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As powerful as the AIDS drugs are, HIV mutates so rapidly that if the antiretroviral compounds are not properly administered, they are quickly rendered useless not just for that patient but for every other patient exposed to the mutated virus. It's a concept that is difficult for even the best-intentioned patients here to appreciate. TIME spoke with a patient advocate, 31, who goes by the pseudonym Ke'Er. He was infected after selling blood and was admitted to a study in Beijing that provided free U.S. antiretroviral drugs, but he accidentally left his two-month supply on the train after his most recent visit to the city. "I dared not tell my doctor," he said, "because I felt bad that I was offered this opportunity but I lost my medicine. So I found a Thailand drug cocktail that is similar, and I'm taking that now." He doesn't know what the Thai drugs are but was assured by a doctor in his village that they would help. Chances are they won't.
Even the best AIDS drugs properly administered can do only so much. What doctors really need to head off a runaway epidemic is an effective vaccine. In fact, it was a vaccine trial that took Ho to China in the first place. In a way, China is an ideal place to conduct vaccine research. Because it is home to huge numbers of people who are HIV negative but at high risk of developing AIDS, Ho will be able to inoculate some of them with his vaccine and find out whether they can generate an immune response robust enough to protect them in case of a future exposure to HIV.
He is scheduled to inoculate his first healthy volunteers in New York with the U.S. version of the vaccine this week. Before he can begin testing a vaccine in China, however, Ho needs to know more about the virus strains circulating there. To protect against HIV, any experimental AIDS vaccine must be designed to match the rapidly changing strains moving through a population. Ho needs access to the blood of a lot of HIV-positive patients, so when he started looking for a place in China to conduct his trials, he turned first to Yunnan, a province with one of the greatest numbers of HIV and AIDS cases. His hope was that health officials there, who see the daily toll the disease takes, would be more willing to accept help from an outsider. It wasn't that simple.
TRACKING HIV
Yunnan is China's fourth largest province and historically one of its most mysterious and remote. (Its picturesque landscape of verdant hills and rustic villages inspired the legend of Shangri-La.) Its distance from the political leaders in Beijing has traditionally made it something of an outlaw province, home to dozens of minority groups and, in centuries past, feudal warlords who ruled with nearly absolute control. Today it is the gateway for heroin traffic that drifts into China from Burma, Vietnam and Laos.
Scattered along the drug route is China's largest concentration of heroin addicts. Yunnan has the highest IV-drug-use rates in China, and a recent U.N. AIDS report estimates that anywhere from 50% to 80% of the users are carrying the AIDS virus. HIV spread via unprotected sex is also on the rise here, accounting for 15% of HIV infections in 2000. All told, say health officials in Yunnan, this single province accounts for one-third of China's reported AIDS cases.