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IV. Continuing Crackdown in Henan Province

Henan province, the site of one of the world’s most disastrous and preventable HIV/AIDS catastrophes, presents all the perils and promises facing AIDS activists in China, often in extreme. Thousands of people, perhaps a million or more, were infected with HIV as a result of a profit-driven blood-selling scheme that operated throughout the 1990s.³⁰ Similar blood-selling schemes operated in a number of other provinces, and Henan’s response to the crisis in many ways exemplifies some of the worst problems caused by China’s center-local AIDS policy divide.

Local authorities, particularly those in Henan provincial and county health bureaus, were deeply involved in the blood-selling enterprise. Some local health officials enriched themselves and their family members by encouraging thousands of Henan residents, mostly impoverished villagers, to sell their blood to government health facilities. Others sold blood to “underground” or illicit blood banks. As AIDS activist Zhu Jinzhong said to a reporter,

They were all officials from the provincial Health Department or the epidemic control bureau, and their relatives and friends. Without those connections, you could not possibly set up a blood collection centre.³¹

However, the blood collection facilities were poorly run, and did not routinely test for HIV. Blood was collected and pooled, and the lucrative plasma separated out. The remaining pooled blood cells were reinjected into donors to prevent anemia and enable them to donate more often – thus quickly and efficiently spreading the AIDS virus throughout whole villages. Officials even allegedly suppressed studies that emerged while this was happening, showing the extent of the problem.³²

As a result, the populations of entire villages are now dying of AIDS, leaving behind thousands – perhaps hundreds of thousands -- of orphans. To date, no official involved in this catastrophe has been held accountable.³³ In fact, some of the senior officials responsible for the catastrophe have even been promoted. This lack of government accountability has left in place officials who continue to impede efforts to help those affected by the disaster. Some Henan people with HIV/AIDS have called for an investigation.³⁴

While Beijing has begun to take a more forward-looking stance on the AIDS epidemic, as noted above, some local authorities continue to hamper the development of a national response, and in particular restrict and harass AIDS activists who raise concerns about their management of the epidemic. This is recognized by China’s State Council in its 2004 joint report with UNAIDS on the epidemic:

The response to AIDS by different ministries and provinces has been uneven. In many sectors and provinces, policy-makers have limited understanding of [AIDS]…and there is inadequate attention to these issues in the planning, implementation, and evaluation of HIV/AIDS policies, laws and interventions.³⁵

Henan province emblemizes these problems. Before the extent of the AIDS crisis in Henan was known, national and local officials tried to prevent the spread of information about the causes and extent of the blood scandal, often by using China’s highly restrictive “State Secrets” law, which can lead to serious criminal penalties for the dissemination of any information deemed – even retroactively – to have been a “state secret.”³⁶ In 2002, Beijing police detained Wan Yanhai, director of the Beijing-based AIDS organization Aizhi Action, on suspicion of circulating state secrets; specifically, an internal government report on the epidemic. He was released after an international outcry.³⁷ In 2003, Ma Shiwen, deputy director of Henan’s Office of Disease Control, was detained several times on suspicion of circulating state secrets, most likely for sending the report earlier circulated by Wan Yanhai. After another international outcry, Ma Shiwen too was released without charges on October 16, 2003.³⁸ In the 1990s and early 2000s, Chinese and international journalists who visited Henan to document the epidemic were often detained, interrogated, and expelled.³⁹

The massive dimensions of the AIDS crisis and Henan’s proximity to the Beijing press corps made it inevitable that the truth would emerge. As the story of this disaster became known in China and abroad, the Chinese government changed its response.

The national government, as well as Henan provincial and county officials, have now promised medical aid and financial support to impoverished villages ravaged by the AIDS epidemic. In September 2003, senior Beijing health officials promised that through the “Four Free and One Care” program, the government would provide free antiretroviral treatment to all those who could not afford it.⁴⁰ In October, China’s Ministry of Health announced that it would begin by implementing a “Comprehensive AIDS Pilot Area” project, targeting fifty-four areas in eleven provinces, including several key areas of Henan, for receipt of treatment and care. In particular, those in the pilot areas who contracted HIV through blood transfusions (and sales) were promised free treatment.⁴¹ In February 2004, seventy-six provincial officials were dispatched to the countryside to oversee implementation of the program.⁴²

