The HIV epidemic in China: history, response, and challenge

The first case of AIDS was reported in 1985 in China, but by the early 21st century, the government estimated that there were 840,000 citizens living with HIV/AIDS. The number is increasing rapidly. The major risk groups are injection drug users (IDUSs; 43%) and former plasma donors (27%), but rates among heterosexual groups are rising rapidly.Sentinel surveillance was initiated in 1986, and now includes IDUs, men-who-have-sex-with-men, sexually transmitted disease clinic attendees, antenatal women, long-distance truck drivers, and .sex workers. Although the government was slow to respond to the epidemic in the late 20th century, it has made a vigorous response in the early 21st century.Components of that response include implementation and evaluation of harm reduction programs for IDUs, education to increase knowledge and reduce stigma, treatment and social support for rural and poor HIV/AIDS patients, widespread testing, and increased funding for HIV/AIDS programs. International agencies have been generous in their support of the government initiatives. To successfully combat the epidemic, China needs to develop and train the necessary infrastructure to implement its intervention programs, particularly in the rural areas, to vigorously combat stigma and discrimination, support research especially in the universities and research institutions other than the China Centers for Disease Control, develop a system for efficient exchange of research and program information, and update legislation to reflect the current situation.     

The HIV epidemic in China: history, response, and challenge

INTRODUCTION One-quarter of the world’s population, 1.3 billion people, live in China. The majority of the population is Han Chi- nese (91.9%), while the rest are a mix of different minor- ity groups living primarily in southern and western China [1]. The GDP per capita is $5,600 per year, but at least 10% of the population lives below the poverty line. Just less than 15% of the GDP is in agriculture, with the re- mainder in industry/construction and services. The total health expend…     

United Nations system efforts to support the response to AIDS in China

In the last two years, we have seen a remarkable intensification in the response to AIDS in China. A number of organizations have joined and contributed to the efforts of the Chinese government in responding the AIDS epidemic in China. This article specifically describes the role of the United Nations in supporting and strengthening those responses.Achievements of the United Nations (UN) highlighted in the article include: strengthened leadership and political commitment to respond to AIDS; improved HIV/AIDS surveillance and information; expanded prevention efforts; improved treatment, care and support to people living with HIV and increased resources for AIDS programs. Additional roles of e., one national plan on AIDS; one national coordinating authority for AIDS; and one monitoring and evaluation system for AIDS. In addition, the UN system is expected to strengthen alignment and harmonization of activities of all international organizations and improved accountability and oversight. Remaining challenges identified include increasing awareness of AIDS and reducing stigma and discrimination; reducing vulnerability and risk behaviour among specific groups;providing improved treatment, care and support for people living with HIV; promoting stronger engagement by civil society, and; addressing the gender dimensions of AIDS.     

United Nations system efforts to support the response to AIDS in China

In the last two years, we have seen a remarkable intensification in the response to AIDS in China. A number of organizations have joined and contributed to the efforts of the Chinese government in responding the AIDS epidemic in China. This article specifically describes the role of the United Nations (UN) in supporting and strengthening those responses. Achievements of the United Nations highlighted in the article include: strengthened leadership and political commitment to respond to AIDS; improved HIV/AIDS surveillance and information; expanded prevention efforts; improved treatment, care and support to people living with HIV and increased resources for AIDS programs. Additional roles of the United Nations system in the near future include strengthening national leadership by supporting the 'three ones', i.e., one national plan on AIDS; one national coordinating authority for AIDS; and one monitoring and evaluation system for AIDS. In addition, the UN system is expected to strengthen alignment and harmonization of activities of all international organizations and improved accountability and oversight. Remaining challenges identified include increasing awareness of AIDS and reducing stigma and discrimination; reducing vulnerability and risk behaviour among specific groups; providing improved treatment, care and support for people living with HIV; promoting stronger engagement by civil society, and; addressing the gender dimensions of AIDS.     

