Asia Owns Up to AIDS, Slowly


By Bruce Einhorn With "Chindia" having captured the attention of so many people in the world of business this year, it's no surprise that China and India took center stage on World AIDS Day 2005. On Dec. 1, as public-health experts worldwide assessed the battle against the virus, many were worrying about whether the governments of Asia's giants can prevent their HIV/AIDS problems from spiraling out of control among their 2 billion-plus people -- and threatening China's and India's ability to become 21st century economic powers.

In China, the question is whether a communist regime can cope with the kind of openness needed when tackling HIV/AIDS. Jeff Busch, a 47-year-old former investment banker, knows from first-hand experience how far China has come -- and how much officials there still need to do. Busch runs the Safe Blood International Foundation, a nonprofit that in the spring formed a joint venture with the Chinese Health Ministry to help cope with the problem of HIV-tainted blood (see BW Online, 5/10/05, "China Wakes Up to the AIDS Threat").

In late November, Busch traveled to China to attend the opening of Safe Blood's first facility, a training center for health workers in central Henan province. This was a big deal, a milestone not just for Busch and his nongovernment organization (NGO) but for China too, since it would be the first time the country had worked with foreigners to overcome Chinese shortcomings in protecting its citizens from the deadly virus.

CHANGE OF ATTITUDE. To mark the occasion, Busch was to travel to Zhengzhou, the capital of Henan, with a top Health Ministry official. The media would be there, to give people in China and the rest of the world an indication of China's new, more open attitude toward HIV/AIDS.

But just a few days before the opening, that attitude gave way. New rules stipulated no reporters. "We had it as an open event, and then we were just told that it wasn't," says Busch. Local officials were nervous about letting in the media and calling too much attention to the facility and the HIV/AIDS problem in Henan, which has some of the highest infection rates in the country. The official figure is 25,000 cases, but many people think that the real number is much, much higher.

While Busch says he's very impressed with the attitude of Health Ministry officials in Beijing, getting the locals on board is another matter. "The provinces are slower in moving," he says.

The good news is that at least officials at the national level are moving speedily. Safe Blood isn't the only NGO from abroad that's making progress in China. The Clinton Foundation, run by the former U.S. President, has started working in the country, and the Global Business Coalition on HIV/AIDS (GBC), run by Clinton's former U.N. Ambassador Richard Holbrooke, is active, too. In November, the Baylor International Pediatric AIDS Initiative, part of the Texas university's medical school, signed an agreement to open a treatment center for HIV-positive children in the city of Kunming, in southwestern Yunnan province, another place where infections are high.

TWO APPROACHES. Both India and China have serious problems (see BW, 8/22/05, "Crouching Tigers, Hidden Dragons"). With over 5 million people with HIV/AIDS, India has more residents with the virus than any place outside of Africa. No reliable statistics exist on the number of people with the virus in China. Estimates range from 840,000 to several million. And for a long time, the Chinese were in denial about their HIV/AIDS problem, with the government starting to face up to the magnitude of the mess only after the SARS debacle in 2003 illustrated the consequences of ignoring or covering up a public-health crisis.

You might think that India, as a democracy, would be better able to deal with the virus than China's communist cadres. China has a history of locking up AIDS activists, for instance. But GBC Executive Director Trevor Neilson says, now that the Chinese government has gotten past the denial stage, he's seeing a lot more progress in China than in India. "India is largely sitting around talking about this [problem]," he says (see BW Online, 3/14/05, "India: Success Tainted by AIDS").

The Chinese, on the other hand, have mobilized the bureaucracy, with top officials in each ministry now responsible for HIV/AIDS prevention and awareness work. (According to the Indian press, on World AIDS Day the Indian Prime Minister, Manmohan Singh, called for a major effort to fight HIV/AIDS. Singh is chairman of India's National AIDS Council. He announced plans to revamp the health-care system to improve the treatment people with HIV/AIDS receive.)

Certainly, the Chinese aren't where they need to be yet, as Safe Blood's Busch can testify. The central government in Beijing may have recognized the importance of tackling HIV/AIDS, but that message still hasn't quite made it down to the provincial level. "The Health Ministry needs the cooperation of the provinces to put together programs for HIV prevention," he says. "It's not [a matter of] ordering them but working with them."

"WE HAD TO BREAK THROUGH." Busch and his colleagues had to spend months reassuring officials in Zhengzhou that they should adopt Safe Blood's American-style methods for training workers to handle blood that might carry HIV. "It took quite a bit of convincing," he says, "and lots of visits." Busch reckons that people from Safe Blood made the trip from Beijing to Zhenghou every week for about six months. "There has never been hostility, " he say, "but they've been used to doing things a certain way for so many years, and we were changing them. We had to break through the resistance."

Now that he has managed to do that, Busch is hopeful that Safe Blood will be able to open more centers -- in Yunnan and the other in Beijing -- next year. If he and other NGOs make more progress, then the gap between China and India might be even bigger by next year's World AIDS Day.

Einhorn is Asia Economics editor for BusinessWeek in Hong Kong


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