07 December 2004
But drastic scale-up necessary to keep ahead of growing pandemics
Beijing – In discussions with senior Chinese government officials, Richard Feachem, the Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, praised China’s recent response to its growing HIV/AIDS problem and its actions against tuberculosis. In China to discuss Global Fund-financed programs for the country, Dr Feachem said that China could avert a major AIDS epidemic through sustained commitment, continued scale up of resources at the pace it has done over the year and further expansion of its open-minded prevention activities and care to vulnerable groups. He also said China’s scale-up against TB – a disease which currently kills many more people than AIDS – may eventually lead to a reduction in new cases.
“We have seen an impressive turnaround in China over the past year,” Dr Feachem said. “China has realized that widespread epidemics, such as HIV/AIDS, TB and malaria, pose a serious threat against economic development, poverty reduction and a stable society.”
Discussing HIV/AIDS, Dr Feachem acknowledged that unlike many other countries, China recognizes that even low overall HIV infection rates pose a serious threat in the long run. It has moved quickly to put in place anti-discrimination laws, to build a treatment program for those already infected and to initiate prevention activities targeting injecting drug users and sex workers. “The Global Fund is pleased that we provide substantial resources for China’s effort to fight HIV/AIDS, and we appreciate the considerable matching budget allocations from the Chinese government,” he said.
The Global Fund has committed $113 million to China; $56 million for HIV/AIDS as well as $53.5 million to fight tuberculosis and $3.5 million fight malaria. If these grants yield agreed results in their first two years, another $160 million will be made available.
The Chinese government, on its side, has over the past year nearly quadrupled its resources to fighting HIV/AIDS and TB, including treatment to people living with HIV and additional resources for HIV prevention programs targeting vulnerable groups. The Global Fund is playing a key role in boosting China’s resources available to reduce the growth in new HIV infections, keep alive those already living with the disease, and turn around the TB epidemic. Already, several hundred thousand people are treated for TB through the Global Fund grant.
In its recently published epidemiological report, UNAIDS states that HIV/AIDS has spread to all of China’s 31 provinces, autonomous regions, and municipalities. In some, such as Henan, and surrounding provinces in central China, HIV was already spreading a decade ago among rural people who sold blood plasma to supplement their incomes. Elsewhere, the virus has established a more recent but solid presence among injecting drug users and, to a lesser extent, sex workers and their clients. Sexual transmission of HIV from injecting drug users to their sexual partners looks certain to feature more prominently in China’s fast-evolving epidemic.
Condom use is increasing but not enough. In Sichuan, only around 40% of sex workers reported using condoms with all of their clients in the previous month, according to a 2002 study. Once HIV becomes established in commercial sex circuits, onward spread of the virus could be quite rapid if current behavioral trends persist. Already, the HIV infection rate among people being treated for sexually transmitted diseases is a grave cause for concern. To hold back this potential proliferation, China needs to move swiftly and with great resolve, UNAIDS warns.
Dr Feachem underscored this sense of urgency, saying investments need to continue to grow if the epidemic is to be contained. He also cited an urgent need to ensure political commitment at all levels, increase awareness of the HIV/AIDS epidemic, improve overall planning, and to reduce stigma through enforcing new anti-discrimination legislation and spread information about the epidemic. The government also need to ensure supplies of second line drugs and children formulation of drugs, increase HIV testing, improve blood safety, and increase monitoring of ongoing efforts.
“It would be fantastic if China could show the world how to contain the epidemic,” Dr Feachem said. “However, should we fail, the consequences would not only be catastrophic for China – they would be felt all over the world.”
Dr Feachem also discussed the Global Fund’s substantial support for TB treatment. The program aims to reduce the TB prevalence, including the spread of multi-drug resistant TB, through an effective and sustained control strategy (DOTS). The two parties discussed how to improve implementation of the program and further improve coordination with TB activities funded by different partners, including the World Bank, the UK Department for International Development. As other financiers of the efforts to fight TB in China, the Global Fund is relying on substantial technical assistance from the World Health Organization and is working closely with other key actors in the fight including the Japanese and Canadian development agencies and the Damien Foundation. Dr Feachem’s visit will be an opportunity to meet with these agencies and improve coordination and collaboration.