Journey to the West: HIV/AIDS, Avian Influenza

UNCLAS SECTION 01 OF 04 GUANGZHOU 005479 SIPDIS SENSITIVE SIPDIS DOL FOR ILAB HHS FOR STEIGER, ELVANDER AND BHAT NIH FOR FOGARTY CENTER (HOLT) NIH ALSO FOR NIAID (HOFF) STATE FOR USAID FOR ANE AND GH/HIV-AIDS STATE FOR S/GAC, OES, OES/PCI, OES/IHA, DRL/PHD, AND EAP/CM CDC FOR GLOBAL AIDS PROGRAM USDOC FOR ITA/MAC/AP/OCEA MCQUEEN BANGKOK FOR USAID (BRADSHAW) USPACOM FOR FPA E.O. 12958: N/A TAGS: KHIV KFLU EAID SOCI TBIO CH SUBJECT: Journey to the West: HIV/AIDS, Avian Influenza and Other Guangxi Health Stories Ref: A) Guangzhou 5377 and previous, B) Guangzhou 4512, -- C) 05 Guangzhou 22787 (all notal) GUANGZHOU 00005479 001.2 OF 004 (U) THIS DOCUMENT IS SENSITIVE BUT UNCLASSIFIED. PLEASE PROTECT ACCORDINGLY. NOT FOR RELEASE OUTSIDE U.S. GOVERNMENT CHANNELS. NOT FOR INTERNET PUBLICATION. ¶1. (SBU) Summary: Local governments have taken some measures to combat the threat of avian influenza (AI) and the spread of HIV/AIDS, but the scale of the threat appears to dwarf the size of government programs. In addition with respect to HIV/AIDS, the accuracy and availability of information about infected and at-risk individuals remains questionable, possibly undermining the government's claims of preparedness. Furthermore, despite the expansion of HIV/AIDS programs -- including ones funded by USAID -- in the region, a thriving sex worker industry in border and port towns continues to challenge outreach efforts. End Summary. AI: See No Evil, But Still Take Precautions -------------- ¶2. (SBU) As part of Consulate Guangzhou's "journey to the west" (ref A),Congenoffs with public health officials in Guangxi cities bordering Vietnam -- particularly Pingxiang and Dongxing -- with a major focus on HIV/AIDS but with spillover discussions on avian influenza. Pingxiang Agricultural and Husbandry Bureau Deputy Director Huang laid out the government's approach to curbing the threat of avian influenza (AI). Huang stressed that while Congzuo (the prefecture governing Pingxiang, a border town with Vietnam) has not yet suffered from any AI infections, officials have paid attention to the looming disease. She detailed the local government's four-tiered anti-AI approach, which includes organized meetings; public education campaigns through various mass media mechanisms such as radio, the Internet, and newspapers; vaccination of all poultry, and the prohibition on sales of unvaccinated and undocumented birds; and authorization of all local 
governments to take immediate action against outbreaks. Deputy Director Huang stated that, in the event of an outbreak, local governments would set up teams to address quarantine and prevention. In addition, she stressed the proven high quality of vaccinations available; fittingly, the same evening, CCTV1 announced that Beijing-based Sinovac had produced a new generation of avian flu vaccines. ¶3. (SBU) In further discussion, local officials acknowledged the market impact of AI on the sales on chicken and duck, but touted the good cooperation between Pingxiang and Vietnam in discussions over the illness. They insisted that public education had reached one hundred percent of all people in the area, including farmers and poor people. When the Consul General raised news of the death of a 10-year-old girl in Ziyuan County, Guilin, who had died the day before, local officials asserted very defensively and on behalf of the entire province that there had been no verification that the girl's death was a result of poultry to human transmission. (Comment: The nature of their comments and attitude raises the question of whether there is information about the issue. The young girl lived in an area that has had no confirmed reports of AI outbreak, and there is still no confirmed source of her illness. See ref B.) Despite the outward confidence of local officials regarding AI, we noted that in all of the Consulate's Guangxi travels other than to Pingxiang, where we discussed the AI issue at length, officials at no time served chicken, even though chicken is among their favorite dishes. A common local saying is, "A banquet is not GUANGZHOU 00005479 002.4 OF 004 complete without chicken." HIV/AIDS: A Longer Track Record, But Hurdles Remain -------------- -------------- ¶4. (SBU) Director Zhao of the Pingxiang Public Health Bureau then presented the local government's HIV/AIDS programs, while still underlining major challenges to their efforts. Since 1996 to date, more than three hundred HIV- positive patients have been identified in Guangxi, and close to thirty people have died. Pingxiang, a susceptible border town, has since become one of the main monitoring sites in the country, and