Challenges and opportunities: the expanded government-led HIV/AIDS programs in China

HIV/AIDS has posed an increasingly serious issue in China. In recent years, Chinese government has taken further intensified efforts to combat HIV/AIDS with high-level political commitment, supportive policy development, increased financial allocation, large-scale of government-led initiatives, expanded international cooperation and great involvement of non-governmental organizations. Meanwhile gaps and challenges coexist impacting the implementation and the results of national HIV/AIDS programs. Thus, further government efforts are needed to improve and tailor the actions to meet the requirement of HIV/AIDS control in China. Foundation item: China International Clinical, Operational, and Health Services Research and Training Award with NIH grant number of U2R TW006918.     

Challenges and Opportunities： the Expanded Government-led HIV/AIDS Programs in China

HIV/AIDS has posed an increasingly serious issue in China. In recent years,Chinese government has taken further intensified efforts to combat HIV/AIDS with high-level political commitment,supportive policy development,increased financial allocation,large-scale of government-led initiatives,expanded international cooperation and great involvement of non-governmental organizations. Meanwhile gaps and challenges coexist impacting the implementation and the results of national HIV/AIDS programs. Thus,further government efforts are needed to improve and tailor the actions to meet the requirement of HIV/AIDS control in China.     

Keeping the faith: African American faith leaders' perspectives and recommendations for reducing racial disparities in HIV/AIDS infection

In Philadelphia, 66% of new HIV infections are among African Americans and 2% of African Americans are living with HIV. The city of Philadelphia has among the largest numbers of faith institutions of any city in the country. Although faith-based institutions play an important role in the African American community, their response to the AIDS epidemic has historically been lacking. We convened 38 of Philadelphia's most influential African American faith leaders for in-depth interviews and focus groups examining the role of faith-based institutions in HIV prevention. Participants were asked to comment on barriers to engaging faith-based leaders in HIV prevention and were asked to provide normative recommendations for how African American faith institutions can enhance HIV/AIDS prevention and reduce racial disparities in HIV infection. Many faith leaders cited lack of knowledge about Philadelphia's racial disparities in HIV infection as a common reason for not previously engaging in HIV programs; others noted their congregations' existing HIV prevention and outreach programs and shared lessons learned. Barriers to engaging the faith community in HIV prevention included: concerns about tacitly endorsing extramarital sex by promoting condom use, lack of educational information appropriate for a faith-based audience, and fear of losing congregants and revenue as a result of discussing human sexuality and HIV/AIDS from the pulpit. However, many leaders expressed a moral imperative to respond to the AIDS epidemic, and believed clergy should play a greater role in HIV prevention. Many participants noted that controversy surrounding homosexuality has historically divided the faith community and prohibited an appropriate response to the epidemic; many expressed interest in balancing traditional theology with practical public health approaches to HIV prevention. Leaders suggested the faith community should: promote HIV testing, including during or after worship services and in clinical settings; integrate HIV/AIDS topics into health messaging and sermons; couch HIV/AIDS in social justice, human rights and public health language rather than in sexual risk behavior terms; embrace diverse approaches to HIV prevention in their houses of worship; conduct community outreach and host educational sessions for youth; and collaborate on a citywide, interfaith HIV testing and prevention campaign to combat stigma and raise awareness about the African American epidemic. Many African American faith-based leaders are poised to address racial disparities in HIV infection. HIV prevention campaigns should integrate leaders' recommendations for tailoring HIV prevention for a faith-based audience.     

An editorial overview： HIV/AIDS in China

China has come a long way in fighting against HIV/AIDS epidemic. The Chinese government has taken an active role in combating this detrimental disease and such a welcome attitude by the Chinese government will certainly provide a positive spin on its effort in reducing the HIV/AIDS epidemic in China.     

