VZCZCXRO0946
RR RUEHCN RUEHHM RUEHLN RUEHPB
DE RUEHGZ #5479/01 0590610
ZNR UUUUU ZZH
R 280610Z FEB 06
FM AMCONSUL GUANGZHOU
TO RUEHC/SECSTATE WASHDC 9036
INFO RUEHOO/CHINA POSTS COLLECTIVE
RUEHHM/AMCONSUL HO CHI MINH CITY 0207
RUEAIIA/CIA WASHDC
RUEKJCS/DIA WASHDC
RUCPDOC/USDOC WASHDC
RUEHC/DEPT OF LABOR WASHDC
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHDC
RHHMUNA/HQ USPACOM HONOLULU HI

UNCLAS SECTION 01 OF 04 GUANGZHOU 005479 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
DOL FOR ILAB 
HHS FOR STEIGER, ELVANDER AND BHAT 
NIH FOR FOGARTY CENTER (HOLT) 
NIH ALSO FOR NIAID (HOFF) 
STATE FOR USAID FOR ANE AND GH/HIV-AIDS 
STATE FOR S/GAC, OES, OES/PCI, OES/IHA, DRL/PHD, AND EAP/CM 
CDC FOR GLOBAL AIDS PROGRAM 
USDOC FOR ITA/MAC/AP/OCEA MCQUEEN 
BANGKOK FOR USAID (BRADSHAW) 
USPACOM FOR FPA 
 
E.O. 12958: N/A 
TAGS: KHIV KFLU EAID SOCI TBIO CH
SUBJECT:  Journey to the West:  HIV/AIDS, Avian Influenza 
and Other Guangxi Health Stories 
 
Ref: A) Guangzhou 5377 and previous, B) Guangzhou 4512, 
--   C) 05 Guangzhou 22787 (all notal) 
 
GUANGZHOU 00005479  001.2 OF 004 
 
 
(U) THIS DOCUMENT IS SENSITIVE BUT UNCLASSIFIED.  PLEASE 
PROTECT ACCORDINGLY.  NOT FOR RELEASE OUTSIDE U.S. 
GOVERNMENT CHANNELS.  NOT FOR INTERNET PUBLICATION. 
 
¶1. (SBU) Summary:  Local governments have taken some 
measures to combat the threat of avian influenza (AI) and 
the spread of HIV/AIDS, but the scale of the threat appears 
to dwarf the size of government programs.  In addition with 
respect to HIV/AIDS, the accuracy and availability of 
information about infected and at-risk individuals remains 
questionable, possibly undermining the government's claims 
of preparedness.  Furthermore, despite the expansion of 
HIV/AIDS programs -- including ones funded by USAID -- in 
the region, a thriving sex worker industry in border and 
port towns continues to challenge outreach efforts.  End 
Summary. 
 
AI: See No Evil, But Still Take Precautions 
------------------------------------------- 
¶2. (SBU) As part of Consulate Guangzhou's "journey to the 
west" (ref A), Congenoffs with public health officials in 
Guangxi cities bordering Vietnam -- particularly Pingxiang 
and Dongxing -- with a major focus on HIV/AIDS but with 
spillover discussions on avian influenza.   Pingxiang 
Agricultural and Husbandry Bureau Deputy Director Huang 
laid out the government's approach to curbing the threat of 
avian influenza (AI).  Huang stressed that while Congzuo 
(the prefecture governing Pingxiang, a border town with 
Vietnam) has not yet suffered from any AI infections, 
officials have paid attention to the looming disease.  She 
detailed the local government's four-tiered anti-AI 
approach, which includes organized meetings; public 
education campaigns through various mass media mechanisms 
such as radio, the Internet, and newspapers; vaccination of 
all poultry, and the prohibition on sales of unvaccinated 
and undocumented birds; and authorization of all local 
governments to take immediate action against outbreaks. 
Deputy Director Huang stated that, in the event of an 
outbreak, local governments would set up teams to address 
quarantine and prevention.  In addition, she stressed the 
proven high quality of vaccinations available; fittingly, 
the same evening, CCTV1 announced that Beijing-based 
Sinovac had produced a new generation of avian flu 
vaccines. 
 
¶3. (SBU) In further discussion, local officials 
acknowledged the market impact of AI on the sales on 
chicken and duck, but touted the good cooperation between 
Pingxiang and Vietnam in discussions over the illness. 
They insisted that public education had reached one hundred 
percent of all people in the area, including farmers and 
poor people.   When the Consul General raised news of the 
death of a 10-year-old girl in Ziyuan County, Guilin, who 
had died the day before, local officials asserted very 
defensively and on behalf of the entire province that there 
had been no verification that the girl's death was a result 
of poultry to human transmission.  (Comment: The nature of 
their comments and attitude raises the question of whether 
there is information about the issue.  The young girl lived 
in an area that has had no confirmed reports of AI 
outbreak, and there is still no confirmed source of her 
illness.  See ref B.)  Despite the outward confidence of 
local officials regarding AI, we noted that in all of the 
Consulate's Guangxi travels other than to Pingxiang, where 
we discussed the AI issue at length, officials at no time 
served chicken, even though chicken is among their favorite 
dishes.  A common local saying is, "A banquet is not 
 
GUANGZHOU 00005479  002.4 OF 004 
 
 
complete without chicken." 
 