Furthermore, an official statement about the policy said that “rural residents and AIDS patients [living] in cities and towns, who have never participated in health insurance, or a treatment insurance program, and who are in economic difficulties” could receive treatment and medication at designated public health facilities.⁴³ Henan authorities have added their own promises of support. A “Six Ones” policy commits the province to building:

One road, one water well, one school, one standardized clinic, one orphanage and one education room at villages hit hard by HIV/AIDS, and [to providing] housing, clothes, food, basic health care, and access to schooling for all school-aged children.⁴⁴

The Henan government further pledged to establish orphanages for children orphaned by AIDS, and to provide a small subsidy to families that adopt orphans.⁴⁵

But in practice the Henan response to the AIDS crisis continues to be uneven, and in some cases hostile to efforts by HIV-positive villagers and activists who have formed local NGOs to help provide care, treatment and emotional support to fellow families struggling with the devastating impact of the epidemic. Residents and activists continue to raise concerns about the lack of adequate facilities to meet the overwhelming needs of tens of thousands of children affected by AIDS, the poor quality of the care and treatment provided, the sometimes abusive treatment by local authorities when senior officials come to visit; and about alleged corruption in the administration of internationally and nationally-funded aid programs.

While more information about the harassment of AIDS activists has emerged from Henan than from other provinces, this does not necessarily mean that other provinces are less restrictive; rather, they are subject to less scrutiny. As an AIDS activist explained to Human Rights Watch,

In Henan, there are angry farmers and famous doctors; it is near Beijing, journalists can visit it easily, and the local government cannot cover it up. [Another province with high HIV prevalence] is different. People know little about it, there are not many activists, and it is easy for the government to act less openly. They may appear open to foreigners and AIDS organizations -- that is easy for them to do. But if you get onto the ground and see the grass roots, you will see experiences like that of [an AIDS activist who was hounded out of town by local officials].⁴⁶

Some local authorities, such as those in Yunnan and, more recently, Shanxi, have garnered praise from AIDS activists who see local officials as concerned about and responsive to the crisis.⁴⁷ In Hebei, however, journalists have recently begun to document similar attempts to cover up the state’s role in comparable blood scandals by firing a whistle-blower who spoke to media, and suing a newspaper for libel when it reported on tainted blood sales.⁴⁸ The Chinese state has acknowledged similar blood donation scandals in five other provinces.⁴⁹ In this sense, the experience of Henan is instructive.

Detention and harassment of Henan AIDS activists

Henan officials continue to detain those who publicly criticize provincial efforts, or who attempt to disseminate information about the AIDS situation, either through the media or during official visits by high-ranking Chinese and international delegations.⁵⁰ Some authorities have explained their actions by saying that AIDS activism, and even orphanages established for children affected by AIDS, make local officials look bad by drawing attention to the epidemic and discouraging external investment.

China reports that its “Four Free and One Care” program has been a success so far, with 10,388 patients receiving antiretroviral drugs in eighteen provinces and autonomous regions, including Henan.⁵¹ However, grassroots AIDS activists in Henan paint a picture of chaotic and poorly-run healthcare facilities, hampered by poor training of healthcare workers, discrimination, and corruption.

While areas that receive a higher degree of international and domestic attention get resources, such activists say, other equally hard-hit towns out of the spotlight are neglected. One AIDS activist told Human Rights Watch that many local healthcare facilities are unclean and poorly-run, that antiretroviral distribution is uncoordinated and “chaotic,” and that many nurses continue to fear physical contact of any kind with HIV-positive people. He also reports the emergence of “medicine scalpers” -- people with good personal connections at local clinics and hospitals who are reportedly getting extra supplies of medicine and re-selling them at a profit.⁵² In another case, a popular doctor implementing the new free treatment program faced repercussions: in August 2004, Henan authorities detained Zhu Longhua, a popular village doctor, for handing out “too much” medicine, an allegation that was not explained by Henan officials.⁵³ International news reports say that the domestically-manufactured drugs are poor quality, with intense side effects. Because Henan healthcare clinics are short-staffed and often closed, and workers are poorly trained, many patients are not being seen regularly by doctors, and are not being warned about possible side effects. As a result, a number have stopped taking the medication.⁵⁴

