UNCLAS SECTION 01 OF 05 SHANGHAI 000324

SIPDIS

SENSITIVE
SIPDIS

DEPT FOR EAP/CM, DRL
STATE PASS FOR USTR STRATFORD, WINTER, MCCARTIN, ALTBACH, READE
TREAS FOR AMB HOLMER, WRIGHT, TSMITH
TREAS FOR OASIA - DOHNER/HAARSAGER/KUSHMAN
USDOC FOR ITA/MAC - DAS KASOFF, MELCHER, MCQUEEN
NSC FOR WILDER AND TONG
HHS FOR OGHA/STEIGER AND AMER BHAT

E.O. 12958: N/A
TAGS: PGOV PHUM KHIV SOCI TBIO CH
SUBJECT: HIV/AIDS IN SHANGHAI'S GAY COMMUNITY

REF: SH 318

(U) Sensitive but unclassified. Not for dissemination outside
USG channels; not for Internet distribution.


1. (U) Summary: While most members of the Shanghai gay
community believed that they were not at great risk for becoming
infected with HIV/AIDS, researchers and health specialists said
HIV/AIDS was spreading faster in Eastern cities such as Shanghai
than through drug usage. According to health workers and
researchers, NGOs were having difficulties in Eastern China
reaching high-risk members of the gay community due to the
precarious nature of NGOs in China and the illegal status of sex
workers. Many complained that the Shanghai Center for Disease
Control (CDC) registry of HIV/AIDS patients infringed on
patients' privacy, had a "scolding" attitude towards patients
and was reluctant to share statistics on HIV/AIDS for fear of
"alarming" people. This is the second of four cables updating
the social, legal, medical and media issues of the gay community
in Shanghai. End Summary.
--------------
RISKY BEHAVIOR
--------------


2. (SBU) During the month of April, Poloff met with members of
Shanghai's gay community, healthcare specialists and academics
to discuss medical issues in the gay community. According to
Shanghai CDC HIV/AIDS Deputy Director Pan Qiqiao, in 2006 there
were 718 new HIV/AIDS patients reported in Shanghai, which was
50 percent higher than the number reported for 2005. Around
500-600 of the new HIV/AIDS patients did not have a Shanghai
residency permit, and the gay community comprised only a small
percentage of the 718 cases.


3. (SBU) Members of the gay community were aware of HIV/AIDS
but were not concerned about the disease. Two young gay men

living in Shanghai said HIV/AIDS was something they had known
about since they were very young and first heard about it on TV.
They believed, however, that in China it was mainly a disease
of "drug users and not spread among people having sex." None of
them knew anyone who had contracted the disease. A lesbian said
that the gay community in Shanghai was not concerned enough
about AIDS or the need to protect themselves. She did not know
anyone with AIDS and said "the concept of contracting it was not
a reality to most gay Shanghainese."


4. (SBU) Researchers and healthcare specialists held a
different view and were concerned about risky behavior among the
gay and lesbian communities. Deputy Director Pan Qiqiao said
although HIV/AIDS was spreading fastest in China through drug
use, in Shanghai and other large eastern cities HIV/AIDS was
spreading most rapidly through sexual intercourse. He noted
that from an infectious disease perspective, although the
percentage of HIV/AIDS patients in Shanghai was quite low, there
was a great deal of potential risk, so the best approach was to
change people's lifestyles.


5. (SBU) Researchers have also noticed the increased rates of
HIV/AIDS transmission among Shanghai's homosexual community.
Director of the Shanghai Academy of Social Sciences (SASS)
Research Center for HIV/AIDS Public Policy Professor Xia Guomei
said, "I don't know the exact rate, but we've discovered that
those who tested positive are mainly from the gay community."
Fudan University School of Public Health Associate Professor Gao
Yanning said the local challenges of countering HIV/AIDS were
more difficult than in the West because many men did not fully
identify as being gay. He has tried to educate men about using
a condom not only with their male partners but also with their
female partners. A senior doctor at the International Peace
Maternity and Child Health Hospital engaged in HIV/AIDS
prevention was also concerned about risk behavior that he saw in
the gay community. According to a survey he conducted of 200
people in gay venues, only 20 percent of gay men said they used
condoms. He believed that many in the gay community viewed
HIV/AIDS as "trying their luck." Much like smokers and lung

SHANGHAI 00000324 002 OF 005


cancer, "people knew there was a risk but kept smoking."


