(4 of 7)
Given the Chinese penchant for careful record keeping, it's no surprise that officials here have been collecting and analyzing information on these cases for more than a decade. But access to the data--especially for outsiders--has been carefully guarded. The man in charge of generating the statistics is Dr. Lu Lin, director of the Yunnan Center for Disease Control (CDC), who has been monitoring HIV infection among the highest-risk groups in nearly 50 sites around the province since 1991.
A former prison guard with hooded eyes and a smart buzz cut who, at over 6 ft. tall, towers over most Chinese, Lu might seem a tough nut to crack. But when Ho approached Lu and his colleagues three years ago with a proposal to collaborate on vaccine trials, Ho was surprised by the response he got. They were eager to cooperate, he recalls, but had little interest in a vaccine. They were more concerned with helping those already struggling with the disease. "We wanted to push the vaccine," says Ho, "and they wanted to get more treatment for patients, more trained people and better labs to take care of the patients."
So for the past two years, Ho has retreated from his vaccine agenda and set up the pilot drug-treatment program in Kunming. Using funding from both ADARC and private donors, he has also built a clinic, set up a virology lab capable of performing basic viral-load tests and put together a state-of-the-art immunology lab--all of which will eventually absorb the testing required for the future vaccine studies.
In return, Ho has asked for access to the blood samples--some 24,000--collected from HIV patients throughout the province over the years. The samples will give him critical information about which populations in Yunnan would be suitable as the first subjects for his vaccine trials. "We realized we needed a quid pro quo," he says.
As part of that exchange, Lu's CDC team shared with Ho, in the first presentation of its kind to anyone outside the Chinese government, the details of AIDS penetration in Yunnan. Last March Lu informed Ho that in a 2002 survey of high-risk populations, 43% of IV drug users had shared needles with others in the past month, and that among female sex workers, 89% were unaware of their risk of contracting HIV. A majority of sex workers, about 60%, reported inconsistent condom use. Since they have begun collecting data, says Lu, there has been a 25% to 30% increase in HIV cases among IV drug users in the province. The incidence of HIV infection among sex workers has also risen steadily.
It was what Ho suspected but could never confirm without the data. Clearly, the few programs that the Chinese had put in place--distributing condoms and educating people about the dangers of unprotected sex--were having little effect on the spread of HIV, and most of the population was still both misinformed and uninformed about how dangerous the virus is. "We all appreciate that the epidemic in China was bigger than our expectations," he says. "We found ourselves taking on issues beyond just our research agenda. We realized that with a few more partners, we could--and should--do more educating, treating and training of people about AIDS in China."