简体中文
When Zhao Hong (a pseudonym) and her husband tested positive for human immunodeficiency virus (HIV) in July 2012, she was already three months into her pregnancy.
"We were just devastated, knowing that we couldn't afford all the medication and can't possibly give birth to a healthy baby," said Zhao, a 30-year-old resident of Zhongshan County in south China's Guangxi Zhuang Autonomous Region.
Shortly after receiving their diagnoses, the local disease control and prevention center told the couple that they would be entitled to free medical treatment, including medications to prevent the virus from being transmitted to the fetus, at an accredited local hospital.
Zhao gave birth to a healthy, HIV-free baby in February this year.
Under a pilot program launched in July 2012, the Zhongshan County People's Hospital began providing free medication, including antiretrovirals, to everyone who tests positive for HIV. Prior to expanding its medical outreach services, only AIDS patients with severe damage to their immune systems were eligible to receive the free medication.
In the one-year period ending on June 30, 2013, 110 people tested positive as HIV carriers in the county, including 10 who died. Of the rest, 90 are currently receiving free treatment, mostly starting within 14 days of the confirmation of their HIV status.
The pilot program has expanded treatment from 70 percent to 90 percent of infected people in the county, and the mortality rate there has dropped by 70 percent.
The program also closely monitors prostitutes, prison inmates and families in which at least one spouse is HIV-positive in the region, where sexual intercourse accounts for 90 percent of virus transmission, compared with 60 percent nationwide.
Expanded coverage
Having seen the success of the program in Zhongshan, the Chinese Center for Disease Control and Prevention (CDC) on Aug. 2 announced its decision to expand the program to nine other provinces.
The program widens access to free medication to everyone with HIV or AIDS. To qualify for the free medication in the past, people with HIV had to take a test to prove that their body's CD4 cell count had been reduced to a level that points to a badly weakened immune system.
The normal count of CD4 cells, sometimes called T-cells, stands between 500 to 1,600 per cubic millimeter for a healthy adult, but HIV weakens the immune system by damaging functioning CD4 cells.
In China, to receive the free medication, a test would need to show that a patient's CD4 cell count is below 350 per cubic mm, according to the CDC.
Prior to the pilot program in Zhongshan County, it took at least four weeks to schedule a CD4 test after someone was diagnosed with HIV. Once proven eligible for free medication, the carrier would need to wait at least another four weeks to initiate treatment.
The process often required patients to shuffle back and forth between a hospital and a local disease control and prevention center for paperwork and medical check-ups. It became quite a burden for some carriers, many of whom eventually gave up on treatment.
However, under the pilot program, health authorities in Zhongshan County hoped to streamline the process. They scrapped the CD4 test as a threshold for free medication and instead, made medication accessible to all patients. This is how Zhao and her husband were able to receive treatment.
All the procedures, including tests, consultations, paperwork and check-ups are conducted at the Zhongshan County People's Hospital, where Zhao and her husband take their prescribed medicine every Wednesday.
Effective, but challenges remain
Offering free treatment to HIV carriers who have not yet been diagnosed with AIDS has proven effective in reducing the mortality rate and virus transmission in many counties, said Ge Xianmin, an AIDS prevention official with the Guangxi health authorities.
Despite the positive effects, health authorities in China balked at the prospect of increasing financial strains imposed on the fiscal budget as a result of expanded treatment, Ge added.
Zhongshan County spearheaded the pilot project, as the autonomous region has struggled to rein in rising cases of HIV over the years.
"To ensure the expanded coverage of free treatment, health authorities in the region earmarked more than 2 million yuan (326,830 U.S. dollars) to run the program," Ge said.
Around 80,000 people tested positive for HIV in China in 2012, and 60,000 of them qualified for free medical treatment based on their CD4 cell count. The costs, which the CDC estimates at around 300 to 400 million yuan, will rise if China decides to expand treatment to all carriers.
Zhang Beichuan, a prominent sexologist and AIDS prevention expert, said medical outreach has yet to tackle patient compliance, which is a fundamental issue that impacts the effectiveness of any AIDS program.
Health authorities in Zhongshan County have also voiced similar concerns, noting that some HIV-positive people are not committed to treatment and high population mobility poses challenges to monitoring.
"It could take as long as 10 years to diagnose AIDS after one is infected. How do we guarantee the carrier will stick to the regimen during this period?" Zhang said.
With these factors in mind, many analysts have urged local authorities planning to run the program to tailor it to suit the unique challenges facing their regions, because merely copying Zhongshan's practice may not guarantee comparable success.
