HIV/AIDS AND AVIAN FLU IN NORTHEAST CHINA: STATUS,

C O N F I D E N T I A L SECTION 01 OF 03 SHENYANG 000147 SIPDIS SIPDIS DEPARTMENT FOR EAP/CM, EAP/EP, OES/STC, OES/IHA E.O. 12958: DECL: 08/01/2032 TAGS: KFLU KHIV TBIO PGOV SOCI EAGR CH SUBJECT: HIV/AIDS AND AVIAN FLU IN NORTHEAST CHINA: STATUS, DEVELOPMENTS AND CONCERNS Classified By: CONSUL GENERAL STEPHEN B. WICKMAN. REASONS: 1.4(b)/(d). ¶1. (C) SUMMARY: Health officials in Liaoning Province claim remarkably few official HIV/AIDS cases, though they acknowledge a nexus between the virus, the province's growing drug problem and its seedy sex industry. Liaoning's Center for Disease Control (CDC) is "not worried" about an imminent avian influenza outbreak, but it is also "not fully optimistic" either, and remains "on alert." The CDC's budget--and Beijing's contribution to it--has grown on the heels of SARS and bird flu scares, and the center is now partnering with groups as unlikely as the local Catholic Church on HIV/AIDS work. Officials seem to suggest that information-sharing across provincial lines in northeast China is still less than ideal. END SUMMARY. ¶2. (SBU) Poloff on July 11 discussed HIV/AIDS and avian influenza (AI) prevention/control efforts in Liaoning Province--northeast China's most populous--with Dr. GUO Junqiao, Deputy Director of the Liaoning Provincial Center for Disease Control; LU Chunming, chief of its HIV/AIDS Control section; and YAN Dawei, head of the Liaoning Provincial Health Bureau's Disease Control section. HIV/AIDS: THE DRUGS/PROSTITUTION NEXUS -------------- ¶3. (SBU) Health officials claim the HIV/AIDS situation in Liaoning is "among the best" in China, even if official cases outnumber those in Jilin and Heilongjiang, northeast China's other two provinces. Since 1991, Liaoning has officially registered over 600 cases, according to LU Chunming, who attributed two-thirds to sexual transmission and the remainder to intravenous drug use and other "unknown" vectors. Particularly vulnerable populations in Liaoning, he said, include drug addicts and prostitutes. Lu claimed "few" infections among Liaoning's many migrant workers but noted all the same that his office continues to conduct special education programs for migrants at one of Shenyang's largest labor markets. ¶5. (C) This astoundingly low number of infections is likely underreported in this province of over 42 million. Officials did, however, more frankly acknowledge that Liaoning's seedy sex industry and--perhaps more importantly--its growing problem with drugs have been particularly irksome on the HIV/AIDS front, and even more so than in other areas in China. Lu claimed that although drug abuse in Liaoning is not as serious as it is in places like "Yunnan or Xinjiang"--where drugs are far cheaper than in Liaoning---Jilin and Heilongjiang have experienced fewer infections because of intravenous drug use. Liaoning Public Security Bureau (PSB) estimates put the number of addicts in the province at 10,000, probably a conservative figure. But Lu noted that the CDC does not presently offer any clean-needle programs because the number of addicts officially reported in any given area of Liaoning falls below the threshold--i.e., a minimum of 500 addicts in an administrative district--required by national regulations for such programs to be allowed. ¶6. (C) Infection rates among sex workers are on the decline, Lu also reported, ascribing progress to educational efforts on prevention; growing condom use by prostitutes (over ninety percent, he claimed, also at the encouragement of the CDC); and new requirements that condom machines be installed for clients at hotels and "entertainment" outlets (i.e., the many karaoke parlors, bathhouses and similar venues that pepper the province's cities and host parts of the sex industry). (NOTE: In our memory, Lu is the first local Chinese official Post has encountered to openly refer to sex workers as "prostitutes" during on official meeting in the presence of a superior; most officials are generally not keen to acknowledge their existence. END NOTE.) ¶7. (U) Against this backdrop, the CDC's HIV/AIDS efforts are primarily focused on four areas: effective monitoring and reporting of infections by sub-offices throughout the province; a network of over 200 testing stations offering free, anonymous HIV tests to anyone interested; a growing educational outreach program targeting at-risk populations, as well as the general public; and, lastly, free medical treatment for those already infected. Lu claimed the Liaoning CDC is currently providing medication--and quarterly check-ups--for over 80 HIV-positive patients. SHENYANG 00000147 002 OF 003 AVIAN FLU: "NOT FULLY OPTIMISTIC," BUT ALSO "NOT WORRIED" -------------- -------------- ¶8. (C) The Liaoning CDC is "not fully optimistic," but also "not worried" about an imminent outbreak of avian influenza, according to Dr. GUO Junqiao, a frank, impressive young CDC official who recently spent several years in New York, where she earned her PhD. The provincial CDC remains "on alert," she said, and continues to coordinate AI monitoring, reporting and control efforts at 15 hospitals in the province's 14 