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R 281000Z APR 06
FM AMCONSUL GUANGZHOU
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UNCLAS SECTION 01 OF 03 GUANGZHOU 013565 
 
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 EAID SOCI TBIO CH
SUBJECT: AIDS in Guangxi: "The Problem Is Overwhelmingly 
Ours" 
 
REF:  A) Guangzhou 13381; B) Guangzhou 12155; C) Guangzhou 
 
11657; D) Guangzhou 5479; E) 05 Guangzhou 22492;  F) 04 
Guangzhou 21493 
 
(U)  THIS DOCUMENT IS SENSITIVE BUT UNCLASSIFIED.  PLEASE 
PROTECT ACCORDINGLY.  NOT FOR RELEASE OUTSIDE U.S. 
GOVERNMENT CHANNELS.  NOT FOR INTERNET PUBLICATION. 
 
¶1. (U) Summary:  Guangxi Zhuang Autonomous Region's HIV-AIDS 
problem continues to worsen.  During a recent visit to 
Guangxi's Center for Disease Control (CDC) and AIDS Care 
China, an AIDS-related non-governmental organization (NGO) 
based in South China, Congenoffs learned about how the 
province is dealing with the problem.  On the positive side, 
local CDC officials did not blame Vietnam as the source of 
all AIDS problems and have been increasing domestic 
programming to deal with AIDS prevention.  Nevertheless 
China's cultural stigmas toward AIDS, slow NGO development, 
and a weak overall medical infrastructure cannot stop a 
rising tide of AIDS patients in Guangxi.  End Summary. 
 
¶2. (U) As part of the Consulate's continued efforts to 
monitor HIV-AIDS in the Guangxi Zhuang Autonomous Region, 
Congenoffs recently visited Nanning, Guangxi's capital, to 
consult with two of the province's CDC experts, Chen Jie and 
Liu Wei.  According to the CDC, Guangxi has the third 
largest number of HIV/AIDS cases in China (after Yunnan and 
Xinjiang) with 20,000 HIV cases and 2,000 confirmed AIDS 
patients.  The CDC officials later unofficially estimated 
that in five years the figures could be as high as 15,000- 
20,000 AIDS cases and 60,000-80,000 HIV cases.  The AIDS 
problem is prevalent throughout Guangxi -- about one-fourth 
of all counties in Guangxi have over 100 HIV cases. 
 
Looking Beyond Vietnam for Sources of HIV/AIDS 
--------------------------------------------- - 
¶3. (U) The reason for Guangxi's inordinately high HIV-AIDS 
rates is a combination of factors.  Traditionally, Chinese 
authorities believed Guangxi's border with Vietnam was the 
key to the problem.  In the early 1990s, both legal and 
illegal trade connections with Vietnam exposed Guangxi to a 
nexus of HIV-AIDS patients and a flourishing drug trade (see 
refs D, E).  Today, Guangxi has over 100,000 drug users and 
the majority of HIV-AIDS patients in Guangxi are intravenous 
drug users (56 percent).  According to the CDC, throughout 
China, intravenous drug users account for only 30 percent of 
total HIV-AIDS cases. 
 
¶4. (U) However, according to the CDC officials, border 
security has improved to the point that currently most of 
the illegal drug supply comes from domestic Chinese sources. 
Officials stated that the Chinese drug market is self- 
sustaining and does not rely as much on cross-border 
traffic.  This is evidenced by the fact that the most 
prevalent HIV-AIDS subtypes in Guangxi are types B and C, 
which are typical in Yunnan and Xinjiang provinces, while 
type E, typical of Vietnam, is decreasing.  (Note: HIV-AIDS 
can have a number of different subtypes with different 
levels of virility.  End Note.)  Guangxi has an overall 
migrant labor surplus of 10 million workers; thus the CDC 
assumed that HIV/AIDS patients must also be coming from 
other provinces. 
 
Programs Improving, but Need More Help 
-------------------------------------- 
¶5. (U) The Guangxi CDC is increasing its cooperation with 
international organizations and implementing preventative 
programs.  International partners that provide funding 
include a British government project called China AIDS Road 
Map Technical Support (CHARTS), the World Bank, the U.S. 
National Institutes of Health, the Clinton Foundation, and a 
 
GUANGZHOU 00013565  002 OF 003 
 
 
USAID program along the Guangxi-Vietnam border.  Last year 
the CDC gave out 250,000 condoms, mostly to sex workers and 
at clinics that specialize in treating sexually transmitted 
diseases (STD), and, in its clean needle program, passed out 
707,932 clean needles to drug users.  Even more impressive, 
drug users returned 635,000 needles last year (89 percent 
return rate), which signifies the program has a steady 
market of "repeat customers".  This latter program, now 
running smoothly, has had a somewhat checkered history, with 
the Public Security Bureau (PSB) having mixed views, torn 
between seeing addicts as criminals needing to be arrested 
and sent for rehabilitation through "cold turkey" or 
treating them as patients, as in this program. 
 
¶6. (U) Unfortunately, budgetary constraints are limiting the 
program opportunities already in place.  For example, 
support from the Clinton Foundation, which provides anti- 
retroviral (AVR) treatment for children under the age of 18 
months, cannot be properly be implemented.  Today the CDC 
has enough AVR medicine for over 700 children, but it lacks 
the necessary pediatric diagnostic machines and, as a 
result, can only support 200 children. 
 
