Stalking a Killer

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In 1996, researchers were startled to discover the Thai and Indian strains had combined in and around Ruili to form a new one: B/C. This recombinant virus, incubated in the bodies of individuals infected with two distinct strains, moved at frightening speed. In just two years, it vaulted through Sichuan and Gansu and invaded Xinjiang. At first, researchers feared B/C might be a superstrain of the virus, capable of replicating more rapidly in the blood and semen of its victims than its parent strains. They have since concluded it does not, but they are still not sure why it is spreading so efficiently. Experts at Beijing's CDC are testing one hypothesis: that China's minority populations are more vulnerable genetically than are the Han majority. First, B/C swept through the Dai along the Burmese border. Then it struck another tribe, the Yi, in Sichuan, followed by the Hui in Gansu and then the Uighurs in Xinjiang, where it quickly came to account for 100% of HIV infections. Reported cases alone in Xinjiang more than doubled to 4,416 between 1998 and 2000. The actual number of those with the disease may be much higher.

Beyrer from Johns Hopkins doubts the answer lies in genetics. He suggests the reason may be simpler: tribesmen use drugs more than the Han Chinese do, and minorities have the tradition of sharing community resources—from food to dirty needles. "Behavior always comes first," Beyrer says.

Indeed, when scientists shared their notes with Chinese police, they found the new strain was sticking closely to China's heroin trafficking route. Long-distance truckers carry Burmese heroin hidden in their flatbeds. They can end up hauling deadlier freight in their veins. One pharmacist at a roadside stop between Urümqi and the desert oasis town of Turpan says that many truckers have gonorrhea, a sign that they are having unprotected sex—and leaving themselves wide open to HIV. In the Sichuan capital, Chengdu, by the Four Carriage Horses Bridge, a hundred or so trucks were parked last month in a muddy courtyard, waiting for new loads. The drivers wolfed down bowls of spicy noodles, gambled at cards and, if they hadn't lost their earnings, summoned over the teenage waitresses. The girls led them up a stairway filled with trash to rooms for a 30-minute romp. Sex without a condom was negotiable, a couple of yuan extra. According to UNAIDS, half of prostitutes surveyed in Sichuan said they never used condoms.

All it takes is a single infected trucker to arrive at one of these motor courtyards and pass HIV to a girl, who in turn spreads it to another trucker, and another, and soon the virus has fanned out across the country. Until recently, China's AIDS problem was largely confined to people infected through tainted blood transfusions and intravenous drug users—about 70% of China's HIV/AIDS victims got the disease by sharing dirty needles, according to 2001 government statistics. But epidemiologists say it is starting to infiltrate a larger swath of the population, using as conduits China's booming prostitution industry and 100 million unregistered migrant workers. Migrants and prostitutes, because they work illegally, are beyond the reach of state health care.

Farther up the AIDS road, at the Salt Lake truck stop in Xinjiang, Yufa leans against the pink neon-lit doorway of a cafè. She's a farm girl who has been in the sex game for only two weeks. She's wearing an ill-fitting red gown, and her feet hurt. Her pale, exposed shoulders are a sharp contrast to her face, burnt from laboring in fields. She came from Sichuan to look for factory work in Urümqi after her young husband died, leaving her with two children "and only the sky overhead," she says. In Urümqi, there were no jobs. A stranger fixed her up at a roadside brothel where she sells herself for $3. "Sure, I know about the disease," she says. "But I'm not so pretty, and I only get maybe three clients a week. If they won't use a condom, fine. I'll do it anyway. What choice do I have? I can't let my children die of hunger." Then her eyes return to the desert highway, where the trucks roll by.

In the provinces, many people have never heard of AIDS. Even when they have, awareness is distorted by superstition and bureaucratic myopia. An official for a foreign ngo operating in western China says an AIDS survey in Yunnan was halted when a local official realized that the HIV rate was rising far higher than expected. The official didn't want to lose face with his superiors, so he stopped counting. In Kunming, the capital of Yunnan, a local government billboard proclaims AIDS a "foreigners' disease" and cautions that anyone who has overseas guests should burn their bedsheets and slippers. (HIV is not transmitted through incidental contact with objects.) "My damn pimp lied to me," complains a Burmese girl at a Ruili cafè upon being informed that HIV is passed on by sex without condoms. "He told me I couldn't get the disease from men who were Han Chinese—only from the Dai minority. If I have it, I'll kill myself."

The fragmented nature of China's AIDS prevention and treatment programs leaves the country's flanks exposed to epidemic. Beijing's current five-year plan for AIDS education aspires to enlighten just 45% of the country's 900 million peasants by 2005. Officials are so conflicted over how to attack the problem that they wind up attacking those who are trying to help. On the mainland, there are a handful of AIDS activists, scientists and health care workers waging lonely campaigns against the disease. One of the most famous, Wan Yanhai, founder of an organization called the AIDS Action Project, is best known for exposing the plight of perhaps as many as a million farmers in Henan province who contracted HIV when they sold their plasma to illegal blood banks using unsanitary collection methods. Wan's whistle-blowing has made him very unpopular in certain Communist Party offices. On Aug. 24 he was picked up by state security officers and held secretly for nearly a month. Last Friday, amid mounting international pressure, he was released without formal charges. He could not be reached, but a friend who visited him shortly after he was freed noticed "a clear change in his demeanor. He seemed disoriented and rather shaken."

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