Some of these problems appear to relate to scarce resources and others to poor coordination by the healthcare system, problems that are chronic throughout China. However, Henan AIDS activists who try to publicly draw attention to these and related issues can face serious repercussions. The threat to AIDS activists is particularly high during visits to Henan by high level national and international figures. The growing numbers of detentions, and the discriminatory views of many Henan officials, are emblemized by the fact that local authorities have now established a separate prison facility specifically for detainees who are HIV-positive.⁵⁵

Recent cases include the following:

• Henan AIDS activist Zhu Longwei has been repeatedly harassed and detained by local police and officials in connection with his advocacy on treatment access and on the plight of orphans. In October 2004, after returning from a conference on AIDS orphans in Beijing, he was attacked by a local official who has reportedly beaten other AIDS activists in the past. Zhu reported that he fought back to defend himself, seriously injuring the official. Afterwards, Zhu reported the incident to local police and government officials, and met with a lawyer. The following day, a group of five police officers came to Zhu’s home and questioned him about his trip to Beijing. Fearing arrest, Zhu left Henan for several months. In January 2005, Zhu returned to his home, met with police, signed an agreement, and paid a fine of 400 yuan [about U.S. $50]. In March, police returned to his home and detained him for a few days.⁵⁶
• In a series of incidents between August and October 2004, AIDS activists and journalists report that six volunteers working with the Orchid Orphanage organization were beaten by officials and by local thugs whom local activists believe were hired by officials.⁵⁷
• In May 2004, Chinese AIDS activists contacted the U.S. ambassador to brief him on the failure of provincial authorities to adequately assist the thousands of AIDS orphans in Henan, and encouraged him to visit. After the ambassador began to plan a visit, a colleague reported that one of the activists was detained for eight days.⁵⁸
• Three men and two women, all HIV-positive, were detained in May 2004 after seeking economic aid to repair their homes that had been publicly promised to HIV-positive persons by the Henan provincial government. As noted above, Henan authorities have promised economic assistance of this kind to Henan residents with HIV/AIDS. Police sentenced the two women to fifteen days’ detention.⁵⁹
• In April 2004, police detained a group of eight HIV-positive Henan residents who had traveled to Zhengzhou, Henan’s capital, to petition for government assistance promised by the province to people with HIV/AIDS.⁶⁰
• At the same time, two HIV-positive men from another village were detained after traveling to Beijing to ask for economic aid to pay for living expenses, and were released after their village head promised to give some aid.⁶¹
• In late April 2003, Kong Anli, a Henan man with HIV/AIDS who complained to the local health department that anti-retroviral drugs distributed by the department were past their expiration dates, was detained by Henan police in advance of a rumored visit planned by Chinese premier Wen Jiabao.⁶² He and others detained for petitioning the government for aid were released after their cases were raised with Chinese authorities by international HIV/AIDS experts and activists.
• When the World Health Organization visited Henan to investigate the SARS epidemic in May 2002, local officials reportedly ordered two people with HIV/AIDS who were seen as “troublemakers” to leave the area or be taken away by police. Yang Nidan, an HIV-positive woman who along with others had previously protested lack of access to healthcare or antiretroviral treatment, was also taken away, and when she resisted, was beaten and injured by police. When Yang demanded to know what law she had violated, police officers threatened to kill her.⁶³

These detentions are not isolated events, but are part of an ongoing pattern in which officials attempt to prevent information about the Henan blood scandal from getting out to the public.

Having restricted access by journalists during the 1990s and early 2000s, Henan authorities today continue to restrict media reporting about the epidemic. Minister of Health Wu Yi has warned that local officials who continue to cover up the epidemic will face “severe punishment.”⁶⁴ However, Human Rights Watch has gathered information about several Henan AIDS activists who were detained or harassed for speaking to or working with domestic and international media. Some activists also allege censorship or overt manipulation of government-run media by other sectors of the government.

Wu told Human Rights Watch that he fled the province in order to avoid being arrested for his contacts with the media:

The government is not letting the media report about AIDS in Henan….In some areas near our village, they won’t let reporters in, so we [AIDS activists] go out and meet them, and we take them into the village ourselves. After I brought some reporters in, the government’s attitude towards me became very bad. The government wants to organize any media reporting themselves.

