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V. HONG KONG: ONE COUNTRY, TWO EPIDEMICS?

In Hong Kong, the situation is a bit better than on the mainland. Here, the government helps us to buy medicine, and there are NGOs that support us. There are sports for AIDS [AIDS charity walks], and there are big posters, I have seen them on the train platforms. They even have hospitals, just for AIDS. We don’t have anything like that on the mainland.⁴²⁶

Law, an HIV-positive person from Fujian now living in Hong Kong

HIV prevalence rates in Hong Kong are estimated to be relatively low. In the second quarter of 2003, the AIDS Office of Hong Kong reported that 2,116 residents were HIV-positive in a population of approximately 6.8 million.⁴²⁷ While some problems remain in the treatment of people living with HIV/AIDS in Hong Kong—particularly with stigma and discrimination—people living with HIV/AIDS, medical professionals, and NGO workers in Hong Kong familiar with the situation on the mainland point to a number of differences in Hong Kong's approach that has made Hong Kong more successful in respecting the basic human rights of people with HIV/AIDS. These include the ready availability and affordability of treatment and care, the strength of Hong Kong’s NGO community, and the enforcement of a strong antidiscrimination ordinance by the Equal Opportunities Commission.

Jenny W., who runs an HIV/AIDS education program in Hong Kong, said that while most people living with HIV/AIDS do not feel safe enough to publicly identify themselves as HIV-positive, with the arrival of combination therapy, “it is possible for them to live longer, and there is no need to tell” others that they have HIV.⁴²⁸ Treatment for people living with HIV/AIDS, including ARV treatment, is subsidized for Hong Kong residents. The region's official HIV/AIDS unit at Queen Elizabeth hospital charges H.K.$60 (U.S.$7.80) for each consultation, with prescriptions costing H.K.$10 (U.S.$1.30) each.⁴²⁹ If hospitalization is required, rooms at Queen Elizabeth hospital cost about H.K.$100 (U.S.$12.80) per day.⁴³⁰ Those experiencing financial difficulties may apply for social security coverage. Hong Kong’s Queen Elizabeth hospital treats people living with HIV/AIDS, and most users and NGO workers interviewed reported a relatively high degree of satisfaction with health care workers at this AIDS unit.⁴³¹

Hong Kong’s relative wealth and greater commitment to public health makes treatment relatively more affordable than in China. Hong Kong’s health system as a whole is of an international standard. The importance of access to treatment for people living with HIV/AIDS cannot be overstated. Appropriate drugs and medical treatment save lives and greatly improve the quality of life for people with HIV/AIDS.

While treatment is a crucial component, people living with HIV/AIDS have a range of other needs, too. In Hong Kong people living with HIV/AIDS are able to obtain services from a number of NGOs and church groups, form their own support groups, gain access to all sorts of HIV/AIDS-related information, including state-held information, and participate actively in grassroots organizations. NGO staff report that they try to tailor their programs to the requests of people with HIV/AIDS. As an example, the Hong Kong AIDS Foundation (HKAF) runs educational programs in schools and workplaces, relying on about 300 volunteers and a pilot peer education program in mainland China. HKAF also runs a discussion forum on the Internet where anonymous writers can post questions and have them answered by trained counselors. Two service workers provide individual counseling and run support groups for people living with HIV/AIDS, their families and partners, including a group for gay men.

To address problems with stigma, HKAF has developed some alternative strategies, says Barry Lee, Senior Service Officer:

Because of Chinese cultural issues, people are reluctant to come for group work. So we organize interest classes, such as English language, computer training, and yoga. People are more relaxed, and then we do the group interventions afterwards.⁴³²

Other HIV/AIDS NGOs offer a variety of services and educational programs. AIDS Concern has a well-known home soup delivery program and gives free transportation from home to clinic for people living with HIV/AIDS, and runs outreach programs in saunas and public toilets targeting men who have sex with men and sex workers.⁴³³ The Society for AIDS Care has a day center offering medical care, a computer center, a gym with volunteer personal trainers, physiotherapy, support groups, and a community kitchen.⁴³⁴

NGOs like these offer an alternative support network in a society where stigma is often still a problem. In 1999 when a clinic for the treatment of people living with HIV/AIDS opened in Kowloon Bay, near the Richland Gardens housing project, community members organized protests. Some protestors blocked access to the clinic, hurled invective at patients and health care workers, and threw buckets of water at those trying to enter the clinic.