6. (U) Male sex workers emerged as prime candidates for
HIV/AIDS transmission because they service both male and female
clients. Last year, Professor Xia conducted a study on female
prostitutes in Shanghai. While conducting research, she was
shocked to discover that the buildings known to house
prostitutes contained more male sex workers than female. Male
sex workers sleep with both genders, some even maintaining a
girlfriend or wife. Fees ranged from 50-700 RMB, on average
around 375 RMB, and female customers were charged much higher
rates than male customers. Some sex workers accepted even more
money to not use a condom. Le Yi Foundation, a NGO helping male
sex workers, has had three sex workers who tested positive for
HIV/AIDS, and all have fled Shanghai. Le Yi Program Officer
Tony Zheng said that the majority of the sex workers have not
been tested which is alarming considering the high-level of
customer turn-over. According to Mr. Zheng, "a client will be
met maybe one or two times but after that there usually won't be
a third time," since clients preferred a new sex worker.
--------------
5-Year Plan to Counter HIV/AIDS
--------------


7. (U) On April 9, the National CDC in Beijing posted a draft of
"China's Five-Year Strategy for AIDS Prevention Amongst MSM
(men-who-have-sex-with-men) Population" on its public website
with a deadline of April 30 for any critiques. According to the
draft, it was estimated that 47,000 of among 650,000 people
infected with HIV/AIDS in China, were MSM, or 7.3 percent. It
said that China had monitored the MSM population for HIV/AIDS
since 2004. Shanghai CDC HIV/AIDS Deputy Director Pan added
that, "in the past two years, the Shanghai CDC has done
biological monitoring of sexually transmitted diseases (STD) and
HIV/AIDS rates through NGOs like Le Yi."


8. (U) The report's data indicated that the national percentage
of HIV/AIDS infections had increased from 1-3 percent in 2004 to
2.5-6.5 percent in recent years. The report's three main
suggestions to counter HIV/AIDS in the gay male population were
to encourage governmental cooperation with all related groups
(social groups, NGOs and MSM groups); to fully encourage the MSM
group to participate in AIDS prevention; and to give priority to
prevention education combined with treatment plans.
--------------
Obstacles to Reaching the Gay Community
--------------


9. (SBU) Professor Xia considered NGOs and people within the
MSM community to have done the best work in educating the
community about protection from sexually transmitted diseases.
She said that "only gay volunteers could spot gay Chinese and
truly be concerned for their rights." However, she pointed out
that in China, NGOs and volunteers operated in an unstable
environment.


10. (SBU) For example, the Le Yi Foundation was not registered
as a government-owned non-governmental organization (GONGO),
although the Shanghai government was aware of its work with male
sex workers. Instead, Le Yi was registered as a private company
which made it ineligible for government funding. Le Yi received
support from Oxfam in Hong Kong, but since it was a private
company, the money was subject to an 11 percent income tax.
Professor Xia said funding from foreign sources, even well-known
groups like the Ford Foundation and Oxfam, put Chinese NGOs in
"a sensitive existence" with the government.


11. (SBU) Professor Xia also complained that the most effective
types of outreach and advertising campaigns to target the gay
community were not permitted by the government. She believed
Shanghai needed more direct advertisements, or social marketing,
to the gay community. Xia added that people knew the risks of
not using condoms but pointed to the example of a PhD student
who contracted HIV/AIDS through intercourse. "If even a PhD

SHANGHAI 00000324 003 OF 005


student will have high-risk behavior, what about everyone else?"
she asked.


12. (SBU) A senior doctor who worked with the gay community also
thought that social marketing directed at the gay community
would be effective. He said, however, that it would be
impossible to have social marketing directed at the gay
community in China because of the government's unclear policy
towards the gay community. "They have no regulations towards
the group, the only thing illegal is public sex." Due to the
government's silence towards the gay community, and since it is
not a protected class or minority, he could only use posters
advertising condoms rather than tailored ads featuring two men.

