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III. BACKGROUND

Exact figures are difficult to arrive at because government at local levels are very reticent to report on actual cases, a situation compounded by individuals who are reluctant to come forward because of discrimination.

Qi Xiaoqiu, director of China’s Department of Disease Control31

For many years, the Ministry of Health claimed that only a few thousand persons were infected with HIV, though these numbers were widely contradicted by public health experts inside China and abroad. Though actual numbers remain unclear, as discussed below, UNAIDS estimates that at least 1.5 million people are living with HIV/AIDS in China, and there are quite likely many more.

There are many reasons for the confusion, including the underdeveloped Chinese public health “surveillance” system, which frequently does not provide the full picture of a disease; and cover-ups of the HIV/AIDS epidemic by the Ministry of Health and local authorities, who feared their cities or regions would lose external investment if the full extent of the problem were known, or that they would be punished by superiors for failing to prevent the spread of the disease.

There has been a long, internal fight within the Chinese government and its public health agencies over actual HIV prevalence and the importance of publishing accurate figures. One focus of this argument has been the question of whether to publish the number of confirmed cases reported by the Ministry of Health, or to rely on estimates generated by public health officials and official epidemiologists. For example, as of June 1998 China’s 31 provinces, municipalities, and autonomous regions had reported just 10,676 cases of HIV transmission, only 301 cases of full-blown AIDS, and 174 deaths.32 In September 2000 the Ministry of Health reported that there were just 20,711 confirmed, registered cases of people with AIDS.33 These numbers were not a credible reflection of the extent of the problem. By insisting on recognizing only the number of confirmed cases—creating the impression of a relatively small problem by recognizing only a small fraction of the total—the Chinese government seemed to be burying its head in the sand, perhaps hoping that the problem would miraculously go away.

But others in China’s public health system were already sounding the alarm. As early as November 1998 the Chinese “National Medium-and Long-Term Strategic Plan for HIV/AIDS Prevention and Control (1998-2010),” jointly drafted by the Ministry of Health, the State Development Planning Commission, the Ministry of Science and Technology, and the Ministry of Finance, stated that “the actual number of HIV infections in China might exceed 1.2 million by the year 2000.”34 This report asked China’s local governments to “implement its recommendations in a conscientious manner” and described AIDS as:

a major disease, which is a high priority for disease control in China ... Every region and every sector must formulate their own plans and strategies to implement according to this strategic plan according to specific local situations, and to incorporate them into their overall socio-economic development programs. The high priority given to HIV/AIDS prevention and control should be manifested through strong leadership and by implementing various plans and strategies in order to achieve the objectives and tasks of the Chinese national strategic plan in time.

However, these words were contradicted by the government’s simultaneous failure to report accurate numbers or to provide resources to local governments and public health systems too poor and ill-equipped to cope with the problem.

The past two years have seen a slow revelation of more realistic numbers from Chinese authorities, though the full picture still has not emerged in official statements. In December 2001 the government began to publish estimates, suggesting there were 600,000 people living with HIV/AIDS.35 That same month it revised its estimate to 800,000.36 The decision to use estimates reflected the seriousness with which at least some officials were beginning to see the HIV/AIDS epidemic. In December 2002 the Ministry of Health acknowledged one million people living with HIV/AIDS.37

Other experts have put the number of cases in China higher by varying amounts. A UNAIDS report in China in 2002 estimated as many as 1.5 million people living with HIV/AIDS.38 In September 2002 a report by the U.S. National Intelligence Council forecasted that China would have 10-15 million AIDS cases by 2010.39 Though the data is not clear, injection drug users in the western border regions and farmers in Henan and other central provinces who became infected after donating blood probably make up the majority of persons living with HIV/AIDS in China.

China’s efforts to limit information about the disastrous spread of HIV through government-run blood collection centers in the pursuit of revenue from the sale of blood plasma during the 1990s has contributed to the confusion about numbers. Some NGO workers and doctors familiar with conditions in Henan province have estimated that there are at least one million HIV-positive people in that province alone. China’s application to the Global Fund for AIDS acknowledged that six other provinces had similar blood collection disasters and that the officially reported numbers of people living with HIV/AIDS in these seven provinces were probably low.40

China’s upward revision of its estimate in 2002 was one sign of a gradual acknowledgment in the Chinese government of the epidemic, as was a new policy announced during the SARS epidemic of holding officials responsible for under-reporting of infection rates. As with many other aspects of China’s changing AIDS policy, it is not clear to how much political will exists to address the problem or to what degree the central government will or can enforce its policies and require accountability.

One measure of a government’s commitment to deal with a problem is the amount of money it spends to address it. Unfortunately, understanding how much China spends, both at the national and the provincial levels, on HIV/AIDS treatment and prevention is even more difficult than determining the number of people living with HIV/AIDS. Chinese government budgets are notoriously opaque and unreliable. It is also unclear whether funds allocated are actually spent on the intended subject. Corruption is a major and widely acknowledged problem.

China’s reported gross domestic product in 2002 was RMB 10.2 trillion (about U.S.$123.2 billion). 41 How much does the government spend annually on AIDS programs? It is difficult to say for sure, but there are some indications. In May 2003 Dr. Yiming Shao of China’s National Center for AIDS Prevention and Control stated that the national budget for HIV/AIDS has continually increased during the past two years, and is currently over RMB 100 million (U.S.$12.08 million), with provincial governments additionally contributing RMB 500 million (U.S.$60.41 million). “Over eighty percent of the national budget [for AIDS programs] goes to rural areas,” he said, adding that the national government had recently added RMB 1 billion (U.S.$120.9 million) in additional funding to be allocated to western regions “to strengthen blood banks and public health infrastructure.”42

The following presents a brief overview of the recent history of the epidemic in China, the once-strong, now greatly deteriorated national health care system, the gradual opening towards this once-taboo epidemic in the past three years, and persistent problems with social stigma attaching to AIDS.

Brief history of HIV/AIDS in the People’s Republic of China

An introductory section to China’s 2003 application to the Global Fund states that “the epidemic in China is in fact not unitary and consists of a number of overlapping epidemics.”43 China’s HIV/AIDS epidemic may roughly be conceived of in three phases: 1) the 1980s; 2) the early 1990s; and 3) the late 1990s-early 2000s.

In the first phase during the 1980s, the first persons to be diagnosed with HIV in China were foreigners, overseas Chinese visitors, and Chinese who had traveled overseas. Thus, the earliest responses to the disease focused on the control of foreigners and targeted the navy and customs department as important participants in AIDS prevention and control measures. These attitudes still prevail: local regulations in Shanghai require that work units and individuals report all those suspected of having AIDS to the local health bureau, “including foreigners, overseas Chinese, Hong Kong residents, Macao residents, and Taiwan residents.”44

The concept of AIDS as a foreign disease brought into China from the west began to take hold during this period, stigmatizing sufferers as a particular social group different than the average Chinese citizen. Many of the same homophobic, anti-drug user, and xenophobic attitudes seen in other parts of the world in response to the outbreak of HIV/AIDS began to form in China. During this period, it appears that the number of people with HIV in China was small.

