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DE RUEHSH #0147/01 2130604
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FM AMCONSUL SHENYANG
TO RUEHC/SECSTATE WASHDC PRIORITY 8143
INFO RUEHOO/CHINA POSTS COLLECTIVE
RUEHBJ/AMEMBASSY BEIJING 7881
RUEHPH/CDC ATLANTA GA
RUEAIIA/CIA WASHDC 0048
RUEAUSA/DEPT OF HHS WASHDC

C O N F I D E N T I A L SECTION 01 OF 03 SHENYANG 000147 
 
SIPDIS 
 
SIPDIS 
 
DEPARTMENT FOR EAP/CM, EAP/EP, OES/STC, OES/IHA 
 
E.O. 12958: DECL: 08/01/2032 
TAGS: KFLU KHIV TBIO PGOV SOCI EAGR CH
SUBJECT: HIV/AIDS AND AVIAN FLU IN NORTHEAST CHINA: STATUS, 
 DEVELOPMENTS AND CONCERNS 
 
 
Classified By: CONSUL GENERAL STEPHEN B. WICKMAN. 
REASONS: 1.4(b)/(d). 
 
¶1. (C) SUMMARY: Health officials in Liaoning Province claim 
remarkably few official HIV/AIDS cases, though they 
acknowledge a nexus between the virus, the province's 
growing drug problem and its seedy sex industry. 
Liaoning's Center for Disease Control (CDC) is "not 
worried" about an imminent avian influenza outbreak, but it 
is also "not fully optimistic" either, and remains "on 
alert."  The CDC's budget--and Beijing's contribution to 
it--has grown on the heels of SARS and bird flu scares, and 
the center is now partnering with groups as unlikely as the 
local Catholic Church on HIV/AIDS work.  Officials seem to 
suggest that information-sharing across provincial lines in 
northeast China is still less than ideal.  END SUMMARY. 
 
¶2. (SBU) Poloff on July 11 discussed HIV/AIDS and avian 
influenza (AI) prevention/control efforts in Liaoning 
Province--northeast China's most populous--with Dr. GUO 
Junqiao, Deputy Director of the Liaoning Provincial Center 
for Disease Control; LU Chunming, chief of its HIV/AIDS 
Control section; and YAN Dawei, head of the Liaoning 
Provincial Health Bureau's Disease Control section. 
 
HIV/AIDS: THE DRUGS/PROSTITUTION NEXUS 
-------------------------------------- 
¶3. (SBU) Health officials claim the HIV/AIDS situation in 
Liaoning is "among the best" in China, even if official 
cases outnumber those in Jilin and Heilongjiang, northeast 
China's other two provinces.  Since 1991, Liaoning has 
officially registered over 600 cases, according to LU 
Chunming, who attributed two-thirds to sexual transmission 
and the remainder to intravenous drug use and other 
"unknown" vectors.  Particularly vulnerable populations in 
Liaoning, he said, include drug addicts and prostitutes. 
Lu claimed "few" infections among Liaoning's many migrant 
workers but noted all the same that his office continues to 
conduct special education programs for migrants at one of 
Shenyang's largest labor markets. 
 
¶5. (C) This astoundingly low number of infections is likely 
underreported in this province of over 42 million. 
Officials did, however, more frankly acknowledge that 
Liaoning's seedy sex industry and--perhaps more 
importantly--its growing problem with drugs have been 
particularly irksome on the HIV/AIDS front, and even more 
so than in other areas in China.  Lu claimed that although 
drug abuse in Liaoning is not as serious as it is in places 
like "Yunnan or Xinjiang"--where drugs are far cheaper than 
in Liaoning---Jilin and Heilongjiang have experienced fewer 
infections because of intravenous drug use.  Liaoning 
Public Security Bureau (PSB) estimates put the number of 
addicts in the province at 10,000, probably a conservative 
figure.  But Lu noted that the CDC does not presently offer 
any clean-needle programs because the number of addicts 
officially reported in any given area of Liaoning falls 
below the threshold--i.e., a minimum of 500 addicts in an 
administrative district--required by national regulations 
for such programs to be allowed. 
 
¶6. (C) Infection rates among sex workers are on the 
decline, Lu also reported, ascribing progress to 
educational efforts on prevention; growing condom use by 
prostitutes (over ninety percent, he claimed, also at the 
encouragement of the CDC); and new requirements that condom 
machines be installed for clients at hotels and 
"entertainment" outlets (i.e., the many karaoke parlors, 
bathhouses and similar venues that pepper the province's 
cities and host parts of the sex industry).  (NOTE: In our 
memory, Lu is the first local Chinese official Post has 
encountered to openly refer to sex workers as "prostitutes" 
during on official meeting in the presence of a superior; 
most officials are generally not keen to acknowledge their 
existence. END NOTE.) 
 
¶7. (U) Against this backdrop, the CDC's HIV/AIDS efforts 
are primarily focused on four areas: effective monitoring 
and reporting of infections by sub-offices throughout the 
province; a network of over 200 testing stations offering 
free, anonymous HIV tests to anyone interested; a growing 
educational outreach program targeting at-risk populations, 
as well as the general public; and, lastly, free medical 
treatment for those already infected.  Lu claimed the 
Liaoning CDC is currently providing medication--and 
quarterly check-ups--for over 80 HIV-positive patients. 
 