The reporters get to the next village, and we organize people for them to interview. Then the Henan government puts pressure on them and the reports don’t come out. From July up to now, you won’t find a single news report on our village….If the media report on our village, they are supposed to leave out the name of the village [by agreement with local officials]….In August [2004], CCTV [China’s official television station] went to Henan, they interviewed people, and when the reporter went back to Beijing, they were not allowed to air it. The reporter felt very bad, but he said there was huge pressure, just no way to do it.

In August [2004], one time, I helped to bring in a group of over ten reporters. I let them in [the village], I took them around, and the government was extremely unhappy. After the media left, they found ways, they found excuses – this is their method.

Then they were about to detain me. I heard this from some of my relatives in the village. So I came here [outside Henan]. They would have found an excuse. I have been here for two-and-a-half months. My wife is concerned about my safety here because I’m doing a lot of interviews.⁶⁵

The local authorities do not always have to rely on fear or force to stop the spread of information about their ongoing mismanagement of the AIDS crisis in Henan. In some cases, local authorities resort to overt manipulation of the media to maintain a responsive public image. AIDS activist Wu reported information he had received from other activists about official attempts to manipulate media coverage:

On November 20th [2004] or so, a bunch of people from my village went to the county government to protest, to Shangqiu city. It was really a petitioning activity. There were over fifty people, and they went to request the cost-of-living support that the government had previously promised us. [On August 17], the government officials…brought [Hong Kong and other] media to our village. They paid three people with HIV to say [to media] that they had each received 160 yuan [U.S. $19] for cost-of-living support. Those people were paid to say lies.

So we went to protest because we hadn’t gotten this cost-of-living support. I wasn’t there but I spoke to people on the phone who were. They were there for about four hours. The city officials called our county government to come and get them. They sent a lot of cars and convinced everyone to go back to their village in the cars. But we still haven’t gotten the money.⁶⁶

Each incident of harassment of AIDS activists has a chilling effect on those who attempt to assist the people of Henan. As one volunteer who witnessed the crackdown on the Orchid Orphanage reported:

The volunteers cannot protect their [own] lives….They came to Henan in order to help these AIDS orphans, but only received bad treatment from the government. After consideration, they decided to go back home.⁶⁷

Another Henan activist asked by Human Rights Watch about detentions of AIDS activists in his town, said, “They do this to us all the time.” He declined to speak further because of security concerns.

The mistreatment of activists helping AIDS orphans

According to official Chinese figures, there are one hundred thousand children orphaned by AIDS nationwide; activists working in Henan estimate there are in fact one hundred thousand children orphaned by AIDS in that province alone.⁶⁸ In an impoverished region where the epidemic is severely stigmatized, the presence of children orphaned or otherwise affected by the AIDS epidemic poses a significant challenge to local authorities.

International standards generally recommend that institutional care for children be used only as a last resort, and prominent Henan AIDS advocate Gao Yaojie has also recommended establishing a foster care system.⁶⁹ While this would be a wise long-term policy, the urgency of the current catastrophe in Henan requires swift action. Currently, widespread discrimination against people with HIV/AIDS in China, and the poverty faced by many rural Henan families, make institutions the first and virtually only solution for children whose families are unable to care for them. The tens of thousands of Henan children who have lost their parents due to complications related to AIDS, or whose parents are HIV-positive, are often turned away by local schools.⁷⁰ While the government has promised free tuition to children orphaned by AIDS, it has made no provisions for those who have lost one parent, even where that parent may have been the sole wage-earner. Schools do not uniformly implement the government’s free tuition policy, and many children affected by AIDS leave school because their families can no longer afford to pay school fees.⁷¹

The Convention on the Rights of the Child in article 20(1) provides that “a child temporarily or permanently deprived of his or her family environment, or in whose own best interests cannot be allowed to remain in that environment, shall be entitled to special protection and assistance provided by the State.”⁷² The Convention on the Rights of the Child specifically obliges states parties to take “all appropriate” measures to protect children from trafficking, being separated from parents against their will, and economic exploitation, hazardous labor, involvement in drug trafficking, sexual exploitation and abuse, and any other form of exploitation.⁷³ Regarding children orphaned by HIV/AIDS, the Committee on the Rights of the Child noted that states must provide assistance “so that, to the maximum extent possible, children can remain within existing family structures,” that where this is not possible, states should provide, “as far as possible, for family-type alternative care (e.g. foster care),” and that “any form of institutionalized care for children should only serve as a measure of last resort.”⁷⁴

