Chongqing students call on the public to treat those living with HIV/AIDS as normal people

Cai Ling, 41, can now speak openly about her life. But a decade ago, the woman with HIV was always guarded and kept her status firmly under wraps.

"I can sense a gradual change in how people look at me and my son," said the Beijing shopping mall cleaner. "But 10 years ago, or even five, I would rather have died than let people around me know I was HIV positive."

Cai migrated from a small town in central China's Henan Province to Beijing two years ago with her son, who is now 15.

In 2000, her husband had an operation and was given HIV-contaminated blood during transfusions. He infected his wife before he died in 2002.

Living in a small village with a population of no more than 500 people, Cai was shunned by others, not even allowed to fetch water from the public well.

Three years later, when she enrolled her son in the village primary school, the principal sent him back home. She was told that other parents would withdraw their children from school if her son was allowed to attend.

"I was so helpless and desperate at that time," she said. "I saw [then Chinese Premier] Wen Jiabao shaking hands with people with HIV/AIDS several times on TV. He even made dumplings and had dinner with them. It meant it's fine to associate with people living with HIV/AIDS. Then why can't we have a normal life?"

Why, indeed! 

Ups and downs

In 2006, Cai met a woman from Love Family, a social organization founded by people with HIV/AIDS to assist one another. She and her son were helped to move to a nearby county a year later, where she got a job in a factory making paper boxes and her life began to turn around. More importantly, her son could attend the nearby primary school.

"We stayed in the county for three years. That was the best period in my life since I discovered I was HIV positive because we could have a quiet life," she said.

In 2006, China institutionalized the policy of exempting people with HIV/AIDS from paying for regular examinations, medicines and treatment. Orphans whose parents had died of AIDS were exempted from paying school expenses. This policy has transformed the lives of tens of thousands of people with HIV/AIDS, including Cai's.

She can now have regular examinations and treatment despite her low income - a salary of 1,500 yuan ($244) a month. In addition, Cai was surprised to find that she is also eligible to receive a yearly subsidy of 6,000 yuan ($977) from the government for living expenses. This is another policy to help impoverished families living with HIV/AIDS.

Yet things were set to change further for Cai. She met a co-worker from her village who let out her HIV status, forcing her to quit her job at the factory.

According to Cai, people's attitudes to those living with HIV/AIDS have been undergoing a gradual positive change since 2006, "maybe because they know more about the disease, but I decided to move again because I could not stand people watching us," she said. "People with HIV/AIDS also need to live in dignity."

Cai turned to the China Red Ribbon Foundation, another organization assisting those with HIV/AIDS. Helped by the foundation, she moved to Beijing with her son. She found work as a cleaner in a shopping mall and her son enrolled in a nearby middle school for migrant workers' children.

"Now more and more people are growing tolerant toward us," she said. Though some still "act nervous," Cai said she understands their mindsets. 

Changing mindsets

"Prejudice and discrimination against people living with HIV/AIDS poses the biggest barrier in preventing the spread of HIV," said Li Xiaoliang, a professor at Kunming Medical University, Yunnan Province. According to him, China has made great progress in preventing discrimination against people living with HIV/AIDS by educating the public. It has been widely disseminated that HIV can be transmitted only by unprotected sex and contaminated blood transfusions, and from mother to child during pregnancy or breastfeeding. People cannot be infected simply by living or associating with people with HIV/AIDS.

"Thanks to the widespread scientific information, most people in urban areas know the facts. But in rural areas, especially in remote ones, people with HIV/AIDS are still like monsters in the eyes of others," said Li.

The Chinese Government has taken a lot of measures to eliminate such prejudice and discrimination, trying to create a sound social environment for those who are infected. On World AIDS Day - December 1 - numerous activities will be held to urge people to treat those living with HIV/AIDS as fellow human beings. China's top leaders would also visit the latter. 

Goodwill ambassador

"More attention should be given to under-developed regions as well as the infected people there to make sure patients get social justice and the right to medical care," said Peng Liyuan, wife of Chinese President Xi Jinping, at the 2014 National Conference on HIV/AIDS on October 20.

