In Rural China, a Steep Price of Poverty: Dying of AIDS 艾滋病在河南蔓延 In Rural China, a Steep Price of Poverty: Dying of AIDS By ELISABETH ROSENTHAL October 28, 2000 New York Times http://www.nytimes.com/2000/10/28/world/28AIDS.html Dr. Gao Yaojie, who is fighting an AIDS epidemic in rural China. Issue in Depth The AIDS Epidemic ZHENGZHOU, China To celebrate the Moon Festival last month, a frail retired doctor named Gao Yaojie scraped together money to hire a taxi, packed it full of medicines, brochures, sweet drinks and cakes ?and slipped off, once again, from this provincial capital to see patients in remote mud- brick villages where countless farmers are silently dying of AIDS. Chinese officials here generally deny there is AIDS in rural parts of Henan Province, a farming region in central China south of Beijing. They have forbidden the local news media and government health workers to discuss the topic and blocked outside researchers from studying it. Dr. Gao, a small serious woman of 76 in dark hand-me-down clothes, is regularly chased out of the villages she goes to help. But Dr. Gao and a few others familiar with the area say small towns here and scattered elsewhere in central China are experiencing an unreported, unrecognized AIDS epidemic. A few covert studies suggest some of the towns have some of the highest localized rates of H.I.V. infection in the world; some say 20 percent. The problem is that for many years large numbers of poor farmers have illegally sold their blood to people known as blood heads, whose unsterile collection methods have left many infected with the virus that causes AIDS. The blood donors get the virus not only because blood heads reuse contaminated needles but also because donated blood is often pooled and, after the desired elements are removed, the remainder divided and returned to donors. So blood-borne diseases spread rapidly among the blood sellers ?who have now passed the AIDS virus to their spouses and children, and also to patients who get transfusions made from the blood. And while the Chinese government has acknowledged AIDS outbreaks in its western provinces and cities (caused mostly by drug use), discussion of this outbreak remains taboo. "This is a minefield, an extremely sensitive issue that is going to be a big problem for China," said one Western AIDS expert who has worked extensively in Asia. Against this backdrop of hostility and denial, the stubborn Dr. Gao is waging a lonely campaign to publicize the issue, educating the healthy and treating the sick in villages where many people have only a primary school education. She tries to discourage women from selling their blood, hands out medicine to control the diarrhea associated with AIDS and cuddles infected infants to show neighbors that there is nothing to fear. Her medicines, like pain killers and cough syrup, cannot cure patients, only ease their suffering. "No hospitals here take these patients," she said. "Their families turn them out. There's no option ?just to die. Many people think AIDS is a bad disease, so they don't talk about it and don't admit they have it." She said people are often so ignorant about the disease that they continue to sell their blood even after watching dozens of fellow villagers die, thinking that if they eat right and dress warmly, they cannot fall ill. One concerned local official said that widows and widowers of AIDS patients ?many of whom were themselves infected ?often quickly remarried. "They are continuing to spread the virus," he said. "When will this tragedy end?" Because provincial officials have blocked efforts by government scientists to survey these areas, there is no clear idea of the magnitude of the problem, only disturbing hints. Working without permission, Dr. Gui Xien, a researcher from neighboring Hubei Province, drew 155 blood samples from