Fengshi Wu—a board member for AIDS Relief Fund for China —began the meeting noting that the first reported case of HIV/AIDS in China was in 1985, when a foreigner working in China was diagnosed with the disease. She explained that instead of investing in education or prevention programs the government responded with a low-level propaganda campaign issuing vague warnings to the Chinese public of this "capitalist/Western disease." Ignored by the government, HIV/AIDS spread silently in China for nearly a decade, until the mid-1990s when news of a major contamination of China's blood supply broke. Mobile blood donation centers had been traveling around north-central China offering farmers the opportunity to make money by donating platelets. Unsanitary donating conditions and pumping and mixing blood of several people at once led to an explosion of HIV/AIDS cases among poor rural citizens.

This blood donation scandal in north-central China and the growing infection rate among sex workers and intravenous drug users in the southwestern regions of the country led the government to recognize a major public health crisis. In the winter of 2002, the Chinese government reported one million HIV/AIDS infection cases in China, of which 160,000 Chinese have already died.

The Chinese government has now created several programs to address the growing HIV/AIDS problems and begun to cooperate actively with the international community to fight against the disease. Collaboration with the international community led the central government to substantially increase its budget for HIV/AIDS programs. In 2004, the government devoted 800 million RMB, and with assistance from the Global Fund, created the China CARES (Comprehensive AIDS RESponse) program under the State Council to coordinate HIV/AIDS programs in China. The State Center for Disease Control (CDC) launched this program at the end of 2003 initially covering the 51 worst AIDS hit counties in 11 provinces. In 2004, the second phase of this program expanded to cover 128 counties in 28 provinces. Health bureaus in these counties receive extra-budgetary funds designated for AIDS treatment and care.

In April 2004, the Chinese government also announced the 4-free-1-care policy, which offers free medicine for HIV carriers, free and anonymous HIV tests, free education for orphans of HIV/AIDS victims, and free prenatal treatment of infected pregnant women. Elderly people who have lost children to AIDS receive free care to support them in their old age.

International and bilateral aid organizations (e.g., UN HIV/AIDS, WHO, China UK Program, Global Fund, and the U.S. Department of Health and Human Services), corporations (e.g., Merck), and nearly 30 international health nongovernmental organizations (NGOs) are active in HIV/AIDS education, assistance to victims, research, and policy development activities in China.

In addition to the growth of international and Chinese central government efforts in HIV/AIDS, indigenous Chinese HIV/AIDS activism has quietly emerged. Since much of this activism is carried out by volunteers in rural areas or consists of compassionate acts between citizens, few inside or outside China are aware of this significant trend of volunteerism. To fill this knowledge gap, the speakers presented a veritable "patchwork quilt" of stories and short videos to illustrate the innovation and dynamism of grassroots HIV/AIDS activism in China. The three speakers highlighted examples of compassionate volunteerism in China ranging from peer education and grassroots initiatives to help support HIV/AIDS orphans, to citizens reaching out to high-risk communities and empowering rural women to protect themselves against HIV/AIDS.

Peer Education Programs

Preventative education programs are among the most common activities undertaken by grassroots organizations and international NGOs working on HIV/AIDS in China. Many of these programs are part of larger reproductive health initiatives—most notable are the peer education programs executed by the Seattle-based health NGO, PATH , in high schools, factories, and among sex worker communities in 12 Chinese provinces. PATH has been working on reproductive health programs in China for 25 years, giving its staff strong connections with Chinese health agencies and considerable experience in working with communities. Geng Qian—a senior program officer at PATH—discussed one of PATH's most successful reproductive health and HIV/AIDS youth peer education programs, which has worked with employees at the Haigan Restaurant Company—a chain with restaurants in 15 provinces with over 10,000 employees, most of whom are migrant workers lacking basic reproductive health skills.

Before the program started in 17 restaurants in 2002, nearly 30 percent of the female workers had to leave the workplace each year due to unwanted pregnancies. In 2003, the peer education program helped lower that number to 20 percent. The program also informed employees about measures to prevent contracting HIV/AIDS and other sexually transmitted diseases (STDs). This success and enthusiastic employee and management response to the program led PATH to expand the program to all of Haigan's restaurants in China. The company intends eventually to continue the peer education work on its own. PATH staff view this program as a major new model for promoting better reproductive healthcare for youth in China.

Orphan Care

Infection of large numbers of adults in north central China due to mismanaged blood donation centers has left countless orphaned children in the area. The Chinese government has created special programs to help care for these children. The biggest program is under the 4-free-1-care policy, in which orphans of HIV/AIDS victims are provided free education.