China has signed and ratified the Convention on the Rights of the Child.⁷⁵ However, China’s national laws and regulations on HIV/AIDS lack clear guidelines on the care of orphans and children affected by AIDS.⁷⁶ Doctors and activists note that children affected by AIDS in China are becoming vulnerable to exactly the problems warned of by the Convention. As Gao Yaojie observes,

These orphans are plunged into such difficulties that boys enter easily into child labor while girls are vulnerable to sexual abuse. They are ripe for exploitation and need assistance…Without due care, some of them develop twisted personalities and hold grudges against everyone. If they are not placed in safe hands and given a normal education, they might end up as a threat to society.⁷⁷

While the Henan government has begun initiatives to educate children affected by AIDS, AIDS activists and doctors working in the province say that the small number of government orphanages are “overloaded” and unable to meet the need.⁷⁸

Thus, activists began several grass-roots initiatives in Henan to fill the gaps left by the state. The Henan government’s response to these efforts has been mixed at best. Some authorities encourage them, but others are resistant to any initiatives that are not government-controlled.⁷⁹ Henan authorities have sometimes dealt harshly with these activists.⁸⁰

The forcible closure of the Orchid Orphanage in July 2004 (discussed above) was one example of this harsh treatment. After the closure, activists working with the orphanage decided to travel to Beijing to petition the national health department and contact media to raise the issue. Wang Guofeng, who with his wife Li Suzhi⁸¹ had acted as the orphanage’s liaison with the government, were reluctant to abandon the orphanage. On July 11, police in Shangqiu city detained Wang Guofeng, Li Suzhi and two other AIDS activists who were all preparing to leave for Beijing, on suspicion of inciting trouble.⁸²

Wang Guofeng, who himself was HIV-positive, had already expressed fears that his local prominence and his connection with the controversial orphanage would lead soon to his arrest.⁸³ Wang and his wife Li Suzhi had long been outspoken, often sought by Chinese journalists researching AIDS in Henan, and this media work often brought them into conflict with local authorities. One Henan AIDS activist told Human Rights Watch, “The government didn’t like Wang Guofeng before [the Orchid crackdown]. Reporters were always going to see him, and that gave him ‘face.’”⁸⁴

In response to Wang and Li Suzhi’s detention, Li Dan engaged in negotiations behind the scenes with local officials, while Chinese and international organizations and experts criticized the detention and signed a petition calling for their release.⁸⁵ After nearly a month in detention, Wang Guofeng and Li Suzhi were released on August 7, but were sentenced to house arrest on charges of fraud and disrupting social order.⁸⁶ They were reportedly required to sign agreements promising not to have further contact with Orchid or with the media.⁸⁷ Four other AIDS activists detained for conflicts unrelated to the case were also released on that date.⁸⁸

However, colleagues of the six activists said that the month-long detention, combined with poor nutrition, had serious health effects on some of the HIV-positive detainees. In particular, Li Suzhi reportedly suffered some deterioration of her health because she was not allowed to continue on the course of imported antiretroviral medications she had been on until her detention, and instead was required to switch to a different and inferior course of medications produced in China.⁸⁹

Further detentions followed. Police detained Li Dan and a colleague on Sunday, August 8, 2004, as they prepared to visit Shuangmiao village to visit AIDS activists who were still in detention, and to plan a protest by people with AIDS in the village.⁹⁰ Li Dan and the other AIDS activists were all released on August 9. Li Dan reported that while waiting at a train station in Shangqiu city just hours after his release, he was attacked by two young men who told him, “You know why we are beating you.” He told a reporter, “I guess the local government is anxious about our lobbying for AIDS patients.”⁹¹ In March 2005, he reported that from August to October 2004, six members of his organization had been beaten by local officials “or villagers hired by local officials.” He added,

One of our volunteers was beaten and injured by an HIV-positive person hired by local officials, and received cuts from the beating. Now he has developed psychological issues, worrying that he has contracted the HIV virus, and developed severe depression. However, the local police have not yet started processing these assault cases.⁹²

While the closure of Orchid Orphanage case gained international attention because of the harshness of official treatment of the orphans and the orphanage staff, other orphanages run by nongovernmental groups have also faced serious official obstacles. Another emblematic case, highlighting the use of institutional barriers, occurred in early 2004, when Henan province authorities closed the Loving Care Home, a privately run not-for-profit orphanage, and appropriated the donations in order to establish a new state facility.