AIDS Care China:  A Human Face to the Disease 
--------------------------------------------- 
¶7. (SBU) Besides the government perspective, Congenoffs also 
met with the NGO, AIDS Care China (ACC).  The Consulate had 
requested a meeting with Medecins San Frontieres (MSF), but 
MSF declined to meet (perhaps not wanting to raise their 
status with Chinese authorities) (see ref C on NGO 
registration).  The Consulate previously reported on ACC in 
2004 (ref F).  AIDS Care China deals with about 200 AIDS 
patients.  Although an unregistered NGO, ACC works very 
closely with the Guangxi CDC, and the two are housed in the 
same complex.  In general ACC enjoys a degree of freedom in 
its work.  Nevertheless, CDC officials insisted on 
participating during the meetings with ACC. 
 
¶8. (U) NGOs such as AIDS Care China are important because 
they fill a void the state-run medical system overlooks. 
Many Chinese still maintain biases and superstition 
regarding AIDS patients.  This partly stems from their 
educational system.  Chinese schools rarely teach sexual 
education, much less cover the topic of sexually transmitted 
diseases.  The medical system is relatively effective at 
diagnosing HIV-AIDS patients, but the social counseling and 
community network needed for individuals are missing. 
 
¶9. (U) AIDS Care China deals with the situation through two 
main efforts.  First, it can identify child patients who are 
then referred to the CDC's Clinton Foundation program. 
Second, once an individual is confirmed as an HIV/AIDS 
patient, ACC can provide them with counseling and social 
activities.  For those patients coming from the countryside, 
ACC has a dormitory where they stay while receiving 
treatment.  The social activities, although seemingly banal, 
can have a powerful effect.  ACC officials cited as an 
example one young man disowned by his family when they 
discovered he had contracted HIV.  However, after attending 
some ACC cultural events with other patients, the parents 
eventually learned to accept the fact that even with his 
disease, he is still their son. 
 
¶10. (U) The local CDC chooses to shelter ACC not only as a 
way to monitor the NGO, but also because of its own funding 
agenda.  AIDS Care China has traditionally worked with many 
international donors such as USAID and the United Nations. 
Since China's new NGO laws have made international aid to 
NGOs more difficult, the CDC benefits by offering its 
services to act as the middleman between many international 
donors and ACC.  While this creates added surveillance for 
 
GUANGZHOU 00013565  003 OF 003 
 
 
ACC, the situation is still better than in other NGO 
sectors.  For example, in the area of women's rights, the 
Chinese Women's Federation refuses to work with any other 
(see ref C). 
 
Challenges in Guangxi:  How to Ensure Equal Treatment? 
--------------------------------------------- --------- 
¶11. (U) Unfortunately a number of challenges remain in 
Guangxi, which undermine the HIV/AIDS effort.  Due to the 
long distance between major cities in Guangxi, ACC mainly 
focuses on patients in the Nanning area.  Many patients in 
rural areas cannot receive AVR treatment because the cost is 
too great or medical facilities do not carry the drugs.  The 
Central Government's policy of "sige mianfei" or the "four 
frees" includes access to free ARV medicine for those living 
in rural areas.  However, the system to track HIV/AIDS 
patients is limited and there are countless patients who may 
come to the provincial capital for treatment once or twice 
but cannot afford to come on a regular basis. 
 
¶12. (SBU) Finally, Guangxi's bureaucratic situation also 
creates unique problems for HIV/AIDS patients.  Many 
pregnant mothers with HIV-AIDS face potentially deadly 
bureaucratic headaches.  All HIV-AIDS patients are required 
to visit specific designated hospitals for treatment.  Due 
to the blood-intensive nature of birthing, many doctors 
recommend a cesarean section for pregnant HIV-positive 
mothers.  Unfortunately, most of the HIV-AIDS designated 
hospitals in Guangxi do not have the facilities or trained 
personnel to perform cesarean sections.  Thus the mothers 
are forced to birth their babies normally, greatly 
increasing the chance of infecting the baby.  As a CDC 
official pointed out, the practice of a normal hospital 
refusing treatment is illegal but local NGOs charge that the 
practice still exists. 
 
COMMENT:  Facing Facts and Making Compromises 
--------------------------------------------- 
¶13. (SBU) The openness of the CDC officials regarding 
HIV/AIDS in Guangxi was impressive.  The CDC officials 
clearly understood the extent of the HIV/AIDS problem and 
were open to accepting the fact that there are domestic 
factors in play instead of simply blaming their southern 
neighbor, Vietnam.  Although there is still the problem with 
the lack of sufficient funds, HIV/AIDS patient care in 
Guangxi's capital seems adequate. 
 
¶14. (SBU) Additionally, CDC's cooperation with AIDS Care 
China is respectable, especially in comparison with other 
NGO sectors in China.  While the CDC does not sponsor the 
NGO for registration, the CDC does share its patients with 
the NGO and provides office space for it.  This support is 
vital for NGO development and a networked society to combat 
HIV/AIDS.  The CDC itself also gains from the relationship, 
by using the NGO groups as vehicles to encourage more 
international aid.  In contrast, many government-led NGOs 
just take over the sector (for example the Women's 
Federation) and do not encourage genuine NGOs to grow (see 
refs A, B, and C).  Unfortunately, despite the efforts of 
the CDC and NGOs in Guangxi, the combination of a poor, 
rural medical infrastructure, limited NGO growth, and 
bureaucratic mismanagement means that too many HIV/AIDS 
patients are still slipping through the cracks. 
 
DONG