Current progress of China's free ART program

China's Free ART Program was initiated in 2002 as an emergency response to save and improve the lives of AIDS patients living mainly in impoverished rural regions of central China. With little experience in HIV/AIDS treatment and care and resource limitations, China's efforts to provide widespread access to free antiretroviral therapy has been a process fraught with difficulty. However, the Free ART Program is progressing from an emergency response to a standardized treatment and care system. The development of national guidelines, training programs, a laboratory support network, a national patient database, programs for special populations such as children and patients living with co-infections, and operational research has improved the scope and quality of the free treatment program. As of June 30, 2005, a total of 19,456 patients in 28 provinces, autonomous regions, and special municipalities had received free ART. Challenges stemming from the nature of China's health system and patient population persist, but with strong government support and a diverse set of resources, China has the capacity to overcome these challenges and to provide nationwide access to high quality treatment and care.     

Is human immunodeficiency virus/acquired immunodeficiency syndrome decreasing among Brazilian injection drug users? Recent findings and how to interpret them

We briefly review findings from Brazilian settings where the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic among injection drug users (IDUs) seems to be decreasing, highlighting recent findings from Rio de Janeiro and discussing methodological alternatives. Former analyses using serologic testing algorithm for recent HIV seroconversion have shown that HIV incidence has been low in IDUs recruited by two different surveys carried out in Rio, where low injection frequencies and infection rates have been found among new injectors. The proportion of AIDS cases among IDUs in Rio has been fairly modest, compared to S?o Paulo and especially to the southernmost states. Notwithstanding, the interpretation of findings from serial surveys constitutes a challenge, magnified in the assessment of HIV spread among IDUs due to the dynamic nature of the drug scenes and limitations of sampling strategies targeting hard-to-reach populations. Assessment of epidemic trends may profit from the triangulation of data, but cannot avert biases associated with sampling errors. Efforts should be made to triangulate data from different sources, besides exploring specific studies from different perspectives. In an attempt to further assess the observed trends, we carried out original analyses using data from Brazilian AIDS databank.     

Health and Human Rights Concerns of Drug Users in Detention in Guangxi Province,China

Background

Although confinement in drug detoxification (“detox”) and re-education through labor (RTL) centers is the most common form of treatment for drug dependence in China, little has been published about the experience of drug users in such settings. We conducted an assessment of the impact of detention on drug users'' access to HIV prevention and treatment services and consequent threats to fundamental human rights protections.

Methods and Findings

Chinese government HIV and anti-narcotics legislation and policy documents were reviewed, and in-depth and key informant interviews were conducted with 19 injection drug users (IDUs) and 20 government and nongovernmental organization officials in Nanning and Baise, Guangxi Province. Significant contradictions were found in HIV and antinarcotics policies, exemplified by the simultaneous expansion of community-based methadone maintenance therapy and the increasing number of drug users detained in detox and RTL center facilities. IDU study participants reported, on average, having used drugs for 14 y (range 8–23 y) and had been confined to detox four times (range one to eight times) and to RTL centers once (range zero to three times). IDUs expressed an intense fear of being recognized by the police and being detained, regardless of current drug use. Key informants and IDUs reported that routine HIV testing, without consent and without disclosure of the result, was the standard policy of detox and RTL center facilities, and that HIV-infected detainees were not routinely provided medical or drug dependency treatment, including antiretroviral therapy. IDUs received little or no information or means of HIV prevention, but reported numerous risk behaviors for HIV transmission while detained.

Conclusions

Legal and policy review, and interviews with recently detained IDUs and key informants in Guangxi Province, China, found evidence of anti-narcotics policies and practices that appear to violate human rights and imperil drug users'' health.     