During the early 1990s, groups of injection drug users in Yunnan Province (Dehong Dai Autonomous Prefecture, a largely Dai [Tai] ethnic minority region on the Burmese border45) began to test positive for HIV.46 Burma is a major source of heroin and opium for the rest of the world. The growing prevalence of HIV in areas dominated by ethnic minorities only bolstered the impression of many in China that AIDS was a problem for stigmatized tribal peoples, and that it was linked to moral corruption and “backwardness.” Because of centuries of imperial relationships with the western ethnic minorities, many believe that ethnic minorities are morally “loose” and sexually promiscuous.47 Dehong quickly became the epicenter of the epidemic for the nation, and the trade in drugs among farmers and other rural people spread the virus north along the impoverished western belt of China.

Official statistics in China suggest that drug use is the dominant transmission route for HIV, with “most reports of new HIV infections (66.5%) related to the sharing of needles among injection drug users.”48 The highest prevalence rates have been reported in Yunnan, Xinjiang, Guangxi, and Sichuan, all western provinces that lie on the drug route.49 UNAIDS reports “prevalence rates higher than 70 percent among injecting drug users in areas such as Yili Prefecture in Xinjiang and Ruili County in Yunnan.”50 These statistics reflect the seriousness of the epidemic in these areas.

The third phase of the epidemic, from the late 1990s to the present, has three defining characteristics. First the disease increasingly affects the general population and not just populations traditionally perceived as high-risk, meaning that it can no longer be wished away as affecting only “others,” such as foreigners, ethnic minorities, or drug users. Second is the continuously unfolding blood scandal centered in Henan that has affected untold numbers of persons (see section G below for more on the blood scandal). Third, and perhaps most important, are the first signs that the national government is beginning to understand the severity of the epidemic and the imperative of action (see below). The first nationwide conferences on the subject have now been held, public education programs have been initiated, and the Chinese media now speaks relatively frequently on the subject. However, the government has still not addressed a myriad of problems, ranging from discrimination and the lack of patient confidentiality to the rights to form advocacy groups and gain access to treatment. Journalists and activists often do not know whether what they say and do will find favor—or land them in prison.

China’s HIV/AIDS policy in the past five years

In the past five years, China has begun to engage actively in legal and policy reform pertaining to HIV/AIDS. The first move by the State Council51 was to craft two national strategic plans on the epidemic: the Chinese National Medium- and Long-term Strategic Plan for HIV/AIDS Prevention and Control (1998-2010), and the China Action Plan for Stopping and Controlling AIDS (2001-2005).

The goals of the first strategic plan were ambitious. They included such benchmarks as mandating that by 2002 HIV transmission through blood collection would be eliminated,52 that 85 percent of all health care professionals would receive training on STDs, and that “85% of the medical institutions at county or prefectural level and above would be capable of providing standardized diagnosis, treatment, and counseling.”53

China has made some progress toward some of these goals, including pilot projects on HIV/AIDS education and prevention and reform and attempts to standardize the screening of blood. Others remain a distant dream; for instance, standardized training, treatment, and HIV/AIDS counseling are still undeveloped in most impoverished rural regions on the front lines of the epidemic. Funding remains insufficient, the health care infrastructure remains weak, and there is no national agency with the authority to enforce these recommendations.

In other cases, the plan has not been implemented because it came into conflict with longstanding state practices that restrict civil rights. The first strategic plan made some important recommendations for the lifting of restrictions on civil society to permit this sector to grow from the grass roots:

All social bodies, voluntary organizations and the community should be mobilized and actively involved in HIV/AIDS prevention and control and they should be encouraged and supported to provide home-based care and psychological counseling service for people living with AIDS, and health education among high-risk populations. Insofar as possible, these organizations should be assisted in offering support to help HIV infected individuals and people living with AIDS and their families.54

Despite these recommendations by the State Council, implementation of these recommendations is under the control of local Communist Party authorities and police bureaus, who generally are reluctant to permit the expansion of civil society for fear that it will increase public scrutiny of officials, expose corruption, lead to increased demands on government, and perhaps even lead to civil unrest. China’s national laws on the registration of NGOs and its restrictions on freedom of expression, information, assembly, and association create numerous obstacles to the growth and involvement of community groups in AIDS policy.

China’s second strategic plan, the China Action Plan for Stopping and Controlling AIDS (2001-2005) revisited the ambitious goals set by the first. Notably, the second plan addressed in strong language and in some detail the blood contamination scandal centered in Henan although, curiously, without ever referring to the province by name or holding its officials directly accountable. Noting that “some headway” had been made against the AIDS epidemic, the second strategic plan includes some strong language indicating growing frustration among Beijing policymakers with the sluggish response of local governments, cautioning that “some local government leaders are not fully aware of the potential risk of an enlarged HIV epidemic, and the social and economic impact on society in China. Implementation of the ‘Plan’ develops at different rates, and the coordinating capacity for comprehensive HIV/STDs prevention must be improved.”55 This is strong self-criticism in China, but to those in local administrations who read statements by the State Council as signs of the prevailing winds in Beijing, the absence of any clear references to Henan by the central government was a sign that there would be no accountability for that scandal or for cover-ups.

As with the earlier plan, the second action plan combined ambitious goals with vague implementation strategies. It revised some of the goals of the first plan: while the first plan stated that 85 percent of all health professionals should have short-term training on STDs by 2002,56 the second plan said that 100 percent of all health professionals should have HIV/AIDS education by 2005.57 Many provisions were laudable but vague: the plan recommends the installation of automatic condom vending machines without specifying numbers or locations of such machines, and advocates for promotion of the use of clean needles without specifics about how this should be done. 58 In addition, the plan set out a series of new goals for the monitoring of blood supplies, expanding insurance coverage, and conducting AIDS research.

But the plan is also heavy on morality and exhortation, such as with the vague recommendation to “strengthen the construction of socialist spiritual civilization” by cracking down on drug use, an ill which the government implies grows out of China’s contact with the morally corrupting forces of global capitalism.59 The risk of such language is that it increases the social stigma attaching to drug users, driving them underground, and making it difficult for state services to provide testing, treatment, and care to them.

While references are made in both plans to combating discrimination against people living with HIV/AIDS, there are no clear mechanisms for redress. While the second action plan recommends that the government increase and earmark special funding for AIDS programs, amounts are not specified and contributions by local governments are left to local discretion “according to the local need of HIV/AIDS prevention and control.”60 This undercuts the State Council’s explicitly stated concern about the sluggishness of local governments in tackling the AIDS epidemic.

