Please feel free to talk about anything, as long as you’re nice.

Also, please listen to this new piece on National Public Radio’s Marketplace. It’s about sex shops in China, and I’m interviewed briefly. An amazing subject; sex shops there are a world of difference from those in the West.

There’s also a lengthy new article by James Fallows on the possibility of more companies, especially tech start-ups, choosing to manufacture their goods in the US, not only in China. An important new trend?

Finally, there’s a disturbing new article on the surging AIDS epidemic in China. Some heartbreaking stories. (It’s World AIDS Day today.)

And now you can continue the never-ending debate on China’s system vs. America’s, if you don’t think you’ve yet said it all.

Long-time readers know this is a topic that always annoyed me (to put it mildly) – the treatment of hepatitis B carriers as lepers, banning them from certain types of jobs and needlessly stigmatizing them.

If this story is accurate, change is finally in the air:

China is set to issue regulations to remove hepatitis B check from physical examination for school entrance and work, according to the Ministry of Health.

Mao Qunan, a spokesman with the ministry, said here Tuesday that the move was based on related organizations’ thorough demonstration in regard to whether hepatitis B carriers will affect other people’s health.

However, Mao said restrictions will still exist in jobs that may induce hepatitis B virus transmission such as blood sampling.

“The list of these special professions that need restriction will have to go through a series of legal procedures for approval,” said Mao, adding that the upcoming regulations will cover related aspects.

In addition, the results of hepatitis B tests for other medical purposes should be protected as part of examinees’ privacy, and such tests should not be carried out by force.

“As we know more about the hepatitis B virus, our prevention and treatment measures become more specific,” said Xie Rao, a senior liver disease physician with the Beijing Ditan Hospital, adding that the move showed that the country’s understanding of the disease had entered a higher level.

Hepatitis B has been around about as long as humanity itself and has been well understood for many decades. There has been no sudden breakthrough that convinced the Chinese authorities that it was safe to end the ban, and the line that their understanding has now “entered a higher level” is baffling. All they did was catch up with what’s been common knowledge around the world for years: hepatitis B carriers, like those who test positive for AIDS, pose no extraordinary danger to their colleagues.

If this actually happens and the ban is lifted, I give China credit for reversing what was a vile policy. That it took this long, ruining many people’s lives along the way, is a tragedy.

Link via Danwei.

Every once in a while my work puts me in the presence of greatness. It did so yesterday when I had the pleasure and privilege of working with South African Justice Edwin Cameron, the only public official in all of Africa to publicly state that he has AIDS. He is probably also the only openly gay official on the continent. Oxford-educated and a Rhodes Scholar, Justice Cameron’s contributions to human rights and AIDS awareness, and his personal courage, cannot be exaggerated.

Yesterday he spoke with reporters in Beijing about a recent Renmin University-UNAIDS survey [pdf file] on the attitudes of Chinese people in six cities – Kunming, Shenzhen, Shanghai, Wuhan, Zhengzhou and Beijing – toward AIDS and AIDS sufferers. The survey sampled four groups, migrant workers, blue collar workers, white collar workers and youth, and it provides some depressing if not especially surprising findings:

– More than 48% of respondents thought they could contract HIV from a mosquito bite, and over 18% by having an HIV positive person sneeze or cough on them.

– Around 83% of interviewees had never searched for information on HIV/AIDS.

– Nearly 30 % did not know how to use a condom correctly.

– Only 19 % said they would use a condom if they had sex with a new partner.

– Nearly 11% of respondents had had sex with people who were not their spouse, girlfriend or boyfriend during the past 6 months; 42% of those respondents had not used condoms.

– 30% think HIV positive children should not be allowed to study at the same schools as uninfected children.

– Nearly 65% would be unwilling to live in same household with an HIV-infected person and 48% of interviewees would be unwilling to eat with an HIV-infected person.

In other words, we haven’t made much progress since I first started writing about this topic five years ago, at least not in terms of people’s attitudes and awareness. In terms of treatment, there has been huge progress in China, including anti-discrimination laws and free retrovirals for anyone with AIDS. The government needs to do much, more, however. Justice Cameron said, for example, that while the government provides free retrovirals for treatment of AIDS, people must still pay for medications for opportunistic infections from their own pockets, which can easily impoverish them.

I don’t really know what it is about natural leaders, the way they stand out in a crowd even when silent, and the way that they make those they’re talking with feel like they are the only person in the entire world. Edwin Cameron has those qualities, and the reporters he spoke to were visibly moved when he made an urgent appeal to them to encourage HIV sufferers in China to act as activists and to speak out the way he has. That is the only way to overcome stigma, he said., noting that what makes AIDS so insidious is that in many places it remains “a silent disease.” People suffer in silence for fear of ostracism if they tell the truth. This fear discourages Chinese people from getting tested, and those who are tested seek to hide their HIV status at all costs.

