HIV and AIDS in China

China map

China has made substantial progress in tackling their HIV epidemic. Chinas HIV history has been
anything but steady, with national negligence a critical factor in the spread of HIV in the early
1990s. However, significant progress in the last decade and increased national response have
greatly decreased the epidemic across the country as well increasing the quality of life for people
living with HIV.

The HIV epidemic in China is largely characterised by low national prevalence (specific figure
known) but with certain regions having higher and more severe HIV prevalence rates.1 China is
also faced with the increasing challenge of providing more targeted prevention programmes to key
affected populations such as men who have sex with men (MSM), people who inject drugs (PWID)
and young people.

Treatment, care and support challenges prevail in China. In 2013 alone, 28,000 people died from
AIDS-related causes.2 The number of people living with HIV receiving treatment has steadily
increased across the country. However, progress in reducing mother to child transmission (MTCT)
rates is still regarded as slow as well as addressing the high levels of stigma and discrimination
people living with HIV experience across the country.3

China has made substantial progress with regards to funding their HIV response. 88% of funding
comes from domestic sources.4 This is very encouraging when considering the sustainability and
longevity of many of the national HIV and AIDS commitments.

Key affected populations in China

China has a relatively low national HIV prevalence rate, however the HIV epidemic is still a major
concern for some of the key affected populations within the country. Targeted prevention strategies
are critical to curb the epidemic amongst these vulnerable groups as well as addressing the stigma
and discrimination that many of these groups face on a daily basis, preventing them from accessing
vital HIV services.

Men who have sex with men (MSM)

HIV prevalence among men who have sex with men (MSM) has been rising in China with a
prevalence rate of 7.3% in 2013.5 It has been estimated that MSM represent over a quarter of new
reported infections,6 however very limited studies exist that aim to understand the epidemic among
this population. Stigma and marginalisation are key factors that are preventing a greater
understanding of the epidemic in China among MSM. As like many countries in the world,
homosexuality is still met with large levels of discrimination.7

The epidemic is not contained to MSM, with research showing that in some regions around 26% of
MSM have had female partners in the last six months.8 Unawareness of HIV status is a major factor
in the rising epidemic amongst MSM and needs to be greatly considered, focusing on HIV testing
services for these vulnerable populations. One study in Chongqing City, which has a high HIV
prevalence among MSM, found that HIV testing was actually higher for MSM (58%) than average
populations (44%). This is encouraging, however HIV testing among this group remains much lower
than other countries in the Global North.9

Strategies such as self-testing have also been explored in China amongst MSM. One study found
that 20% of MSM had used self-testing kits for HIV. The increased use of self-testing kits was also
greatly correlated with factors such as the individual being married, having a recent HIV test and if
they had engaged in anal sex.10 It is clear that the HIV epidemic among MSM is concerning in
China but more targeted prevention strategies for this affected population will enable a more
effective response that meets this groups needs.

Young people

One of the growing key affected populations in China is young people. Between 2008 and 2012, the
prevalence among 15-24 year olds doubled from 0.9% to 1.7%.11 Despite these figures still being
relatively low, there is increasing concern about the impact of the HIV epidemic on younger
generations. Understanding the main mode of transmission amongst this population is crucial to
providing effective support and services. It has been found that the majority of young people
infected are male (95%), and 70% of those infections have been among young MSM.12 It is
therefore vital that HIV services and education are tailored to younger generations and key
affected groups within these younger populations.

Including young people in the design and formulation of HIV and AIDS policies and programmes
will be important in tackling the epidemic amongst this population in China. Research has found
that youth HIV and AIDS policy in China is limited and that more holistic approaches, including
young people in policy development is an important step in tackling the epidemic.13 This will also
challenge stigma and discrimination and also increase knowledge of HIV and AIDS and reduce
risk-taking behaviour.
People who inject drugs (PWID)

Blood sharing through drug taking equipment has increased the spread of HIV in China. HIV
prevalence among PWID is 3.6%.14 The first cases of HIV among people who inject drugs were
recorded in 1989 and since then people living with HIV has steadily risen amongst illicit drug users.
Both Yunnan and Guangxi provinces have the highest recorded HIV prevalence rates in the country.
In Guangxi alone, 69% of the PLHIV were infected through injecting drugs.15 Providing targeted
intervention programmes for these populations is vital for effectively supporting PWID and their
risk to HIV.