provides other services such as HIV awareness, voluntary counseling and testing, initial blood sample testing, training for government officials both domestically and abroad, needle exchange programs, and distribution of condoms and HIV/AIDS information in over thirty hotels in the city. (Comment: Congenoffs note that the state-run guest house in Pingxiang did not offer condoms or HIV/AIDS information in the rooms, but each of the Consulate visitors received a nighttime phone offer of a "massage," a not-uncommon occurrence in Chinese hotels.) The Family Health International Project -------------- ¶5. (SBU) Pingxiang's major projects include partnerships with Johns Hopkins University, USAID, and international NGO's such as Family Health International (FHI). As of August 2004, FHI in conjunction with the local Center for Disease Control (CDC) has provided anti-retroviral drug treatment and consulting for HIV/AIDS patients. Also, as part of the Greater Mekong Sub Region (GMS) program, they provide treatment and voluntary testing specifically for drug users. Since May 2005, FHI began providing a full range of service to local people including voluntary counseling and testing, and to date have counseled 142 individuals, 45 of whom received initial treatment against infectious diseases, and 22 of whom received additional anti-retroviral treatment. FHI also has developed outreach programs, health clinics and recovery centers targeting entertainment sites and truck drivers in the Puzhai border crossing area, and has employed several Vietnamese partners to help educate Vietnamese sex workers and patrons. In November 2005, FHI hosted several events during which they tested 1,500 truck drivers and handed out 3,700 condoms. These outreach programs were still in development as of June 2005, when Congenoffs visited the Puzhai crossing (ref C). In December 2005, FHI founded a peer support group for HIV/AIDS patients, and six patients attended the kickoff meeting. (Comment: While FHI and Pingxiang CDC's efforts are commendable, the number of attendees indicates that the scale of remediation does not yet match the scale of the problem.) ¶6. (SBU) Despite progress in recent months, Director Zhao outlined many challenges to their anti-HIV/AIDS efforts. These challenges include a growing number of visitors due to the recent opening of the Nanning-Pingxiang highway; an increasing number of deaths from HIV/AIDS, causing a shortage of supplies and medical assistance for other patients; insufficient psychological care for patients and relatives; the spread of disease beyond at-risk groups; a need for more NGO coordination to facilitate exchanges with Vietnam; a limited reach for voluntary counseling and testing programs; and the need for more technical support from NGO's and the United States government. When asked about stigma and discrimination, Director Zhao stated that Pingxiang had fewer problems with stigma than did other areas because of the success of public education. Lack of Reliable HIV/AIDS Data for Modeling Purposes GUANGZHOU 00005479 003.2 OF 004 -------------- -------------- ¶7. (SBU) During a subsequent visit to FHI offices, opened in June 2005 in a small wing of the Pingxiang CDC offices, as well as to the anti-retroviral treatment center in the local hospital, FHI Regional Associate Director Pratin Dharmarak summarized the group's collaboration with local officials while criticizing the government's ability to tackle HIV/AIDS. Dharmarak stated that the Chinese government was unable to model the problem because they do not have reliable data. In addition, she opined that the government applies remedies in isolation and addresses only limited parts of the problem, because it lacks broader vision and integrated solutions. To illustrate, she pointed out the government's emphasis on attacking HIV/AIDS geographically, while failing to meet different needs within various locales. While Dharmarak expressed concern about the government's ability to develop programs in their absence, she also noted that FHI's USAID funding will run out in September 2006. Port Towns Bring In More Than Just Bulk Cargo -------------- ¶8. (SBU) In Dongxing, a border-crossing town comparable to Pingxiang, Congneoffs visited another USAID-funded HIV/AIDS project managed by Population Services International (PSI), which in the past three years has established HIV/AIDS outreach points and a drop-in clinic and activities center. City officials were very supportive and spoke highly of the work done by PSI. Dongxing contains various concentrations of sex workers, such as year-round sex workers in the city who usually operate under the aegis of organized criminal