“This is a tragedy,” Justice Cameron said. “The Chinese government has a good treatment program. But there is a disturbing pattern here: 35-40,000 people in China are receiving antiviral treatment but more than double that number need treatment.” And they remain silent, and will die unnecessarily, as AIDS today is fully treatable. He pointed to activists in the US in the 1980s who generated a wave of publicity and awareness that put a human face on the disease, lessening the stigmatization in America dramatically. In China and Africa, there are few such activists. That is one of the keys to ending stimatization, he said: Africa needs a Magic Johnson to tell people they do not need to be ashamed of having AIDS.

It isn’t just a matter of fearing ostracism from friends and family, however. He said that AIDS sufferers still get turned away from health clinics in China’s provincial areas. The most poignant moment came when he described to reporters how he needed a special invitation sent from the Chinese government to its consulate in South Africa for him to be permitted entry into China. He added that when he comes to the US he must undergo an even more humiliating ordeal, being tested at the airport to determine whether his AIDS is under control (I am not sure exactly what they test for).

Hu and Wen have visited hospitals and spoken out on AIDS, he said, but efforts to educate the public remain seriously inadequate. “I beg them to do more,” Justice Cameron said.

Perhaps the most controversial topic he discussed was how markedly different the AIDS epidemic is in southern and western Africa, where the level of infection is above 11 percent. This is, he explained, “a mature epidemic, meaning that everone, gay or straight, young or old, knows someone who has died of AIDS.” This is unique; no other geography on earth has seen a massive AIDS epidemic that has spread beyond the main risk groups (injection drug users, plasma donors, “MSM” – men having sex with men – and sex trade workers). It was feared back in the time when I wrote my original post that China would be like Africa, home to a massive epidemic seeping into the mainstream, heterosexual population. It appears that will not happen. Justice Cameron said no one was sure why this phenomenon occurred only in a specific section of Africa, but said the reason could be genetic. In China, the number of people infected by shoddy plasma collection has leveled off, and the levels of infection are beginning to mirror those in other countries, with MSM and injection drug users being the most affected groups.

Working with Edwin Cameron was an inspiration. It was also inspiring to see the level of interest in this topic among the Chinese media. You can se some of the articles here and here. This was the high point of my nearly two years in China, and a day I’ll never forget.

A late-night quickie:

The European Parliament on Thursday awarded its top human rights prize to jailed Chinese dissident Hu Jia despite warnings from China that its relations with the 27-nation bloc would be seriously damaged if it did so.

In selecting Hu to receive the Sakharov Prize for Freedom of Thought, the European lawmakers said they are “sending out a signal of clear support to all those who support human rights in China.” Hu has advocated for the rights of Chinese citizens with HIV-AIDS and chronicled the arrest, detention and abuse of other activists.

After I posted a few weeks ago that I felt Hu was deserving of the Nobel Peace Prize, I had an opportunity to discuss his career with friends of mine (Westerners involved in government) who are much more familiar with his activities than I. Since then, I’ve had rather mixed feelings about Hu Jia.

His arrest is certainly prima facie evidence that today’s CCP retains much of the prickly, pig-headed, uptight, asinine qualities of yore. And yet, there’s no denying Hu was often a self-promoter, practically shouting at the government, “Arrest me,” especially considering his timing. (He was warned that such antics right before the Olympic Games would not be tolerated, and he persisted in a most in-your-face manner.) None of that even begins to justify his arrest, but maybe it raises questions about Hu’s judgment and motivations?

Hu did dedicate much of his time to raising awareness of AIDS and environmental issues in China. But my friends, one of whom works at the United Nations, challenged me about what Hu has actually done aside from draw attention to himself and get himself arrested. I mentioned a project he launched to help AIDS orphans in Henan, and they countered that it was more hype than anything else. “Basically he wrote some emails,” my friend countered. “Do we award the Nobel Prize to someone who just sent out emails?” Before anyone jumps on a high horse and says I’m slandering Hu Jia (whom I’ve defended many times on this blog), please understand I am only saying I don’t know – that maybe he’s an example of our emotions (mine included) making us jump to conclusions. Or maybe he actually did deserve the Nobel Prize. As I said, mixed feelings.

Whether he deserves the Sakharov Prize is up for debate, as with any prize for political activism. In any case, if this inspires greater scrutiny of China’s repressive tendencies, paranoia and eagerness to arrest anyone who threatens to shed light on them, then I’m glad Hu Jia won.

I meant to put up a one-liner, and suddenly it became a tome. Good night.

