Uneven disease economies
Although the national prevalence rates of HIV in China are lower than rates in many developed countries, such as the USA or Australia, HIV attracts a disproportionate amount of resources and attention in comparison with the amount of people it affects. The sheer numbers of publications and media on the various aspects of the virus and on living positively with HIV suggest there are other benefits to be gained from the media, political, and economic focus on a problem that only one in 2,500 are predicted to have (China Ministry of Health 2012). This is particularly notable when compared to China’s exceptional rates of hepatitis and tuberculosis (TB).
According to international and domestic studies on TB between 2010 and 2012, China has the second largest TB epidemic in the world and the highest annual number of cases of multidrug- resistant TB infections. These amount to 25 per cent of the world total (China Ministry of Health 2012). While some 1.5 million in China are currently infected with active TB (World Health Organisation 2011b: fig. 2.1, p. 12), 500 million are suspected to carry the virus without knowing (China Ministry of Health 2010b, People’s Daily Online 2011). When China’s AIDS ‘problem’ was coming to light in the early 2000s, TB infection rates were even higher than now, as there have been considerable improvements in TB control in China over the past decade (World Health Organisation 2011b, pp. 7, 11). As a secondary infection suffered by HIV carriers, TB nonetheless remains one of the contributing factors to deaths from AIDS in contemporary China.
Hepatitis is an even more widespread problem. An estimated one in ten Chinese people carry hepatitis, putting the total number of estimated sufferers at 120 million (China Ministry of Health 2010a). Discrimination against those with hepatitis is widespread (Chang 2006; China Daily Online 2012). As a result of hepatitis prevalence, China also has an elevated incidence of associated medical conditions, like liver cancer (Wang 2007).
Despite being more than one hundred times less prevalent than hepatitis, HIV prevention, treatment, and research has been a major focus in Chinese society and media over the last two decades. HIV draws attention from the general public and from educated audiences and graduates through a variety of fora. These include: sensational media stories, celebrity advocacy, local and foreign research grants, internship and employment opportunities in HIV-related programs and project evaluation and management (Jing and Worth 2010a: 3). Media interest in HIV may be partly explained by the role of training centre programs which sponsor and assist journalists — such as the joint initiative between Bayer-Schering pharmaceuticals and Tsinghua University, a partnership which is still in operation (Bayer-Schering Pharmaceuticals 2004; Tsinghua University 2010). To my knowledge, similar centres and resources do not exist for other diseases.
Corporations and business organisations and an assortment of celebrities, doctors and philanthropists have also donated their time and financial resources to HIV-based research and social organisations in China. These range from the development arms of foreign governments and many international organisations, including the Red Cross, Rotary International, branches of the UN, the Gates and Clinton foundations, as well as industry and CSR initiatives from companies such as Bayer-Schering pharmaceuticals, Durex condoms, and M. A.C. cosmetics. The exact amount of funding directed at HIV/AIDS is difficult to ascertain. This makes direct comparisons to funding figures for hepatitis and TB impossible, but interest in hepatitis and TB is not well-developed outside organisations that engage multiple diseases (Global Fund to Fight AIDS, TB and Malaria, and the Global Health Initiative of the World Economic Forum’s foci on AIDS and TB).
Celebrities, public intellectuals and grassroots organisations also reinforce the focus on HIV – AIDS (Chen et al. 2004: 18-39; Jing and Worth 2010b: 11-42). The number of Chinese celebrities who offer public support for HIV campaigns overwhelms other concerns. Exceptions can be found, but the engagement of other celebrities with non-HIV activities has been arranged by public relations companies and global bodies such as the World Health Organisation and APCO (Public health round-up: a new ambassador for TB and HIV, 2011: 472-73; World Health Organisation 2011a; Blue Focus PR Consulting 2012; Wang 2012b: 5-8). The few who endorse hepatitis or TB – for example actor Andy Lau and folk singer Peng Liyuan – endorse campaigns around HIV too (Xinhua News Agency 2005; Lau 2006; CCTV news 2010; Blue Focus PR Consulting 2012). First lady Peng Liyuan’s latest public service announcement (PSA) – directed by Gu Changwei (yongyuan zai yiqi 2012) and produced by the Chinese Ministry of Health – was released on World AIDS Day. This was weeks after she assumed the role of first lady amidst speculation that she would withdraw from public life completely (Makinen 2012). This significant moment suggests that HIV will remain a focus of celebrity and government public relations.
The dominant focus on HIV by public intellectuals, creative artists, documentarians, film makers, governmental and non-governmental charities and corporations can be frustrating for those working on issues which do not attract similar levels of attention and funding. This disproportionate attention entrenches HIV’s dominant status within China’s unequal economy of disease at the expense of other more prominent problems and illnesses. Many of these well- intentioned projects and organisations have been unable to address key issues regarding the spread of the virus in China. These include changing the pattern of HIV infection in China according to income, occupation, ethnicity, geographic origin, and social status. However, this local and international investment in the social, political and economic lives of HIV has been key in paving the way for the development of Chinese civil society, including the hybridisation of state-civil society partnerships (Shieh and Deng 2011: 181-94; Spires 2012: 125-46). Non – HIV based organisations have learned important lessons from the struggles experienced in the HIV sector.