(New York) - China's decision to provide HIV/AIDS medicines to the poor is a major breakthrough, but it could be undermined by a threatened crackdown on high-risk groups and continued discrimination by hospitals and clinics, Human Rights Watch said today.
The Chinese government announced on November 7 that it will provide antiretroviral drugs to all rural residents with HIV/AIDS and to urban residents experiencing "economic difficulties." But Human Rights Watch warned that other elements of the Ministry of Health's "five promises on AIDS work," particularly the increased crackdown on drug users and sex workers, could open the door to systematic human rights abuses that would compromise the effective delivery of AIDS drugs.
"Providing antiretroviral drugs to poor people is a great step forward," said Brad Adams, executive director of Human Rights Watch's Asia division. "But draconian crackdowns against people at high risk of HIV will only drive them underground and make it less likely that they will come forward for testing and treatment."
The promise of antiretroviral drugs was but one of "five promises on AIDS work" announced by Chinese Deputy Minister of Health Gao Qiang. Another commitment is to expand the crackdown against injection drug users and sex workers, two of the groups at highest risk of HIV infection. A recent Human Rights Watch report, "Locked Doors: The Human Rights of People Living With HIV/AIDS in China," showed that China's current harsh policy toward drug users includes arbitrary detention without due process, forced labor, detention in unclean and overcrowded facilities, and mandatory testing for HIV without informing detainees of the test results.
"China should repeal laws requiring forced detoxification, and work together with drug users and sex workers on HIV prevention and AIDS care," said Adams. "They are important allies in the fight against a burgeoning AIDS epidemic."
A further commitment is to protect the rights of people living with HIV/AIDS, but the Ministry of Health fails to say how it will do so. Human Rights Watch's recent report found that discrimination is widespread in Chinese hospitals and clinics. Many hospitals refuse to admit as patients people living with HIV; in Yunnan province, Human Rights Watch found that a hospital AIDS ward was closed and padlocked, barring all people with HIV/AIDS. People living with HIV/AIDS lack any means to seek redress because there is no national antidiscrimination law.
In Henan province, the Chinese government has yet to address a scandal in which hundreds of thousands-or perhaps a million or more-villagers contracted HIV through state-run blood collection centers. In May, HIV-positive villagers in Henan were beaten and jailed when they protested lack of access to care.
"China urgently needs a national law barring discrimination against people with HIV/AIDS, and should establish a mechanism through which victims of discrimination can file complaints," said Adams. "How will the Chinese government give out medicine if the patients can't even get in the hospital?"
Speaking at Beijing's Tsinghua University yesterday, former U.S. President Bill Clinton called on China to pass an antidiscrimination law protecting the rights of people living with HIV/AIDS. Tsinghua University scholars have repeatedly pressed for national legal reform to protect from discrimination people living with HIV/AIDS.
Human Rights Watch also expressed concern about the apparent downward revision of China's official estimate of the numbers of people living with HIV/AIDS in China. In 2001 the Ministry of Health estimated that there were 800,000 people living with HIV/AIDS in the country. Six months later, UNAIDS announced that there were as many as 1.5 million. In 2002, after international criticism, China revised its estimate up to 1 million people living with HIV/AIDS. As recently as September 2, Assistant Foreign Minister Shen Guofang said in Bangkok in a speech to the U.N. Economic and Social Commission for Asia and the Pacific that there were 1 million people living with HIV/AIDS in China.
This month, without explanation, the Ministry of Health suddenly revised the estimate down to 840,000. Many observers estimate that there may be as many as 1 million cases in Henan alone, and China's application to the Global Fund to Fight AIDS, Tuberculosis and Malaria also disclosed in six other provinces percentages of HIV infection higher than previously reported.
"This is no time for China to play games with numbers," said Adams. "If the state is going to offer treatment to all impoverished people with HIV/AIDS, it urgently needs an accurate number of how many there are."