The first reported case of HIV in China was in Yunnan province in 1985 and had the highest rate of HIV infections in China from 1989-2004.[i] Yunnan province is in South West China and borders Myanmar, Laos, and Vietnam region known as the golden triangle for its drug production. It is estimated that 60-70 percent of drugs in China enter from this region.[ii]
Initially, the HIV cases were concentrated among intravenous drug users (IDU) near Ruili City, however over time HIV spread geographically and to the general population through sexual transmission.[iii] The picture below shows the spread of HIV in Yunnan from 1992-2004.[iv]
Through 2004, transmission through IDU was the primary source of the spread of HIV, with average prevalence of HIV among IDUs 21.2-27.8 percent. However, the rate of HIV transmission from sexual contact increased from 5.3 percent in 1996 to 11.8 percent in 2004.[v] In Yunnan province, drug use and risky sexual behavior were highly correlated during this time. A 2002 study found that in Yunnan 82 percent of drug users reported having sex with more than one partner, but only 18 percent in the rest of the population.[vi]
At first, the government response to the spread of HIV focused on strengthening laws on prostitution and illegal drug use, as well as allowing authorities to isolate HIV positive individuals. However, this approach was ineffective in stopping the spread of the disease. Attempts to contain HIV positive individuals, and punish high-risk behavior increased the incentive to conceal these behaviors, or the disease, from authorities.[vii]
After the failure of early attempts to contain HIV, officials in Yunnan turned to harm reduction and preventive policies to deal with the public health problem. Examples of these programs included needle exchange programs and promotion of condom use and health education for commercial sex workers.[viii] Another approach that Yunnan took to fight the spread of HIV was cooperation with NGOs. Because of the stigma of HIV, and the fear of punishment, NGOs can be more effective at reaching out to HIV positive individuals, or those engaged in high-risk activity. In 2014, the Yunnan provincial government allocated 1.5 million Yuan to NGOs to promote education and provide medical services to address HIV issues.[ix]
[i] Xiao, Yan, Sibylle Kristensen, Jiangping Sun, Lin Lu, and Sten H. Vermund. 2007. Expansion of HIV/AIDS in china: Lessons from yunnan province. Social science & medicine 64, (3): 665.
[ii] Xiaobo Su, “China’s Antidrug Policies in Southeast Asia’s Golden Triangle,” East-West Center, September 26, 2013, http://www.eastwestcenter.org/sites/default/files/private/apb234.pdf
[iii] Xiao, Yan, Sibylle Kristensen, Jiangping Sun, Lin Lu, and Sten H. Vermund. 2007. Expansion of HIV/AIDS in china: Lessons from yunnan province. Social science & medicine 64, (3): 665.
[vii] Wu, Zunyou, Sheena G. Sullivan, Yu Wang, Mary Jane Rotheram-Borus, and Roger Detels. 2007. Evolution of china’s response to HIV/AIDS. The Lancet 369, (9562): 679-690
[ix] Hu Yongqi and Guo Anfei in Kunming, “Yunnan takes action to stem spread of HIV/AIDS,” China Daily USA, February 22, 2014, http://usa.chinadaily.com.cn/epaper/2014-02/21/content_17297789.htm