In addition to the national strategic action plans, a number of laws and policies have been passed by the State Council which contradict both local laws and international human rights standards. Some of these laws are holdovers from an earlier period where China’s understanding of the AIDS epidemic was less sophisticated than it is now. The national epidemics law categorizes HIV/AIDS as a class B infectious disease, grouping it with viral hepatitis, amoebic dysentery, and syphilis, among others.61 Persons diagnosed with a class B disease are to be isolated for treatment for a period to be determined by medical experts, and the police can be used to enforce isolation if patients refuse to cooperate or attempt to flee before the isolation period is finished.62 As discussed in more detail in section B on discrimination, forcible restraint and detention not only violate the right of victims, but contribute to the stigmatization of people living with HIV/AIDS.

Unfortunately, there is as yet no national law that prohibits discrimination against people living with HIV/AIDS. There are a number of policies that have strongly recommended against discrimination of persons living with HIV/AIDS, such as the Certain Number of Regulations and the Medium-term plan.63 However, there are no legal mechanisms for the enforcement of these national policies.

National laws on HIV/AIDS have been copied almost verbatim by some municipal and provincial governments into local regulations, though local regulations often include additional provisions or restrictions. Two pieces of local legislation, however, that could serve as partial models for legal reform in other parts of the country are antidiscrimination laws recently passed in the city of Suzhou and in Hong Kong. Suzhou's regulations include provisions that protect persons with HIV/AIDS from discrimination. Hong Kong's Disability Discrimination Ordinance, while enacted in a different political system than that of mainland China, includes a number of examples of positive, clear language, and mechanisms for enforcement that merit further study by policymakers in mainland China.

In 2002 Tsinghua University policy consultants in Beijing held a number of conferences to discuss possible policy changes on HIV/AIDS, and the United Nations funded a report on legal reform on HIV/AIDS issues by a prominent Chinese scholar. Senior Chinese economists are beginning to advocate for the reform of China’s public health system, noting the likely impact of the dysfunctional system on the country’s developing economy.64 Chinese scholars began to publicly endorse human rights protections in the AIDS epidemic; Beijing University Health Law professor Wang Yue recently noted in a government controlled newspaper, “It is an international trend to protect the human rights of people with AIDS and other sexually transmitted diseases.”65 The report was not published, and legal changes on the national level have yet to be implemented. International donors and NGOs, which have become an increasingly important force in China’s response to HIV/AIDS, could lobby for these changes to take place and for further human rights protections as part of their agreements with Chinese partners.

Many who work on AIDS in and outside of China believe that the past three years have shown the first real signs of commitment by Chinese authorities to fight the disease. But even optimists recognize that the government continues to send contradictory signals, calling into question its commitment. For instance, the growing number of international projects on AIDS in China, while indicating increasing openness on the subject, has not been matched by national funding and commitment to AIDS projects.

In the late 1990s-early 2000s, China began to collaborate with international programs on AIDS education and prevention. Many of these situated their offices in Yunnan province, a mountainous and ethnically diverse region known for attracting Chinese and international visitors for its combination of temperate weather and a developing sex tourism industry. Gambling parlors, the illegal market in Burmese gems, eroticized ethnic song and dance revues staged in hotels and restaurants, and sex tourism, have been key motors of development in these border towns.66 In 2000 a U.S. embassy report estimated that people living with HIV/AIDS in Yunnan, “largely intravenous drug users, [account] for fifty percent of all reported Chinese HIV infections.”67

Since the beginning of the AIDS epidemic, Yunnan's government has had a reputation for being relatively open in its willingness to confront the problem. The bulk of Yunnan’s paltry RMB 3 million (U.S.$362,437) allocated for AIDS education and care came from the provincial government in 2000.68 Yunnan is also unique in its success in attracting and cooperating with international NGOs on AIDS. As of 2002 an unusually large number of NGOs and agencies had offices in Yunnan working on HIV/AIDS: the Australian Red Cross, the Salvation Army, Daytop Village, Save the Children-UK, and Futures Group Europe. The Australian Red Cross, Salvation Army, and Yunnan Red Cross also jointly opened the country's first AIDS information and counseling center, Home AIDS, in Kunming in 2002.69

Most Chinese and international NGO workers interviewed for this report stated that Yunnan’s government was the most open in China to confronting AIDS. A number of the international NGOs that began pilot projects in Yunnan have begun expanding these to neighboring provinces.

However, while Yunnan is relatively open to assistance and discussing the problem, some officials continue to adopt a policy of denial. For example, in Dehong an internal memo circulated among prefectural officials forbade them to speak of AIDS with “outsiders” to avoid negative impacts on Dehong’s booming tourism industry.70 A U.S. Embassy report notes that, “In this case ‘outsiders’ were not limited to foreigners, but included Chinese officials and media from outside of Dehong prefecture as well.”71

Ministry of Health officials in Beijing have expressed frustration with the intransigence of some provincial and local authorities. Zheng Xiwen of the national AIDS Prevention and Control Center wrote that:

Some government leaders do not understand the potential for the further spread of HIV and its consequences for China. A minority of leaders conceals the true situation and block measures to prevent HIV. Investment in HIV prevention is inadequate.72

In November 2001 central authorities began to make some efforts to change the national approach to HIV/AIDS when China held its first major AIDS conference. The four-day conference featured an official pop song (“Red Silk Ribbon”), a new logo (a smiling condom with sunglasses), and a dimly-lit testimonial by an AIDS patient thanking the Chinese Communist Party and the Chinese government for their efforts to combat AIDS.73 The meeting also brought together international experts with Chinese experts and policymakers.

In 2001 the State Council established an AIDS/STD Control Coordinating Committee to implement its national action plans.74

In conjunction with its conference in Barcelona in 2002, UNAIDS released a report on AIDS in China that succeeded in drawing international attention to the issue. The report pointed to a number of factors in China that could lead to an explosion in the infection rate in the near future if the government did not act quickly.75 Soon after, Zhang Yishan, Deputy Permanent Representative of China to the U.N. General Assembly, responded by calling for international assistance in China’s plans to combat the AIDS epidemic:

As a country with a huge population, China faces special difficulties in preventing and controlling HIV/AIDS. We would like to continue our cooperation with the countries and international agencies concerned in such areas as financing, developing prevention and treatment projects, lowering drug prices and further leveraging the advantage of traditional Chinese medicine in treatment in a bid to contribute to the fight against the epidemic in China and around the globe. 76

“World AIDS Day” on December 1, 2002, was the occasion for some of China's most widespread and open media discussions of HIV/AIDS. In the weeks leading up to and following World AIDS Day many provincial newspapers, especially in hard-hit regions, published articles on AIDS, stressing stories where people living with HIV/AIDS were enjoying basic civil rights, such as the right to marry.77 State-owned and international press announced the marriage of an HIV-positive couple.78 The event sparked a national debate, with the Ministry of Health weighing in favor of the right of people with HIV/AIDS to marry.79 “Waking Up,” China’s first play about HIV/AIDS, opened in Beijing. According to the state-run People’s Daily, “The play not only introduces scientific knowledge about AIDS, urging young people to abstain from sexor practice safe sex, but also explores ethical and moral issues and how HIV/AIDS patients are treated, urging more understanding of their plight.”80 A number of government spokespeople emphasized the importance of HIV/AIDS prevention work.81

A week after World AIDS Day, China's national television network CCTV2 aired a half-hour program featuring an interview with Li Jiaming, the author of the first memoir published by a Chinese person living with HIV/AIDS, The Final Battle (Zui houde xuanzhan).82 His face shrouded in shadows, Li talked frankly about his personal experiences of shame and fear after his infection with HIV by a commercial sex worker, and his feelings of isolation and loneliness because he felt he could not reveal his status to his family and friends. At the end of the interview, his interviewer warmly and politely thanked Mr. Li for sharing his experiences with viewers.

