Jim Yardley, New York Times
Friday, November 21, 2003
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DONGGUANG VILLAGE, China. The free medicine arrived in July, and Lin Degui and Zhao Sanmin swallowed it down. In this village of 700, more than 100 people trudged the mud alleyways to the small clinic, each hoping for a reprieve from the scythe of AIDS. Forty, maybe 50, had already died.
Health workers cautioned that a few people might suffer side effects, but as they handed out the antiretroviral pills, they gave out something more.
"They gave us comforting words that we didn't have to be afraid anymore," Zhao recalled, "because after taking the cocktail medicine, there wouldn't be any more problems".
That promise lasted a day. "People were vomiting, dizzy," Zhao said, describing the strong side effects some suffered. "Some people even went into shock. A lot of people couldn't take any more after just one try."
Four months later, Zhao, 36, is still taking the antiretroviral drugs, which are used to slow the onset of AIDS. Lin, 60, is not. They are two cases that capture the potential and the peril of China's new plan to distribute free anti-AIDS drugs, the first significant effort to curtail the spread of a disease that Chinese health officials now acknowledge may affect 10 million people by 2010.
The potential, of course, is that this AIDS-ravaged village in Henan Province is finally getting something from the Chinese government besides denial, inaction and intimidation. Some people say they are feeling better Several believe that the drugs have slowed the steady death toll already.
The peril, as shown in the case of Lin, comes if China thinks it can address AIDS simply by handing out pills. Experts warn that patients could develop drug-resistant strains of HIV, the virus that causes AIDS, if they quit taking the drugs or fail to take them properly. China's health system is so inadequate that experts are skeptical that it can monitor a broad program effectively.
"This is not the same as hunger relief, where you can drop the food and leave," said Dr David Ho, the prominent New York-based AIDS researcher, who is focusing much of his work on China.
But villagers in Dongguang say that to a large degree that is what is happening. The local clinic is sometimes closed for days at a time.
Zhao and others who pick up the drugs once a month say they have almost no contact with doctors. Instead, villagers say, they pick up their pills at the clinic and monitor themselves.
The drugs they do get are limited to four low-cost generic drugs that China can produce because they are no longer under patent. AIDS researchers say the combination can often cause strong side effects.
Chinese officials are trying to reach deals with pharmaceutical companies so that a broader range of AIDS drugs can be cheaply produced in China. But, as yet, no deals have been struck, and patients who cannot tolerate the combination are left to fend for themselves.
"When they issued the medicine I was filled with hope, because there was a way of stopping the disease," Lin said. But within a day he was vomiting. His head pounded with migraines and his lips and face swelled. Blotches covered his skin, and he said he could not stand the pain. "I had to stop," he said.
Top health officials said this month that they eventually intend to give free drugs to all poor people with AIDS. For now, the free drug program is still accessible only to a small fraction of the people in China with HIV. But already officials report that there are many people in Lin's situation.
Through October, government statistics showed that 5,289 patients had enrolled in the program. But roughly 20 percent had already told health officials that they had stopped taking the medicine. AIDS researchers say many others are likely to have dropped out without notifying anyone, succumbing to the side effects. How far up the road China should go toward distributing AIDS drugs without providing adequate oversight is a difficult question.
Bates Gill, a China expert at the Center for Strategic and International Studies in Washington, said that while antiretroviral pills need to be taken under a precise regimen, waiting for China's health system to be improved was an imperfect answer.
"Do you begin the treatment now, learn as you do it and make mistakes?" he asked. "Or do you wait? It's a tough choice."
The social costs and stigma of AIDS, meanwhile, are scarcely being addressed. Villagers here in Dongguang estimate that as many as 100 children have lost one or both parents to AIDS or live with a parent dying of the disease.
While villagers say the government gives the families two sacks of flour a year and a small discount on school fees, children of HIV positive parents are often segregated at school.
The precise number of people with HIV or AIDS in China is a matter of debate. Chinese officials estimate that roughly a million people have died of AIDS or are HIV-positive. Some experts, though, suspect that Henan, with nearly 100 million people, may itself have a million cases. A recent story in the official news media, by contrast, estimates that Henan has about 35,000 cases.
There is no doubt that the province is an epicenter. In the early 1990's a blood-selling campaign promoted by local officials as a means for people to earn money caused mass HIV infections. Villagers, barely scratching by in one of China's poorest regions, repeatedly joined in.
Lin said he had sold blood 10 or 12 times a month. He and his wife used the money to pay for his son's wedding. His wife is now dead, a victim of AIDS. His son is HIV-positive.
Zhao, who was born without a left hand, said he had sold blood because as a handicapped man he needed money to attract a wife.
Zhao said he dutifully took his pills, and still vomited occasionally, but his diarrhea subsided in October. He said the drugs had given him a glimmer of optimism, even if AIDS had left him sinking into poverty. "We need more assistance, but we can't seem to rely on the government," he said.
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