Detecting and calculating HIV
Since the early 2000s, HIV has also become a major concern in Xinjiang and some areas of Sichuan province among the injection drug using (IDU) population. Mother-to-child transmission has also been detected nationwide, but not in large numbers. HIV has also begun to be reported among particular populations in urban China. For example, considerable HIV-related panic was directed toward the internal migrant population (Migrant Workers 2006). This group is made up of young adults who are largely single or separated from their spouses and are thus popularly perceived to be ‘at risk’ from HIV. So far, however, no such explosion has been detected in this group.
The numbers of HIV-positive Chinese reported in local media has fluctuated and continues to do so. For example, the national infection rate was reported as being relatively low until 2001 when, as described above, the reported rate escalated rapidly following the publication of the UN report China’s Titanic Peril (UNAIDS 2002). Up to then, in the rare instances where HIV was communicated as a local threat, it was shown to affect primarily non-Han or lower class rural and ethnic populations. This changed, however, in 2002 when securitisation of HIV occurred and the entire nation and the Chinese economy was portrayed to be at risk from HIV.
HIV statistics have been, and continue to be, similarly unreliable. The estimated prevalence dropped from 1.2 million in 2002 to 600,000 several years later. Estimates then rose to 840,000, and until 2012 the number of HIV positive sufferers in the country estimated by most organisations was from 740,000 to 780,000 (Jin 2011; Li et al. 2012: 2069-78). On World AIDS Day 2012, statistics on HIV prevalence were revisited yet again, dropping the figure to a record low of 490,000 (Zhang Ran 2012). The year-to-year variance has not only incited panic but also serves to attract funds and social, political, and commercial attention to HIV. These shifts have been used to show that China is making massive strides in HIV prevention and treatment. The actual situation, though, is much more complex, and with regional variation. In the latest statistics, approximately less than half have actually tested positive (Jin 2011; Zhang Ran 2012).
One of the major shifts in the detection of HIV occurred in 2008, when sexual transmission overtook injection drug use and blood commodification as the primary transmission path of HIV in China. This remains unchanged today. The groups most affected by this are sex workers and MSM, although the growing reported infection rates in the latter may reflect concerted efforts to popularise voluntary counselling and testing (VCT) among gay men (Jacobs 2009). This program is targeted at particular risk groups and pushes people in those risk groups to test, often offering financial incentives. MSM advocacy currently forms a major campaign and donor focus, yet the detection of HIV among China’s then invisible gay community was late. Reports now indicate that HIV is spreading most rapidly among them, as well as elderly men, who are a relatively new risk group identified by latest research findings (Abrams 2012; Shan 2012;
Xu 2012). New trends in detection can be linked to better understandings of China’s sex trade, the growing acceptance of homosexuality and the practice of ‘coming out’ (chugui), the popularisation of patient confidentiality, and the financial incentives provided for HIV testing (Jacobs 2009). Meanwhile, HIV infection in non-urban areas is now reported, albeit infrequently, to be concentrated primarily in marginalised communities in poorer inland provinces, such as Xinjiang and Guangxi. These areas have populations with large proportions of ethnic minorities and are home to China’s poorest and most vulnerable people.
Reports on and representations of HIV in China have not always reflected actual demographies of infection. The media focus typically has been on the epidemic in rural China where coverage paints HIV sufferers as a pariah class marked for their low social standing, their low quality (suzhi), poor health, and community and family exclusion. These ways of explaining HIV infection continue into the present although (sometimes patronising) resilience stories and stories of urban areas are given more, but not all, media attention.
Reports in urban areas typically identify HIV in non-normative populations, such as among sex workers, drug users and, increasingly, gay men. Celebrities are also increasingly involved in HIV campaigns, making public appearances and public service announcements, which draw increasing amounts of citizen attention to HIV in China. Because of the media role in public health in China, new pathologies involving a trend called AIDS phobia (kong’ai zheng) have also been discussed at length. This shows how important it is to look closely at HIV reporting and the role of the media in shaping public perceptions and panic.
Despite the occasional publication ban and the levels of self-censorship that plague China’s media generally, HIV has remained a well-reported concern since the mid-1980s, particularly around World AIDS Day in December every year. HIV research in China is also very well developed and well reported. Over a decade since The Titanic Peril was published, though, discussion of HIV continues to be carried on in moralistic terms. Particular research findings remain sensitive, such as the relationship between ethnicity and HIV infection (Huan 2010: 196—214; Jing and Worth 2010a: 28), in that non-Han have significantly higher infection rates in provinces such as Yunnan, Xinjiang, and Gansu, and people in these areas have increased difficulties in accessing anti-retroviral medication (ARVs) (Wan et al. 2009: 1—25; Wan 2010; Wan and Beijing Aizhixing Institute 2011). Additional problems also remain regarding access to the treatment guaranteed under the ‘four frees and one care’ policy, as well as with legal protections for HIV-positive citizens. Although ARVs are free under the policy mentioned above, in 2012 only a quarter of those registered HIV positive in China actually had access to them (Carter 2012). Those involved in work related to HIV, be it in civil society organisations or in bringing rights and medication to China’s most vulnerable communities, are still commonly harassed and threatened. One year ago, China’s rights movement suffered a considerable setback when an HIV positive teacher first lost his job and then his appeal to continue teaching, and when an HIV positive activist, Tian Xi, was detained for over a year on trumped-up charges. The teacher has since been able to receive compensation for damages (He 2013), but earlier efforts to intervene for Tian Xi failed to secure him an earlier release (Housing Works 2011).