AIDS and Social Policy in China The Asia Public Policy Series The Asia Public Policy series seeks to promote interdisciplinary research on key challenges facing the region. Specifically the series focuses on the provision of public goods and services, the health of financial systems, and regional security. Tony Saich General Editor AIDS and Social Policy in China edited by Joan Kaufman, Arthur Kleinman, and Tony Saich Published by the Harvard University Asia Center Cambridge, Massachusetts, 2006 © 2006 by the President and Fellows of Harvard College Printed in the United States of America The Harvard University Asia Center publishes a monograph series and, in coordination with the Fairbank Center for East Asian Research, the Korea Institute, the Reischauer Institute of Japanese Studies, and other faculties and institutes, administers research projects designed to further scholarly understanding of China, Japan, Vietnam, Korea, and other Asian countries. The Center also sponsors projects addressing multidisciplinary and regional issues in Asia. Printed on acid-free paper Last figure below indicates year of this printing 16 15 14 13 12 11 10 09 08 07 06 Acknowledgments 7 The Michael Crichton Fund of the Department of Social Medicine at Harvard Medical School, Harvard University’s Provost Office, Asia Pro- grams of the Kennedy School’s Mossavar-Rahmani Center for Business and Government, Asia Center of Harvard University, and the Fairbank Center for East Asian Research of Harvard University generously funded the Social Policy and AIDS in China Conference, the 3rd Asia Public Policy Workshop, and the 4th W.H.R. Rivers Symposium. This volume’s publication was sup- ported by the Michael Crichton Fund, the Folger Fund and Lee Folger, and by the China AIDS Public Policy Training Project at the Kennedy School’s Mossavar-Rahmani Center for Business and Government. Special thanks are due to Kathrine Meyers for her assistance in all matters relating to the workshop and seminar series organization and management; to Marilyn Goodrich, Liz Meyer, Jennifer Moltoni, and Wu Fei for their help with lo- gistics; and to Kristin Eifler and Victoria R. M. Scott for their assistance in editing the volume. We also thank the anonymous reviewers for their con- structive comments and insights. The Editors Contents 7 Contributors ix Abbreviations xv Preface: A Biosocial Understanding of AIDS in China xix Paul Farmer I. Background and Policy 1 Introduction: Social Policy and HIV/AIDS in China 3 Joan Kaufman, Arthur Kleinman, and Tony Saich 2 Social Policy Development in the Era of Economic Reform 15 Tony Saich 3 AIDS Surveillance in China: Data Gaps and Research for AIDS Policy 47 Joan Kaufman and Kathrine Meyers II. Treatment 4 Controlling HIV/AIDS in China: Health System Challenges 75 Yuanli Liu and Joan Kaufman 5 Initiation of the National Free Antiretroviral Therapy Program in Rural China 96 Fujie Zhang, Michael Hsu, Lan Yu, Yi Wen, and Jennifer Pan 6 Access to HIV/AIDS Treatment in China: Intellectual Property Rights, Generics, and Barriers to Effective Treatment 125 Jean-François Dechamp and Odilon Couzin viii Contents 7 The Social Origin of AIDS Panics in China 152 Jun Jing 8 Perspectives on Stigma and the Needs of People Living with AIDS in China 170 Thomas Cai III. Prevention 9 Opportunity for Effective Prevention of AIDS in China: The Strategy of Preventing Secondary Transmission of HIV 177 Ray Yip 10 Sexual Partners in China: Risk Pattern for Infection by HIV and Possible Interventions 190 William L. Parish and Suiming Pan 11 A Delicate Balance: Law Enforcement Agencies and Harm Reduction Interventions for Injection Drug Users in China and Vietnam 214 Theodore M. Hammett, Yi Chen, Doan Ngu, Dao Dinh Cuong, Ly Kieu Van, Wei Liu, Meng Donghua, Hoang Ngoc Quyen, Robert S. Broadhead, and Don C. Des Jarlais 12 Youth and HIV/AIDS in China 232 Xiaomei Ru IV. Impact Mitigation 13 Children Affected by AIDS: Orphans and Impact Mitigation in China 243 Andy West and Kate Wedgwood Afterword 265 Contributors 7 Volume Co-editors Joan Kaufman Kennedy School of Government Joan Kaufman is a Lecturer in the Department of Social Medicine at Har- vard Medical School, Senior Scientist at the Heller School of Social Policy and Management at Brandeis University, and Director of the AIDS Public Policy Program at the Kennedy School of Government. The AIDS Public Policy Program seeks to build the capacity of government officials in de- veloping countries on the multi-sectoral requirements for implementation of HIV/AIDS policies and programs. The Program is now active in China and Vietnam. Arthur Kleinman Faculty of Arts and Sciences and Harvard Medical School Arthur Kleinman, a physician and anthropologist, is the Esther and Sidney Rabb Professor of Anthropology in the Faculty of Arts and Sciences, Harvard University, and Professor of Medical Anthropology and Psychiatry at Harvard Medical School. Kleinman is currently on the board of advisors of the Beijing Municipal Suicide Prevention Center