According to a report in yesterday’s WaPo, police detained AIDS activist Gao Yaojie at her home on Sunday and prevented the octogenarian doctor from traveling to Beijing to apply for a U.S. visa. Dr. Gao, instrumental in exposing the severity of China’s HIV/AIDS crisis, planned to travel to the U.S. to collect an award from Vital Voices for her work.

Gao, a retired physician, was among the first to expose Henan’s blood scandal in which millions sold blood to unsanitary, often state-run health clinics, making the province the epicenter of China’s AIDS problem.

She wrote and distributed material warning people of the risks of blood-selling, making her a target of local authorities fearful of the social stigma and political sensitivity surrounding AIDS.

The story was told to Reuters by Beijing AIDS activist Hu Jia who claims that Dr. Gao is now under house arrest and that her telephone service has been suspended.

This is the not the first time that Dr. Gao has been prevented from leaving China to receive an award for her work, Chinese authorities also barred her from traveling to award ceremonies in 2001 and 2003.

Beijing’s actions could also come up as an early issue in the 2008 presidential campaign, Hillary Rodham Clinton serves as honorary chair for Vital Voices and her name was reportedly included in the invitation letter to Dr. Gao.

UPDATE via CDT: After the issue was raised by the US Embassy in Beijing, Chinese foreign ministry spokeswoman Jiang Yu claimed that the ministry had no knowledge of Gao’s detention, according to a Reuters report. Jiang referred questions to the local Zhengzhou government (who is not talking) and reminded reporters that China was: “a country with a system of law and everyone is equal before the law.”

Richard Spencer also has a great post on his meetings with Dr. Gao and the difficulties she has had to endure as the result of her activism.

This was once the topic I wrote about more often than any other, but I stopped following it so closely some months ago, when I got the impression that China was finally getting serious about the tragedy and cleaning up its act. And in some ways I know they have. But after Ellen of Crackpot Chronicles pointed me to this article, I’m forced to wonder whether all those stories I was reading about education programs for the rural workers really amount to anything.

Stigma and discrimination form the main barrier to China’s HIV/AIDS prevention, said a UNICEF health official here Saturday.

Overcoming stigma and discrimination is crucial to China winning the war against AIDS, said Koen Vanormelingen, chief of the Health and Nutrition Section of the United Nations Children’s Fund (UNICEF) Office for China.

In China and in the rest of Asia, social and cultural discrimination prevents people from wanting to know more about AIDS, and makes it especially hard to stop the spread of the disease.

A recent investigation by Horizon Market Research, a leading survey company in China, shows that nearly 19 percent of Chinese people have never heard of AIDS, almost the highest percentage in the world. In some regions of central China’s Henan Province, where unsanitary blood sales have caused a serious increase in HIVinfection, the local people do not even know the term AIDS, and just call it a “mysterious disease.”

In addition, for many people, HIV/AIDS is considered a disgraceful condition. Those infected with HIV are usually considered morally bad, and are therefore despised by others.

Stigma and discrimination are also very dangerous in that they may push the HIV-affected group to criminality and other behavior which destabilizes society, said Vanormelingen.

It’s a damned depressing piece. It sounds like we are right where we started when I wrote my first long post about this nightmare. Nineteen percent of the population has still never heard of AIDS? I would have believed that back in 2002, but now, after so many highly touted moves by the government to alert the at-risk population, could we really still be stuck on square one?

Ellen also alerted me to an article in the WaPo that says the AIDS problem is worsening and seeping from the drug users into the general population.

President Hu Jintao was shown on state television Tuesday shaking hands with AIDS patients for the first time, as a report warned that the disease is spreading in China from high-risk groups such as drug users to the general population.

The number of people contracting the AIDS virus in China is rising, according to a report by a U.N. agency and the Chinese Cabinet’s AIDS commission released on the eve of World AIDS Day….

“The party and the government are all concerned about you,” Hu added. “I hope you will have confidence in your treatment by cooperating with the hospital and trying to have an early recovery.”

It was the first time China’s president was shown meeting AIDS patients and part of a government campaign to show it cares. Premier Wen Jiabao set the new tone in December 2002, when he was photographed shaking hands with ordinary Chinese stricken with the disease.

The new joint U.N.-China report warned, however, that the epidemic is spreading to the general population.

I am glad that Hu did what he did, though I’m not happy that’s it’s taken two decades to happen. The key question is, as long as AIDS victims are stigmatized and marginalized and, in effect, punished for their bad fortune, how can China expect them to seek treatment? How can they expect to win? As we in America know, silence really does equal death when it comes to AIDS, and the more they try to push it down, sweep it under the rug, the worse it will get.