SHENYANG 00000147  002 OF 003 
 
 
 
AVIAN FLU: "NOT FULLY OPTIMISTIC," BUT ALSO "NOT WORRIED" 
--------------------------------------------- ------------ 
¶8. (C) The Liaoning CDC is "not fully optimistic," but also 
"not worried" about an imminent outbreak of avian 
influenza, according to Dr. GUO Junqiao, a frank, 
impressive young CDC official who recently spent several 
years in New York, where she earned her PhD.  The 
provincial CDC remains "on alert," she said, and continues 
to coordinate AI monitoring, reporting and control efforts 
at 15 hospitals in the province's 14 largest cities, which 
have been designated as special treatment centers for AI 
infections.  Guo maintained that sudden outbreaks of 
"unpredictable" infectious diseases like SARS and avian flu 
remain the CDC's most significant challenge (and worry). 
 
¶9. (U) Per national guidelines, the province elaborated and 
now maintains an Avian Influenza Emergency Reaction Plan, 
which it updated in 2005 and 2006.  In the event of a 
suspected outbreak, Guo explained, preliminary information 
is to be submitted to a nationwide reporting/monitoring 
network while an emergency reaction team is dispatched to 
the scene "within two hours."  Upon submission of the data, 
information on the incident would be available to the 
Ministry of Health and other provincial CDCs "within 
minutes," Guo claimed.  At the scene, the CDC's emergency 
reaction team would make an assessment and give further 
instructions, presumably in coordination with relevant 
provincial and/or national authorities. 
 
PARTNERSHIPS TRADITIONAL AND LESS SO 
------------------------------------ 
¶10. (SBU) The Liaoning CDC in recent years has not been 
acting in isolation, and at times has worked in tandem with 
somewhat surprising partners.  A more traditional partner 
has been the World Health Organization (WHO), with whom the 
CDC pairs in monitoring 11 different types of infectious 
diseases, Guo noted.  On the AI front, in 2005 both 
partners expanded to year-round surveillance their joint 
influenza monitoring program that had previously run only 
from March through September.  (The WHO does not fund the 
Liaoning CDC's AI programs.)  A somewhat less traditional 
(and "private") partner has been Liaoning's Catholic 
Church, with whom health authorities have quietly partnered 
on the HIV/AIDS front. 
 
¶11. (C) Reverend Joseph Zhang Kexiang and Sister Fabian Han 
Fengxia run the Liaoning Diocese's Catholic Social Service 
Center (CSSC), which was established in 2004 and runs a 
number of innovative HIV/AIDS initiatives blessed by the 
Liaoning CDC.  Examples of CSSC programs include awareness 
and prevention campaigns, both in urban and rural areas; 
educational workshops; financial support and counseling for 
families of HIV-positive patients; and home-care visits to 
infected patients.  Zhang and Han--both former students in 
the United States-- have been frank and open and in their 
conversations with Poloff over the past several months and 
have generally struck a positive note on the local health 
authorities' support of their HIV/AIDS-related work.  The 
Liaoning CDC itself, for instance, now refers patients to 
the CSSC for home-care, something which Guo and Lu 
acknowledged without hesitation.  Both the CSSC and the 
Liaoning CDC, moreover, have been quite visible in their 
HIV/AIDS educational efforts in Shenyang, particularly 
during occasions like International AIDS Day. 
 
FUNDING AND INFORMATION-SHARING: CAUSE FOR CONCERN? 
--------------------------------------------- ------ 
¶12. (C) Liaoning health officials consider their budgetary 
levels to be generally sufficient, noting the catalytic 
effect of SARS, which sparked multi-million renminbi (RMB) 
upgrades to the CDC, its budget and provincial health 
infrastructure more broadly.  The Liaoning CDC's budget is 
largely drawn from provincial funds, according to Guo and 
Liaoning Health Bureau official Yan Dawei.  But "twenty to 
thirty percent"--up from ten percent before SARS and AI 
scares hit in 2003 and 2005, respectively--now comes from 
Beijing.  Interestingly, Guo and Lu noted that funding for 
the province's HIV/AIDS work has not changed dramatically 
since Liaoning Party Secretary LI Keqiang officially took 
office in 2005. (NOTE: As a high-level official in charge 
of Henan Province during the tail end of its infamous 
blood-selling scandal several years ago, Li is perceived by 
some to have suffered some political fallout. END NOTE.) 
They did, however, note that Li had recently managed to 
secure an additional RMB 2 million (USD 263,000) in 
 
SHENYANG 00000147  003 OF 003 
 
 
"special funds" for HIV/AIDS control. 
 
¶13. (C) If Liaoning health officials were generally upbeat 
on budgetary issues, they seemed somewhat less so when 
asked about information-sharing with other provinces.  On 
the one hand, the Liaoning CDC now has over 130 constituent 
CDC offices at different levels throughout the province, 
according to the Liaoning Health Bureau's Yan Dawei; these, 
in turn, figure into a broader nationwide network for 
statistical reporting, monitoring and so on.  But when 
asked about the regularity and quality of the Liaoning 
CDC's communication and information-sharing with other 
parts of northeast China, Yan and Lu Chunming both conceded 
that the situation was less than ideal.  Both noted that 
their offices rarely communicate with, much less see, their 
counterparts in Jilin and Heilongjiang.  (Lu, for example, 
had trouble describing to Poloff the nature of the HIV/AIDS 
situation in the rest of northeast China.)  CDC Deputy 
Director Guo Junqiao pointed out a reality not dissimilar 
from that in other PRC government offices: that 
information-sharing is more typically conducted vertically 
(i.e., through functional networks, from the national level 
down, or vice versa), rather than horizontally (i.e., 
across provinces). 
WICKMAN