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:
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:
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:
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:
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:
In a similar case, said Ma:
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:
426 Human Rights Watch interview with Law, Hong Kong, 2003.
427 “AIDS situation in second quarter of 2003,” Virtual AIDS Office of Hong Kong, August 12, 2003, posted at http://www.info.gov.hk/aids/english/news.htm, retrieved on August 21, 2003.
428 Human Rights Watch interview with Jenny W., Hong Kong, 2002.
429 Human Rights Watch correspondence with Loretta Wong, 2003; Human Rights Watch interview with Ma, Hong Kong, 2003.
430 Human Rights Watch correspondence with Loretta Wong, 2003.
431 Concerns about this treatment policy have also been raised. Loretta Wong of AIDS Concern notes, “The government provides health care services to those who have a Hong Kong ID card. Those who don't have to pay for the full cost. There are quite a number of people having AIDS (PHA) affected by the new policy, particularly HIV positive couples if the wife is from China” (Human Rights Watch correspondence with Loretta Wong, August 2003).
432 Human Rights Watch interview with Barry Lee, Hong Kong, 2002.
433 See the website of AIDS Concern, www.aidsconcern.org.hk (this site appears to be sometimes blocked in mainland China). See also AIDS Concern’s collection of anonymous narratives by Hong Kong people with AIDS and soup recipes collected from their home soup delivery service, Feichang song tang renwu [Extraordinary soup delivery mission], Hong Kong, 2001.
434 Human Rights Watch interview with Alice Chan, CEO, Society for AIDS Care, Hong Kong, 2002.
435 Equal Opportunities Commission, November 1999, “Report on Case Study of Kowloon Bay Health Centre”; EOC, January 25, 2002, “Richland Gardens Case Settled Out of Court” (press release); EOC, January 6, 2002, “Final Conclusion of Richland Gardens Case” (press release).
436 Human Rights Watch interview with Alice Chan, chief executive officer, The Society for AIDS Care, Hong Kong, 2003.
438 Human Rights Watch interview with Anna Wu Hung-yuk, chairperson, Equal Opportunities Commission, Hong Kong, 2003.
440 Human Rights Watch interview with Loretta Wong, deputy chief executive, AIDS Concern, Hong Kong, 2002; interview with Jenny W., Hong Kong, 2002; interview with Lili P., Hong Kong, 2003. Anna Wu, chairperson of the EOC, responds that in a recent court case the EOC was able to obtain a court order protecting the identity of the plaintiffs, and suggested that courts might consider this more generally for plaintiffs who were HIV-positive (Human Rights Watch interview with Anna Wu, Hong Kong, 2003).
441 Human Rights Watch interview with Lili P., Hong Kong, 2003; interview with Ma, Hong Kong, 2003.
442 “Watchdogs are meant to have teeth”, South China Morning Post, Feb. 11, 2003.
443 Human Rights Watch interview with Ma, Hong Kong, 2003.
444 Lili P., a Hong Kong PLWHA, reported that a friend who stayed in Queen Mary hospital towards the end of his life was neglected by medical staff. In another case, Lili accompanied a friend who was mentally disabled to the emergency room and when the doctor learned of the patient's HIV status, "he dropped his pen and rushed off to wash his hands.” Human Rights Watch interview with Lili P., Hong Kong, 2003.
445 Human Rights Watch interview with Anna Wu Hung-yuk, chairperson, Equal Opportunities Commission, Hong Kong, 2003.
446 Human Rights Watch interview with Alice Chan, Hong Kong, 2003.
447 Human Rights Watch interview with Barry Lee, Hong Kong, 2002.
448 Human Rights Watch interview with Loretta Wong, Hong Kong, 2003.
449 Disability Discrimination Ordinance, chapter 487, section 61 (2).
450 Human Rights Watch interview with Anna Wu, Hong Kong, 2003.
451 Human Rights Watch interview with Loretta Wong, Hong Kong, 2003.
452 Human Rights Watch interview with Ma, Hong Kong, 2003.
453 Human Rights Watch interview with Anna Wu, chairperson of EOC, Hong Kong, 2003.
454 Human Rights Watch interview with Lili P., Hong Kong, 2003.
455 O.C. Lin, “Community Efforts in Fighting Against Discrimination and Promoting Acceptance”, Paper presented at Hong Kong AIDS Conference 2001, September 16, 2001.
456 Human Rights Watch interview with Han, Kunming, Yunnan, 2002.
457 Human Rights Watch interview with Barry Lee, Senior Service Officer, Hong Kong AIDS Foundation, Hong Kong, 2002; and Loretta Wong, deputy chief executive, AIDS Concern, Hong Kong, 2002.
458 Chung To, presentation at Columbia University East Asian Institute, November 13, 2002.
459 Human Rights Watch interview with Harry Z., Hong Kong, 2003.
460 Human Rights Watch interview with Ma, Hong Kong, 2003.