I was so optimistic after reading of Bill Clinton’s and Dr. David Ho’s efforts to de-stigmatize AIDS in China last summer, and it looked like it was working. Reading the latest reports, it’s hard to feel so sanguine.

After all the fanfare I’ve been hearing about giving out condoms in China to fight AIDS, this is surprising.

China’s top two universities have suspended a free handout of condoms, describing the plan as inappropriate.

China is grappling with AIDS but the country’s top two universities do not want their students touching condoms.

Beijing University and Tsinghua University yesterday stopped a disease prevention centre handing out 2,500 free condoms.

Administrators said it was not acceptable and that organisers had not obtained approval.

Despite the urgent need to curb the spread of HIV/AIDS, conservative attitudes about sex in China often keep the prevention message from being broadly publicised.

I wonder what brought on this change of heart…? Recent stories like this had given me hope this would become a nationwide movement. I should learn by now never to get my hopes up about China becoming more liberal about sex. (Anyone remember the Vagina Monologues fiasco last winter?)

I’ve posted before about the feisty elderly doctor, and she’s been profiled a lot this past year. But it was only after reading this article that I decided she really does deserve the Nobel peace prize. How do I nominate her?

This exhaustive article tracks Time’s 1996 Man of the Year Dr. David Ho as he fights to convince the Chinese government to acknowledge and respond to its festering AIDS crisis.

The article focuses on Ho’s efforts in Yunnan, where he’s initiating trials of an AIDS vaccine for those most likely to become infected, mainly injection drug users and sex workers. Every step of the way, Ho has to struggle with the government and the effects of its stigmatization of AIDS:

“They desperately want help,” he [Ho] says of the doctors he met in Wenlou. “They obviously have the data on AIDS patients but are afraid to show us.”

That fear is well founded. Adding to the stigma surrounding AIDS in these villages is the role that local leaders played in the blood-buying program. “Many government officials made a lot of money,” says the patient advocate who calls himself Ke’Er. To protect themselves, they wrapped their villages in the cloak of state secrecy, effectively sealing off AIDS patients from foreign aid groups as well as health officials from other provinces. AIDS-care centers still won’t put the word AIDS on their doors, opting instead for such intentionally obscure labels as “home garden.”

To their credit, the authors also note how helpful some of the health officials are being to Dr. Ho, as their alarm at the magnitude of the crisis grows.

The article includes the usual horror stories of China’s AIDS victims and their children (200,000 of whom are now parentless in Henan Province), and the maddening attempts to move officials to action. It also gives us reason to hope as it chronicles Dr. Ho’s successes in pushing the boulder up the mountain.

More than anything, the article is a tribute to Dr. Ho, whose patience, perseverance and dedication make him one of the greatest heroes of our time. How ironic, that he is forced to play a David-and-Goliath scenario when he is trying desperately to save Goliath from death and destruction.

Related post: The indescribable tragedy of AIDS in China

A commenter pointed me to an article by Xiang Dong, senior producer with BBC World Service. It’s an important story because right now it seems to many that China has finally wised up about AIDS and is being open and responsible on the issue. But is it true?

I had hoped that China had learned some lessons after the outbreak of Sars, but reporting on or talking about HIV and Aids in China remains both difficult and dangerous. The situation is still very sensitive and journalists – whether foreign or local – asking questions are routinely prevented from reaching the areas where people are dying.

Even the outspoken Aids activist Dr Gao Yaojie was concerned. When I telephoned her in Zhengzhou, the capital of Henan province, where hundreds of thousands of people contracted HIV through selling their blood, she told me that her telephone was bugged and that she was being watched to try to stop her revealing the true picture of the HIV/Aids epidemic. I know that many other journalists have been harassed, detained and even expelled from the province.

So much for the new transparency on AIDS.

The article focuses on Xiang’s attempt to interview AIDS victims in a village in Henan province. The level of government harassment against any “outsider” who tries to reach these people is intense, and the locals who assist them are arrested. But the saddest part of the story is how the victims are still treated as second-class citizens, and how any attempt to improve their lives is challenged by local officials:

The following evening we began the 11-hour train journey to Henan. On board, my guide introduced me to two other volunteers and explained that he was setting up an orphanage for children whose parents had died from Aids. He told me of the difficulties he faces in dealing with the local authorities. Local schools won’t accept any of the children so he has been forced to set up the orphanage in a local mosque.

In the wake of World AIDS Day and all the noise China has made regarding its new openness on AIDS, it’s time to see the hype translated into action. Most of the efforts to stop AIDS must ocur at the local level. If this example is systemic, then we’re still pretty close to square one.

Related post: The indescribable tragedy of AIDS in China