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The United Nations has released a damning report that heavily criticises China’s response to the AIDS epidemic, and insists that the country takes urgent action.

The report — written by the UN Theme Group (UNTG) on HIV/AIDS in China — warns that “China is on the verge of a catastrophe that could result in unimaginable human suffering, economic loss and social devastation”. More than one million people in China are estimated to be infected with HIV, and this could rise to a staggering 10 million by 2010.

The report, HIV/AIDS: China’s Titanic Peril, echoes demands made five years ago after the last UNTG assessment. “Much of the hope, expected commitment, and planned action… have resulted in few outcomes and an infinitesimally small impact on the spread of the epidemic”, it says.

Several factors account for China’s lack of progress, the report states, including insufficient openness in confronting the epidemic, a lack of governmental commitment and leadership, inadequate resources (especially trained manpower), a crumbling public health system, and severe discrimination against those affected by HIV/AIDS.

“Several areas will need priority attention if a catastrophic AIDS epidemic is to be averted in China,” it says.

The report's recommendations (see below) include the need for good and transparent governance. “Development of quality AIDS policies critically needs more government openness for acknowledging the seriousness and potential of the epidemic”.

The authors encourage the Chinese government to show “courageous leadership” and say that policies should be in line with international best practice guidelines. For example, they underline the importance of strategies that integrate multiple sectors — until now the control of AIDS has tended to fall solely on the health department.

Urgent steps need to be taken both to prevent AIDS, especially among vulnerable populations, and to curb the explosion of sexually transmitted diseases witnessed in recent years. Improving awareness of AIDS through the involvement of the mass media, and more widespread sex and drug education among the young must also be undertaken.

The report also underlines that China, as a member of the World Trade Organisation, has the right to override patents on medicines, including anti-retroviral drugs, on public health grounds. China has the technical capacity to manufacture generic equivalents of patent-protected drugs, but has not taken up this option.

The UN group urges China to act now, saying, “we can still prevent the worst from happening, but time is quickly running out.”

Key recommendations
  • Guidance by international consensus such as the UNGASS Declaration of Commitment

  • Openness, political commitment and expanding the response to the whole of society

  • Urgency in AIDS prevention, especially among vulnerable populations

  • Increase HIV/AIDS awareness, for example through mass media

  • Implement bold and high quality policies based on sound public health rationales

  • Investment in HIV/AIDS prevention at this early stage of the epidemic

  • Strategic planning based on a multi-sectoral approach and accurate situation analysis

  • Life skills education among vulnerable groups, especially the youth

  • Urgent control of sexually-transmitted diseases through regulatory processes

  • Access to indiscriminate care, treatment and support for people living with HIV/AIDS
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