All of these signs indicated increasing commitment to fighting the epidemic at higher echelons of the Chinese government. However, in stark contrast with official calls for international assistance in fighting the AIDS epidemic, in September 2002 Wan Yanhai, a former Ministry of Health official turned AIDS activist, was detained and interrogated for a month. Wan had been chosen to receive a joint award from the Canadian HIV/AIDS Legal Network and Human Rights Watch. The Chinese government said that the detention was in response to Wan’s “crime of leaking state secrets:” Wan circulated via electronic mail an internal government report acknowledging government responsibility for the Henan blood-selling scandal.83 After an international outcry, including protests by AIDS and human rights activists in front of the Chinese consulates in New York and Paris, Wan was released.84

Poverty and China’s health care system

In the early days of the People's Republic, the socialist government built a subsidized national health care system that made China a model for many parts of the world, especially in its unusually low infant mortality rates. In an earlier era, the Chinese state committed itself to creating an accessible and affordable health care system to rural peoples, encouraging city-trained doctors to dedicate themselves to improving the lives of peasants. Chairman Mao Zedong spoke often of the need for better rural health care.85 Between 1965 and 1997, China built a formidable health care system targeting rural areas with many renowned successes. Chinese experts assert that the country’s infant mortality rate dropped from 200/1,000 live births to 32/1,000, and that average life expectancy increased from 35 to 71.86

In the period of economic liberalization that began in the 1980s, this system was almost completely dismantled, resulting in the privatization of most services, tests, and treatments.

China's response to public health crises such as the SARS and AIDS epidemics has been hampered by the weakened state of its national health care system. As Dr. Daniel Chin of the World Health Organization observed in a radio report on SARS and tuberculosis:

The public health program in China is in a shambles. It’s underfunded, understaffed, and basically the poor, which have the most to benefit from public health because they can’t afford many of the treatments, are being left out of the picture.87

China’s most recent application to the Global Fund reports that catastrophic illness is one of the major causes of poverty in China, and adds “HIV infection can be assumed to be a significant element of the burden of catastrophic illness in the seven project provinces.”88 The disease has disproportionately affected poor, rural regions.

The seven hard-hit provinces selected by China for Global Fund support are all regions “below national average in terms of income” where rural populations sold blood in order to supplement household incomes.89 The Global Fund application acknowledges that the seven central provinces have also been severely affected by “increasing unemployment, increases in rural to urban migration, reducing rates of retention in schools and a dramatic decline in the rural health care system” and the spread of HIV/AIDS has exacerbated the situation such that “poor households, through poverty, weak infrastructure and rural health system decline, are unable to access quality treatment and care, or information to prevent the further spread of HIV.”90 While rural residents make up seventy percent of the country’s population, urban regions receive a disproportionate percentage of China’s total health care budget.91

The lack of funding for public health has meant that hospitals in impoverished rural regions pass many of their expenses on to patients, who do not have the means to pay for necessary services or drugs. Moreover, according to the Global Fund application, “The costs of care also mean that households need to use various coping mechanisms, including borrowing money, selling off assets and changing plans. This results in a lack of support for the elderly of the household, as well as children…. [HIV/AIDS] also acts as a push for members of the community to migrate to find work, possibly leading to further spread of the [virus].”92

Moreover, and perhaps most worrisome, the absence of large-scale care, of pre- and post-test counselling, and of prevention programs in these regions means that many people living with HIV/AIDS in central China are probably unknowing transmitters of the virus to spouses, infants, and others.

International law and the right to the highest attainable standard of health

China is a state party to the International Covenant on Economic, Social and Cultural Rights (ICESCR). Article 12 of the ICESCR provides that states parties “recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” Necessary steps for achieving the full realization of the right to health include the “prevention, treatment and control” of epidemic and other diseases and the “creation of conditions which would assure to all medical service and medical attention in the event of sickness.”93 China’s treatment of persons with HIV/AIDS must be considered within the obligations of the right to health.

Article 2 of the ICESCR requires that each state “undertakes to take steps, individually and through international assistance and cooperation, especially economic and technical, to the maximum of its available resources, with a view to the achieving progressively the full realization of [these] rights.” Because states have differing development and resources, the U.N. Committee on Economic, Social and Cultural Rights issued General Comment 14, which provides a framework through which the right to the highest attainable standard of health can be understood and given force.94

General Comment 14 explains that the right to health is not understood as a “right to be healthy,” but rather as “the right to a system of health protection which provides equality of opportunity for people to enjoy the highest attainable level of health”95 such that all citizens are able to access comparable health facilities. It stipulates that the right to health includes guarantees of non-discrimination in access to health facilities and services and proscribes discrimination “on the grounds of race, colour, sex ... [or] health status (including HIV/AIDS).”96

According to General Comment 14, the right to health must be progressively realized as economic and other conditions permit: “Such steps must be deliberate, concrete and targeted towards the full realization of the right to health.”97 Further, “progressive realization means that States parties have a specific and continuing obligation to move as expeditiously and effectively as possible towards the full realization of article 12.”98

Such rights are also deemed to have a minimum core content, which in all cases the state must guarantee:99 According to paragraph 43 of General Comment 14, these core obligations include the provision of access to health facilities, the provision of essential drugs in accordance with World Health Organization (WHO) guidelines, and the implementation of national action plans with clear benchmarks and deadlines.100 Paragraph 44 also specifies obligations to ensure reproductive health care, to take measures to prevent epidemics, to provide access to information about health problems, and to provide training for health personnel.101

In the case of epidemics and public health emergencies, the General Comment specifies the “right to prevention, treatment and control of diseases” and states that this includes “the creation of a system of urgent medical care in cases of accidents, epidemics, and similar health hazards.”102 In ratifying the ICESCR, China undertook to establish systems that would provide health care to all in epidemics, including HIV/AIDS.

States should also be guided in their response to the AIDS epidemic by international guidelines and recommendations crafted by the United Nations. In 1996, UNAIDS and the U.N. High Commissioner for Human Rights created “The U.N. HIV/AIDS and Human Rights International Guidelines,” a set of guidelines outlining human rights recommendations for the fight against AIDS.103 These guidelines were endorsed by the U.N. Commission on Human Rights in 1997, of which China was a member.104

The guidelines do not have the force of law, but reflect international experience with the AIDS epidemic and the role that basic human rights protections play in fighting AIDS. The twelve guidelines include recommendations for community participation in policy design, the reform of national public health laws to make them applicable to the AIDS epidemic, the strengthening of antidiscrimination laws to protect people with HIV and those in high-risk groups, the regulation of goods and services, the reform of criminal and correctional systems to ensure that they are not used to target high-risk groups, and the implementation of legal support services for people with HIV/AIDS.

