China meets AIDS crisis with police raid

Tuesday, August 19, 2003

XIONGQIAO, China -- Xiong Jinglun was lying in bed on the night of the raid, resting his frail, AIDS-weakened body when the shouting outside jarred him awake. The 51-year-old farmer struggled to his feet and shuffled out of his shack to investigate, but someone had cut off the electricity in the village, and it was difficult to see in the pitch dark.

Suddenly, several men wearing riot gear and military fatigues surrounded him, struck his head with a nightstick and knocked him to the ground, he recalled. Xiong begged them to stop hitting him, crying out that he was an old man, that he had AIDS. But he heard one of the assailants shout: "Beat them! Beat them even if they have AIDS!"

A few days earlier, residents of this AIDS-stricken Chinese village had staged a protest demanding better medical care, rolling two government vehicles into a ditch to vent their frustration. Now, local authorities here in central Henan province, about 425 miles northwest of Shanghai, were answering their appeal for help. But instead of doctors, they sent the police.

More than 500 officers, local officials and hired thugs stormed the muddy hamlet of 600 residents on the night of June 21, shouting threats, smashing windows and randomly pummeling people who got in their way, witnesses said. Police jailed 18 villagers and injured more than a dozen others, including an 8-year-old boy who tried to defend his sick mother.

"They beat me because I stepped outside," Xiong said, coughing and pointing out scars and bruises on his head, arms and legs. Like many villagers, he said he was afraid the police would return. But he agreed to an interview, saying, "I'm going to die anyway."


The desperation of residents in Xiongqiao and the local government's blunt response has complicated China's bid for $100 million in aid from the U.N. Global Fund to Fight AIDS, TB and Malaria. AIDS activists have demanded human rights guarantees from the government as a condition for any funding. The incident also highlights the political challenge that AIDS presents to China's ruling Communist Party, which struggles to deliver such complex public services as health care and often ignores or punishes those who complain.

Earlier this year, the Chinese government contained an outbreak of SARS by mobilizing the party's vast apparatus to quarantine anyone with symptoms of the respiratory disease. But the AIDS virus, which the United Nations estimates has infected as many as 1.5 million people in China, poses a far greater problem for China's rigid political system.

Experts say strong political leadership, grass-roots activism and the free flow of information are critical to fighting AIDS. But China's top leaders, including its new health minister, Wu Yi, have been silent on the subject, while the government has harassed activists, restricted reporting on AIDS in the state media and devoted few resources to educating the public about the disease.

The leadership is reluctant to allow an open discussion about AIDS in part because it fears it would be blamed for the epidemic.

Hundreds of thousands of poor farmers like Xiong contracted the virus by selling blood in the early 1990s at state hospitals run by local officials and their friends. These programs often used unsanitary collection methods, including a process in which blood was mixed in a centrifuge to remove plasma and then reinjected into donors.

Selling blood was extremely popular in the impoverished countryside of central China. In its application for U.N. AIDS funding, Beijing acknowledged for the first time that at least 250,000 people in seven provinces had contracted AIDS by selling blood. AIDS activists said the actual figure was much higher.

In Xiongqiao, a dirt-poor village where naked children play amid fields of corn and sesame and most residents share the surname Xiong, villagers said they often sold blood several times a month. At least 100 of the 600 residents have contracted the AIDS virus, and many others have been unwilling to be tested. People began showing symptoms a few years ago, and almost everyone has a relative who has died.

Xiong Changshun, 35, said his wife died first, committing suicide three years ago by throwing herself into a well so the family could use all its money to treat their daughter. But the next year, Xiong watched his 3-year-old girl pass away. Then, last year, complications from AIDS killed his father.

"The AIDS situation in our village is as serious as any of the villages around here. We urgently need a clinic, but the local leaders don't care. They want to save face. They don't want outsiders to know what's happening," said Xiong Changshun, who is HIV-positive. "We want to go to Beijing to ask for help, but we're scared. What if they come back and beat us again?"

In another home nearby, an emaciated boy lay listless on a hard mattress, his ribs visible through his skin. His father, Xiong Zhiping, 36, administered an intravenous drip to the child, Pengcong, after using a cigarette lighter to sterilize the needle.