In Guangxi province, an extensive prevention programme was launched in 2009 funded largely by
external donors. The programme provides a variety of support for PWID including needle and
syringe programmes (NSPs), HIV and AIDS education and HIV comprehensive education
programmes through drop-in centres and peer-led outreach. These services have shown to be
effective in promoting safe injecting practices as well as increasing understanding of HIV and AIDS.
16 NSPs have increased across China, with over 60,000 PWID using the programmes.17

HIV testing and counselling (VCT) in China

Since the beginning of the millennium, China has intensified HIV testing efforts, tailoring the
approach depending on the type of group or population they are aiming to reach.18

An active-testing approach has largely been adopted across the country, inviting high-risk groups
such as PWID, pregnant woman and MSM to take an HIV test. This approach has showed a low
refusal rate in certain provinces. In 2004, active testing was initiated in Yunnan province, 424,000
were invited to be tested and only 1.3% refused. Active testing is therefore been found to be an
effective approach for key affected populations however there have been concerns that with HIV
testing comes great social pressure, often leaving people unable to refuse a test.19

VCT services have continued to develop in China. In 2013, there was a recorded 18,367 health
service facilities providing and conducting HIV testing and counseling, which has been crucial in
diagnosing more people with HIV than ever before.20 China has also put significant effort into
establishing and developing HIV and AIDS labs, which a crucial for both prevention and treatment
programmes.21

HIV prevention in China

Sexual transmission is the main mode of HIV transmission in China and reducing this transmission
has been of critical concern in Chinas HIV response.22

Prevention programmes

HIV prevention programmes have consistently developed across the country in last decade.23
Reducing sexual transmission of HIV has largely been tailored to the key affected populations at
greater risk to HIV. National prevention efforts have also focused on serodiscordant couples,
providing treatment for the infected spouse, condom promotion and HIV testing. Between 2010 and
2013, the level of transmission between serodiscordant couples dropped by 57%.24

HIV prevention programmes in schools have showed differing results. With the HIV epidemic in
China greatly affecting young people, it is crucial that comprehensive HIV education is provided to
young people in schools and colleges. One study that analysed HIV prevention programmes in
secondary schools across China, found that there was a large amount of young people who despite
understanding how HIV was transmitted, did not show a good understanding of misconceptions
relating to HIV.25 Sources such as the internet and television have been crucial in providing young
people with HIV and AIDS information, however it is unclear how much these sources increase
their understanding of HIV and AIDS.26

Public HIV campaigns have been important in Chinas response to the HIV epidemic. Targeting key
affected populations, different events have been held around the country. The Youth Red Ribbon is
one such project providing HIV education for young people and adolescents. A further example of
these mass HIV campaigns can be seen in Chinas 100 universities going into 1000 enterprises.
The campaign involved utilising university students who have been educated by HIV prevention
programmes to go to different organisations and businesses and educate workers in HIV prevention.
The programme provided over 300,000 workers with HIV and AIDS education.27

Prevention of mother-to-child transmission (PMTCT)

Chinas PMTCT programme has substantially developed in recent years, with MTCT a critical
concern of the national HIV response. This has resulted in a reduction in HIV-infected newborns
from 7.4% in 2001 to 6.7% in 2013.28 Despite this, some studies in different Chinese provinces
have found that even if PMTCT programmes exist, there is a lower availability of PMTCT
interventions such as provision of antiretroviral medicines.29 In one province, Guangdong, PMTCT
programme failed to meet their objectives due to a shortage of antiretroviral drugs for HIV positive
mothers, with 60.2% receiving antiretroviral drugs and only 48.2% receiving these during
pregnancy. Research has suggested that in many cases pregnant women were unaware or lacked
knowledge of HIV antenatal health services. Factors such as early HIV testing for pregnant women
are one method of raising awareness of PMTCT programmes and lowering the overall MTCT in
China.30

Prevention of infected blood donation and transfusion

Chinas HIV epidemic was profoundly marked by negligent blood donation activities in the early
1990s, which led to a dramatic increase in the spread of HIV across China.31 Following a ban on
imported blood products in the 1980s, thousands of blood and plasma sites were established across
China. Most operated illegally and collected blood from rural, impoverished areas where there
would be less interference from authorities. People sold their blood to make money and the
collected blood was pooled together and the plasma removed. The remaining blood was then
injected back into the donors.32
Blood or plasma donation had been reported in all provinces across China by 2003 and it was
estimated that HIV transmission through blood products accounted for 10% of infections in 2005.33