largest cities, which have been designated as special treatment centers for AI infections. Guo maintained that sudden outbreaks of "unpredictable" infectious diseases like SARS and avian flu remain the CDC's most significant challenge (and worry). ¶9. (U) Per national guidelines, the province elaborated and now maintains an Avian Influenza Emergency Reaction Plan, which it updated in 2005 and 2006. In the event of a suspected outbreak, Guo explained, preliminary information is to be submitted to a nationwide reporting/monitoring network while an emergency reaction team is dispatched to the scene "within two hours." Upon submission of the data, information on the incident would be available to the Ministry of Health and other provincial CDCs "within minutes," Guo claimed. At the scene, the CDC's emergency reaction team would make an assessment and give further instructions, presumably in coordination with relevant provincial and/or national authorities. PARTNERSHIPS TRADITIONAL AND LESS SO -------------- ¶10. (SBU) The Liaoning CDC in recent years has not been acting in isolation, and at times has worked in tandem with somewhat surprising partners. A more traditional partner has been the World Health Organization (WHO),with whom the CDC pairs in monitoring 11 different types of infectious diseases, Guo noted. On the AI front, in 2005 both partners expanded to year-round surveillance their joint influenza monitoring program that had previously run only from March through September. (The WHO does not fund the Liaoning CDC's AI programs.) A somewhat less traditional (and "private") partner has been Liaoning's Catholic Church, with whom health authorities have quietly partnered on the HIV/AIDS front. ¶11. (C) Reverend Joseph Zhang Kexiang and Sister Fabian Han Fengxia run the Liaoning Diocese's Catholic Social Service Center (CSSC),which was established in 2004 and runs a number of innovative HIV/AIDS initiatives blessed by the Liaoning CDC. Examples of CSSC programs include awareness and prevention campaigns, both in urban and rural areas; educational workshops; financial support and counseling for families of HIV-positive patients; and home-care visits to infected patients. Zhang and Han--both former students in the United States-- have been frank and open and in their conversations with Poloff over the past several months and have generally struck a positive note on the local health authorities' support of their HIV/AIDS-related work. The Liaoning CDC itself, for instance, now refers patients to the CSSC for home-care, something which Guo and Lu acknowledged without hesitation. Both the CSSC and the Liaoning CDC, moreover, have been quite visible in their HIV/AIDS educational efforts in Shenyang, particularly during occasions like International AIDS Day. FUNDING AND INFORMATION-SHARING: CAUSE FOR CONCERN? -------------- -------------- ¶12. (C) Liaoning health officials consider their budgetary levels to be generally sufficient, noting the catalytic effect of SARS, which sparked multi-million renminbi (RMB) upgrades to the CDC, its budget and provincial health infrastructure more broadly. The Liaoning CDC's budget is largely drawn from provincial funds, according to Guo and Liaoning Health Bureau official Yan Dawei. But "twenty to thirty percent"--up from ten percent before SARS and AI scares hit in 2003 and 2005, respectively--now comes from Beijing. Interestingly, Guo and Lu noted that funding for the province's HIV/AIDS work has not changed dramatically since Liaoning Party Secretary LI Keqiang officially took office in 2005. (NOTE: As a high-level official in charge of Henan Province during the tail end of its infamous blood-selling scandal several years ago, Li is perceived by some to have suffered some political fallout. END NOTE.) They did, however, note that Li had recently managed to secure an additional RMB 2 million (USD 263,000) in SHENYANG 00000147 003 OF 003 "special funds" for HIV/AIDS control. ¶13. (C) If Liaoning health officials were generally upbeat on budgetary issues, they seemed somewhat less so when asked about information-sharing with other provinces. On the one hand, the Liaoning CDC now has over 130 constituent CDC offices at different levels throughout the province, according to the Liaoning Health Bureau's Yan Dawei; these, in turn, figure into a broader nationwide network for statistical reporting, monitoring and so on. But when asked about the regularity and quality of the Liaoning CDC's communication and information-sharing with other parts of northeast China, Yan and Lu Chunming both conceded that the situation was less than ideal. Both noted that their offices rarely communicate with, much less see, their counterparts in Jilin and Heilongjiang. (Lu, for example, had trouble describing to Poloff the nature of the HIV/AIDS situation in the rest of northeast China.) CDC Deputy Director Guo Junqiao pointed out a reality not dissimilar from that in other PRC government offices: that information-sharing is more typically conducted vertically (i.e., through functional networks, from the national level down, or vice versa),rather than horizontally (i.e., across provinces). WICKMAN