How Not to Fight HIV/Aids
The charity founded by Bill Gates is pouring millions into combating HIV in China. But it's repeating old mistakes
There's a new public service announcement on HIV/Aids on Chinese TV. Starring Jackie Chan and funded by the Bill and Melinda Gates Foundation, it features a man and a woman spinning through the air in a not-so-subtle combat which includes elements of courtship, foreplay and climax. The ad ends with Chan saying: "In life, we need to be safe. Life is too good. Please protect yourself." Sounds promising? Actually it's a remarkable distillation of everything we know that doesn't work in the fight against HIV/Aids.
More than 25 years into the global Aids epidemic, one thing we've learned is that you can't fight HIV through artful, oblique messages approved by government ministries and broadcast on television. Where HIV prevalence has declined, what has made the difference is frank, specific discussion about HIV, why people are at risk and what can be done to avoid infection. Grassroots, community-led efforts which empower those at highest risk have been critical, and the emergence of an organised, vocal civil society, advocating an end to sexual violence and access to information, condoms, clean needles, and medicines, have changed the face of the epidemic in many countries.
While the Chinese government has taken some steps in this direction, too much of the response remains style over substance. Those groups most vulnerable to infection - injecting drug users, men who have sex with men, and sex workers - are still routinely harassed and abused by the police, and driven away from the information and services that could help them. Aids activists continue to be detained, intimidated and prevented from speaking out.
In 2007, public security forces in Guangdong, Guangzhou and Kaifeng cancelled meetings of Aids activists, academics and programme implementers, and ordered the closure of two offices of a nonprofit organisation working on Aids in Henan provinces. Eighty-year-old Aids activist Dr Gao Yaojie was barred from going to the US to receive a human rights award until an international outcry forced the Chinese government to relent, and 2005 Reebok human rights award winner Li Dan and the husband-and-wife HIV/Aids activist team of Hu Jia and Zeng Jinyan have been repeatedly detained and put under house arrest.
In November, two weeks before the advertisement by Jackie Chan launched, Hu was beaten up by the police on his way to the hospital to visit his pregnant wife, and in late December Hu was arrested for "inciting subversion". His wife and infant have been prevented from leaving their home. Human Rights Watch has also learned that Hu's lawyers have been denied access to their client because the case involved "state secrets". At about the same time that Hu was detained, Dr Wan Yan Hai, a prominent Chinese Aids advocate and the developer of China's first HIV/Aids telephone hotline and website was briefly detained.
Along with the unveiling of the Jackie Chan advertisement, the Gates foundation announced last month that it was launching a new $50m HIV/Aids programme. The foundation spent months negotiating its entry into China and plans to use nearly half of its money directly funding the Ministry of Health. Like the TV advertisement, the Gates Foundation's decision to directly fund the Chinese government is a decision rooted less in what will be effective at driving down HIV prevalence, and more in what is considered "acceptable". Not surprisingly, the foundation has had no comment on the detention of those activists working on the front lines in the fight against Aids in China.
It's easy to ask people to protect themselves. To stop the Aids epidemic in China we also need to ask the Chinese government not to harass, intimidate and beat up those seeking the means to be protected.
Joe Amon is the director of the HIV/Aids program at Human Rights Watch based in New York. Before joining Human Rights Watch, Joe worked for more than 15 years conducting research, designing programs, and evaluating interventions related to Aids worldwide. Joe has a PhD in epidemiology and a Masters degree in tropical medicine.
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