In September 2018, China announced that the number of citizens living with HIV/AIDS has increased by 14 percent, with more than 820,000 people infected. By the second quarter of 2018, there had already been reports of 40,000 new cases. What has happened to spur such a sudden increase in these diseases, and what is being done to combat the rising AIDS epidemic in China?
Spreading the Disease
Recently, the spread of the diseases has been through sexual intercourse, which is a change from the past where the majority of transmissions were through blood transfusions. Officials report that HIV being contracted through transfusions has been reduced to almost zero percent. On a year by year basis, HIV/AIDS has been rising by almost 100,000, with the LGBTQ+ community being one of the main populations affected.
Despite homosexuality being decriminalized in 1997, the conservative and traditional values of the Chinese continue to reinforce discrimination against the community. Studies show that eventually 70 to 90 percent of men who have sex with men (MSM), will eventually marry women due to social pressure, familial legacy protection or fear of discrimination. Women who marry MSM are a high-risk group for contracting HIV as a study concluded that only 16 percent of the sexually active MSM population have used a condom consistently in the past 6 months.
Injection drug users (IDUs) and sex workers make up the majority of the people affected in AIDS epidemic in China. An estimated 44 percent of IDUs and 19.6 percent of sex workers have contracted the disease through infectious surfaces, partners, clients or unsanitary employment offices. Since the majority of IDUs and sex workers live in detention centers due to the illegality of drug use and sex work, screening programs and sex education are more accessible for this high-risk population. However, it is difficult to provide free sex education outside of detention centers to those who are currently working in the field.
Sexual health education is also not a requirement of the current education curriculum in China. Many lessons that are offered are through non-government organizations or private schools through pilot projects. A survey of Chinese university students published in 2017 reported that only 44 percent had received sexual health courses before entering university.
With the younger generation becoming more liberal, attitudes towards premarital sex are becoming more progressive and less conservative. Combined with the lack of sex education, the number of HIV diagnosis from 2008 to 2015 of citizens aged 15-24 years has doubled. As a result, many Chinese universities are now offering HIV testing kits at a discounted price.
Despite government efforts to fight the disease and reduce rates of transmission, there is no legislation that protects HIV-positive and AIDS-positive individuals from employers that discriminate them. Many employment laws bar these individuals from several professions and increase the negative social stigma around individuals positive for the disease.
In a report issued by the International Labour Organization and China’s Center for Disease Control and Prevention, it is noted that the national policy for civil servants requires individuals to be HIV and AIDS negative. Along with other sexually transmitted diseases and infections, those who are positive for such disease are barred from working in public places such as bars, hotels, restaurants, beauty salons, and hairdressers. Many employers also demand to test employees, and those who are HIV-positive are denied employment, forced to resign from their position, or demoted.
Given the widespread misconception and stigma that surrounds HIV/AIDS in China, results of a survey by the Chinese Health and Education journal prove unsurprising. It found that 51 percent of respondents would not shake hands with someone who is HIV-positive, and 80 percent would not buy a product with them. The lack of education and knowledge around HIV/AIDS not only increases social pressure and discrimination but provides an unhealthy mental headspace for those who are positive for the diseases and may result in a fear of seeking treatment.
The Four Frees and One Care policy implemented in 2003 continues to promote universal medical aid for those who suffer from HIV or AIDS. Since 2014, 99 percent of medical funding towards treatment for these diseases have been domestically funded with the first low-income HIV treatment pill being introduced into the market in early 2018. The Chinese government also provides antiretroviral (ARV) programmes and have increased the accessibility to methadone, an opioid drug used to combat HIV.
China has the economic stability and medical research to halt the HIV/AIDS epidemic. However, efforts against the diseases are being curtailed by the lack of sex education and negative social stigma. Discussion about safe sex and how to avoid transmission through sexual intercourse should be mandatory in curriculum before entering higher level education and accessible for low-income populations in order to effectively decrease the number of cases in the AIDS epidemic in China.