13. (SBU) Mr. Zheng noted that it was very difficult to reach
some members of the community, especially male sex workers. He
said that male sex workers tended to be very resistant to
outside assistance because their line of work was illegal. They
constantly lived in fear of the police who target sex workers if
they receive a tip or complaint about solicitation. Police
raids resulted in a 5000 RMB fine and 15 days of detention. Mr.
Zheng pointed out that ironically a sex worker who was arrested
for prostitution needed to service even more customers in order
to pay the fine. The majority of sex workers suspected that Mr.
Zheng was linked to the police. This attitude impacted the
number of men Mr. Zheng was able to convince to be tested for
HIV/AIDS and other diseases. He was also unable to advertise Le
Yi's services because of China's strict regulations regarding
NGOs and GONGOs, and because the male sex worker population did
not want to be exposed.
--------------
TESTING: PRIVACY A CONCERN
--------------


14. (SBU) According to Shanghai CDC HIV/AIDS Deputy Director
Pan, HIV/AIDS testing was available at every district's CDC
office in Shanghai. The first time someone took an HIV/AIDS
test at a testing center, the patient was not required to use
his or her real name. If the result was negative, the applicant
could leave, but if the result was positive the applicant was
required to provide his or her real name and submit to another
test to rule out a false positive. Additionally, the patient's
identity number and other basic information, including home
address, would be entered into CDC's national registry. Pan
said that the Shanghai CDC followed up with patients who tested
positive and provided free treatment and appointments. He added
that this was not the case in other parts of China, but in
Shanghai "treatment for HIV/AIDS is free from start to finish."
He noted that "not all people with HIV/AIDS need immediate
treatment," and that the treatment course was determined by
sporadic appointments that checked for symptoms.


15. (SBU) Testing centers and hospitals did not require patients
and blood donors in China to sign consent forms or privacy
waivers for HIV/AIDS tests. Pan said that all blood donors in
China were automatically screened for HIV/AIDS and other
diseases, as were "suspicious" patients in hospitals - in
particular, those receiving treatment for sexually transmitted
diseases. He added that "some people know about the tests, but
patients do not have to sign consent forms." Hospital patients
or blood donors found to have HIV/AIDS were automatically
entered into the CDC registry of HIV/AIDS patients.


16. (SBU) Health professionals and researchers voiced some
concerns about CDC's handling of registry of HIV/AIDS patients.
Zheng believed that the Shanghai CDC had good intentions to
protect privacy but that, once a name was entered into a
registry, all the CDCs across China had access to the
information. He relayed a story from a male sex worker who
tested positive for HIV/AIDS. The sex worker's hometown CDC
visited his parents' home and told them "your son has a serious
disease and is very sick." The sex worker fled to Guanghzou and
was now receiving treatment by an undisclosed organization.


17. (SBU) Following this incident Mr. Zheng informed the

SHANGHAI 00000324 004 OF 005


Shanghai CDC that Le Yi male sex workers would not give their
real names during HIV/AIDS tests. The Shanghai CDC advised him
to have the workers provide their real names but not to put down
their hometown or place of permanent residence. The Shanghai
CDC explained that for the primary HIV/AIDS test, a fake name
could be used, but for the second test, the CD4 confirmation
test, the real name, but not place of residence, was required by
law.


18. (SBU) Fudan University School of Public Health Associate
Professor Gao Yanning pointed to another incident in which
officials used the CDC registry to track down patients. In
2006, hemophiliacs who had contracted HIV/AIDS through
blood-based injections from the Shanghai Biological Product
Institute staged a protest in front of the Institute during
which a policeman was stabbed with a dirty needle. Afterwards,
the police used the CDC registry to locate the various
hemophiliacs who had tested positive for HIV/AIDS and make
arrests. Soon, the neighborhood committees easily figured out
who in their community had HIV/AIDS. Professor Gao knew of some
HIV positive patients who refused to take the free drugs because
they worried that their privacy would not be protected and who
instead chose to pay out-of-pocket. Professor Xia was also
concerned about the lack of privacy and said that during the
test, CDC staff called people by name to get their test results,
so "what happens if a neighbor or co-worker is in the waiting
room?"


19. (SBU) Shanghai CDC HIV/AIDS Deputy Director Pan Qiqiao told
PolOff that protecting privacy was one of the most important and
basic responsibilities of the CDC. He added that "there are few
cases where someone's privacy was exposed, and those happened
outside of Shanghai." He also pointed out that there were very
few reports of cases of exposed privacy in the Shanghai media.
--------------
ATTITUDES TOWARDS THE SHANGHAI CDC
--------------


20. (SBU) The Shanghai CDC received mixed reviews from
healthcare workers and researchers. The Shanghai CDC is a
government entity, although its employees are not civil
servants. The sex workers approached by Le Yi Foundation faced
many obstacles if they tested positive for HIV/AIDS. The free
HIV/AIDS medication distributed by CDC in Shanghai was allotted
according to a patient's residence permit. The majority of the
male sex workers were migrants from Northeastern China and were
living in Shanghai illegally. Furthermore, to qualify for free
drugs patients needed to meet many other qualifications, such as
proof of unemployment or low salary, which was impossible to
provide working in an illegal, untaxed industry. Mr. Zheng was
able to work out an agreement with the CDC to allow Le Yi sex
workers to receive leftover drugs allotted to Shanghai, but they
still had to provide their identity number, name and address.