HIV/AIDS: A Longer Track Record, But Hurdles Remain 
--------------------------------------------- ------ 
¶4. (SBU) Director Zhao of the Pingxiang Public Health 
Bureau then presented the local government's HIV/AIDS 
programs, while still underlining major challenges to their 
efforts.  Since 1996 to date, more than three hundred HIV- 
positive patients have been identified in Guangxi, and 
close to thirty people have died.  Pingxiang, a susceptible 
border town, has since become one of the main monitoring 
sites in the country, and provides other services such as 
HIV awareness, voluntary counseling and testing, initial 
blood sample testing, training for government officials 
both domestically and abroad, needle exchange programs, and 
distribution of condoms and HIV/AIDS information in over 
thirty hotels in the city. (Comment: Congenoffs note that 
the state-run guest house in Pingxiang did not offer 
condoms or HIV/AIDS information in the rooms, but each of 
the Consulate visitors received a nighttime phone offer of 
a "massage," a not-uncommon occurrence in Chinese hotels.) 
 
The Family Health International Project 
--------------------------------------- 
¶5. (SBU) Pingxiang's major projects include partnerships 
with Johns Hopkins University, USAID, and international 
NGO's such as Family Health International (FHI).  As of 
August 2004, FHI in conjunction with the local Center for 
Disease Control (CDC) has provided anti-retroviral drug 
treatment and consulting for HIV/AIDS patients.  Also, as 
part of the Greater Mekong Sub Region (GMS) program, they 
provide treatment and voluntary testing specifically for 
drug users.  Since May 2005, FHI began providing a full 
range of service to local people including voluntary 
counseling and testing, and to date have counseled 142 
individuals, 45 of whom received initial treatment against 
infectious diseases, and 22 of whom received additional 
anti-retroviral treatment.  FHI also has developed outreach 
programs, health clinics and recovery centers targeting 
entertainment sites and truck drivers in the Puzhai border 
crossing area, and has employed several Vietnamese partners 
to help educate Vietnamese sex workers and patrons.  In 
November 2005, FHI hosted several events during which they 
tested 1,500 truck drivers and handed out 3,700 condoms. 
These outreach programs were still in development as of 
June 2005, when Congenoffs visited the Puzhai crossing (ref 
C).  In December 2005, FHI founded a peer support group for 
HIV/AIDS patients, and six patients attended the kickoff 
meeting.  (Comment: While FHI and Pingxiang CDC's efforts 
are commendable, the number of attendees indicates that the 
scale of remediation does not yet match the scale of the 
problem.) 
 
¶6. (SBU) Despite progress in recent months, Director Zhao 
outlined many challenges to their anti-HIV/AIDS efforts. 
These challenges include a growing number of visitors due 
to the recent opening of the Nanning-Pingxiang highway; an 
increasing number of deaths from HIV/AIDS, causing a 
shortage of supplies and medical assistance for other 
patients; insufficient psychological care for patients and 
relatives; the spread of disease beyond at-risk groups; a 
need for more NGO coordination to facilitate exchanges with 
Vietnam; a limited reach for voluntary counseling and 
testing programs; and the need for more technical support 
from NGO's and the United States government.  When asked 
about stigma and discrimination, Director Zhao stated that 
Pingxiang had fewer problems with stigma than did other 
areas because of the success of public education. 
 
Lack of Reliable HIV/AIDS Data for Modeling Purposes 
 
GUANGZHOU 00005479  003.2 OF 004 
 
 
--------------------------------------------- ------- 
¶7. (SBU) During a subsequent visit to FHI offices, opened 
in June 2005 in a small wing of the Pingxiang CDC offices, 
as well as to the anti-retroviral treatment center in the 
local hospital, FHI Regional Associate Director Pratin 
Dharmarak summarized the group's collaboration with local 
officials while criticizing the government's ability to 
tackle HIV/AIDS.  Dharmarak stated that the Chinese 
government was unable to model the problem because they do 
not have reliable data.  In addition, she opined that the 
government applies remedies in isolation and addresses only 
limited parts of the problem, because it lacks broader 
vision and integrated solutions.  To illustrate, she 
pointed out the government's emphasis on attacking HIV/AIDS 
geographically, while failing to meet different needs 
within various locales.  While Dharmarak expressed concern 
about the government's ability to develop programs in their 
absence, she also noted that FHI's USAID funding will run 
out in September 2006. 
 
