- Wang Yanguang

Graduate School of Chinese Academy of Social Sciences, Chinese Academy of Social Sciences, 80 Xinkai Lu, Dongdan, Beijing, CHINA 100005

The pattern of infection in China is that the primary population group affected are intravenous drug users located in the Yun Nan province (about 80%). The population groups affected are foreigners and people who came back from foreign countries. Sexual transmission is responsible for only a small percentage of cases, but is increasing rapidly.

China has a very large population, about 1200 million. The proportion of HIV positive persons is very small. So some Chinese officers have said that there are not dangers of an AIDS epidemic in China, so we need not do things to control the AIDS epidemic.

In our opinion, dangers of an AIDS epidemic exist in China, because the infected numbers have grown so rapidly now in the whole world and Asia, especially in our neighbouring countries such as Thailand (5). Through intravenous drug use and unprotected intercourse, Chinese people who are living in the bounds of China have been infected. Another important reason is that following the economic expansion and open door policy there is a great change of sex behaviour in China and there are some increasing population groups with unsafe behaviour. These reasons make us think that there is a potential threat of a AIDS epidemic to the future of the nation as well as to the nation's health. We must do something for controlling this epidemic.

What things should we do?

Now medical science still cannot control the AIDS epidemic, the primary way of controlling the AIDS epidemic might be asking somebody to change unsafe activity without discriminating against them and help HIV positive persons and AIDS patients without discriminating against them. This is a very difficult task in the face of Chinese government and our bioethical workers.

There are many ethical issues to be resolved. For example, the education about the knowledge of AIDS is not popular in China. Most people do not understand thoroughly about AIDS. Suffering AIDS has been called God's punishment for the patient's misbehaviour, some discrimination has occured.

Someone reported a case in 1993. In one Chinese city, a physician was ill and was found HIV positive after he came back from working for the government in Africa. This was disclosed by someone and the whole city fell into panic. The patients who had been living in the same hospital with the physician asked him to leave this hospital, the furniture used by the physician's wife in her workplace was thrown away, some workers of this city even demanded the city officer to expel the physician from this city. Later the physician had to go to another city hospital and died there. We also have heard of some AIDS patients losing their work and school (6).

From the cases like above we know that apart from the ethical issue of discrimination, another ethical issue is confidentiality. There is a dilemma about confidentiality, when reporting the case with the patient's name, this may cause discrimination and violate the interests of patient and make them afraid of going to hospital to get good treatment and education. But reporting the case without the person's name, it is not easy to trace them for their health and public health. Then, we think reporting without name and using code may be a better way.

A difficult ethical issue is about the laws of prohibiting prostitution and drug use in China. These laws made many prostitutes and intravenous drug users go underground and had no chance to accept education for changing the unsafe activity. But these laws might not be abolished in China at the present. For controlling AIDS epidemic we have to submit some recommendations to the government such as to support non-Governmental Organisations to work for these population groups in order to change their unsafe activity.

In a word, our view about solving these ethical issues is that for the aim of controlling the AIDS epidemic we have to tolerate some unsafe activity population groups and to help these HIV positive individuals and the patients with AIDS. To do like this, we hope we can achieve a solidarity among the public, the HIV/AIDS individuals and some groups with unsafe activity.

Now, the government of China has made some policies according to our recommendations. There are some recommendations. For example: to drug users, apart from obeying laws, if someone does not change their behaviour or becomes addicted to a drug, the public officials and health professionals ought to be educated to help them give up this risky practice and give them treatment.

Prostitutes will never disappear by legal prohibition, therefore whenever prostitutes are found, they have to accept the compulsory testing for HIV and STD and the government ought to treat the disease and tell them to use condom for safe sex.

For homosexuals and bisexuals, because many people think homosexuals and bisexuals are immoral according to the different ways of sex in China, the government ought to educate the public that alternative modes of sex should be allowed as well as such mode or action is non-maleficence to others and beneficence of themselves. In other aspects, the government ought to educate them to change the unsafe activity and to do self-regulation and to use condom.

Whether these can work to control the AIDS epidemic or not, we will have to wait and see.

References

1.The Program Group of the State Council of P.R.China, The situation of HIV/AIDS epidemic and the trend of development, Beware of AIDS: For the survival of the Chinese Nation, Xin hua Publishing House, 1993. 12: 20.

2. The Department of Disease Control of Ministry of Health. P. R. China, The Numbers of HIV/AIDS Screening form 1985 to 1994.12, Bulletin of AIDS, The Department of Disease Control of the Ministry of Health, P.R.China and the Academy of Preventive Medical Sciences of China, 1995.3 (1): 24.

3. Sun Xinhua, Dr. Merson Investing in Beijing, Bulletin of AIDS, The Department of Disease Control of the Ministry of Health, P.R.China and the Academy of Preventive Medical Sciences of China, 1994 (1): 1.

4. The Department of Disease Control of Ministry of Health. P. R. China, The Numbers of HIV/AIDS Screening form 1985 to 1994.12, Bulletin of AIDS, The Department of Disease Control of the Ministry of Health, P.R.China and the Academy of Preventive Medical Sciences of China, 1995.3 (1): 24.

5. Bloom, Lyons, "Economic Implications of AIDS in Asia", UNDP, 1993: 7-34.

6. Zhang Zu, Physician infected by HIV, (Programme, Abstracts sand List of Participants) Expert Workshop on Epidemics of STD and its Counter-measures: Social, Ethical and Legal Issues, 1993 3: 35.