http://www.washingtonpost.com/wp-dyn/articles/A11021-2002Dec4.html 　　 　　washingtonpost.com 　　 　　In China, AIDS Crisis Is at the Mercy of Global 　　Commerce 　　 　　By Peter S. Goodman 　　Washington Post Foreign Service 　　Thursday, December 5, 2002; Page A01 　　 　　FUYANG, China -- Her oldest son died in August, 　　claimed by an illness the doctor could not bring 　　himself to name, let alone treat with his shelf of 　　Chinese herbs and aspirin. "Blood poisoning," the 　　mother was told. Not until days before he was gone did 　　she hear the word for the first time: AIDS. 　　 　　Now, her youngest son is dying, too, confined to bed 　　in his brick house in the village of Gaoji. This time, 　　Hu Ziying knows the name of the disease wasting her 　　grown child to bone. She knows its source: the 　　government-run hospital where her boys sold their 　　blood. Still, she is powerless to save him. There are 　　no AIDS drugs in northern Anhui province. None in 　　nearly all of China, for that matter. 　　 　　She could take him 600 miles to Beijing, where a 　　special hospital can provide Western medicines. She 　　might just as well contemplate taking him to the moon. 　　The examination would cost more than $300. The drugs 　　run $350 a month. She is a farmer in Chinas grain 　　belt, where many households make do with $100 a year. 　　 　　"Theres no way," Hu said, her face buried in her 　　weathered hands. "Its just impossible." 　　 　　As the worlds most populous nation takes tentative 　　steps to confront a pandemic that its government says 　　has already infected at least 1 million Chinese and 　　could reach 10 million by the end of the decade, no 　　one, save for the richest, can afford the 　　life-prolonging drugs produced by multi- national 　　pharmaceutical giants. 　　 　　Some in the government argue that the situation is so 　　dire that China must set aside respect for patents and 　　other such protections and immediately produce 　　cheaper, generic copies of the medicines. China has 　　the right to do this under the rules of the World 　　Trade Organization. It has threatened that course as 　　it negotiates with drug companies for lower prices. 　　But Chinas leadership is deeply torn between the 　　competing imperatives of confronting a disease that 　　could kill millions and respecting the norms of the 　　global trading system on which it has staked its 　　economic future. 　　 　　Many other countries in the developing world have 　　confronted this same choice. None has violated drug 　　patents. India produces generic copies of Western AIDS 　　drugs on a massive scale, but it has no patent law. 　　Thailand, South Africa and Brazil -- which has cut its 　　rate of AIDS-related deaths in half since 1996 -- have 　　all wielded the threat of violating patents to force 　　sharp reductions in price from drug companies. Drugs 　　are far more widely available in those countries than 　　in China. 　　 　　For China, the choice is fraught with special tension. 　　Despite two decades of market-embracing reforms, this 　　country is still nominally Communist. That would seem 　　to compel action free of the interests of 　　profit-making multinational companies. Yet China has 　　cast its lot with the forces of global commerce as the 　　means of lifting people out of poverty. It is 　　increasingly reliant on foreign investment. Foreign 　　and Chinese companies alike want a system in place 　　that reliably protects their international property. 　　 　　Chinas government is also in a sensitive position 　　because it is complicit in a primary cause of its AIDS 　　epidemic: the illegal blood-collection centers that 　　bought plasma from mostly rural Chinese in the 1990s 　　and sold it to factories that make biomedical products 　　such as vaccines and dubiously useful health tonics. 　　Local government officials -- many of them in on the 　　profits -- touted the blood-selling stations as 　　sources of cash for poor farmers. To persuade farmers 　　to donate frequently, the collection stations pooled 　　the blood they collected, removed the plasma, then 　　re-injected the rest back into donors, usually without 　　screening. If one of those in the pool was infected 　　with HIV, the virus that causes AIDS, virtually 　　everyone else now had it, too. 　　 　　This was the origin of the "AIDS villages" that now 　　abound in Chinas countryside -- entire communities 　　consumed by the epidemic, some with infection rates as 　　high as 80 percent. The existence of such villages has 　　already been widely documented in the central province 　　of Henan. Recent interviews with government officials, 　　Western diplomats and a network of Beijing-based 　　activists who survey the countryside revealed a far 　　broader problem, one that touches most of Chinas vast 　　interior, including the provinces of Anhui, Jiangsu, 　　Hebei, Shanxi, Qinghai, Sichuan, Gansu, Shandong and 　　Hunan. 　　 　　The AIDS problem in China is nowhere near as large as 　　in the worst-hit countries of the world. In some parts 　　of sub-Saharan Africa -- center of 70 percent of the 　　worlds cases -- 1 in 3 adults carries HIV. But 　　Africas experience offers caution for every country 　　in the developing world, and particularly for China. 　　In Africa, the epidemic can be seen in part as an 　　outgrowth of globalization. Its spread has neatly 　　followed the corridors of development. Truck drivers 　　traveling great distances have been infected through 　　liaisons with roadside prostitutes, carrying the virus 　　home to spouses in villages. 　　 　　