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