In November 2009, a joint assessment conducted by the Ministry of Health (MoH), UNAIDS and WHO showed that the development of the HIV/AIDS epidemic had lowered its speed in China and the number of new infections decreased, but the situations were still arduous, especially in some populations and areas. Deputy Director Hao Yang with the Disease Control Bureau of the MoH warned that the pattern of HIV infection in China is the same as in Africa, Europe and the United States, so that prevention and control would be much more difficult.

    74.7% of new infections due to sexual transmission in 2009
    The latest assessment report shows that there were 740,000 people living with HIV/AIDS (PLWHA) in China by the end of 2009, of which 44.3% were infected through heterosexual transmission, 14.7% through male-to-male sexual transmission, 32.2% through injecting drug use, 7.8% through paid blood collection and donation, transfusion or use of blood products and 1.0% through mother-to-child transmission. Among the newly infected 48,000 persons in 2009, 42.2% of them were infected through heterosexual transmission and 32.5% through male-to-male sexual transmission.
    Hao Yang analyzed that compared to previous years, the number of PLWHA in 2007 was estimated larger than 2005 by 50,000 and the number in 2009 larger than 2007 by 40,000, which means the epidemic has lowered its speed; and the number of new infections in 2007 was smaller than 2005 by 20,000 and the number in 2009 smaller than 2007 by 2,000. However, we must be highly aware that sexual contact is still the most common route of HIV transmission in the country. Among all PLWHA, nearly 60% are infected due to sexual contact. Particularly, male-to-male sexual transmission is in an increase. The proportion of new infections through male-to-male sexual transmission increased from 12.2% in 2007 to 32.5%, which became a major transmission route in 2009.

    More people affected and epidemic patterns diversified
    According to WHO's scale of HIV/AIDS epidemic, a high-prevalence area means that the HIV infection rate reaches 1% in the general population. Thus China is in a low-prevalence situation as a whole, but some regions are in a high-prevalence situation and several counties have reported a HIV infection rate of over 1%.
    Hao Yang said in recent years, cases reported by Yunnan, Sichuan, Guangxi, Xinjiang, Guangdong and Henan account for around 80% of the total. Some prefectures and cities report much more cases and the number of cases in some counties and districts grow faster. Meanwhile, epidemic patterns have become diversified and more people are affected.
    Epidemic reports show that during 2005-2008, the number and proportion of cases among children under 15 years increased year by year. These cases were usually caused through MTCT or blood transfusion/use of blood products. During 2000-2009, the number of cases among adults above 50 years increased significantly and the proportion of reported cases among adults above 65 years increased from 0.34% to 3.4%, affecting more males than females.
    In the past three years, more students are living with HIV/AIDS. Among these cases, the proportion of students aged 20-24 years increased from 20.3% to 39.8%; the proportion of homosexual transmission increased from 8% to 36.9%, ranking the first among all transmission routes; and the proportion of heterosexual transmission increased from 4% to 10.9%.

    Epidemic factors still exist widely
    The national comprehensive HIV surveillance shows that risk factors still widely exist. 25% of IDUs share syringes; 41% of FSWs fail to use condoms each time; and 68% of MSM have sex with several males in the past six months, with a condom use rate of 42%.
    Hao Yang pointed out that if an intervention cannot cover 60% of a high-risk population, the epidemic situation of the population would be hard to improve. Currently we urgently need to further expand intervention coverage to high-risk populations. Besides, registered PLWHA only account for a small share, and most infected persons have not been identified, of which many people do not know their HIV status and pose a risk of transmitting the virus to others.

    Many challenges in epidemic control in the next step
    During an interview, Director Wu Zunyou with the National Center for AIDS/STD Control and Prevention, China CDC said that in 2008 and 2009, approximately 40% of new infections were diagnosed by medical institutions. One reason is that most patients did not think that they were among high risk populations and had the chance to get HIV infection. As HIV is spreading widely, HIV infection among family members and through accidental extramarital sex has become more common. It is a challenge in future epidemic control that high-risk populations have no awareness of VCT.
    Wu said that many farmers became infected with HIV due to paid blood donation in the 1990s. In 2004 and 2005, the government specially organized large-scale screening for former blood donators and included all HIV-positive persons into the national policy of "Four Frees and One Care". However, some people still tried to avoid testing. During 2006-2009, nearly 3,000 advanced stage patients were found from former blood donators each year. In the future, the proportion of HIV infections through sexual transmission would increase and infected persons would be more unwilling to be counseled and tested for HIV. That is another challenge in future epidemic control.
    The third challenge is that it is more difficult to intervene with MSM. They know much about HIV/AIDS, but they use condoms very little. Besides, they are afraid to be exposed and unwilling to do counseling and testing or seeing a doctor as people discriminate against both HIV/AIDS and their sexual orientation. (Source: Health News)