But in Hong Kong, unlike the mainland, victims have a forum for complaints. A group of patients from the Richland Gardens clinic lodged complaints with the Equal Opportunities Commission (EOC), which investigating the complaints, held hearings in the neighborhood, and ultimately filed lawsuits against some individuals in order to pressure them to apologize. Most of these efforts were successful in resolving the incidents, although NGO workers report that the “Richland Gardens episode” has left many people living with HIV/AIDS with lingering fears of stigma.⁴³⁵ The Society for AIDS Care, sensitive to fears of stigma among its clients in the period after the Richland Gardens protests, established its day center behind a car sales lot in the old Hong Kong airport.⁴³⁶ Alice Chan, the Society's CEO, remembers that the Richland Gardens protests were “a big deal,” and explains:

With our location, we took that into consideration. This is a nice place, and once you know where it is, it's not hard to find, but it's quite remote ... Outside the door, we don't use the name. It just says 'fitness center' or 'activity center'. Even with the remote location, people living with HIV/AIDS feared that people would see them going in and out.⁴³⁷

Treatment, care, and the input of NGOs and community groups are important, but in extreme situations, people living with HIV/AIDS in Hong Kong also have legal recourse. In 1997 the Equal Opportunities Commission was empowered to address complaints of discrimination by people living with HIV/AIDS by a Disability Discrimination Ordinance (DDO). The DDO guarantees the right of people living with HIV/AIDS to not be verbally or physically harassed, and protects rights to equal access to services, facilities, and equal opportunity in employment. Brochures explaining the DDO in English and Chinese are available at NGO offices and at the Red Ribbon Centre, and include contact information for the Equal Opportunities Commission.

According to Anna Wu, chairperson of the EOC, the commission investigates all complaints of discrimination and attempts to settle problems through confidential conciliation. Wu explained:

[This is] a statutory process, and our officers stay in the room, but they have to be neutral, they are not directive. Our average rate of success with this is two out of three. We have the power of litigation, which we use to create a deterrent effect.⁴³⁸

The highest settlement to date, said Wu, has been for HK$1 million (U.S.$129,870), but other settlements have included training programs for discriminators, charity work, verbal apologies, “or even a basket of fruit to show respect to the complainant.”⁴³⁹

Most Hong Kong interviewees felt that the work done by the EOC had improved the situation, especially in addressing complaints stemming from the Richland Gardens protests. However, several raised concerns about the requirement for HIV-positive complainants to reveal their identity in the process of filing and conciliating disputes,⁴⁴⁰ and two said they saw the EOC as insufficiently aggressive.⁴⁴¹ Some expressed concerns that the workings of the EOC has been hampered post-1997 by government fears of independent watchdog agencies, and an editorial in the South China Morning Post warned of rumors that the EOC would be dismantled, though not for its work on people with HIV/AIDS.⁴⁴²

Hong Kong residents still report some problems of HIV-related discrimination. The EOC and NGOs are working on addressing some of these issues, but additional legal reforms may be necessary. The problems with discrimination described by persons living with HIV/AIDS in Hong Kong largely fell into three categories: problems with individual health care workers, problems with cross-border marriages and relationships, and problems of mandatory testing and discrimination by employers.

Two interviewees reported experiences of verbal harassment by health care workers. In 2002 Ma saw an ear surgeon about persistent deafness in both ears. During a pre-surgery intake interview, the surgeon confronted Ma about his HIV status. After the first surgery on one ear had been completed, Ma saw the surgeon again at the Yaumatei Jockey Club's Ear, Eye, Nose and Throat Clinic for a follow-up meeting. At this meeting, the surgeon became confrontational and shouted at Ma for not being more forthcoming about being HIV-positive:

He started telling me about his wife and children, and said, “If by mistake I got infected by you, you might give my family trouble.” So I fought back. I said, “Whether or not I'm positive, you still have to provide care to me.” The doctor then started praising himself. He said, “I'm a good doctor! None of my colleagues would perform surgery on you, I'm the only one who was willing.” He indicated the three nurses who worked in his clinic. “None of them were willing to assist me to perform the surgery. They had to draw lots to choose, and that's how I got a nurse to assist me to perform the surgery.”

The surgery was only done on my left ear ... Because of this incident, I gave up on the right ear. I couldn’t accept that doctor's attitude, so I decided to give it up.⁴⁴³

Another person living with HIV/AIDS also reported experiences of verbal harassment by doctors.⁴⁴⁴

Anna Wu commented that such incidents could potentially be addressed by the EOC. “We have had incidents of that type [reported],” she said. “There was one man [who was HIV-positive] who needed surgery on his knee and it was postponed, from six months to twenty months. The conciliation was successful.”⁴⁴⁵

Many people living with HIV/AIDS are reluctant to file complaints because the procedure requires them to reveal their HIV-positive status. The EOC has managed in some cases to negotiate solutions to this, but may need a more systematic approach to guarding anonymity of HIV-positive complainants through court orders protecting plaintiff identities.