gangs, as well as summer migrants coming from Yunnan, Sichuan, and local areas, who work the beach area during summer months. PSI has worked closely with local government officials to provide checkups, promote HIV/AIDS awareness and teach useful prevention techniques to sex workers, truck drivers and migrant laborers. While the drop-in clinic "Sisters Health Home" does not explicitly mention HIV/AIDS in order to protect the privacy of people visiting the center, it is positioned adjacent to one of Dongxing's red light districts. ¶9. (SBU) As with FHI, PSI staff commented that their USAID funding will run out in September 2006. PSI officials said the project was a work in progress and that Chinese officials needed more experience with working with international NGOs. The PSI project is the first non- Chinese NGO to work in its city and has spent much staff time educating city officials on how to work with international NGOs. PSI Director Grace Hefner, based in Kunming, came to Dongxing to show Consulate officials the program. She expressed her gratitude for the Consulate's visit, saying that it has helped her in her work with government officials in supporting the program. Hefner also noted that NGOs such as PSI and FHI have the ability to coordinate with sister projects in Vietnam in a way that Chinese and Vietnamese officials would find difficult without first going through their respective capitals. Operating Without NGOs in Fangchenggang -------------- ¶10. (SBU) In Dongxing's neighboring port city, Fangchenggang (the prefecture level city administratively inclusive of Dongxing),CDC officials informed Congenoffs that the local center runs a very active anti-HIV/AIDS program providing information to local residents including junior and senior high school students. Fanchenggang's Vice Mayor said in turn that the majority of HIV/AIDS cases are due to drug use, though he also acknowledged the role of sex workers in spreading the disease. The Vice Mayor GUANGZHOU 00005479 004.2 OF 004 attributed the drugs to sources in Vietnam and Yunnan, but said that Yunnan and Guangxi authorities have mounted a very rigorous campaign to combat drug smuggling, and noted that in recent years Vietnam had undertaken a similar anti- drug strategy. Officials claimed that the number of drug addicts is increasing in Fangchenggang because of the increase in traffic, but also confirmed that the city does have a needle exchange program. CDC representatives described the city's plan to more than quadruple the existing drug recovery center by increasing capacity from 180 to 800 beds, or to one bed per one thousand people in the city. They added that the recovery center plans to provide special treatment for HIV carriers in the future as well. When asked about avian influenza, the officials simply responded that they have had no cases. ¶11. (SBU) Similar to Dongxing's active waterside red light district, Fangchenggang houses a red light area near the busy ports. During an evening stroll through the town, congenoffs noted at least 19 red light establishments by the ports, though none appeared to be doing anything resembling a robust business. In Fangchenggang, port workers make a reasonably good salary at an average of RMB 36,000 per year (about USD 4,465),whereas people working in the town outside the port earn an average of RMB 10,000 (about USD 1,240) per year. By comparison, the average urban income in the region is RMB 8,900 (about USD 1,100) per year. Comment -------------- ¶12. (SBU) While Guangxi's border and port towns are vehicles for rapid growth and international trade, the increase in economic traffic raises stakes for public health officials combating avian influenza and HIV/AIDS. An active international NGO presence heightens awareness of the illnesses and boosts government capacity building, but the government's current piecemeal solutions need to evolve to a larger and more integrated approach to addressing public health challenges. Furthermore, the cross-border nature of avian flu, HIV/AIDS, and other health problems indicate that more cross-border linkages should be promoted. International NGO participation appears to be a key catalyst for effective programs, and it would appear that in their absence, local government capacity to stem public health outbreaks such as HIV/AIDS will be crippled. ¶13. (U) Departing the area bordering Vietnam, Congenoffs headed back up north to Nanning for a Sunday visit to the much healthier environment of Guangxi's two major milk producers, the subject of the next message in the series on the Consulate's continuing "journey to the west." ¶14. (U) This message has been cleared by AmEmbassy Hanoi. DONG