In addition, the guidelines recommend the creation of enforcement and monitoring mechanisms “to guarantee the protection of HIV-related human rights,”105 and call on states, relevant programs, and agencies of the United Nations to assist in and ensure that these mechanisms are created. In 2002 the U.N. guidelines were revised to include recommendations that states guarantee access to anti-retroviral treatment.106

China should ensure that its public health policies and laws, including provincial and municipal regulations, are consistent with these guidelines, and should seek technical assistance from the U.N. and others with expertise in these subjects in order to implement them.

Social stigma

Chinese society is made up of many overlapping and powerful social networks, and the stigma associated with HIV/AIDS can be extremely isolating for persons living with the disease. Informal social connections, or guanxi, including extended family networks, networks of former schoolmates, and networks of fellow natives of the same village, are reinforced through exchanges of gifts and favors. Guanxi undergird a variety of public and private transactions in daily life and are an important factor in daily life. 107 The economy of favors and indebtedness facilitates the individual’s access to employment, education, health care, investment capital, and many state services. It is usual for adults to continue to live with the extended family until they marry, and sometimes after marriage, enabling family members to share household costs, childcare responsibilities, and financial capital.

However, due to the tremendous stigma and shame surrounding HIV/AIDS, many HIV-positive persons find themselves rejected by their families or decide to leave home in order to hide the truth from family and friends. Some leave home not to protect themselves, but to protect their parents from stigmatization by the larger community. This marginalization in a densely-networked society like China launches AIDS sufferers into extreme social and psychological isolation at a time when they need support the most, and even curtails their ability to access employment, housing, and state services.

Partly because of the national failure to educate Chinese citizens about HIV/AIDS in the 1980s and 1990s, misunderstandings and ignorance about the disease are common (as they have been in many parts of the world where public education has been lacking or the government has failed to take the lead in insisting on nondiscrimination). A survey in January 2003 found that 17 percent of Chinese citizens had never heard of HIV/AIDS. 77 percent did not know that transmission could be prevented through the use of condoms.108 Many thought HIV could be transmitted through casual contact: 75 percent of those surveyed in four major cities said they would avoid a person who they knew had AIDS, and 88 percent of those surveyed in a rural region of Sichuan province said they would prefer that people living with HIV/AIDS not have interactions with other people.109 Some63 percent of respondents in a Sichuan province study “had no clear understanding of differences between HIV and sexually transmitted diseases.”110 Such attitudes are prevalent even among China’s small educated elite: the Beijing Morning Post reported that a survey of Chinese university students found that more than half would refuse to eat a meal with an HIV-positive person.111

Such taboos extend to the subject of sex itself and create obstacles for HIV/AIDS education programs. In 2002 the Guangdong Federation of Trade Unions distributed one million condoms to female migrant workers in the province, and was “blasted” by workers: “The move is an insult to migrant workers like us because by [distributing condoms] they are suggesting that we have a lot of casual sex,” said one female worker. She added, “Why don't they also tell the media that Guangdong people, both men and women, from all occupations, must also protect themselves?”112

Persons living with HIV/AIDS in China and NGO workers told Human Rights Watch of personal experiences of stigmatization and rejection by families, friends, and coworkers. According to Han, a Chinese NGO worker, if a person is known to be HIV-positive:

Your family won’t eat with you, they give you food to eat apart from them, and they won’t have contact with you. Your friends ignore you. They are afraid of getting it from casual contact. If you pass them a cigarette, they won’t accept it.113

In one case, a young woman in her twenties of Dalian was apparently killed by her father when he learned that she had HIV/AIDS. Her father, distraught because his other daughter was already seriously ill and the family had pinned their hopes on the success of this younger daughter, allegedly struck her in the head and killed her.114

Families that do not reject their HIV-positive members may suffer stigma themselves. Some rural villages shun families when one family member is known to be HIV-positive, for instance by banning an uninfected relative from using the village bathhouse.115 In a Western news account, a person with HIV/AIDS described the experience of a family he knew whose daughter died of AIDS: “After her death, her family was not able to lead a normal life. People would not talk to them or contact them, out of fear. The shops refused to sell to them. Instead, overnight, the shopkeepers would leave what they wanted at their door, secretly.”116 A few interviewees told Human Rights Watch that in areas of Yunnan and Henan where HIV/AIDS is extremely common, villages may rally around and support sick neighbors. However, most interviewees agreed that this was an exceptional response in China.117

Because of the fear of stigma and discrimination, it is common for people with HIV to hide their status from even close family members. “I don’t dare to tell my family,” said Ji, an HIV-positive former drug user from a rural town in Yunnan.118 Author Li Jiaming writes that he moved to another city in order to protect his family from the knowledge that he was HIV-positive:

Giving my mom a telephone call is a challenge every time. Before I pick up the telephone, I always practice a few times: ‘Hi, Mom, it’s me! Hi, Mom, it’s me!’ I do this until I think my voice sounds steady, and only then do I dial the number.119

In Hong Kong, where discrimination appears to be less severe than in China, many HIV-positive persons remain closeted. “Most people are not willing to disclose their identity,” says Alice Chan, CEO of Hong Kong’s Society for AIDS Care. “Some patients request that the Society for AIDS Care not disclose their identity to their closest relatives, and Society for AIDS Care policy is to respect that. When we visit someone at home, we say we’re just a friend.”120

Stigma creates an environment harmful to the prevention of the spread of HIV. At a time of extreme stress, people with HIV/AIDS are marginalized and driven underground, afraid to seek help or to participate in programs that might reveal their status to others. As Zhang, an AIDS activist in Beijing, put it:

People who are HIV-positive need emotional support. Many people, when they find out they are HIV positive, suffer very much and are very sad. They have many needs—psychological, medical and legal—but many people just stay at home for years and years.121

Doubly Disadvantaged

Drug users, particularly those perceived to be infect with HIV, may be doubly vulnerable to isolation and ostracism. NGO workers interviewed by Human Rights Watch noted that because of the social problems inflicted by drugs on rural communities, drug users are even more likely than people with HIV/AIDS to be forcibly expelled from their home towns.122 In June 2003 the plight of drug users in southwest China received international attention when a three-year-old girl starved to death in Chengdu after her mother, a drug user, was arrested by police. Though the mother asked police to contact the child’s aunt, the police failed to do so, and the child was left locked at home without food for eighteen days.123 After a national outcry about the incident, some police were punished.