A second problem is technically addressed by the DDO, but not effectively. A number of NGO workers expressed concerns with a loophole in the law that allows employers to require blood tests of employees as part of their annual mandatory medical examinations. Said Alice Chan of Society for AIDS Care, “Employers require an annual medical checkup, and many people don't know if they're testing for HIV and if that's why [the applicants are] turned away for jobs. Companies find an excuse.”⁴⁴⁶

“They can fire you and say it's for other causes,” agreed Barry Lee of the Hong Kong AIDS Foundation.⁴⁴⁷ Loretta Wong of AIDS Concern noted that migrant workers and domestic workers in Hong Kong are especially vulnerable: they can be compelled to be tested for HIV by their employers, and may then be fired if they test positive, leaving them with invalid visas. “The question arises, who owns the medical information?” notes Wong. “The employer says that they paid for the test, so they own the medical records.”⁴⁴⁸ According to the language of the Disability Discrimination Ordinance, however, while employers may require medical information such as whether the job applicant has an infectious disease, this specifically excludes HIV-positive status as a basis for firing an employee.⁴⁴⁹ Anna Wu of the EOC observes, “The law doesn’t forbid (employers) from asking everyone to go through medical tests. It is easy to manipulate it and reject the person.”⁴⁵⁰

The third problem raised by Hong Kong interviewees is a problem with China’s restrictive laws forbidding marriage and entry permits for HIV-positive persons. Because of this, cross-border couples may be split up because one member of the pair is HIV-positive. Loretta Wong reported a case where a man, a Hong Kong resident, became engaged to a Chinese mainland resident. Because they were in the mainland, the couple was required to test for HIV in order to acquire a marriage permit:

She was negative, he was positive, and he was kicked out. His family is still there. This was one to one and a half years ago, and she's pregnant. Because of the situation, the guy had to smuggle her to Hong Kong to have the baby, and she's an illegal immigrant here.⁴⁵¹

In a similar case, said Ma:

One Hong Kong citizen I know went to the mainland, got HIV there and was kicked out, forbidden to go back for the rest of his life. His wife is in China, and when he goes back he needs to go illegally. His wife lives in Guangzhou, and she can't come here.⁴⁵²

Anna Wu of the EOC reported a formal complaint of discrimination by an HIV-positive mainland woman whose Hong Kong-resident husband also had HIV/AIDS. The woman tried to relocate to Hong Kong in order to care for her husband, and ultimately was only given a three-month visitor’s permit. Said Wu, “Her permit did not allow her to work in Hong Kong, and we can not work on immigration because it is exempted from our law.”⁴⁵³

Many people living with HIV/AIDS underscored the importance of having NGOs as intermediaries and advocates. Lili reports that she has drawn on the help of NGO staff in dealing with problems of discrimination and remembered that one staffer often threatened to file complaints with the EOC when negotiating with discriminatory funeral parlors or other facilities.⁴⁵⁴

Hong Kong’s NGOs played a critical role in establishing the legal framework in the first place: the NGOs successfully mobilized a grassroots movement to push for the inclusion of antidiscrimination language on HIV/AIDS in the DDO—an effort that included peaceful marches and a quilt with squares sewn by people with HIV/AIDS which was used at teach-ins in neighborhood libraries.⁴⁵⁵ The experience of these NGOs contrasts with the sense of powerlessness of AIDS activists in mainland China. Asked about any plans for legal reform in Yunnan province, a Chinese NGO worker responded, “That's a matter for big officials, we can't do anything about that.”⁴⁵⁶

Given the increasingly open borders between Hong Kong and mainland China, there are more opportunities for Hong Kong organizations to take their expertise with the HIV/AIDS epidemic into mainland China. At least three Hong Kong NGOs and civic organizations have initiated pilot projects on the mainland. Hong Kong AIDS Foundation and AIDS Concern have education, prevention and service projects in southern China, and AIDS Concern led some workshops for counselors in Kunming in 2002.⁴⁵⁷ The Hong Kong-based Chi Heng Foundation conducts AIDS education projects with male sex workers in southeast China, and provides scholarships to HIV-positive children and children affected by AIDS in selected towns in Henan province.⁴⁵⁸

Some people living with HIV/AIDS in Hong Kong expressed concerns about their peers on the mainland, and a desire to help. Said one: “Me and my friends all support each other. You can't do that on the mainland.”⁴⁵⁹

Asked if he has any suggestions for the Chinese government in how to better deal with the HIV/AIDS epidemic, Ma recommended freeing up NGOs in mainland China and allowing more to register, guaranteeing equal opportunity for people with HIV/AIDS, and doing more education and publicity about HIV/AIDS to reduce stigma and discrimination. He noted:

In the last thirty years or so, we can say that it had limited resources, so China couldn't do much about HIV. But nowadays, that’s not the case. Now we can't use that as an excuse to not do more.⁴⁶⁰