Port Towns Bring In More Than Just Bulk Cargo 
--------------------------------------------- 
¶8. (SBU) In Dongxing, a border-crossing town comparable to 
Pingxiang, Congneoffs visited another USAID-funded HIV/AIDS 
project managed by Population Services International (PSI), 
which in the past three years has established HIV/AIDS 
outreach points and a drop-in clinic and activities center. 
City officials were very supportive and spoke highly of the 
work done by PSI.   Dongxing contains various 
concentrations of sex workers, such as year-round sex 
workers in the city who usually operate under the aegis of 
organized criminal gangs, as well as summer migrants coming 
from Yunnan, Sichuan, and local areas, who work the beach 
area during summer months.  PSI has worked closely with 
local government officials to provide checkups, promote 
HIV/AIDS awareness and teach useful prevention techniques 
to sex workers, truck drivers and migrant laborers.  While 
the drop-in clinic "Sisters Health Home" does not 
explicitly mention HIV/AIDS in order to protect the privacy 
of people visiting the center, it is positioned adjacent to 
one of Dongxing's red light districts. 
 
¶9. (SBU) As with FHI, PSI staff commented that their USAID 
funding will run out in September 2006.  PSI officials said 
the project was a work in progress and that Chinese 
officials needed more experience with working with 
international NGOs.  The PSI project is the first non- 
Chinese NGO to work in its city and has spent much staff 
time educating city officials on how to work with 
international NGOs.  PSI Director Grace Hefner, based in 
Kunming, came to Dongxing to show Consulate officials the 
program.  She expressed her gratitude for the Consulate's 
visit, saying that it has helped her in her work with 
government officials in supporting the program.  Hefner 
also noted that NGOs such as PSI and FHI have the ability 
to coordinate with sister projects in Vietnam in a way that 
Chinese and Vietnamese officials would find difficult 
without first going through their respective capitals. 
 
Operating Without NGOs in Fangchenggang 
--------------------------------------- 
¶10. (SBU) In Dongxing's neighboring port city, 
Fangchenggang (the prefecture level city administratively 
inclusive of Dongxing), CDC officials informed Congenoffs 
that the local center runs a very active anti-HIV/AIDS 
program providing information to local residents including 
junior and senior high school students.  Fanchenggang's 
Vice Mayor said in turn that the majority of HIV/AIDS cases 
are due to drug use, though he also acknowledged the role 
of sex workers in spreading the disease.  The Vice Mayor 
 
GUANGZHOU 00005479  004.2 OF 004 
 
 
attributed the drugs to sources in Vietnam and Yunnan, but 
said that Yunnan and Guangxi authorities have mounted a 
very rigorous campaign to combat drug smuggling, and noted 
that in recent years Vietnam had undertaken a similar anti- 
drug strategy.  Officials claimed that the number of drug 
addicts is increasing in Fangchenggang because of the 
increase in traffic, but also confirmed that the city does 
have a needle exchange program.  CDC representatives 
described the city's plan to more than quadruple the 
existing drug recovery center by increasing capacity from 
180 to 800 beds, or to one bed per one thousand people in 
the city.  They added that the recovery center plans to 
provide special treatment for HIV carriers in the future as 
well.  When asked about avian influenza, the officials 
simply responded that they have had no cases. 
 
¶11. (SBU) Similar to Dongxing's active waterside red light 
district, Fangchenggang houses a red light area near the 
busy ports.  During an evening stroll through the town, 
congenoffs noted at least 19 red light establishments by 
the ports, though none appeared to be doing anything 
resembling a robust business.  In Fangchenggang, port 
workers make a reasonably good salary at an average of RMB 
36,000 per year (about USD 4,465), whereas people working 
in the town outside the port earn an average of RMB 10,000 
(about USD 1,240) per year.  By comparison, the average 
urban income in the region is RMB 8,900 (about USD 1,100) 
per year. 
 
Comment 
------- 
¶12. (SBU) While Guangxi's border and port towns are 
vehicles for rapid growth and international trade, the 
increase in economic traffic raises stakes for public 
health officials combating avian influenza and HIV/AIDS. 
An active international NGO presence heightens awareness of 
the illnesses and boosts government capacity building, but 
the government's current piecemeal solutions need to evolve 
to a larger and more integrated approach to addressing 
public health challenges.  Furthermore, the cross-border 
nature of avian flu, HIV/AIDS, and other health problems 
indicate that more cross-border linkages should be 
promoted.  International NGO participation appears to be a 
key catalyst for effective programs, and it would appear 
that in their absence, local government capacity to stem 
public health outbreaks such as HIV/AIDS will be crippled. 
 
¶13. (U) Departing the area bordering Vietnam, Congenoffs 
headed back up north to Nanning for a Sunday visit to the 
much healthier environment of Guangxi's two major milk 
producers, the subject of the next message in the series on 
the Consulate's continuing "journey to the west." 
 
¶14. (U) This message has been cleared by AmEmbassy Hanoi. 
 
DONG