farmers in Shangcai County in Henan, where blood selling is common; 96 of them were H.I.V. positive, including blood sellers, their spouses and children, according to another doctor familiar with the study. Although it was not a random sample, the 62 percent infection rate was alarming. "These villages should have a rate of zero," said the Western researcher. "Even 20 percent indicates a very serious problem." He said the statistics trickling out of the countryside presented a "classic picture of a blood-associated epidemic," because rates of other blood- borne infectious diseases, particularly hepatitis C, were also very high. In Shangcai County, more than a dozen families in one village of 2,000 people included individuals who had died from AIDS ?and rates are similar in all the surrounding villages, a local cadre told a small Beijing magazine called China News Weekly, one of the few publications to broach the subject. When an infectious-disease specialist from Beijing made an undercover tour of hospitals in rural Henan this year, he saw many patients who appeared to have AIDS. When his identity was discovered, he was thrown out of the province and faced a reprimand. "Lots of people at the center are really good and know what needs to be done," said a Western diplomat who was told by health officials in Shangcai that there was no AIDS there. But those officials are ineffective, he said, because "they depend on the provincial health folks who nominally work for then, but in reality don't." In some of the most affected areas, a few local officials and medics have tried to help the ill with donations and improvised education campaigns. But with no support from higher levels of government, little money and limited knowledge, they are often ineffective. "You run into many obstacles doing this kind of work, both from higher officials and from townspeople, who don't understand the disease," said a local official, a Mr. Kong, who spoke by phone from one of the affected villages. Then he asked, "Tell me, is there a cure for this sickness?" The illegal blood trade thrives in China because of perpetual blood shortages at hospitals and at companies that make medicines derived from blood: most Chinese are unwilling to donate blood. In rural Henan, most donors are women because people here argue that men's blood is too precious to waste, and women lose blood to menstruation anyway. In an unpublished article circulated to call attention to the trade, a local official named Du described this scene: "Villagers became crazy about selling blood because they are so poor and life is so hard. Many had built their houses by selling blood. Some will even bribe traffickers to be able to sell more than once a day. Once we saw hundreds of people lined up there at the entrance of our village. I thought it must be a vegetable market or a movie. It turned out to be blood selling! I felt so terrified because there is no sterilized equipment at all. Villagers just tell the traffickers their blood type and then lie down on the ground to offer blood." The practice has decreased since blood selling was made a criminal offense several years ago, but experts say it continues and black market blood is still used by hospitals and by drug manufacturers for making things like gamma globulin and clotting factors. It is a huge business, Dr. Gao said, blaming corrupt hospital officials. It is unclear how much of the tainted blood makes it into the hospitals, where theoretically it is tested for the virus that causes AIDS. The United States government says that Chinese blood products are not sold in the United States. Dr. Gao, formerly one of the province's leading gynecologists, was drawn into AIDS work in 1996, when she was called out of retirement to consult with younger doctors about a woman whose illness confounded them. Dr. Gao