By Bruce Einhorn On May 8, China's official news agency, Xinhua, carried an item that a few years ago would have been almost unthinkable. The government of Yunnan province, a region in southwestern China that has the greatest concentration of HIV infection in the country, has formed a partnership with the Clinton Foundation to combat the spread of HIV and AIDS in the area.
The news is significant because for many years, China was unwilling to admit the scope of its HIV problem. As a result, asking for help -- let alone from the U.S. -- was unthinkable. And the government looked askance at those who tried to bring attention to the issue -- arresting activists was not uncommon.
DANGEROUS TRADERS. But Beijing's attitude toward HIV and AIDS has started to change, especially since President Hu Jintao and Premier Wen Jiabao took charge in 2003. Indeed, the Clinton Foundation, run by former President Bill Clinton, isn't the first nongovernment organization to make inroads into China. Last month the Safe Blood International Foundation, a U.S. nonprofit, formed a joint venture with China's Health Ministry to help the governments of Yunnan and Henan -- a province in central China that, like Yunnan, has a significant problem with HIV.
Safe Blood's aim is to improve the blood supply -- a vital goal if China is to make any headway in tackling not only HIV but hepatitis. "The general problem is just bad blood-safety practices -- reuse of needles, bad quality-control systems, poor training," explains Jeff Busch, the 47-year-old former investment banker who launched Safe Blood in 1999. The NGO now has operations in 18 countries in Africa alone.
Busch says the traders who ran private blood banks, buying blood from anyone and selling it to official blood centers, made the problem even worse. One of the reasons that Henan has such a serious problem today is the popularity these blood entrepreneurs enjoyed. "They were in Henan going around and pooling. They were mixing people's blood together," says Busch. They conducted no screening, and the donors themselves were put at risk because the blood traders didn't take the proper precautions to prevent them from getting infected.
"A LOT OF ACTIVITY." The government has banned blood trading so most of if has stopped. But many of the blood centers outside the major cities still suffer from poor quality control. Reusing equipment without proper cleaning is not uncommon, according to Busch, and these centers' screening is insufficient to prevent people who have HIV from donating blood. "If you're testing [blood] and finding people who are HIV-positive, you're not screening properly beforehand," says Busch.
Proper predonation interviewing should prevent the infected from giving blood, he points out. In Henan, about 9% of the donors are HIV-infected. That Henan's number is so high is troubling because it increases the chance that HIV-tainted blood will get past the inspectors.
Safe Blood plans to introduce Western standards and controls to improve the blood supply in the two provinces, with the goal eventually being to spread such practices to other parts of China, too. Busch says while the government isn't being forthcoming with figures, it's moving past its old denial policy."They're doing some significant info programs and treatment programs," he says. "There's quite a lot of activity."
BLOOD SHORTAGE. Busch says the 2003 SARS epidemic played a part, getting the country's leaders to focus on public health and its impact on the economy and social stability. "I think everybody got scared," he says, adding: "Everybody rightly so got scared of AIDS."
Perhaps the Beijing government also realizes that, as the Chinese economy continues to grow, more and more Chinese will be expecting better health care. And the country already has a serious shortage of blood. According to Busch, China produces about 25 million units of untainted blood each year (with a unit being somewhat less than a pint).
By contrast, the U.S. (with a population about one-fifth that of China) produces 20 million units a year. "China needs more blood," says Busch simply. And as health care becomes more sophisticated, the need will increase.
THE AFRICA ROUTE. The willingness of China's government to enlist the help of NGOs like the Clinton Foundation and Safe Blood is a sign that the Communist leaders understand the choice they face. The potential for HIV to spread in China is obvious. The country has 1.3 billion people, a thriving sex industry, a relatively backward health-care system, and a culture that makes it especially hard for many gay people to come out of the closet.
"You can go the Western route, keeping HIV under 0.5%, or you can go the Africa route, where some countries are pushing 40% of the adult population," says Busch. "The problem is there's not a lot of in-between. China has woken up to that." Beijing still needs to do a lot more, of course, but there's reason to be hopeful that the world's biggest country is now serious about stopping the spread of HIV. Einhorn is Asia Economics Editor for BusinessWeek. Follow the China Journal column, only on BW Online