Fifteen years ago, in light of the rapid spread of the HIV cases and the absence of effective government response, UN officials warned that China could have over 10 million HIV cases by 2010. Thankfully, that prophesy was not fulfilled. In fact, China today has an estimated 780,000 people living with HIV/AIDS. The adult prevalence rate of HIV/AIDS is only 0.1 percent, the same as Japan’s and less than the United Kingdom’s (0.2 percent) and the United States’ (0.6 percent). Comparatively, in 2010, China had 36,200 AIDS-related deaths—the same number of people die annually as a result of seasonal flu in the United States—compared to 1.7 million who died of stroke and nearly 1 million who died of heart disease.
To the credit of the government and international health agencies, China has made great strides in HIV/AIDS prevention and control over the past decade. The government crackdown on unsafe and illegal blood collections has contributed to the rapid drop in the share of HIV/AIDS cases attributed to blood transfusion and plasma donation, from nearly 30 percent during 1985-2005 to 3.3 percent in 2011. Between 2004 and 2009, the number of injecting drug users (IDUs) under methadone maintenance treatment expanded from 1,029 to 344,254, which, in combination with other harm reduction measures, are associated with a marked fall in new HIV infections in IDUs, whose share in total reported HIV/AIDS cases dropped from around 44 percent during the 1985-2005 era to 17 percent in 2011.
Interventions to reduce risks for sexual transmission have nevertheless not been successful. Cases attributed to unsafe sex continue to increase. From 1985 to 2005, an average of only 12 percent of HIV cases were contracted through unsafe sex. In 2007, sexual contact became the main mode of HIV transmission for the first time. Today, it accounts for nearly 90 percent of China’s new HIV infections.
The changing mode of HIV transmissions parallels the ongoing sexual revolution in China. In the Mao era, even the discussion of sex was taboo. Today, with more than six million workers practicing the world’s oldest profession, China likely has the largest commercial sex industry in the world. A 2005-06 survey conducted in three cities in the Sichuan province found that 95.2 percent of men had visited a commercial sex worker (CSW) within six months. In a more recent survey, nearly one quarter of the respondents admitted having more than one sex partner. While the HIV prevalence rate among female sex workers remains consistently low (no more than 1 percent in most provinces), the virus is spreading fast among China’s elderly population (most of whom were believed to be infected by using the services of CSWs). Furthermore, infection rates among men who have sex with men are as high as 4.9 percent, despite huge investment in behavioral interventions in this segment of the population. As HIV/AIDS is spreading from the most-at-risk population to the general population, it becomes even more difficult for the government to track HIV/AIDS cases and further bring down new infections.