concluded that the woman had AIDS, making the patient the first official casualty of the disease in the province. Since then, Dr. Gao has transformed the spartan unheated flat she shares with her husband into a command center, using her pension money to print educational leaflets and conduct simple surveys as well as answering thousands of letters from teachers, patients needing money, even other doctors wanting information. While local officials at first tolerated her campaign, they quickly became annoyed by her blunt talk and harsh words. She says, for example, that if the government does not confront AIDS, more people will die than during the Japanese occupation. "Yes, they've threatened me," she said. "Even my friends don't understand me; they think I should enjoy my retirement. But people are dying. And this is something that can be totally stopped." With tears in her eyes, Dr. Gao told how on a recent trip, she visited a mother and son, both near death. The mother, Wu Long, a veteran blood seller, had a painful rash that covered her body and could not eat because of the sores in her mouth. Wei Wei, her 2-year-old son, had been sick since birth with fevers, vomiting and diarrhea. His grandfather described him as gaunt "as a child from Africa." The father tried to commit suicide when he learned the child had AIDS. To such people, Dr. Gao, with her small gifts of love, medicine and knowledge, seems the Chinese equivalent of a saint. One AIDS victim named Cheng Yan, who has since died, wrote to her, "It must be Chairman Mao who sent you here." Dr. Gao said that the local press does not print articles about the problem in Henan, and that the situation is generally ignored or covered up by local authorities, who fear it will reflect badly on their work or interfere with plans for business development. "Big officials tell small officials to deny it's here, and so people don't get help," she said. In Shangcai County, the medical examinations that are required for all Chinese citizens before marriage still do not include AIDS testing or counseling, for example, said Dr. Gui, the researcher from Wuhan, at a medical lecture this year. More than half of hospitalized patients who test positive for H.I.V. are not informed of the test results, he said. And Dr. Gui added that he was rebuffed when he approached health officials in Henan to begin an AIDS prevention program, offering to act as a free adviser. Chinese officials have made him promise not to publish the specific results of his survey. "The gravity of AIDS in Shangcai has not attracted the concern of the relevant authorities," Dr. Gui said. "And this is something I'm broken- hearted about." 艾滋病在河南蔓延 【多维新闻社28日电】多维社记者孙国运报导/今年中秋节之前，身体虚弱的退休医生高 瑶洁（音译）凑足了搭出租车的钱，带上药品、小册子、饮料和月饼，再次悄悄离开河南 省府郑州市，到遥远的乡村看望那些正在悄悄死亡的艾滋病人。 中国官员不承认河南省农村有艾滋病人。他们禁止当地新闻媒体和政府卫生人员讨论这个 话题，阻挡外界专家研究这个问题。身材瘦小、76岁的高医生常常被赶出她要帮助病人的 村庄。 自1958年浮夸风到目前的封锁艾滋病消息，弄虚作假在河南省已经成为传统。尽管中央高 官也到河南视察，似乎很难了解实情。 但高医生和其它几个熟悉当地情况的人说，艾滋病正在中原地区的小乡镇蔓延。各别暗地 研究显示，有些乡镇的艾滋病毒感染率达到世界最高水平：百分之二十。 那些地区的问题是多年来，许多贫穷的农民向“血头”非法卖血，“血头”使用未经消毒的 抽血器械，造成许多人感染艾滋病毒。“血头”不仅使用污染的针头，还把□集的鲜血放到 一起，提取所需成份之后，再把剩馀部分还给卖血者。 因此，血液传染疾病很快传播：艾滋病毒从卖血者传染给自己的配偶和子女以及输血的病 人。 尽管中国政府承认由于吸毒问题，艾滋病在西部地区和城市蔓延，但讨论艾滋病蔓延仍然 是个话题禁区。 就在这种敌视和否认的环境下，高医生发起了孤立的宣传教育活动，并诊治病人。她试图 说服那些妇女不要卖血，给她们发放药品治疗由于艾滋病引起的腹泻，亲近那些已经感染 的婴儿，告诉邻居没有什么可怕的。她的药品，包括止痛片和咳嗽糖浆，不能治好病人， 但可以减轻他们的痛苦。 她说，当地医院不收这些病人，他们的家庭也把他们赶出来，他们没有选择，只有死亡。 许多人都认为艾滋病是坏病，因此都不说，也不承认有病。很多村民对于艾滋病完全无知： 有些村子几十个人死了之后，其它人还继续卖血，认为只要吃好穿暖就不会生病。 另一问题是，艾滋病人的鳏孀很快再婚，他们其实已经感染，因此继续传染给别人。当地 官员说，这样悲剧何时才到头？ 由于省府官员阻止官方科学家调查那些地区，无法了解问题的严重程度，只有某些令人不 安的迹象。 湖北省研究人员桂娴（音译）在没有得到许可的情况下，悄悄到河南省南部卖血活动普遍 的上蔡县抽取155份血样，96份都是艾滋病毒阳性，多数是卖血者、她们的配偶和子女。 尽管那不是随机调查，但百分之六十二的感染率的确惊人。一名西方专家说，这些地方应 当是零发病率，即使百分之二十已经很严重。同时，那些地方其它血液病也很普遍，尤其 是丙型肝炎。 今年北京一名传染病专家乔装到在河南农村医院访问，发现很多艾滋病人。当他的身份被 发现之后，他被赶出河南并面临处分。 一名西方外交官说，中央很多人很好，知道应当如何做。但问题是他们要依靠省里卫生官 员，而下面不肯合作。