China's Secret Plague

JOHN STANMEYER/VII FOR TIME
RUILI'S RED-LIGHT DISTRICT: At the brothels that line this border town, 63% of sex workers say they don't regularly use condoms, a lapse that helps spread the disease

They line the dusty roads outside the tiny villages of China's Henan province, several hours' drive from Beijing mounds of dirt funneled into crudely shaped cones, like a phalanx of earthen bamboo hats. To the uninitiated, they look like a clever new way of turning over fields an agricultural innovation, perhaps, meant to increase crop yields. But the locals know the truth. Buried under the pyramids, which now number in the thousands, are their mothers and fathers, brothers, sisters and cousins, all victims of AIDS. Like silent sentries, the dirt graves are a testament to China's worst-kept secret.

They are the reason Dr. David Ho has come to China. The New York City based virologist was named TIME's 1996 Person of the Year for his pioneering work on the drug therapies that have largely quelled the AIDS epidemic in the U.S. and Europe. Now Ho is confronting the AIDS virus in its most populous stronghold. Up to 1 million Chinese are HIV positive, and that number could easily grow to 10 million by 2010, according to the Joint U.N. Program on AIDS. If current trends continue for another decade or so, China could overtake Africa, where 29 million people have been infected with the virus.

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It's to head off that scenario that Ho has traveled more than a dozen times to China over the past three years, setting up labs, visiting clinics, gathering blood samples, educating health workers and negotiating the intricately layered bureaucracy of the Chinese health establishment. Ho's efforts and those of other AIDS activists finally paid off last week when, on World AIDS Day, the Chinese government took a lesson from its sluggish response to the severe acute respiratory syndrome (SARS) epidemic and launched its first big AIDS public-awareness campaign, complete with posters, TV spots and an unprecedented visit by Premier Wen Jiabao to a Beijing hospital, where he shook hands with AIDS patients.

TIME accompanied Ho and his team from the Aaron Diamond AIDS Research Center (ADARC) for two weeks earlier this year as he traveled from Kunming, the cosmopolitan capital of Yunnan province, where his drug-treatment and vaccine projects are based, to the remote border town of Ruili, where heavy heroin trafficking and a thriving sex trade create a perfect HIV breeding ground, to Beijing, for his meetings with party leaders, including the newly appointed Minister of Health, Wu Yi. Everywhere Ho went, his mission was the same: to persuade Chinese officials to step up their modest anti-AIDS efforts and commit the resources necessary to launch a comprehensive nationwide program, modeled on the projects he has begun in Yunnan.

Kunming, Yunnan
The neatly dressed husband and wife are in their 50s and comfortingly average looking. Their once-smooth dark skin is now veined and burnished to a proud sheen, reflecting the decades of hard work they have put into raising a family, earning their salaries and, now, battling HIV.

They seem out of place in the world of AIDS. Neither injects drugs. Neither has had any contact with the sex trade. But they represent the newest and most troubling front in China's war against the AIDS virus. As in other countries hit by HIV, the epidemic in China began in the margins of society among migrant workers, drug users and prostitutes and then gradually entered the mainstream population. In China this process was facilitated by the government, which, through the tragic mismanagement of its blood-buying program in the early 1990s, permitted blood-collecting practices that ended up contaminating the country's blood supply with HIV. Anyone who gave blood or received a transfusion during that period was at high risk of contracting the virus and then passing it on to his or her partners during intercourse.

That was how this couple, who declined to give their names, got the AIDS virus. They have kept it a secret from everyone but their immediate family, preferring not to risk being ostracized by their community. "Nobody knows," says the wife quietly. "They would not understand." The husband, as far as they can determine, was the first to get infected, perhaps from blood transfusions during surgery. It wasn't until his wife required an operation in 2001, however, that they were both found to be HIV positive. "I could not believe it," she says. "I told them they were totally wrong, that their detection was wrong. I heard reports that there was HIV in China, but that was mainly from people who traveled overseas. We never thought the virus would get here, in our family."

In a way, they are the lucky ones. Along with 68 other patients, they are part of a treatment program that Ho established in Kunming. There they will get the latest antiretroviral medications and the same careful monitoring that AIDS patients in the U.S. receive, including regular measurements of their viral loads and their immune-cell counts and tests to determine how quickly the virus is mutating to resist the drugs.