Compared with many of its neighbors, China has hardly felt the AIDS pandemic. As of last fall, the government had recorded only 80 AIDS cases and 2,600 HIV infections among the country’s 1.2 billion people. Even if the true number of infections is closer to 100,000, as health officials suspect, that’s a tiny fraction of Thailand’s estimated 1 million or India’s 4 million. But economic growth, dizzying social change and an unstable blood supply are conspiring to create unprecedented hazards for the world’s most populous nation. “If protective measures are not taken in time,” a 1993 government report concluded, “the Chinese nation will suffer a disastrous assault and irredeemable losses.”
The assault is advancing on several fronts. So far, the greatest losses have occurred in the southern Yunnan province, where HIV has followed heroin across the borders from Burma, Laos and Thailand. The first victims were drug users, who contracted the virus through needle-sharing. Now heterosexual contact is spreading HIV through Yunnan’s ethnic communities. Meanwhile, free markets and open borders have brought AIDS to China’s burgeoning coastal cities. In the island province of Hainan, where prostitutes crowd the palm-lined streets, the reported incidence of sexually transmitted diseases rose more than 170-fold between 1984 and 1994.
In the past, what was dangerous in Hainan might have been safer in Shanghai. But as China grows more mobile, regional problems become national ones. In recent years, an estimated 120 million peasants have fled rural villages to seek work in the cities and on the roads. And as Africa’s experience makes clear, rootlessness is itself a risk factor for AIDS. Unskilled migrants sustain the sex trade, both as buyers and sellers. Their venereal infections go untreated, leaving them doubly vulnerable to HIV. And those with the virus continue to support themselves, whether by selling sex or by selling blood.
Health experts worry more about sex than they do about blood, if only because love-making is more common than any hospital procedure. But no one denies that China’s blood supply is a hazard. Penniless migrants can earn up to $50–the equivalent of a month’s factory wages–for a 200-ml donation. And as the recent tragedy near Beijing suggests, the standards for screening and sterilization are at best sporadic.
Can the country avert the “irredeemable losses” its leaders foresee? The obstacles range from fear and ignorance to the corruption of local party officials. But experts are optimistic. With help from the World Health Organization, Beijing has adopted a sweeping five-year prevention plan. Teachers and health workers are blanketing some provinces with leaflets, lectures and videos about safe sex. Clinics are relearning the art of treating syphilis and gonorrhea. The plan includes initiatives for screening blood and sterilizing medical instruments. The effort will be costly, but as the Chinese proverb says, “Repair the house before it rains.”
