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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.
The vast majority of the Chinese who are HIV positive have no such access and must make do with drugs that treat the side effects of the disease--antibiotics for mouth sores and pneumonia, creams for skin lesions. Others rely heavily on traditional Chinese herbal medicines, which have no documented record of success. And even for those who are able to squeeze into one of the small studies supported by foreign aid groups, there is no guarantee of receiving proper follow-up care. "We have heard of places in China where the drugs are delivered but there is no training of the doctors in how to use them," says Ho. "We stress to them that drug treatment for AIDS is not like food relief, where the food is just dropped off."