Guangxi Province has the third-highest number of HIV-infected people in China. In November 2000, it recorded 2038 HIV/AIDS cases, a 35% increase from the previous year. Two areas in the province, Pinxiang City and Yen Shan County face similar challenges from increasing HIV infection rates but have approached the problem in dramatically different ways. In Pinxiang, the annual increase of HIV prevalence has remained under 20% since 1997. Pinxiang, with a willingness to "wash its dirty linen in public," has become one of the few sites in China with active HIV prevention and control activities. In Yen Shan County, however, like most other places in China, AIDS is still a taboo subject. Journalists visited both places to determine the impact of the different approaches towards HIV/AIDS on awareness levels and HIV prevention.

Pinxiang, a city with one million inhabitants, is in the border area with Viet Nam – a centre for trade and drug trafficking in Southeast Asia and an entry point for the spread of HIV into the rest of China. In 1996, Guangxi Province's first AIDS case was identified in Pinxiang. In 1997, a local AIDS survey showed most medical personnel did not know HIV transmission routes. By the time of the 2000 survey, however, most lay people could list the three major routes of transmission.
At the entrance to the city, a prominent billboard in Chinese and Vietnamese says: "Those ignorant about AIDS are those most likely to catch AIDS." While the general population seems to have at least basic knowledge of HIV/AIDS, the impact of HIV education on vulnerable populations such as injecting drug users (IDUs) and sex workers is particularly interesting: "You must use a condom: if you have AIDS you can kill me," says the Vietnamese girl who works at the "flower street" (red-light district) beauty parlour at Jigua, a border town 20 kilometres south of Pinxiang. She has read the HIV prevention brochures and knows the message on the  billboard 100 metres from her street: "Condoms not only prevent pregnancy but also protect you from STIs and AIDS."

The Pinxiang drug rehabilitation centre treats about 100 drug users. Due to the multimedia dissemination of HIV education, drug users are knowledgeable about HIV/AIDS.

Denial is not the solution

"When the first case of AIDS was detected in Pinxiang, everybody got very nervous and did not know what to do," the Director of Pinxiang's Public Health Office says. "When the need for HIV prevention was first discussed, the Pinxiang city council was mainly concerned about the potential damage to Pinxiang's image and its booming border trade. We made repeated requests to the local authorities and told them that HIV prevention should not be influenced by personal opinions. We asked them: "Who would be willing to take the responsibility if HIV/AIDS became a major epidemic due to inaction." In Pinxiang today, HIV/AIDS is no longer a taboo topic.

Several factors led to successful HIV education among the general population and highly vulnerable groups such as drug users and sex workers. In 1997, Pinxiang produced a short video broadcast on prime time local TV for more than a month. People in Pinxiang suddenly became aware of the implications of  HIV/AIDS in their daily lives. In 1998, Pinxiang started full-scale HIV/AIDS education activities. Students, women, health professionals, drug users, entertainment facilities employees, long-distance truck and bus drivers, and even village elders participated in HIV education activities on special days.

In the past two years, the Health Education Unit conducted courses on AIDS, each attended by between 100 and 500 people. Because of the courses, people no longer use the misleading term "high-risk groups," because they realise everybody is vulnerable to HIV infection. HIV education has also led to a decrease in other sexually transmitted infections.
The director of the Public Health Office says the Pinxiang City Council and local government have consistently created a supportive environment for HIV prevention. According to Pinxiang's deputy mayor, many government officials from other districts laughed at them for "washing their dirty linen in public," when they started their large-scale HIV prevention campaign. Many other local leaders tried to cover up the actual AIDS cases in their communities for fear of damaging their image and scare away investors. These attitudes have caused an unnecessarily slow response in other districts.

Yen Shan: a more typical response

Nearby Yen Shan, a large county in Guangxi with more than 12 million people, has seen a sharp increase in HIV infections. While billboards warn that "preserving life, keep away from drugs," not one warns about AIDS.

The number of drug users in Yen Shan County is growing rapidly. At present, some 300 patients are undergoing mandatory detoxification at the local centre, with the youngest client being under 12 years of age. According to the director, there are at least ten drug users outside the centre for every person undergoing detoxification. More than 80% of the patients coming to the centre are injecting drug users (IDUs), many of them (former) rural farmers. Although some of the IDUs are HIV-positive, they are not informed of their status and are sent home after completing detoxification.
The towns of Yen Shan County also have many female sex workers, some of whom start selling sex at the age of 15. In the many video arcades surrounding local hotels, clients can "touch" the service girls. These service girls do not mind taking clients to a hotel room. Attitudes towards safer sex are quite careless: "AIDS? I seldom do sex work, so it won't be a problem. In Yen Shan, we are not afraid: most of our clients do not want to use condoms and neither do we", one sex worker said.

When asking people on the streets of Yen Shan about AIDS, most people just stare at you. Compared to Pinxiang, AIDS awareness and knowledge in Yen Shan are limited.
Yen Shan is one of the surveillance sites for HIV/AIDS. Every year, 50-100 HIV tests are performed. In the last three years, at least 45 positive cases were found. The county government is concerned about AIDS, but there is not enough education material." Yen Chan's deputy director of public health admits that HIV prevention and control is still a "headache": "At present, Yen Shan cannot do what Pinxiang is doing: the public would consider condom promotion through prime time TV advertising as promoting promiscuity in the society."

According to a public health official, the HIV prevalence rate among IDUs in Yen Shan has increased exponentially from 0.7% in 1997 to 50% in 2000. "Of course we know the situation is critical. We hope to collaborate with other government sectors to do surveillance among IDUs and sex workers," he said. "However, without funding and without the green light from the leadership, the plan will remain on paper."

It is time successful local approaches to HIV/AIDS, such as in Pinxiang, are taken seriously by other areas in China: this is the only way to halt the further spread of the disease.