China has, until recently, been largely insulated from 　　the epidemic by its relative isolation. But as the 　　country engages the outside, it opens up places where 　　the virus can filter in along with everything else. 　　 　　In a recent report, the United Nations described AIDS 　　in China as "a titanic peril," one that places the 　　country "on the verge of a catastrophe that could 　　result in unimaginable human suffering, economic loss 　　and social devastation." Experts say China, along with 　　India, is likely to eventually be home to the largest 　　population of AIDS sufferers in the world. 　　 　　Were in Denial 　　 　　In the village of Gaoji, home to about 800 people, at 　　least 20 percent of the population participated in the 　　selling of blood, Hu Ziying figures, many of them 　　several times a week. How many became infected with 　　HIV is not known. 　　 　　Hu, 66, said her six sons made their living growing 　　corn, wheat and sweet potatoes. Their land supplied 　　enough to eat, but they lacked cash, and they 　　increasingly needed it to pay for daily necessities. 　　 　　"They didnt have any money to send their children to 　　school," Hu said during an interview in Fuyang, a 　　small city about 35 miles from the village. "They 　　didnt have money to send them to the doctor." 　　 　　Then they discovered an easy way to get some. They 　　could bicycle to the county hospital in the town of 　　Lingquan, four miles away. They could submit to a 　　quick poke of a needle, wait for a vial to fill with 　　400 milliliters of their blood, receive some pooled 　　blood in return and then bike home with 50 renminbi in 　　their pockets -- about $6. 　　 　　Qi Baobiao, Hus oldest son, was 41 when he died. The 　　county hospital said nothing about AIDS after testing 　　his blood. It was not unusual. Local doctors rarely 　　inform patients they have AIDS, instead employing 　　euphemistic diagnoses. 　　 　　"They tell them they have fever disease or strange 　　disease or blood poisoning, " said Li Dan, a 　　Beijing-based activist who visited Gaoji twice in 　　mid-September. "No one wants to admit there is an AIDS 　　problem because then no one will buy the villages 　　crops or marry their women. The local officials just 　　want these people to die. If these people die, then 　　they figure the problem will just go away." 　　 　　In the past six months, six people in the village have 　　died, according to Li. 　　 　　The roots of the epidemic now interfere with efforts 　　to stop it. Local officials fear that even 　　acknowledging the problem amounts to an admission of 　　complicity in its spread. This has deprived the 　　central government of reliable data. Prevention 　　programs are nonexistent in many areas, stymied by 　　enduring social taboos about discussing sex and by 　　shame over the ubiquity of prostitution and illegal 　　drugs in a country that supposedly stamped out such 　　vices decades ago. According to the government, about 　　6 million people work as prostitutes in China. Western 　　governments say the real number is probably 20 　　million. While data are scarce, most experts think 　　condoms are used in commercial sex less than one-third 　　of the time. 　　 　　"The government hasnt paid attention to this 　　disease," said Xu Keyi, a medical doctor with years of 　　experience at the Centers for Disease Control and 　　Prevention in the United States who supervises the 　　Beijing Clinical Research Center for AIDS. "Were in 　　denial." 　　 　　Recently, however, AIDS has been elevated as an issue 　　by Chinas establishment. On Saturday, on the eve of 　　World AIDS Day, the English-language China Daily 　　endorsed the U.N. report as "the harshest assessment 　　and sternest warning ever given," adding that the 　　epidemic has become "a delicate social issue that 　　needs joint efforts from all sectors of society." 　　 　　In recent days, a team of Chinese AIDS experts 　　released a study asserting that rapid action by the 　　government could spare 10 million people by 2010 and 　　avert a major epidemic. "Right now there still exists 　　a chance to prevent and control the broad spread of 　　AIDS in China," declared the study, released to 　　coincide with World AIDS Day. "It also may be the last 　　chance." 　　 　　On Monday, state media reported that the government 　　will soon lift a ban on condom advertising. Beijing is 　　mobilizing teams of college students to hand out free 　　condoms. 　　 　　But even as Chinas leaders begin to grapple with the 　　problem, the situation in the countryside seems far 　　removed, colored by fear and ignorance. 　　 　　In Chinas largest cities, where people do know 　　something about AIDS and some doctors know how to 　　treat it, most are still helpless. The patients simply 　　cannot afford the medicine. 　　 　　"Its very painful to tell people you can do nothing 　　for them," said Li Taisheng, director of the AIDS 　　Center for Diagnosis & Treatment at Beijing Union 　　Medical College Hospital, one of the few such 　　institutions in the country. "Im a doctor and I know 　　how to treat these people, but I dont have the drugs, 　　and the patients cant pay." 　　 　　Even those who say China should disregard drug patents 　　acknowledge that the country needs far more than pills 　　to address the epidemic. Blood-testing facilities are 　　in limited supply. Only a few dozen doctors in all of 　　China are skilled in treating AIDS. Rudimentary health 　　care is beyond the reach of millions of Chinese 　　peasants because a once-socialized system now requires 　　payments for virtually everything. 　　 　　