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An evolving HIV epidemic

Interview: Gabriel DomínguezDecember 3, 2014

With an estimated 800,000 people living in China with HIV/AIDS, the WHO’s country representative Bernhard Schwartlaender tells DW the nation needs to do more to prevent infection and eliminate stigma and discrimination.

China AIDS Parole am Krankenhaus Peking
Image: Ruth Kirchner

Around the world, there were around 35 million people living with HIV in 2013, and 2.1 million people becoming newly infected, according to the World Health Organization (WHO). There were an estimated 4.8 million people living with HIV across the Asia-Pacific region in 2013.

China's National Center for AIDS/STD Control and Prevention last year estimated that as many as 810,000 people are living with HIV/AIDS in the country, including those who have not yet been diagnosed.

In particular, HIV infections in China continue to increase among men who have sex with men (MSM). A study published in Clinical Infectious Diseases in 2013 showed that the HIV epidemic among MSM is expanding rapidly across all parts of the country.

Bernhard Schwartlaender WHO
Schwartlaender: 'One of the biggest enemies to the elimination of HIV is stigma and discrimination'Image: WHO

Compounding the problem, many MSM remain unaware of their status given the low rates of HIV testing among this group of population, says the WHO.

Bernhard Schwartlaender, WHO Representative in China, says in a DW interview that while the country has made remarkable progress in some areas, China still faces many challenges in terms of preventing new HIV infections, and ensuring equitable access to healthcare and treatment for all who need it.

DW: How would you describe the general situation in China in terms of HIV?

Bernhard Schwartlaender: The estimated number of HIV infections among the general population remains low, at 0.06 percent. However, China is witnessing an evolving HIV epidemic - with sexual transmission of HIV on the rise, especially among men who have sex with men and other groups including students.

How has the Chinese government responded to the situation?

China has shown its capacity for both pragmatism and innovation in responding to the HIV epidemic. For instance, over the last decade, a massive national network of over 700 needle exchanges and methadone clinics has been established. This led to a marked reduction in HIV prevalence among injecting drug users.

The country's strong action on methadone maintenance therapy has not only made a major dent in China's HIV epidemic, but it has also shown the world innovative ways to provide services to this hard to reach population group.

Symbolbild AIDS Schleife auf schwarzem Hintergrund
Schwartlaender: 'Testing for HIV in China needs to be made more accessible'Image: picture-alliance/dpa

China has also made much progress in improving access to HIV diagnosis and providing antiretroviral drugs for those who need treatment. But there is still more to do in both of these areas: making testing more accessible, and making the antiretroviral treatment regime simpler.

What are the biggest challenges China currently faces in terms of preventing new infections?

In China, like elsewhere in the world, only a fraction of people living with HIV know their status. Testing for HIV needs to be made more accessible.

New infections continue among heterosexual people as well as men who have sex with men. We need innovative ways to promote safe sex - including use of condoms 100% all the time. Every new HIV infection is one that can be prevented.

What can you tell us about the stigma those infected with the virus have to face?

One of the biggest enemies to the elimination of HIV in China - as in the rest of the world - is stigma and discrimination.

We have to call an end to stigma and discrimination towards people with HIV. I've seen some of my own colleagues in the medical profession turn patients away because they disapproved of the person's sexual orientation. That is simply unacceptable, and it has to stop.

What must the country do about the stigma issue?

The fact that the first Lady of China, Peng Liyuan, and the Premier, Li Keqiang, are both personally involved in the fight against HIV sends a powerful message to the population.

National leaders are incredibly powerful advocates for stopping stigma towards people living with HIV, and at-risk groups.

Everyone can play a role in ending discrimination and combating prejudice - for instance, by educating ourselves and others.

ASEAN Gipfel in Myanmar Li Keqiang 13.11.2014
The fact that national leaders like Prime Minister Li Keqiang are personally involved in the fight against HIV 'sends a powerful message to the population,' says SchwartlaenderImage: Aung Thu/AFP/Getty Images

What do you urge Chinese authorities to do to accelerate action to tackle HIV and close the gap with other countries?

There are a range of areas of the HIV response where China is doing well, but can do better.

Rapid tests are now available, which give results in 20 minutes. We need to make innovations such as this more widely available. People in China taking antiretroviral drugs need to take 5-6 pills per day, but one pill per day is a reality in many parts of the world, including some of the poorest countries in Africa. Why not in China?

"Close the Gap" is the global theme of this year's World Aids Day. This means that we should do more to close the gaps in access to prevention, treatment, and to stop discrimination. The good news is that we have the tools to end the HIV epidemic by 2030. It is imperative for the Chinese patients that we use them.

Dr Bernhard Schwartlaender is the Representative of the World Health Organization (WHO) in China. Before joining WHO in China, he served as Director for Evidence, Policy and Innovation at UNAIDS headquarters in Geneva and as the United Nations Country Coordinator on AIDS in Beijing, China.