China fight­ing out HIV/AIDS

BioSpectrum (Asia) - - FRONT PAGE - Narayan Kulka­rni narayan.kulka­[email protected]­

China is playing a great role in fight­ing AIDS. In­ter­na­tional pub­lic health ex­perts are prais­ing China for a new open­ness that will be key to ef­fec­tive con­trol of HIV/AIDS. De­spite a re­cent down­ward re­vi­sion of its HIV/AIDS es­ti­mates, China faces a grow­ing epi­demic. Its ambitious pub­lic health plans in­clude free HIV test­ing and AIDS treat­ment and a na­tion­wide roll­out of methadone ther­apy to help drug users lower their risk of con­tract­ing HIV.

China has pre­vented the spread of HIV through blood trans­fu­sions, with nearly zero cases of in­fec­tion recorded through this chan­nel and through using other blood prod­ucts. How­ever, sex­ual in­ter­course is the main chan­nel for con­tract­ing HIV in China. Around ev­ery nine in 10,000 peo­ple are liv­ing with HIV/AIDS in China, a low rate com­pared to other coun­tries, ac­cord­ing to the Na­tional Health Com­mis­sion (NHC).

The HIV trans­mis­sion through in­jec­tive drug use has also come un­der con­trol, with re­ported cases of HIV con­trac­tion via drug in­jec­tion in 2017 see­ing a 44.5 per cent de­crease com­pared to 2012. Mean­while, the rate of mother-to-child trans­mis­sion also de­clined from 7.1 per cent in 2012 to 4.9 per cent in 2017.

Ac­cord­ing to a joint eval­u­a­tion by the Chi­nese Cen­ter for Dis­ease Con­trol and Preven­tion, UNAIDS and the World Health Or­ga­ni­za­tion, there are around 1.25 mil­lion peo­ple liv­ing with HIV/AIDS in China by the end of 2018, and 80,000 newly-in­fected peo­ple ev­ery year.

Some 80.4 per cent of peo­ple liv­ing with HIV/ AIDS in China re­ceived anti-virus treat­ment in 2017, with the treat­ment suc­cess rate stand­ing at more than 90 per cent. A to­tal of 200 mil­lion peo­ple in China had HIV tests last year, dou­ble that in 2012.

Fig­ures from NHC showed that by the end of

June, a to­tal of 253,031 peo­ple in China had died of the virus ever since it was first dis­cov­ered, but the num­ber of HIV in­fec­tions caused by blood trans­fu­sions had es­sen­tially been re­duced to zero. In the sec­ond quar­ter of 2018 alone, 40,104 cases of peo­ple liv­ing with HIV/AIDS were newly re­ported, with about 93.1 per cent hav­ing con­tracted the virus through sex.

China has es­tab­lished an ini­tial net­work for HIV/AIDS preven­tion and test­ing, cov­er­ing both urban and ru­ral ar­eas. The NHC has been step­ping up ef­forts in HIV test­ing and dis­cov­er­ing HIVin­fected peo­ple. As HIV/AIDS preven­tion and treat­ment is still ar­du­ous, the NHC will strengthen ef­forts in warn­ing and ed­u­cat­ing peo­ple at risk of con­tract­ing HIV, pro­mot­ing one-stop ser­vices for test­ing, con­sul­ta­tion, di­ag­no­sis and treat­ment, and mo­bi­liz­ing so­cial forces, in­clud­ing en­ter­prises, fund­ing bod­ies, health or­ga­ni­za­tions and vol­un­teers, to par­tic­i­pate in the fight against the dis­ease.

Ac­cord­ing to the China AIDS Fund for Non­Govern­men­tal Or­ga­ni­za­tions (CAFNGO), about

157 mil­lion yuan ($22.6 mil­lion) has been al­lo­cated to AIDS con­trol projects by non­govern­men­tal or­ga­ni­za­tions (NGOs) in the past three years.

The money has gone to more than 1,700 projects op­er­ated by nearly 1,000 NGOs across China. From 2016 to June 2018, about 820,000 peo­ple were per­suaded by the NGO projects to take HIV tests, which led to the iden­ti­fi­ca­tion of about 23,000 new car­ri­ers. The CAFNGO, ini­ti­ated by the gov­ern­ment in July 2015, re­ceives 50 mil­lion yuan from the cen­tral bud­get an­nu­ally and also takes in pri­vate dona­tions.

China also has made break­throughs in key tech­nol­ogy re­lated to AIDS in the past decade, sig­nif­i­cantly re­duc­ing their spread and low­er­ing their mor­tal­ity rate to the level in de­vel­oped coun­tries. China was able to pro­duce its own po­tent HIV screen­ing agent, re­duc­ing the wait­ing time for re­sults from 28 days to seven. New do­mes­tic drugs and preven­tion meth­ods have cut the cost of AIDS treat­ment by 79 per cent, and re­duced the spread of HIV be­tween spouses by 62 per cent.

