AIDS doctors dispatched to China's countryside
By Antoaneta Bezlova

BEIJING - In a health campaign harking back to Maoist mass mobilizations and the era of "barefoot doctors", China is dispatching droves of young medics to work in rural areas in an effort to rectify the shortcomings of economic reforms that have left the vast countryside poor and vulnerable to health crises, like HIV/AIDS.

Some 800 million people live in the countryside where health care is abysmal, compared with that in urban areas that receive the resources and the doctors.

After years of trying to cover up its human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) crisis, last fall Beijing announced it was beginning to provide free drugs for poor people living with the pandemic. The United Nations estimates that as many as 1.5 million people in China have HIV/AIDS, and that by 2010, some 10-20 million could contract HIV, the virus that causes AIDS.

In an added effort to curb the spread of the disease, this month government officials said free HIV/AIDS drugs and blood tests would be offered to everyone in this country of 1.3 billion people.

However, China's rural health sector, which sees the bulk of the country's HIV/AIDS patients, remains dismally unable, unequipped and unstaffed to carry out the central leadership's volte-face decision to shoulder the cost of curtailing the HIV/AIDS epidemic.

Based on government statistics, China has fewer than 150 doctors qualified to diagnose and treat AIDS patients. And the shortage of trained medical staff in the villages has led as much as 25 percent of people living with AIDS, who had started taking free drugs, to quit the treatment, medical officials say.

This is largely because the combination of anti-retroviral drugs that is given to HIV/AIDS patients has serious life-threatening side effects, and the treatment must be administered and monitored by professionals.

The Beijing Youth Daily quoted Zhou Mingjian from the ministry of health as saying that the policy of sending experienced doctors to the countryside was formulated at the end of 2003. In the early days of modern China, untrained "barefoot doctors" were dispatched to the countryside to deliver basic public health and rudimentary medical care. They worked miracles, but China now needs modern medicine.

Then the ministry issued a notice last month asking doctors who have been certified within the past five years to work for a year in rural health care - sparking a drive that has echoes of the late chairman Mao Zedong's 1968 campaign to send the country's youth "down to the villages and up the mountains". Intellectuals, dissidents and youth also were sent to the countryside for manual labor, some for punishment, some just to learn from the peasants.

Reforming rural health care
Following the Severe Acute Respiratory Syndrome (SARS) panic last spring, Chinese leaders have designed new mechanisms to deal with health emergencies. Discussions are underway to make rural postings mandatory for new physicians, said Zhang Fujie, director for treatment and care of the national center for control and prevention of AIDS/STD (sexually transmitted diseases).

Despite the historical associations with Cultural Revolution-style mass mobilizations, the health drive represents a step forward in reversing years of state neglect of the country's rural health care. Although urban residents account for less than 30 percent of China's population, they absorb two-thirds of public spending on health.

The country's 1980s-era economic reforms forced every branch of the state to become self-sufficient, and as a result, the health system, especially the rural one, was badly hit.

Under the collective system, 90 percent of the rural population was provided with free health services. Today only 10 percent of China's rural residents are insured, leaving some 800 million rural Chinese to pay out-of-pocket for their entire health care costs.

The decentralization of health care spending has made rural hospitals dependent on local governments. To increase revenues, local hospitals learned to charge fees for injections and intravenous drips, disregarding other less costly treatments.

The neglect of preventive care in favor of more profitable curative treatments has led to a precipitous rise in infectious diseases and epidemics, as illustrated by HIV/AIDS and SARS.

Profit-making gives rise to pandemic
The majority of HIV/AIDS patients in China are rural residents. The largest rural group is among the very poor peasants in the central Henan province. They contracted the disease, and many got hepatitis as well, after selling blood in government-run, profit-making schemes in a country where blood donation is a social taboo.

Multiple donors would be hooked up to the same blood plasma machines and the virus spread from one infected patient to many donors, infecting them as well.

Ironically, it was the same health care funding shortage that is now afflicting HIV/AIDS patients that drove local Henan governments to pile into the blood plasma trade as a way of funding their medical services. Once in the business, officials were reluctant to abandon such a lucrative source of revenue, even after the trade was banned.

Tainted blood transfusions are estimated to have infected more than 1 million victims in Henan province alone. But unhygienic blood collection was practiced in 23 provinces, autonomous regions and municipalities in China, according to the Joint UN Program on HIV/AIDS.

Therefore, the number of people with HIV could be much higher because very few people have been able to take blood tests so far.

In Henan province, where some entire communities are infected with HIV/AIDS, many villagers are now given free drugs. The majority, however, stop taking them after a few days because they are not informed about how to cope with the side effects, such as vomiting and dizziness.

"Health officials just gave the drugs to the village doctors who have little AIDS treatment skills," said Gui Xi'en, an HIV/AIDS expert at Hubei University. "And then the drugs are put in the hands of AIDS victims," he said.

No laboratories and tests are available yet to monitor the degree of immunodeficiency and the potential emergence of HIV drug-resistant strains. Without proper counseling and follow-up checks, peasants usually cannot bear the pain and discomfort from the various side effects and prefer to give up on treatment.

Figures from December showed that about 25 percent of the AIDS patients receiving free state drugs had quit because of the strong side effects, Zhang Fujie said. The figure has increased from three months earlier, Dr Zhang said, when the official dropout rate was 20 percent.

One disastrous result of this situation is that HIV might become drug-resistant, experts warn.. As witnessed with SARS and the spread of HIV/AIDS, drug-resistant HIV strains could eventually migrate from central China to other parts of the country and beyond China's borders.

(Inter Press Service)