Because of widespread discrimination against women in China, women lack equal access to health services and to education, and are likely to face difficulties in negotiating safer sex with HIV-positive male partners.124 Sex workers are also highly vulnerable for the same reasons, and are vulnerable to compulsory detention in reeducation centers and to police abuse.125 Rarely do HIV/AIDS education and prevention projects in China reach out to men who have sex with men, another group of stigmatized and marginalized Chinese citizens who are vulnerable in the epidemic.

In 2002 the Chinese Ministry of Health and national and local media and schools joined the U.N.-sponsored global “Live and Let Live” media campaign to promote acceptance of persons living with HIV/AIDS. All U.N. member states participated, so it is unclear what level of commitment China has to this kind of public education. This campaign may help to address some of the stigma described here, but as Zhang observes, other forms of support, including access to treatment, services and legal protections, are also needed.



31 Ed Lanfranco, “HIV/AIDS in China tops million mark,” United Press International, Sept. 6, 2002

32 Chinese National Medium-and Long-Term Strategic Plan for HIV/AIDS Prevention and Control (1998-2010), printed and disseminated by the State Council, November 12, 1998

33 Reuters, “HIV carriers up 37 percent,” November 1, 2000.

34 Chinese National Medium-and Long-Term Strategic Plan for HIV/AIDS Prevention and Control (1998-2010), printed and disseminated by the State Council, November 12, 1998

35 Elisabeth Rosenthal, “Suddenly, AIDS makes the news in China,” The New York Times, December 5, 2001.

36 People’s Daily, “China to promote donation work for blood safety,” December 13, 2001.

37 Zhang Wenkang, quoted in China Health News, December 27, 2002.

38 UNAIDS, HIV/AIDS: China’s Titanic Peril, June 2002; p. 11.

39 National Intelligence Council, The Next Wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India, and China (Washington D.C., September 2002), p. 4.

40 CCM, 2003 Proposal to the Global Fund, June 2003, p. 13.

41 People’s Daily, “China’s GDP hit 1.23 trillion U.S. dollars in 2002: NBS,” December 30, 2002.

42 Telephone media briefing by Dr. Yiming Shao and the Global HIV Prevention Working Group, New York, May 13, 2003. These numbers are generally confirmed by China’s 2003 proposal to the Global Fund, though with variations: the proposal reports the central government has committed U.S.$12.5 million annually, with the Finance Ministry committing an additional U.S.$151 million for blood centers and U.S.$109 million to improve health infrastructure in central and western China (CCM, 2003 Proposal to the Global Fund, June 2003, p. 15).

43 CCM, 2003 Proposal to the Global Fund, June 2003, “Section III: General information about the country setting,” p. 12.

44 Shanghai shi aizibing fangzhi banfa (Shanghai city AIDS prevention methods), Shanghai People’s Government document no. 64, Dec. 30, 1998, article 25.

45 Dehong Dai Nationality Autonomous Prefecture is one of a number of ethnic “autonomous” regions established in China during the 1950s. The process of ethnic identification and categorization China undertook in the 1950s has been criticized by some social scientists, as has the practice of “autonomy”. For more on such regions including Dehong, see Stevan Harrell, ed., Cultural Encounters on China’s Ethnic Frontiers (Seattle: University of Washington, 1995).

46 Such testing was likely to have been conducted at forced detoxification centers.

47 For instance, see Norma Diamond’s germinal essay, “The Miao and Poison: Interactions on China’s Southwest Frontier,” a discussion of the historical roots of contemporary beliefs about the sexual “openness” and dangerousness of minority women (Ethnology 27, no. 1, January 1988, pp. 1-25). For more recent discussions of majority Han Chinese views of minority women’s sexual identity in China, see Louisa Schein, Minority Rules: The Miao and the Feminine in China’s Cultural Politics (Durham: Duke University Press, 2000) and Dru Gladney, “Representing Nationality in China: Refiguring Majority/Minority Identities,” (Journal of Asian Studies 53, February 1994, pp. 92-123).

48 UNAIDS, HIV/AIDS: China’s Titanic Peril, June 2002, p. 14. More recent government statements have estimated that the majority of all new HIV infections in China are a result of needle-sharing among injection drug users [China CCM, 2002 Proposal to The Global Fund, July 2002, “HIV/AIDS Situational Analysis in China” (attachment 4), p. 5]. Given Beijing’s continuing efforts to minimize the role of state-run and licensed blood collection centers in spreading HIV throughout central China and to minimize the extent of the catastrophe in these regions, such estimates should be regarded with skepticism.

49 World Health Organization, HIV/AIDS in Asia and the Pacific Region 2001, www.wpro.who.int/pdf/sti/aids2001/complete.pdf, retrieved May 13, 2003, p. 42.

50 UNAIDS, Report on the global HIV/AIDS epidemic 2002, July 2002, http://www.unaids.org/barcelona/presskit/report.html, retrieved September 10, 2002.

51 The State Council (guowuyuan) is the highest administrative organ in China. It is directed by the premier, currently Wen Jiabao, and includes vice-premiers, state councillors, ministers in charge of ministries and commissions, the auditor-general and the secretary-general. The State Council directs and makes policy for the ministries under its authority. For more information, see Facts and Figures: Structure of the State, Foreign Language Press (Beijing: 1987).

52 State Council, China’s National Medium and Long-term Strategic Plan for HIV/AIDS Prevention and Control (1998-2010), State Council Document GF (1998) 38, November 12, 1998, English translation, p. 6.

53 State Council, China’s Medium and Long-term Strategic Plan, p. 8.

54 Ibid., p. 10.

55 State Council, China HIV/AIDS Prevention and Control Action Plan (2001-2005), 25 May, 2001, English translation, p. 1.

56 State Council, Chinese National Medium- and Long-term Strategic Plan for HIV/AIDS Prevention and Control (1998-2010),26 October, 1998, paragraph 3 (4).

57 State Council, China HIV/AIDS Plan (2001-05), Work goal 4.

58 Ibid., Action measure 3.

59 Ibid., Action measure 3. The term “socialist spiritual civilization” was first used by President Deng Xiaoping during China’s economic reforms in the 1980s, to emphasize the importance of holding onto Maoist principles and values despite increasing contact with the morally corrupting effects of global capitalism. The term was again actively promoted by Deng’s successor Jiang Zemin during the 2002 Sixteenth Communist Party Congress. The revised Constitution of the Chinese Communist Party, passed during that Congress, urges members to “inspire the Party members and the people with the Party’s basic line, patriotism, community spirit and socialist ideology, enhance their sense of national dignity, and their spirit of self-confidence and self-reliance, imbue the Party members with the lofty ideals of communism, resist corrosion by decadent capitalist and feudal ideas, and wipe out all social evils, so that our people will have lofty ideals, moral integrity, a good education and a strong sense of discipline” (Constitution of the Communist Party of China, in the Documents of the 16th National Congress of the Communist Party of China, Foreign Language Press (Beijing), 2002; p. 82).