and is collaborating with colleagues at Tsinghua University (Beijing) and the Chinese University of Hong Kong on several different research projects. Anthony Saich Kennedy School of Government Tony Saich is the Daewoo Professor of International Affairs; Director and Faculty Chair of Asia Programs and the China Public Policy Program at the Mossavar-Rahmani Center for Business and Government at the Kennedy School of Government, Harvard University; and Director of the Harvard x Contributors University Asia Center. His teaching and research focus on the interplay between the state and society in Asia and the respective roles they play in determining policymaking and framing socioeconomic development. He has written several books on the developments in China, including China: Politics and Government; Revolutionary Discourse in Mao’s China (with David E. Apter) and The Rise to Power of the Chinese Communist Party. Volume Contributors Thomas Cai AIDS Activist Mr. Cai is an HIV-positive activist from Guangdong province and has been working for four years in the field of providing care and support to people living with HIV/AIDS. With support from international NGOs and UNDP, in June 2002, Mr. Cai helped organize PLWA to promote greater awareness in China. Under Mr. Cai’s leadership, these individuals have become actively involved in advocacy and prevention efforts, as well as in providing care and support to the PLWA in Guangdong and Guangxi provinces. Odilon Couzin China AIDS Info Odilon Couzin is the Executive Director of China AIDS Info, an inde- pendent non-profit group based in Hong Kong. Couzin has spent the pre- vious decade living primarily in China; from 1993 to 1996 he studied Chinese in Kunming, the capital of Yunnan province. He has worked in a number of different capacities for NGOs in China and has been involved in projects ranging from emergency relief distribution to the planning of program strategies. Couzin resigned after three years of being a foreign correspon- dent in Beijing and founded China AIDS Info. Jean-François Dechamp Independent Consultant Jean-François Dechamp was the Co-ordinator of the European AIDS Treatment Group before being called by the European Commission to join the Ethics and Science Unit of the European Commission (Directorate General for Research) in September 2005. In 2002, he joined the humani- tarian aid organisation Médecins Sans Frontières / Doctors Without Borders (MSF), where he worked within the Campaign for Access to Essential Contributors xi Medicines. This was followed by a six-month mission to China where he worked on strengthening the HIV/AIDS treatment project team. Jean- François Dechamp graduated as a pharmacist from the University of Stras- bourg, France in 1991. Paul Farmer Department of Social Medicine Paul Farmer, MD, PhD, is a medical anthropologist whose work draws pri- marily on active clinical practice and focuses on diseases disproportionately afflicting the poor. He divides his clinical time between the Brigham and Women’s Hospital (Division of Infectious Disease), where he is an attending physician, and a charity hospital in rural Haiti, the Clinique Bon Sauveur, where he serves as medical co-director. An infectious disease physician as well as an anthropologist, Dr. Farmer has worked in communicable-disease control in the Americas for over a decade and is a world-renowned authority on tuberculosis treatment and control. Theodore Hammett Abt Associates Theodore M. Hammett, Ph.D. is a Vice President at Abt Associates Inc., a leading policy research firm with headquarters in Cambridge, Massachusetts. In his 24 years with Abt Associates, Dr. Hammett has focused on HIV/AIDS, in particular its relation to correctional and drug-using popu- lations. He is currently the principal investigator for a four-year cross-border HIV prevention project for injection drug users in China and Vietnam. This project is funded by the National Institute on Drug Abuse (NIDA) and the Ford Foundation. Jing Jun Tsinghua University Jing Jun holds a joint appointment in the Department of Sociology and the School of Public Policy at Tsinghua University in Beijing. He has been working on the HIV/AIDS epidemic in China as a social researcher and policy advocate and teaches a sociological course on AIDS and works as a policy advisor for the Chinese Ministry of Health. A native of Beijing, re- ceived his Ph.D. in social anthropology from Harvard University in 1994. xii Contributors Yuanli Liu Harvard School of Public Health Dr. Yuanli Liu is Assistant Professor of International Health at the Harvard School of Public Health (HSPH) and Director of the HSPH China Initiative, as well as Vice President of China Foundation, a US-based think tank. He was profiled by the HSPH 2003 Annual Report as one of six “Future Leaders in Public Health.” Dr. Liu received his graduate degrees in public health, health policy, and health economics from Tongji Medical University (1987), Harvard University (1988), and University of Minnesota (1995).