In ad­di­tion to tak­ing pre­ven­tive mea­sures, China Food and Drug Ad­min­is­tra­tion (FDA) has ap­proved the sale of a new drug for the treat­ment of HIV-1 in­fec­tion. Aiken­ing, or al­bu­vir­tide for in­jec­tion (ABT), can be used with other an­tiretro­vi­ral drugs to treat in­fected pa­tients who have been treated with an­tivi­ral drugs but still suf­fer from viral repli­ca­tion, ac­cord­ing to Fron­tier Biotech, a phar­ma­ceu­ti­cal com­pany based in the east Chi­nese city of Nan­jing.

Ac­cord­ing to Fron­tier Biotech,The com­pany said “Data from clin­i­cal tri­als showed that Aiken­ing was ef­fec­tive against ma­jor strains of HIV, in­clud­ing re­sis­tant viruses, and the ef­fi­cacy was long-act­ing. Pa­tients who used Aiken­ing didn’t show se­vere symp­toms of side-ef­fects, and they only have to take one in­jec­tion ev­ery week. As a long-act­ing in­jectable drug with a new mech­a­nism of ac­tion,

ABT has the po­ten­tial to be a sig­nif­i­cant ad­di­tion and im­prove­ment to the cur­rently all oral drug reg­i­men.”

“China is playing a great role in fight­ing AIDS,” said Michel Sidibe, Ex­ec­u­tive Di­rec­tor, UNAIDS on June 12 at the United Na­tions head­quar­ters af­ter his re­port on the lat­est progress of the agency’s strug­gle against AIDS. UNAIDS signed an MoU with Xin­hua News Agency, one of the lead­ing me­dia groups in the world, in 2010 and un­rolled joint me­dia cam­paigns on fight­ing AIDS ever since. The UN agency has also strength­ened ties with the Chi­nese gov­ern­ment in com­bat­ing the epi­demic in China and be­yond.

Ac­cord­ing to AVERT, a UK-based or­gan­i­sa­tion that has been work­ing at the fore­front of HIV ed­u­ca­tion for the past 30 years, China has made sub­stan­tial progress in tack­ling its HIV epi­demic. China’s HIV his­tory has been any­thing but steady, with na­tional neg­li­gence a crit­i­cal fac­tor in the spread of HIV in the early 1990s. How­ever, sig­nif­i­cant progress in the last decade and in­creased na­tional re­sponse have stemmed the epi­demic across the coun­try as well as in­creas­ing the qual­ity of life for peo­ple liv­ing with HIV.

The HIV epi­demic in China is largely char­ac­terised by low na­tional preva­lence at 0.037 per cent, with cer­tain re­gions hav­ing higher and more se­vere HIV preva­lence rates. China is also faced with

the in­creas­ing chal­lenge of pro­vid­ing more tar­geted preven­tion pro­grammes to key af­fected pop­u­la­tions such as men who have sex with men, peo­ple who in­ject drugs and young peo­ple. Greater ef­fort will be re­quired for pro­vid­ing more tar­geted in­ter­ven­tions that ad­e­quately and ef­fec­tively support these groups. Greater co­or­di­na­tion be­tween com­mu­nity level HIV or­gan­i­sa­tions and na­tional level ser­vices will also be cru­cial for curb­ing the HIV epi­demic in China in the fu­ture.

Treat­ment, care and support chal­lenges pre­vail in China. How­ever, progress in re­duc­ing moth­erto-child trans­mis­sion rates is still re­garded as slow. Progress has also been slow in ad­dress­ing the high lev­els of stigma and dis­crim­i­na­tion peo­ple liv­ing with HIV ex­pe­ri­ence across the coun­try.

China has a rel­a­tively low na­tional HIV preva­lence rate. How­ever, the HIV epi­demic is still a ma­jor con­cern for some of the key af­fected pop­u­la­tions within the coun­try. Tar­geted preven­tion strate­gies are crit­i­cal to curb the epi­demic amongst these vul­ner­a­ble groups as well as ad­dress­ing the stigma and dis­crim­i­na­tion many peo­ple from key pop­u­la­tions face on a daily ba­sis, pre­vent­ing them from ac­cess­ing vi­tal HIV ser­vices.

The Chi­nese gov­ern­ment has made a se­ri­ous com­mit­ment to the HIV epi­demic across the coun­try by fund­ing 99 per cent of its re­sponse from do­mes­tic sources. How­ever, in­creased fi­nanc­ing will be needed as HIV test­ing and treat­ment con­tin­ues to be scaledup. With­out this, drug and re­source short­ages may oc­cur, pre­vent­ing those most in need of treat­ment to ac­cess it.

China’s multi-sec­toral ap­proach to HIV, which en­gages the gov­ern­ment, civil so­ci­ety and the pri­vate sec­tor and draws on com­pre­hen­sive na­tional data, can pro­vide im­por­tant lessons for many coun­tries in Asia and the Pa­cific and be­yond.

Na­tional Cen­ter for AIDS STD Con­trol and Preven­tion (NCAIDS)

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