Injection drug use and HIV/AIDS transmission in China

After nearly three decades of being virtually drug free, use of heroin and other illicit drugs has re-emerged in China as a major public health problem. One result is that drug abuse, particularly heroin injection, has come to play a predominant role in fueling China's AIDS epidemic. The first outbreak of HIV among China's IDUs was reported in the border area of Yunnan province between China and Myanmar where drug trafficking is heavy. Since then drug-related HIV has spread to all 31 provinces, autonomous regions and municipalities. This paper provides an overview to HIV/AIDS transmission through injection drug use in China. It begins with a brief history of the illicit drug trade in China, followed by a discussion of the emergence of drug related AIDS, and a profile of drug users and their sexual partners who have contracted the virus or who are vulnerable to infection. It ends by summarizing three national strategies being used by China to address both drug use and AIDS as major health threats.     

Virginity Testing: Managing Sexuality in a Maturing HIV/AIDS Epidemic

KwaZulu-Natal province in South Africa is currently the site of the world's fastest growing HIV/AIDS epidemic, where it is estimated that between 30 and 40 percent of the adult population is seropositive for HIV. With support from local politicians and members of various government ministries, several self-styled guardians of tradition have emerged to form organizations that advocate and conduct regular virginity testing of girls. Reference to the current HIV/AIDS epidemic is central to calls for greater support of this practice. Drawing on original research among Zulu-speaking people in the periurban communities of Durban, this article examines the sociocultural construction of HIV/AIDS and locates the growing popularity of virginity testing within a gendered meaning-making process consistent with commonly held beliefs that the epidemic is the result of women being sexually "out of control." With the social impact of AIDS starting to take its toll in the forms of increasing AIDS-related deaths and a growing population of orphans, I argue that virginity testing is an attempt to manage the epidemic by exerting greater control over women and their sexuality. In addition, virginity testing of girls helps to draw attention away from the role of men in the maturing epidemic, consideration of which has been conspicuously absent in the popular discourse on AIDS at all levels of South African society.     

益生菌治疗艾滋病相关腹泻的研究现状和进展

摘要：艾滋病（AIDS）是一种具有极大危害性的传染性疾病。AIDS发病和死亡都呈现明显上升趋势,传播模式发生变化,疫情由高危人群向一般人群扩散。因此,AIDS/HIV已成为中国的一个严重的公共卫生问题,政府对此极为重视。目前AIDS的治疗药物主要包括NNRTIs、NRTIs、PIs、FIs、CRIs和INIs这6大类,因长期使用这些药物的副作用以及此病合并的并发症特性,探讨其发病机制及寻找新的治疗思路,一直是此病研究领域中的热点。随着肠道微生态学研究领域的发展,应用人体无害的益生菌治疗HIV感染相关腹泻逐渐受到全球关注,就此作一综述。     

AIDS Research and Its Role in China＇s AIDS Prevention and Control Policies

By the end of 2005, the estimated number of HIV infected people in China was 650,000. The seriousness of the epidemic calls for effective control measures to tackle the problems in order to avoid the tragedy in Africa from happening in China. ＂Prevention First＂ is the cornerstone of the country＇s health policy. On 2003 World AIDS Day, Premier Jiabao Wen announced a new national AIDS control policy, ＂Four Frees and One Care＂. This policy clearly shows that the Chinese government has once again taken full responsibility to solve public health problems and has profound impact far beyond the AIDS field. In early 2006, the central government put scientific and technology innovation as a national priority and set the target to build an innovative China by year 2020. Since then, the government has been increasing investment in science and technology with major emphasis on both infectious diseases control and new drug research and development. For the first time, development of 100 new drugs and control of major infectious diseases （AIDS, HBV, TB and other emerging infectious diseases） have been selected as national key scientific projects. China＇s best minds in related fields will be pooled to work together in order to remove the technical barriers blocking efficient control of the major infectious disease in China. Knowledge on molecular epidemiology, immunology, pathogenesis, HAART, as well as HIVDR strains will certainly provide urgently needed scientific information for China＇s AIDS control program. Only evidence-based strategy from good research will provide long-term effective control of AIDS.     

Strategy for AIDS Prevention and Treatment

HIV/AIDS has been circulating in China for over 25 year. While making progress and achievements on HIV/AIDS prevention,there still are great challenge and difficulties such as HIV epidemic controlling and vaccine research.     