60 Ibid., p. 9.

61 According to the law, “Class B infectious diseases include: viral hepatitis, bacillary and amoebic dysentery, typhoid fever and paratyphoid fever, AIDS, lymph disease, syphilis, poliomyelitis, urticaria, whooping cough, diphtheria, epidemic cerebrospinal meningitis [NB: the law does not specify which type], scarlet fever, epidemic hemorrhagic fever, rabies, leptospirosis, brucellosis, anthrax, epidemic and endemic typhus, epidemic encephalitis B, black fever, malaria, dengue fever.” Zhonghua renmin gongheguo chuanranbing fangzhi fa [Law on the Prevention and Treatment of Infectious Diseases], ratified by the sixth meeting of the seventeenth people’s congress, Feb. 21, 1989, for implementation September 1, 1989, article 3.

62 Chuanranbing fangzhi fa [Law on the Prevention of Infectious Diseases], article 24 (1).

63Certain number of regulations,article 21; and the Medium-term plan (1998-2010).

64 Hu Angang, “Zhongguo hongguan jingji yu weisheng jiankang” [Chinese macroeconomics and health and sanitation], in Hongguan jingji yu weisheng yanjiu baogao hui [Report of the conference on macroeconomics and health studies], 2002, pp. 38-51.

65 People’s Daily, “Southwest China province set to lift AIDS marriage ban,” June 2, 2003.

66 See Sandra Hyde, “Sex Tourism Practices on the Periphery: Eroticizing Ethnicity and Pathologizing Sex on the Lancang”, in China Urban: Ethnographies of Contemporary Culture, ed. By Nancy N. Chen, Constance D. Clark, Suzanne Z. Gottschang, and Lyn Jeffery (Durham & London: Duke University Press, 2001), pp. 143-164; and Sara Davis, “The Hawaiification of Xishuangbanna: Orality, Power and Cultural Survival in Southwest China,” TDR: The Drama Review (2002), 44:4: pp. 25-41.

67 U.S. Embassy- Beijing, Environment, Science and Technology Section, “AIDS in China: Yunnan Province Confronts HIV”, December 2000, http://www.usembassy-china.org/sandt/yunnanbarth.html, retrieved October 1, 2002.

68 Ibid.

69 Other agencies such as UNICEF and Health Unlimited did not have official offices in Yunnan but supported AIDS education programs in ethnic minority regions of the province. See http://unicef.org/eapro-hivaids/countries/China.htm, and www.healthunlimited.org/china/index.htm for more information.

70 U.S. Embassy- Beijing, Environment, Science and Technology Section, “AIDS in China: Yunnan Province Confronts HIV”, December 2000, http://www.usembassy-china.org/sandt/yunnanbarth.html, retrieved October 1, 2002.

71 U.S. Embassy, “AIDS in China: Yunnan Province Confronts HIV”.

72 Quoted in Recent Reports on HIV/AIDS and STDs in China, posted July 1, 2001, www.usembassy-china.org.cn/english/sandt/hivartic.html, retrieved February 12, 2002.

73 U.S. Embassy- Beijing, Environment, Science and Technology Section, “China Hosts Its First Major Conference on AIDS”, November 20001, http://www.usembassy-china.org.cn/sandt/1st-AIDSconference.htm, retrieved October 1, 2002.

74 CCM, 2003 Proposal to the Global Fund, June 2003, p. 15.

75 UNAIDS, HIV/AIDS: China’s Titanic Peril, June 2002.

[76] Ambassador Zhang Yishan, Deputy Permanent Representative of China, “Statement on HIV/AIDS at the 57th Session of the General Assembly,” November 8, 2002, http://www.china-un.ch, retrieved June 12, 2003.

77 For instance, in Yunnan: “Kunmingren guanzhu Aizibing” [Kunming residents pay attention to AIDS], (Kunming, Dushishibao), December 2, 2002; “Wanren qianming yufang Aizibing” [10,000 people sign petition on AIDS prevention], (Kunming, Dushishibao), December 2, 2002; “Ai tamen jiushi ai ziji” [To love them is to love oneself], (Kunming, Dushishibao), December 2, 2002; and a group of articles and columns on a World AIDS Day newspaper page, with the banner, “Do not abuse drugs, be faithful to partners, General movement for World AIDS Day in the Spring City: Kunming publishes recipe for AIDS prevention,” (Kunming: Shenghuo Xinbao), December 2, 2002.

78 “AIDS couple tie the knot,” China Internet Information Center, November 30, 2002, http://www.china.org.cn/english/China/50083.htm, retrieved June 12, 2003; and “China marriage to mark AIDS day,” Associated Press, November 25, 2002.

79 “Official: HIV carriers have right to marry,” China Daily, November 28, 2002.

80 “China Marks World AIDS Day,” People’s Daily, December 2, 2002, http://english.peopledaily.com.cn/200212/02/eng20021202_107750.shtml, retrieved on June 12, 2003.

81 Guo Nei, “Li: Disease prevention is priority of campaign,” China Daily, December 17, 2002.

82 Xinwen diaocha [News investigation], CCTV2, December 8, 2003, 6:30 p.m. Li Jiaming is a pseudonym. On the CCTV2 program, Li explained that he had taken the name became liming [dawn] symbolized his hopes "that I still have a future,” and jia [home] represented his longing for his home.

83 Xinhua, “Wan Yanhai released after confessing to crimes in leaking state secrets,” September 20, 2002.

84 “Concern escalates over missing Chinese AIDS activist,” Human Rights Watch, August 30, 2002, http://www.hrw.org/press/2002/08/drwan082902.htm, retrieved on June 12, 2003; “PHR letter on behalf of Dr. Wan Yanhai - China,” Physicians for Human Rights, September 19, 2002, http://www.phrusa.org/campaigns/colleagues/china_092102.html, retrieved on June 12, 2003; “China: Authorities confirm detention of Wan Yanhai,” Committee to Protect Journalists, September 5, 2002, http://www.cpj.org/news/2002/China05sept02na.html, retrieved on June 12, 2003. “US-China-AIDS: Protest in New York against detention of Chinese AIDS activist,” Agence France-Presse, September 19, 2002.

85 Maurice Meisner, Mao’s China and After: A History of the People’s Republic (New York and London: Free Press, 1977).

86 Bing Jiang and Yongquan Tian, “Development of Xiangya hospital as a model for Chinese hospitals,” Yale-China Health Journal, Autumn 2002, vol. 1, pp. 47-60; p. 47.

87 Richard Harris, “SARS highlights need to address TB,” Morning Edition, National Public Radio, June 6, 2003.

88 CCM, 2003 Proposal to the Global Fund, June 2003, p. 14.

89 Ibid., p. 16.

90 Ibid., p. 17.

91 Peter Goff, “Virus exposes the weakness of China’s health care,” South China Morning Post, May 4, 2003.

92 CCM, 2003 Proposal to the Global Fund, June 2003, p. 14.

[93] International Covenant on Economic, Social and Cultural Rights (ICESCR), G.A. res. 2200A (XXI), 21 U.N. GAOR Sup. (No. 16) at 49, U.N. Doc. A/6316 (1996), 993 U.N.T.S. 3, entered into force January 3, 1976, article 12. China ratified the ICESCR on DATE. Chinese translations of the ICESCR are available from Human Rights Watch at http://www.hrw.org/chinese/un/iccpr.html and from the Hong Kong Human Rights Monitor at http://www.hkhrm.org.hk/database/1c1.html, both sites that are usually blocked in mainland China.