Still, some officials within Chinas Ministry of 　　Health have privately advocated that, as a start, the 　　government immediately license the generic production 　　of the complete spectrum of AIDS drugs. So far they 　　have been outweighed by their counterparts in other 　　agencies, particularly within the Foreign Affairs and 　　Foreign Trade ministries, according to government and 　　industry sources. 　　 　　Only a few AIDS drugs are protected by patents that 　　are valid in China, but dozens of others are covered 　　by government pledges of protection. Pharmaceutical 　　giants, and U.S. and European officials lobbying on 　　their behalf, have successfully convinced Chinas 　　leaders that abrogating these promises would hurt the 　　countrys reputation among investors and undermine its 　　commitment to free trade only months after it entered 　　the WTO. 　　 　　"Theyre a lot more interested in policing 　　intellectual property than in tackling the AIDS 　　problem," said Stan Abrams, a patent lawyer at the 　　firm Lehman, Lee & Xu in Beijing. "They have been 　　dealing with IP complaints a lot longer. For the 　　governments image abroad, its still a better issue 　　for them." 　　 　　Others say the governments priorities show that 　　Chinas leadership simply does not grasp the magnitude 　　of the threat. 　　 　　"Some departments in our government understand, but 　　they dont have power," said Wan Yanhai, Chinas 　　leading AIDS activist, who was arrested in September 　　and imprisoned for almost a month on charges of 　　revealing state secrets after he posted a government 　　document on the Internet that showed that Henan 　　province officials knew about their AIDS troubles far 　　earlier than previously disclosed. "Some have the 　　power, but they dont understand." 　　 　　We Have a Crisis 　　 　　Government officials angrily reject such 　　characterizations, maintaining that they are fully 　　committed to using the most effective means of 　　delivering affordable drugs to AIDS patients as 　　quickly as possible. 　　 　　"Were not afraid of making drug companies mad," Han 　　Mengjie, assistant director of the National Center for 　　AIDS, which is affiliated with the Ministry of Health, 　　said during a recent interview in Beijing. "We know we 　　have a crisis. We urgently want to be able to provide 　　the cheapest possible drugs." 　　 　　In recent months, China has licensed substantially 　　cheaper, generic copies of four Western AIDS drugs for 　　domestic production, none of them protected by patents 　　or official agreements. The government is soon 　　expected to approve production of a fifth drug, a copy 　　of Viramune, produced by the German firm Boehringer 　　Ingelheim GmbH, which has encouraged China to go 　　ahead. The drug will complete the pieces for the first 　　domestically produced "cocktail" of generics that can 　　be used to treat AIDS patients. It will sell for about 　　$400 a year, according to the companies involved. 　　 　　That is still far more than most patients can pay. 　　China has applied for subsidies from the Global Fund 　　to Fight AIDS, Tuberculosis and Malaria, an 　　international source of grants. China also is 　　negotiating with a trio of pharmaceutical giants -- 　　GlaxoSmithKline PLC of Britain, Merck & Co. of 　　Whitehouse Station, N.J., and Bristol-Myers Squibb Co. 　　of New York -- for reductions in the prices of their 　　wares. The government has already secured two price 　　reductions from Western pharmaceutical companies in 　　recent months, dropping the original $10,000 annual 　　cost of AIDS treatment by more than half. Another 　　price drop is expected in coming weeks. 　　 　　"We have already assured them there will be 　　appropriate reductions in price," said William 　　Stockley, China general manager for Glaxo in Shanghai. 　　"Were close to the endgame." 　　 　　The pharmaceutical giants assert that the debate over 　　whether to break their patents is driven by a false 　　assumption that such a course would amount to the most 　　aggressive means of treating patients. For one, the 　　company already making a drug can get it to patients 　　more quickly than one just launching production, they 　　say. And given the complexities of treatment -- the 　　dangers of side effects, the likelihood of drug 　　resistance building up -- China would do far better to 　　work with the originators of drugs to devise a 　　comprehensive plan rather than going it alone. 　　 　　"Weve already got a factory," Stockley said. "The 　　full A to Z of running an AIDS program is our daily 　　work. Were ready to fly." 　　 　　Nevertheless, some proponents of breaking the patents 　　say that in working with the drug industry, Chinas 　　leaders are making a calculation based more on 　　economic expediency than on compassion. 　　 　　"The feeling is that these are a bunch of farmers and 　　its not worth hurting Chinas reputation as a place 　　to do business to save them," said Li, the AIDS 　　activist in Beijing who has surveyed rural villages 　　ravaged by the disease. "Its a simple cost-benefit 　　analysis." 　　 　　?2002 The Washington Post Company

原文2002年12月4日 发表于http://www.washingtonpost.com/wp-dyn/articles/A11021-2002Dec4.html  浏览：1592

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