Xiong said he treats his 4-year-old son because there are no doctors in the village and he cannot afford to admit him to a hospital. Xiong said he, too, has AIDS, but because medicine is so expensive, he buys it only for his boy.

Prodded by studies showing AIDS could seriously hurt the economy, Beijing has taken tentative steps to confront the epidemic and launched a pilot project to provide free or subsidized treatment in certain hard-hit areas.

The dire conditions in Xiongqiao are striking because the village is covered by the project, which promises free treatment with antiretroviral drugs, the "AIDS cocktail," that can significantly extend a patient's life. About 2,000 people in Shangcai county, where Xiongqiao is located, are receiving the drugs, and the project will cover 5,000 patients in four provinces by year's end, officials said.

In addition, the government said in a written statement, people with HIV or AIDS in Shangcai are receiving monthly coupons worth between $12 and $36 to cover their medical costs, and families with economic difficulties are supposed to receive breaks on agricultural taxes and school fees.

But residents in Xiongqiao said local officials have ignored the tax relief policy, insisting that even households with two sick adults continue to make fixed grain payments although it is harder for them to bring in the harvest.

The villagers also said they were being charged about $3 per month for the "free" drugs, and that the coupons were not enough to buy the other medicine they need to fight infections. They also said the nearest hospital charges more for medicine when they pay with the coupons.

China's health-care system has fared poorly in the transition from socialism to capitalism. Hospitals remain nearly as inefficient as they were under the planned economy, but funding cuts and incomplete reforms have resulted in rising costs for patients. In the countryside, where China's AIDS cases are concentrated, medical care is getting worse and more expensive, and health insurance is almost nonexistent.

Rural doctors routinely rely on drug sales to boost their meager incomes. At the hospital nearest Xiongqiao, doctors said they make as little as $12 a month and acknowledged they try to make a profit on the AIDS medicine.

"We can use the coupons to get medicine from the county," said Ji Yufeng, a young physician at the hospital. "Then we lift the price a little and sell it to the patients."

Many villagers in Xiongqiao who began taking the antiretroviral drugs have already quit, complaining of vomiting, headaches and other side effects. There are no doctors in the village to help them stick with the daily pills, and even those at the nearest hospital lack the training and lab equipment needed to monitor patients and fine-tune their treatment. A local health official said as many as 60 percent of all AIDS patients in the county have refused to take the free drugs.

The residents of Xiongqiao said they complained about these problems, but nothing happened and people continued to die. Rumors began circulating that local officials had received more than $6,000 to build a clinic in the village but had opted not to do so. Then, in mid-June, police arrested an HIV-positive woman who pretended to be a healthy relative and went in for an AIDS test so her family could obtain more benefits.

The arrest upset many villagers, who felt the fraud was justified because local officials weren't doing enough to help them. Angry and desperate, more than 100 people set out for the township government to demand the woman's release and appeal for better medical care, an AIDS clinic and tax relief.

The subsequent raid on Xiongqiao prompted outrage among both Chinese and foreign AIDS activists, who have called on foreign firms not to invest in Henan province and urged the Global Fund to withhold funding from China unless it enacts laws to protect AIDS activists and allow independent monitoring of how U.N. aid is spent.

In its application for the $100 million, the Chinese government said it wanted to expand the pilot project here to 56 counties, focusing on farmers who contracted the virus by selling blood. But activists said the Xiongqiao raid demonstrated that without safeguards, the money is likely to be misused.

"If you give China money, then you should require they add these human rights protections," said Wan Yanhai, an AIDS activist who was detained briefly last year for distributing a government AIDS report. "If you don't stand with the AIDS activists and empower them, these funds may be corrupted. They may be used to hire thugs to beat people with AIDS."

- - - Xiong Pengcong, 4, receives AIDS treatment from his father because there are no doctors in their village and no money to admit him to a hospital. The father, Xiong Zhiping, 36, also has AIDS. Illustrates CHINA-AIDS (category i), by Philip P. Pan © 2003, The Washington Post. Moved Monday, Aug. 18, 2003. (MUST CREDIT: Washington Post photo by Philip P. Pan.)

Researcher Zhang Jing in Beijing contributed to this report.

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