After years of denying it had an AIDS problem, China in the past several months has begun to confront a growing epidemic. However, the methods of the Chinese government are often erratic.
Chinese Prime Minister Wen Jiabao and other top officials shocked many people last December, when state television showed them shaking hands with AIDS patients at a Beijing hospital, one of the few in the capital that accepts those with the virus.
Although China's first AIDS case was reported in 1985, the December handshake 18 years later was the first time high-ranking officials publicly acknowledged an AIDS victim. The government here says 840,000 people are infected, but foreign observers say the figure is probably more than one million.
Dr. Peter Piot, head of the U.N. AIDS program, says official acknowledgment is a big step forward, but the real work is teaching the general population about the disease. "The first place is breaking the silence around AIDS," he says. "Roughly half of the people of the population don't know about AIDS; don't know how it's transmitted."
China's AIDS problem got worldwide attention when thousands of poor farmers in central Henan Province contracted HIV, the virus that causes AIDS, through unsanitary, government-approved blood banks over the past decade. Officials first tried to cover up the scandal, denying news of the outbreak and banning reporters from visiting affected villages. But last year's outbreak of Severe Acute Respiratory Syndrome - which originated in China - brought international pressure on Chinese health authorities, who are now confronting AIDS in unprecedented ways.
The government in Shanghai, China's largest city, recently announced it would provide free or discounted AIDS treatment to the poor.
And in May, Beijing allowed foreign AIDS experts to work in Henan Province, in partnership with local authorities. The two groups in Henan are the U.S. Centers for Disease Control and Prevention and Globalfund, an international group that aims to halt the spread of diseases, including AIDS. The program is under the supervision of Dr. Ray Yip.
"We are in the process of setting up a high quality training center in the most highly affected areas of Henan where senior qualified AIDS medical experts will be assigned to train the local health workers," says Dr. Yip. "When health workers are fearful about AIDS patients, they will turn them away, so you cannot provide meaningful care."
Three months ago, China began offering free HIV testing, and the government last month announced AIDS education would be compulsory in Beijing high schools starting in September. Despite these steps, officials are continuing to restrict or persecute advocates who want improvements in care and more information about how the government handles AIDS.
The most recent example is of Hu Jia, a Beijing activist placed under house arrest when he tried to approach U.S. officials during the May launch of the AIDS programs in Henan. Activists say officials threatened to force Mr. Hu to get psychiatric treatment.
Nicolas Becquelin of the Human Rights in China group in Hong Kong says this is a sign that the government's approach is not broad enough to deal with the complex problem. "It's a top-down approach with little or no external supervision, where the civil society or AIDS groups are limited [in their ability] to really supply services and welfare functions," he says.
Advocates say the government needs to create an atmosphere in which high-risk groups such as prostitutes and drug users can participate in limiting the spread of HIV.
In addition, observers say politics plays a role. Nicholas Becquelin says China's communist leaders have a reason for not wanting open participation in formulating a solution. "The government wants to engage civil society in respect to the containment of the AIDS crisis, but not at the price of being criticized by or supervised by the public and civil society in general," he says.
U.N. officials have called China's AIDS problem a "time bomb" and warn the number of diagnosed HIV infections could double in two years, perhaps reaching 10 million by the year 2010.