94 CESCR, General Comment No. 14, “The right to the highest attainable standard of health” (article 12 of the International Covenant on Economic, Social and Cultural Rights), 11/8/2000.E/C.12/2000/4, CESCR, 22nd session, Geneva, 25 April - 12 May 2000.

95 CESCR General Comment No. 14, paragraph 8 (emphasis in the original).

96 CESCR General Comment No. 14, paragraph 18.

97 CESCR General Comment No. 14, paragraph 30.

98 CESCR General Comment No. 14, paragraph 31.

99 CESCR General Comment No. 14, paragraphs 43-45.

100 CESCR General Comment No. 14, paragraph 43, states that states parties to the ICESCR are obligated:

(a) To ensure the right of access to health facilities, goods and services on a non-discriminatory basis, especially for vulnerable or marginalized groups; …

(d) To provide essential drugs, as from time to time defined under the WHO Action Programme on Essential Drugs100;

(e) To ensure equitable distribution of all health facilities, goods and services;

(f) To adopt and implement a national public health strategy and plan of action, on the basis of epidemiological evidence, addressing the health concerns of the whole population; the strategy and plan of action shall be devised, and periodically reviewed, on the basis of a participatory and transparent process; they shall include methods, such as right to health indicators and benchmarks, by which progress can be closely monitored; the process by which the strategy and plan of action are devised, as well as their content, shall give particular attention to all vulnerable or marginalized groups.

101 Paragraph 44 of CESCR General Comment No. 14 states that these obligations are of comparable priority to those in paragraph 43:

(a) To ensure reproductive, maternal (pre-natal as well as post-natal) and child health care;…

(c) To take measures to prevent, treat and control epidemic and endemic diseases;

(d) To provide education and access to information concerning the main health problems in the community, including methods of preventing and controlling them;

(e) To provide appropriate training for health personnel, including education on health and human rights.

102 CESCR General Comment No. 14, “The right to the highest attainable standard of health,” paragraph 16.

103 Office of the United Nations High Commissioner for Human Rights and the Joint United Nations Programme on HIV/AIDS, “HIV/AIDS and Human Rights International Guidelines” (from the second international consultation on HIV/AIDS and human rights, 23-25 September 1996, Geneva), U.N. Doc. HR/PUB/98/1, Geneva, 1998. While the guidelines have been translated into Chinese, they do not appear to be posted on the UNAIDS Beijing website.

104 Commission on Human Rights, “The protection of human rights in the context of human immune deficiency virus (HIV) and acquired immune deficiency syndrome (AIDS),” Commission on Human Rights resolution 1997/33, 57th meeting, April 11, 1997.

105 Office of the United Nations High Commissioner for Human Rights and the Joint United Nations Programme on HIV/AIDS, “HIV/AIDS and Human Rights International Guidelines” (from the second international consultation on HIV/AIDS and human rights, 23-25 September 1996, Geneva), U.N. Doc. HR/PUB/98/1, Geneva, 1998, paragraph 11.

106 Joint United Nations Programme on HIV/AIDS, "United Nations Entrenches Human Rights Principles in AIDS Response," press release, 10 September 2002.

107 Due to space constraints, the following is a cursory summary of the complex subject of guanxi. For more on this, see Yunxiang Yan, The flow of gifts : reciprocity and social networks in a Chinese village (Stanford, CA: Stanford University Press, 1996); Mayfair Mei-hui Yang, Gifts, favors, and banquets : the art of social relationships in China (Ithaca, NY: Cornell University Press, 1994); Thomas Gold, Doug Guthrie, and David L. Wank, eds., Social connections in China : institutions, culture, and the changing nature of guanxi (Cambridge and New York: Cambridge University Press, 2002); Andrew B. Kipnis, Producing guanxi: sentiment, self, and subculture in a North China village (Durham: Duke University Press, 1997); and Helen F. Siu, Agents and victims in south China : accomplices in rural revolution (New Haven, CT: Yale University Press, 1989). For the influence of guanxi across borders, see Aihwa Ong and Donald Nonini, eds., Ungrounded empires: the cultural politics of modern Chinese transnationalism (New York: Routledge, 1997).

108 China Radio International, “China survey finds one in six haven’t heard of AIDS,” January 2003, http://web12.cri.com.cn/english/2003/Jan/85856.htm, retrieved June 12, 2003.

109 CCM, 2002 Proposal to the Global Fund, July 2002, p. 13.

110 CCM, 2002 Proposal to the Global Fund, July 2002, “HIV/AIDS Situational Analysis in China” (attachment 4), p. 14.

111 “What’s News,” South China Morning Post, August 24, 2001.

112 Fong Tak-ho, “Free condom campaign insulting, say workers,” South China Morning Post, November 20, 2002.

113 Human Rights Watch interview with Han, Kunming, Yunnan, 2002.

114 Zhao Anping, “Nu aizibing huanzhe bei sha diaocha pilu xian wei ren zhi gushi,” Jiankang Shibao [Health Times], December 27, 2002.

115 “Media Begin Battle for AIDS Tolerance”, China Daily, November 30, 2001.

116Esther Kaplan, “POZ in Asia, Beijing, China”, POZ, July 2000, www.poz.com/archive/july2000/inside/china.html, retrieved on August 7, 2002.

117 Human Rights Watch interview with Ai, Jinghong, Yunnan, 2002; interview with Cao, Yunnan, 2002; interview with Tao, Yunnan, 2002.

118 Human Rights Watch interview with Ji, Kunming, Yunnan, 2002.

119 Li Jiaming, Zuihoude Xuanzhan [The Final Battle], (Tianjin: Tianjin Renmin chubanshe), p. 21.

120 Human Rights Watch interview with Alice Chan, Hong Kong, 2003.

121 Human Rights Watch interview with Zhang, Beijing, 2002.

122 Human Rights Watch interview with Wu, Kunming, Yunnan, 2002; Human Rights Watch interview with Cao, Kunming, Yunnan, 2002.

123 “Police blamed for child starving,” Courier-Mail, Queensland, Australia, June 26, 2003.

124 CCM, 2003 Proposal to the Global Fund, June 2003, “Gender equality issues,” p. 55.

125 Human Rights Watch interview with Cao, Kunming, Yunnan, 2002; Human Rights Watch interview with Tang, AIDS activist, New York, 2003.

126 Human Rights Watch interview with Kong, Kunming, Yunnan, 2002.

127 Video cassette disk, a popular technology for watching videos in China and much of East and Southeast Asia that resembles a DVD.


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