Serious efforts have been made to prevent these incidences from ever happening again. In 2008
almost all the blood stations in China were from voluntary, unpaid donors and in 2010 the
government claimed that all collected blood products were screened for HIV.34 Preventing the risk
of HIV transmission through blood products has been significantly funded, with the government
providing over 80 million Yuan to improve the services and HIV testing in blood donation services.
35

Antiretroviral treatment (ART) in China

The number of people living with HIV who have received antiretroviral treatment in China has
significantly increased in the last few years. People on treatment has risen from 126,448 people in
2011 to 227,489 in 2013, with 2013 exhibiting the highest figures for new people accessing
treatment.36

China implemented the 2013 World Health Organisation (WHO) guidelines for HIV treatment,
providing HIV treatment for all PLHIV with a CD4 count of 500 or less.37 This has naturally
increased the pressure on treatment centres and antiretroviral drug supplies but has also had a
tremendous effect in reducing AIDS-related mortality.38 Figures for the percentage of people
eligible for treatment remain unavailable,39 limiting understanding of treatment progress in China.
However PMTCT treatment is still insufficient, with treatment coverage for pregnant mothers
equating to just over 60%.40

It is apparent that HIV treatment across China has been significantly scaled-up, sustaining and
developing this further will ensure even more people are able to access treatment. However,
limited data is impacting upon a clear and informative understanding of treatment progress across
the country.

Barriers to HIV prevention in China

Human rights

HIV and AIDS activism in China has not been as widely celebrated and encouraged in comparison
to many countries in other parts of world. Significant progress has been made in tackling the HIV
and AIDS epidemic, yet many voices in the epidemic are still being suppressed, including HIV and
AIDS activists, NGOs and projects.41 This has had significant repercussions for one group in
particular, people living with HIV.

The government has remained cautious regarding the majority of human rights groups and
non-governmental organisations, which limits their capacity quite profoundly. Harassment,
detention and censorship are just some of the challenges HIV and AIDS activist groups have faced
in the past.42

In 2007, the Guardian reported on a serious human rights violation in the Henan province of
China. PLHIV were placed under house arrest in some villages to prevent them disclosing the
reality of living with HIV in China to Chinese officials.43 Incidences such as this are seemingly not
all that rare across China and have often led to increased stigma and discrimination towards PLHIV.

Despite policies in place to protect PLHIV, these policies are all too frequently undermined by state
authorities such as the police.44 This also leads to increased stigma and discrimination across
Chinese society. In 2014, a village was reported signing a petition to isolate and remove a young
HIV-positive boy from their community.45 Attitudes and the understanding of HIV and AIDS needs
to be readdressed and efforts to help raise awareness of HIV promoted if the stigma and
discrimination that many face within Chinas HIV epidemic is to be reduced.
Legal and punitive barriers

Major barriers to HIV prevention work concerns key affected populations. HIV programmes are
severely limited by the criminalisation of the activities that many of these groups engage in. It is
illegal in China to engage in sex work, often resulting to compulsory detention of sex workers for
re-education and punishment. Sex workers are one of Chinas key affected populations within the
epidemic, with HIV prevalence at around 0.3% in 2013. HIV programmes to increase awareness
and provide support are therefore severely limited by the punitive laws surrounding their work.46

China has however made progress in lifting the restrictions on entry, stay and residence.47 Laws
limiting movement within and entering the country were lifted in 2010 and the Chinese government
has been greatly commended following these actions, taking a positive step in reducing HIV stigma
and discrimination.48

The future of HIV and AIDS in China

It is clear that Chinas epidemic significantly affects key populations around the country, namely
MSM and PWID. Greater effort will be required for providing more targeted interventions that
adequately and effectively support these groups. Greater coordination between community level
HIV organisations and national level services will crucial for the curbing the HIV epidemic in China
for the future.49

It is clear that the Chinese government has made a serious commitment to the HIV epidemic across
the country with 88% of the funding from domestic sources. The challenge however remains that as
HIV testing and treatment continues to be scaled-up, the national response will need to effectively
budget and finance it, preventing drug and resource shortages and enabling those most in need of
treatment to access it.

