Chinese cities, found that more
than 63% said they would be unwilling to accept services such as hairdressing
from an HIV-positive person, and more than 41% said they would be unwilling
to work with someone living with HIV/AIDS. Also of concern is the study’s
finding that less than one-fifth of respondents said they would use
a condom if they had a sex with a new partner. According to another report,
although it is illegal to discriminate against people living with HIV/AIDS
in China, HIV-positive people continue to be banned from public facilities
such as gyms and bathhouses, and some offers of employment make HIV
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The Government of China is
certainly not ignoring the issue when it comes to men who have sex with
men (MSM), having launched a campaign earlier this year targeting the estimated
5-10 million Chinese men in this group. The campaign involves stronger
promotion of condom use, expanded coverage and quality of HIV prevention
activities, increased access to voluntary HIV counselling and testing
services, and improved access to treatment for sexually transmitted
infections. UNAIDS, however, has highlighted the shortcomings of these
efforts, with stigma and discrimination still all too prevalent amongst
the general population and even within the MSM community itself.
Causey, a Bangkok-based
consultant working with the Asia Pacific Coalition on Male Sexual Health
(APCOM) and the United Nations on MSM-related issues, has highlighted
not only the MSM-related stigma but also that the problem in China has
impacts beyond the MSM community: "Most Asian men who have sex with
other men are not open about their sexual behavior. Social taboos and
discrimination mean that many opt to disguise their sexual preferences…Given
that many men who have sex with men also have sex with women, high HIV
rates among MSM can also translate into substantial numbers of women
at risk of exposure to HIV."
HIV-related stigma and discrimination
impede all efforts towards an effective response for HIV prevention,
treatment, and support. The stigma attached to sexual preferences will
clearly impede any potential success of China’s latest MSM campaign.
Such a campaign, if successful, would clearly have positive benefits
beyond the MSM community. However, given the alarming rise in infection
rates since 2005 for heterosexual transmission (up to 37.9 per cent
of infections) and the low-rates of condom use indicated in the Renmin
University study, too great a focus on the MSM community would
leave other vulnerable groups, including women in hetereosexual relationships,
without the necessary information or services to protect themselves.
If the Government of China is serious about addressing the increasing
rates of HIV-infection, not only in the MSM community but across all
vulnerable groups, it must recognize how discrimination and other human
rights violations inhibit not only access to testing, treatment and
other essential services but also discussion amongst the wider population
about prevention and treatment of persons living with HIV/AIDS.