A citizen initiative to provide emotional and small financial assistance to AIDS orphans in rural China is the Pen Pal Club program, created in June 2004 by some university students in Beijing. This program began with 12 volunteers and has today increased to 80 people who write letters, offer advice, and give small amounts of money to orphaned children—a kind of long-distance Big Brother-Big Sister program. This program is providing crucial compassionate support for children going through extremely difficult situations. Humphrey Wou—cofounder of AIDS Relief Fund for China—pointed out that this kind of program, where private citizens voluntarily help others, is novel in China, a country whose citizens are used to waiting for the government to tell them what to do.

Qianxi Association for Women's Health

Rural women are not only vulnerable to contracting HIV/AIDS from husbands returning from migrant labor work in the cities, but are also the last to get healthcare in China's rural areas. In Qianxi County, Hebei province, a group of women who formerly worked for the province's family planning association have created the Qianxi Association for Women's Health to provide reproductive health education and counseling services for rural women, particularly regarding HIV/AIDS and STDs.

The organizers of this group work closely with local and provincial governments to get support for their activities, although none of the educators and councilors in the organization receive salary. The Qianxi Association is encouraging preventative health care, creating a culture of volunteerism, and promoting women's rights. This association has created the first such counseling program for rural women in China and is touted by the government as a model that should be replicated throughout the country.

Compassionate Doctors Helping At-Risk Communities

Intravenous drug use and drug-related prostitution in China are highest in southwest China, an area with major heroin smuggling routes out of Burma. While no national program of harm reduction campaigns—such as free needle exchange—exists, provincial governments in Sichuan, Yunnan, and Guizhou are increasingly devoting funds to such programs, often in collaboration with international organizations like China-UK Program, Futures Group, Save the Children, Oxfam, and the Red Cross.

Liangshan, one of the poorest prefectures in Sichuan province, has a particularly high rate of HIV/AIDS infection due to intravenous drug use and a large sex worker population. The prefecture's capital, Xichang, has been the target for several international HIV/AIDS projects such as the Merck Initiative, China-UK Program, and the Global Fund. Additionally, at-risk communities in the city have received considerable help from an extremely dedicated team of Center for Disease Control doctors who have gone beyond simply helping HIV/AIDS victims obtain medicine to offering financial assistance and pro bono counseling to poor families affected by HIV/AIDS. The doctors often donate 100 Yuan each month—12 percent of their monthly income—to such families. With a grant from the AIDS Relief Fund for China, these doctors also have been able to train and provide salaries for several sex workers to help carry out a peer education program on HIV/AIDS prevention.

Gay Community

Currently, Chinese NGOs in a number of big cities have set up gay hot lines to provide advice on safe sex and HIV/AIDS testing. Many NGOs—particularly in the cities of Chengdu, Dalian, and Shenzhen where the gay communities are more open—are doing HIV/AIDS outreach in the form of condom distribution in bars, parks, and saunas where gay people gather. There are also approximately 200 gay Web sites in China, some of which provide HIV/AIDS information. Throughout China many CDCs and Health Departments are planning to extend their HIV/AIDS education programs to this segment of society, which could help promote more NGO and citizen outreach to this community.

Promoting Innovation

Some international NGOs are helping promote both government and citizen HIV/AIDS initiatives. For example, PATH's peer education program has inspired some young participants to undertake this kind of volunteer work in their own communities—Geng Qian provided an example of a young Tibetan woman who traveled back to Tibet to try to convince the local family planning association to create such an HIV/AIDS peer education program

Geng Qian also mentioned how PATH's peer learning programs in Chinese schools were one catalyst that led the Chinese education ministry to require high school and middle school sex education programs to include HIV/AIDS information. While this goal of broader HIV/AIDS education is admirable, the ministry has not yet provided clear guidelines on how schools should design and execute such education programs.

The AIDS Relief Fund for China focuses on supporting community-based solutions for promoting HIV/AIDS education and victim assistance work. ARFC is innovative in its approach to awarding grants to grassroots activists in that there are no applications to fill out. Instead, individuals simply need to contact ARFC and request an interview. With small grants, ARFC grantees have done impressive work. For example, having received $500 from ARFC, a group in Chongqing, the Green Volunteers Union, was able to sponser 16 HIV/AIDS education lectures at universities and schools in the city. A university student group from Jiaotong University in Shanghai also received $500, which it used to give 22 HIV/AIDS peer education workshops to nearly 900 students. With a second grant this group will train student groups from two other universities how to conduct HIV/AIDS peer education workshops.

The "quilt" of diverse stories highlighted during this Wilson Center meeting illustrates how far China has come in HIV/AIDS prevention, particularly the striking trend of individual citizens reaching out to help others instead of simply waiting to be told by the government to "volunteer." Humphrey Wou noted that some of these grassroots initiatives have emerged in areas where international assistance has been strong, which helped raise local awareness of the problem. External influence is not the only explanation however, for as the government has made room for social organizations to emerge, Chinese citizen have begun to reach out to all kinds of communities in need.

Drafted by Jennifer L. Turner and Charlotte MacAusland.