Assessing HIV/AIDS Initiatives in China - Center for Strategic and ...

Bates Gill 11
strained, reducing long-term chances for success. Additionally, many smaller projects are
unable to effectively address the broader challenges that are faced by the populations they
serve.
A newer concept in the fight against HIV/AIDS in China is the introduction of publicprivate
partnerships. These efforts seek to join the talents and resources of private
entities, such as a business, with the central and local government authorities. Groups
such as the Global Business Coalition on HIV/AIDS have been active in promoting such
initiatives. The concept, which is somewhat contrary to Chinese development aid
practices in the past, is slowly catching on but will take time to be fully understood and
leveraged as Chinese government and private-sector actors work out their respective roles
and responsibilities within such a framework.
Drug Resistance
As of June 2005, the head of the national HIV-treatment program claimed that some
20,453 HIV-positive persons were enrolled in the national drug treatment program known
as China CARES. A number of difficulties attend this program, however. The China
CARES program initially introduced a first-line drug therapy that is poorly tolerated by
patients, is difficult to adhere to, induces serious toxic side effects, and in the end is not
as effective against the virus as other first-line therapies used elsewhere in the world. The
principal reason China CARES chose this particular regimen—either AZT + ddI +
neverapine or AZT + d4T + neverapine—is because these drugs are produced as generics
in China. Beginning in early 2005, China CARES introduced more effective anti-HIV
compounds purchased from abroad into the first-line therapy: 3TC and efavirenz.
According to the head of the China CARES program in mid-2005, about 20 percent of
enrollees received the more effective therapy, and he expects to increase the use of 3TC
and efavirenz in the future.
Data presented in late August 2005 in Beijing by Chinese HIV doctors show that on
average, between 45 and 80 percent of patients treated begin to harbor a resistant virus
and start to fail. In other settings, and especially in the West, when a patient begins to
fail, the treatment is adjusted to a second-line therapy against which the virus is not
resistant, in order to drive the viral load back down again. As of early 2006, China did not
have a second-line therapy under the China CARES program. Once a China CARES
patient has a resistant virus, there are no treatment alternatives within its national
treatment program.
Chinese officials and medical experts have not seriously studied the social or political
ramifications of widespread drug resistance and treatment failure under the China
CARES program. It is important to note, however, that with just over 3 percent of
suspected HIV-positive persons enrolled in the program, antiretroviral drugs are not
available to the majority of those who may need them.
Addressing the Needs of Marginalized Groups
Much of China’s HIV/AIDS challenge will arise from within hard-to-access, at-risk
groups that are socially and economically marginalized. There is a great need to
reorganize the national response in a way that more effectively addresses the needs of