Strategy for AIDS prevention and treatment

HIV/AIDS has been circulating in China for over 25 year. While making progress and achievements on HIV/AIDS prevention, there still are great challenge and difficulties such as HIV epidemic controlling and vaccine research.      

从文献统计看我国离子束生物技术的发展

本文检索了1994-2003年间离子束技术在生物领域的应用研究文章,并从文献量,研究材料及研究的水平,期刊,离子源和基金来源等五个方面对其进行了统计和分析。统计结果表明,我国离子束生物技术在国家和地方政府院校的支持下得到了较快发展,其中微生物领域的发展最快;进入21世纪,地方政府院校开始逐渐加大对离子束生物技术的支持,并出现了有企业人员参与研究和企业基金支持的文献;文献内容主要是应用研究,基础研究较为匮乏。在综合分析数据的基础上,展望了我国离子束生物技术的未来发展趋势。     

Comparison of Projected and Actual Outcomes of the HIV/AIDS Epidemic in Malawi, 1990–2000

Background

In 1992 Liomba et al used HIV-AIDS prevalence data from 1980 to 1990 and projected the adult HIV prevalence and the impact of AIDS for the years 1991 to 2000, under high and low HIV incidence scenarios, using EpiModel, DemProj and the AIDS Impact Model. This report compares the actual outcomes of the HIV-AIDS epidemic in Malawi from 1991 to 2000 with projections made by Liomba et al.

Methods and Findings

Due to the lack of data on rural HIV prevalence in 1992, the prevalence estimates for the years 1980 to 1990 used by Liomba et al were higher than the now published prevalence. We re-estimated the projections for 1991 to 2000 based on more recent estimates of 1980 to 1990 HIV-AIDS prevalence using the Spectrum modeling software, and compared the old and new projections with the actual epidemic figures reported by NAC. The original projections made by Liomba et al and the adjusted projections made in this report are both very similar to the observed course of the AIDS epidemic reported by National AIDS Commission. Unfortunately for Malawi the epidemic seems to have followed the high scenario of HIV incidence.

Conclusion

The course of the epidemic in Malawi and the social and economic devastation caused by it, despite the presence of reasonably good projections and prevention recommendations by Liomba et al, highlights the need for better co-ordination between research and practice. It also emphasizes the need to examine the difficulties faced by countries like Malawi to act more rapidly and implement effective prevention measures in the face of an epidemic.     

Anti-nef antibodies and other predictors of disease progression in HIV-1 seropositive injecting drug users.

A cross-sectional and retrospective longitudinal study has been conducted in three Italian infectious disease centres to evaluate the role of anti-nef antibodies and other markers (HIV-1 p24 antigen, p24 Ag; Beta 2-microglobulin, B2-M; and number of CD4+ lymphocytes) as predictors of disease progression in HIV seropositive injecting drug users (IDUs). The selected patients were: 1) HIV-seropositive IDUs in different stages of HIV infection; 2) HIV-seropositive IDUs who had developed AIDS, from whom serial serum samples were available during the asymptomatic stage, and 3) HIV seropositive IDUs who remained asymptomatic through a follow-up period of the same duration as the patients who developed AIDS. Absence of anti-nef antibodies was associated with symptomatic HIV infection. A significant association between the absence of anti-nef antibodies, the presence of p24 Ag, high levels of B2-M, a number of CD4+ lymphocytes less than 500/ml at first visit and disease progression was found. Subjects who were persistently positive for antibody to nef were less likely to develop AIDS than those who were transiently or persistently negative. This difference was statistically significant (p = 0.03). The results of this study show that absence or disappearance of anti-nef antibodies may be used as predictor of disease evolution in HIV seropositive IDUs. This study also confirms the usefulness of other markers, such as p24 Ag, B2-M and number of CD4+ lymphocytes previously shown to be predictive of rapid disease progression for predicting the course of HIV seropositive IDUs.