Like many others, Henan farmer Zhu Jinzhong contracted HIV by selling his blood at a blood collection center run by the local government. In February 2003, Zhu Jinzhong began to take care of children in his village whose parents had died of AIDS, housing and feeding over fifty of them.⁹³

In December 2003, Chinese media began to report widely on Zhu Jinzhong’s “Loving Care Home,” and nearly 1.34 million yuan [U.S. $162,000] in donations flooded in to support his work, including a donation of one million yuan from CCTV, China’s official television network. Most donations were sent to the local Zhecheng county government to be passed on to Zhu.

However, in January 2004, Zhecheng County ordered Zhu to close his orphanage and transfer the children to the Sunshine Garden Home, a county facility that was still under construction.⁹⁴ One AIDS activist involved with orphan projects in Henan raised concerns about the segregated nature of the state orphanage.⁹⁵

The new facility has refused to accept any new orphans, despite the tremendous need for assistance in Henan. According to media reports, the new facility refused to accept new orphans when other families asked for help with the care of children; director Yang Jiafeng said that he would only accept the children from Zhu Jinzhong’s orphanage because those children “came with the money.”⁹⁶

Li Dan told Chinese journalists of similar comments from officials in relation to the closure of the Orchid Orphanage:

The officials told me the local government has established the Sunshine Home orphanage so it’s unnecessary for us to find another one. But the children now staying at [our] orphanage are from Zhu Jinzhong and our school. What about other AIDS orphans?

Just before the bureau came to our school, we had decided to admit nine more students. After the orphanage took the eighteen students, we asked them to accept the nine others. But they refused.⁹⁷

A Henan official justified the closure of Zhu Jinzhong’s home to the news media by claiming that Zhu had run afoul of government regulations, and, more revealingly, by citing his HIV-positive status as evidence of his lack of fitness to care for the children:

Zhu Jinzhong did not get approval from the local government agency, and his caring for a large number of children, while admirable, is not legal. Moreover, Zhu Jinzhong himself is HIV-positive, and to let him be the caregiver for AIDS orphans is definitely not beneficial to the children’s development.⁹⁸

The official did not account for the fact that donations to Zhu’s orphanage had been not only channeled through the county government but kept by it. In fact, this practice violates China’s own national Donation Law, which stipulates that donations “should be used in a manner respecting the wishes of the donor, and conforming with the end purpose of public welfare. Donated property may not be diverted to other purposes.”⁹⁹ The law also bars government work units from seizing donations intended for public welfare organizations.¹⁰⁰

Many local activists believe that the orphanage was closed because its existence embarrassed the government by pointing out their failure to provide for local orphans, and because authorities wanted the money.

Zhu Jinzhong was unable to re-establish the orphanage. In January 2005, while traveling home from a trip to Beijing, he contracted a rapidly-progressing pulmonary infection and died at the age of thirty-seven, while still urging his family members to find a way to help the children he had cared for.

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A state-organized system of foster care, combined with strong protections against discrimination in public schools, might offer the best long-term solution for Henan orphans and children affected by AIDS. Considering the urgent need right now, however, Henan and other affected provinces can ill afford to wait, leaving thousands – perhaps hundreds of thousands – of children without adequate care or education. Beijing’s promise through its “Four Free and One Care” program to provide free education, medication, and other assistance to AIDS orphans has not been sufficient in Henan; the province does not yet have enough facilities or services for children affected by AIDS in that region. NGOs that wish to establish institutions for the care of these children should be encouraged, and should be governed by reasonable regulations that establish clear standards of care and education. The state should not discriminate against HIV-positive persons who wish to establish such facilities. In fact, people who are living with the virus themselves may be very well positioned to help children cope with the traumatic effect of the epidemic. The state’s top priority in this catastrophe, for which it still bears a heavy responsibility, should be ensuring that children have their basic needs met, not jailing those who aim to help them.