1. China Ministry of Health (2014) China Country Progress Report 2014

2. UNAIDS (2013) 'HIV in Asia and the Pacific'
3. China Ministry of Health (2014) China Country Progress Report 2014
4. UNAIDS (2013) 'HIV in Asia and the Pacific'
5. China Ministry of Health (2014) China Country Progress Report 2014
6. UNAIDS (2013) 'HIV in Asia and the Pacific'
7. DongLiang, Li. et al, (2012) HIV incidence among men who have sex with men in Beijing: a
prospective cohort study, BMJ Open 2012
8. Zhang, L et al, (2013) Predictors of HIV testing among men who have sex with men in a large
Chinese city, Journal of Sexually Transmitted Diseases, Vol 40 (3), Pages 235-240
9. Zhang, L et al, (2013) Predictors of HIV testing among men who have sex with men in a large
Chinese city, Journal of Sexually Transmitted Diseases, Vol 40 (3), Pages 235-240
10. Aidsmap (2014) Self-testing has the potential to boost HIV diagnoses rates among MSM in
China
11. China Daily (2013) AIDS and HIV striking younger Chinese People
12. China Daily (2013) AIDS and HIV striking younger Chinese People
13. Renwick, N., et al (2011) HIV/AIDS and Young People in Provincial China and Thailand:
Global Aspirations, Local Responses, Global Society Journal, Vol 24 (3)
14. China Ministry of Health (2014) China Country Progress Report 2014
15. Wang, K et al, (2014) Do community-based strategies reduce HIV risk among people who
inject drugs in China? A quasi-experimental study in Yunnan, and Guangxi Provinces, Harm
Reduction Journal, Vol 11(15)
16. Wang, K et al, (2014) Do community-based strategies reduce HIV risk among people who
inject drugs in China? A quasi-experimental study in Yunnan, and Guangxi Provinces, Harm
Reduction Journal, Vol 11(15)
17. China Ministry of Health (2014) China Country Progress Report 2014
18. Wu, Z., et al. (2006) HIV testing in China, Policy Forum
19. Wu, Z., et al. (2006) HIV testing in China, Policy Forum
 20. China Ministry of Health (2014) China Country Progress Report 2014
21. China Ministry of Health (2014) China Country Progress Report 2014
22. Wu, Z., et al. (2006) HIV testing in China, Policy Forum
23. China Ministry of Health (2014) China Country Progress Report 2014
24. China Ministry of Health (2014) China Country Progress Report 2014
25. Zaho, Q et al. (2010) HIV/AIDS awareness and knowledge among secondary school students
in China, World Health & Population Journal, Vol 11, Issue 4, Pages 38-48
26. Gao, X et al (2012) Effectiveness of School-Based Education on HIV/AIDS Knowledge,
Attitude, and Behaviour Among Secondary School Students in Wuhan, China, PLOS One, Vol 7 (9)
27. China Ministry of Health (2014) China Country Progress Report 2014
28. China Ministry of Health (2014) China Country Progress Report 2014
29. Li, B et al (2013) Effectiveness of a prevention of mother-to-child HIV transmission program
in Guangdong province from 2007 to 2010, BMC Public Health, Vol 13: 591
30. Li, B et al (2013) Effectiveness of a prevention of mother-to-child HIV transmission program
in Guangdong province from 2007 to 2010, BMC Public Health, Vol 13: 591
31. Human Rights Watch (2003) Locked Doors: The Human Rights of People Living with
HIV/AIDS in China, Vol 15, No. 7
32. UN Theme Group on HIV/AIDS in China (2002) HIV/AIDS: Chinas Titanic Peril
33. China Ministry of Health (2006) China Country Progress Report 2005
34. China Ministry of Health (2010) China Country Progress Report 2008/9
35. China Ministry of Health (2014) China Country Progress Report 2014
36. China Ministry of Health (2014) China Country Progress Report 2014
37. China Daily (2014) Changes considered in HIV treatment
38. Zheng, H., et al (2014) Incidence and risk factors for AIDS-related mortality in HIV-patients in
China: a cross-sectional study, BMC Public Health, Vol 14:831
39. UNAIDS (2013) 'HIV in Asia and the Pacific'
40. China Ministry of Health (2014) China Country Progress Report 2014
41. Human Rights Watch, (2010) The truth of Chinas response to HIV/AIDS
42. Human Rights Watch (2005) Restrictions on AIDS Activists in China
43. The Guardian (2007) Aids cover-up as Chinese PM visits village
44. Human Rights Watch, (2010) The truth of Chinas response to HIV/AIDS
45. BBC (2014) China village petitions to isolate HIV positive boy
46. UNAIDS (2013) 'HIV in Asia and the Pacific'
47. UNAIDS (2013) 'HIV in Asia and the Pacific'
48. UNAIDS (2010) China lifts travel ban for people living with HIV
49. China Ministry of Health (2014) China Country Progress Report 2014

Last full review: 01 May 2015

Last updated: 23 March 2016