Peng was appointed the World Health Organization (WHO) goodwill ambassador for tuberculosis and HIV/AIDS in June 2011, the first envoy of this kind since the People's Republic of China was founded in 1949. She frequently visits people living with HIV/AIDS and features in public welfare advertisements, calling on people to abandon their prejudice against those living with HIV/AIDS.

While visiting the Republic of the Congo in March 2013 with Xi, Peng visited a center for abandoned children, where she met youngsters with HIV/AIDS.

"I will continue to shoulder the obligations of my WHO role as a national HIV/AIDS prevention advocate and promote cooperation between China and other countries on HIV/AIDS prevention and control to contribute to the global fight against the virus," she said. 

Official response

Observers note that in the 12th Five-Year Plan (2011-15) period, China's AIDS prevention work mainly focuses on tracking the people affected by HIV/AIDS through measures such as strengthening education and examinations and intensifying behavioral intervention in high-risk groups.

Statistics from the National Center for AIDS/STD Control and Prevention under the Chinese Center for Disease Control and Prevention show that China had 490,000 registered HIV positive and AIDS patients by the end of August 2014. But experts say a large number still remains undiscovered, taking the total to about 780,000.

The exemption policy means 87 percent of those with HIV/AIDS had free anti-retroviral treatment last year, up from 25 percent in 2005. The death rate from AIDS dropped from 17.9 percent to 6.6 percent in this period.

"I think the policy of exempting people with HIV/AIDS from treatment and examination costs and the great efforts made by the Chinese Government in publicizing information about the disease played an important role in the progress," said Zhao Hongxin, a doctor at Beijing Ditan Hospital who has been working on HIV/AIDS treatment and prevention for more than 20 years. On October 22, Zhao received the Barry & Martin's Prize instituted by the English-registered charity Barry and Martin's Trust to honor people and institutions in China with outstanding contribution to AIDS prevention, treatment and care.

In 2003, China established 13 training centers nationwide, including one in Zhao's hospital, to improve its AIDS prevention system. Experts nationwide can train in these centers and set up training stations when they go back home to teach community-level medical staff.

"China's AIDS prevention and control system is quite good," said Zhao. "Experts can focus on developing technologies and the advanced technologies can be handed down to the community level quickly." 

Continuing challenges

According to Wu Zunyou, Director of National Center for AIDS/STD Control and Prevention, there are several challenges facing China's battle against HIV/AIDS.

With an increasing number of people migrating from rural to urban areas in recent years, preventing the spread of HIV is becoming a complicated problem.

"The most important one is how to eradicate public discrimination against people living with HIV/AIDS," said Wu. "Because of the discrimination, many people are reluctant to have examinations and treatment, which poses a great challenge to HIV/AIDS control and prevention."

In addition to that, people with HIV/AIDS also have problems in finding jobs.

On October 8, Chen Xin, an HIV carrier, finally received an apology and 40,000 yuan ($6,515) as compensation from a local government department in Zhenjiang, east China's Jiangsu Province. Chen had applied for a job in the department a year ago but was rejected after a blood test showed he was HIV positive.

Chen decided to sue. After court intervention, the department agreed to pay the compensation. However, it still refused to hire him.

Li Cheng from Guizhou Province did not even receive compensation. The primary school teacher in Liping County was fired after he was found to be HIV positive. He filed a lawsuit against his school on October 26 but six days later, the court dismissed his claim.

The blood tests are necessary as per the General Standards for Physical Examination for Recruiting Civil Servants issued by then Ministry of Personnel and Ministry of Health in 2005. According to the standards, AIDS patients cannot be employed as civil servants.

"This has become a [massive hurdle] in the way of eradicating discrimination against people with HIV/AIDS and should be modified," said Jiang Yaping, head of a legal aid center in Nanjing.

However, things are improving. In September 2013, Guangdong Province in south China modified its physical examination standards for school teachers, removing the clause related to HIV/AIDS.

According to Wu, China is making progress. "Our long-term goal is getting to zero [no new HIV infections], which is also the theme of this year's World AIDS Day," Wu said.