By Ng Lun Pei*

HIV/AIDS, while no longer a taboo in China, remains a sensitive topic. Government officials tend to shy away from it for fear of upsetting “social harmony,” under the belief that disseminating information about HIV/AIDS will evoke widespread panic. Yet without sufficient public attention, HIV has spread at a rate far beyond expectation. In the first nine months of 2008, nearly 7,000 people in China died as a result of HIV/AIDS, whereas up until three years prior to this the cumulative mortality was less than 8,000.[i] What led to this sudden burst of AIDS deaths?

The unwillingness of the government to share information about the true scope of the AIDS epidemic and its suppression of AIDS activists is a big barrier in the fight against AIDS. Dr. Gao Yaojie, an AIDS activist who became famous in China for exposing a blood transfusion scandal in Henan Province, endured various obstacles in work created by the government, including arbitrary detention, harassment and intimidation.[ii] Other Chinese activists like Zhao Liang and Wan Yanhai, who played important roles in promoting public awareness and education about the disease, met similar obstacles.[iii] This has prevented people, especially health care workers, from conducting AIDS research and from speaking openly about AIDS, thus impeding efforts to control the disease.

If China’s leaders want to eliminate AIDS, they can no longer avoid discussing it openly. Furthermore, they must involve the public in addressing the problem and they must be receptive to those who aim to improve the healthcare system. Concealing information will not only hinder China’s efforts to check the spread of the disease, but will also limit its ability to seek help from the international community.  Beijing should learn from the 2003 SARS pandemic, when the Chinese propaganda department’s attempts to cover up the disease resulted in a rampant spread of SARS from Guangzhou to Hong Kong, and then across the world.  The Chinese government risks making the same mistake with AIDS: without accurate information, delayed preventive measures may lead to an uncontrollable spread of the disease, undermining any previous efforts to address the problem.

Wan Yanhai, China’s best-known AIDS activist, believes China suffers ten times the number of HIV cases (650,000) estimated by Chinese health officials.  If this is true, then a serious outbreak in a country with such a huge population, and whose workforce drives the Chinese economy, could have significant global health as well as international economic impacts.  Health communication reforms, such as the establishment of a separate and independent health surveillance system under direct supervision of the national government, averts corruption by local officials and is necessary for China and for the global community.

That is crucial because the spread of AIDS is not limited by national borders.  Thus, the fight against AIDS must be a collaborative effort, and will require international participation through organizations such as the Global Fund to Fight AIDS.  Such collaboration is imperative in order to survey, investigate, and identify optimal solutions to the HIV/AIDS pandemic.  An outbreak in even a small and remote area today could be detrimental for the whole world tomorrow. Sharing accurate information is not only in every country’s interests, but also part of our common responsibility to promote global health.

The attempt to silence voices and facts might, in the eyes of Chinese officials, maintain a harmonious society in the short term. They should recognize, however, that long-term stability and public trust in the government outweighs these concerns. Depriving people of their right to know, particularly in situations where lack of information constitutes a direct threat to public health, is unwise.  A more transparent and open health communication system is indispensable. The Chinese government should allow free public speech and establish a worldwide platform for data sharing to monitor AIDS cases. Beijing must cost-effectively allocate its resources now, or risk facing an uncontrollable problem later.