21. (SBU) In Dr. Gao's opinion, the Shanghai CDC worked with the
gay community on a very superficial level, mainly selecting
activities with easily achievable goals that made them look
good, rather than actually helping people. For example, he said
they worked with "the community by taking two gay people off the
streets and teaching them about condoms." He found their
attitude to come across as very "scolding," such as when they
ordered prostitutes to use condoms while trying to improve their
image as friendly to socially-marginalized groups. Dr. Gao said
only NGOs or the community themselves could make internal
changes in behavior, not the CDC.


22. (SBU) Professor Xia hoped the CDC would issue "health
intervention badges" to protect volunteers from arrest, which
often happened when police raided gay venues. Unfortunately,
the police did not distinguish between sex workers, customers
and volunteers, informing the families and work units of all
arrested. She also wanted the CDC to encourage and respect
volunteers who worked within the gay community to prevent
HIV/AIDS. She suggested that the CDC hold an annual award event

SHANGHAI 00000324 005 OF 005


for the volunteers which would be covered by the media. "Awards
are very important," she said, adding that the United Nations
AIDS program, UNAIDS, sent people to China to present awards and
"if only the Chinese government could do even a little, it would
go a long way."


23. (SBU) She also noted that the CDC appeared to be
increasingly conservative in its dissemination of information
about the rate of new HIV/AIDS cases in Shanghai. In December
2006, Xinmin Evening Newspaper published an article that
contained the percentage increase of HIV/AIDS patients in
Shanghai. According to Professor Xia, Shanghai government
officials criticized the paper for making the figures public.
Professor Xia typically sent a similar year-end report on
HIV/AIDS in Shanghai to the Wenhui Newspaper, but last year they
refused to carry her article based on the Xinmin Evening
Newspaper's experience. She also commented that the Shanghai
CDC was much more reluctant to release any sort of statistics to
her, often saying, "release of such numbers needs the director's
permission." Professor Xia asked, "Why can't they tell me such
basic information?"


24. (SBU) Professor Xia added that the attitude of people
working at the CDC not only impacted the level of transparency
but also the local government's attitude towards HIV/AIDS. She
cited the former head of the CDC who held meetings with
researchers and academics and incorporated his findings into a
report for the National People's Congress (NPC) in Beijing.
According to Professor Xia, he was eventually demoted, and the
position remained vacant, because the NPC did not like having a
CDC working directly with the university community. She
believed that the current CDC Director, Doctor Pan Qiqiao,
wanted to keep HIV/AIDS statistics in the controlled channels of
the CDC, believing it better to "be vague with the public so as
not to alarm people." She pointed out that the national policy
on HIV/AIDS was a good one, which "called for cooperation among
many organizations and the full cooperation from the public."


25. (SBU) CDC Shanghai Deputy Director Pan was very open about
the numbers of HIV/AIDS patients during his conversation with
Poloff and happily provided statistics on the number of HIV/AIDS
patients in Shanghai, which are in para 2 of this report. He
believed, however, that there was no need to provide gay people
with a special legal status. He said China should not recognize
a certain group by a special legal status "just because they are
linked to a disease, such as elderly people and heart disease or
gay people and HIV/AIDS." He added that the government should
not give "too much political focus to a disease."
--------------
COMMENT
--------------


26. (SBU) The number of HIV/AIDS infected individuals in
Shanghai may be significantly higher than the reported cases due
to concerns about privacy at testing centers and the social
stigma of living with HIV/AIDS. The gay community in Shanghai
is at risk for increased infection rates due to the lack of
understanding of the risks of sexual transmission and the low
level of condom use. In most Western countries, NGOs play a
major role in reaching out to the gay community and educating it
about HIV/AIDs. However, NGOs are restricted in what they can
do in China and governmental organizations such as Shanghai CDC
have not been able to gain the trust of the community.
JARRETT