restricted access 4. China’s Response to HIV/AIDS and Obesity
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4 China’s Response to HIV/AIDS and Obesity In the late 1980s, while making efforts to strengthen its economy and po­ liti­ cal institutions, China joined Brazil and India in confronting the HIV/AIDS and obesity epidemics. Like the governments of Brazil and India, China’s government did not immediately engage in a strong policy response; China would only achieve this ­ after the arrival of criticism and pressure from influential international institutions such as the WHO and the UN. Building on a foreign policy tradition of striving to build the government’s international reputation and peaceful partnerships with other nations, the governing elites eventually pursued a stronger policy response to HIV/AIDS and obesity in order to enhance China’s international reputation as a modern state capable of eradicating­ disease and of developing. ­ These reputation-­ building interests would ­ later­ incentivize the government to provide foreign aid assistance for HIV/AIDS programs in other developing nations. The government’s positive geopo­ liti­ cal positioning therefore mattered considerably, fostering not only stronger policy reforms and global health diplomacy but also the pursuit of financial and technical assistance from the World Bank to sustain China’s domestic reform efforts. Nevertheless, the government was not capable of pursuing a centrist policy response for HIV/AIDS and obesity. This reflects the absence of a strong bureaucratic–­ civil societal partnership and thus the bureaucracy’s inability to garner support for innovative programs and initiatives that would augment its capacity to ensure effective policy implementation at the provincial government level. While the government eventually sought to use NGOs as effective “arms of the state,” that is, in helping the central and provincial governments provide prevention and treatment ser­ vices in hard-­ to-­ reach (mainly rural) China’s Response to HIV/AIDS and Obesity   115 areas and among at-­ risk groups, beyond this, ­ there never emerged an ongoing effort by AIDS bureaucrats to develop a strong sense of solidarity and cooperation with NGOs (especially with ­ those not affiliated with the government) and to strategically use this partnership to advance the bureaucracy’s position within government. Responding to HIV/AIDS The first reported case of HIV/AIDS in China emerged in 1985, when a tourist from Argentina was diagnosed in northern China. The first indigenous cases­ were found among IDUs in 1989, in the province of Yennan, nestled along the Mayaram border. By the mid-1990s, AIDS had spread to hundreds of poor farmers in central China through contaminated blood supplies, as indigent farmers often sold their blood plasma and then required reinjection of blood (N. Li et al., 2010; Wu, Rou, and Cui, 2004). ­ Because of poor surveillance, politicians’ cover-up of the epidemic, and the black market for transfusable blood—­ mainly due to the central government’s 1988 drug importation ban (Lei and Wu-­ Kui, 2008)—­ the virus spread quickly among blood transfusion recipients in rural areas. By the late 1990s, infection through heterosexual sex also began to rise, while cases among gay men and sex workers ­ rose in the 2000s (Lei and Wu-­ Kui, 2008; L. Wang, 2007; Wu, Rou, and Cui, 2004). The trajectory of HIV/ AIDS in China is shown in figure 4.1. 0 10,000 20,000 30,000 40,000 50,000 60,000 cases deaths 1996 2007 2000 Figure 4.1. HIV/AIDS cases and deaths in China, 1997–2007. Source: UNAIDS, 2008. 2008 Update. China. Epidemiological Fact Sheet on HIV and AIDS. 116   Geopolitics in Health The government’s initial response was divided. The premier, president, and MOH officials believed that HIV/AIDS was a foreign disease, transferred from immoral, cap­ i­ tal­ ist, foreign travelers (Y. Huang, 2006; Kaufman, 2010; Knutsen , 2012; Wu et al., 2004). Once word got out that the virus was spreading through extramarital sex and drug use, Party and se­ nior MOH officials claimed­ there was simply no way AIDS could have come from China. The cultural revolution of the 1960s, government leaders held, had cleansed Chinese society of such atrocious, immoral acts. It was also believed that Confucian conservatism, especially in the realm of sexual activity, safeguarded China from AIDS (Knutsen , 2012; H. Zhang, 2004). The government therefore ­ initially viewed ­ people living with HIV/AIDS as “social deviants,” “immoral sinners,” the naughty and disgusting “other them,” partakers of forbidden western vices. The virus was often referred to as AIZibing, the “loving cap­ i­ tal­ ist disease” (­People’s Daily Online, 2009). ­ Those afflicted with AIZibing ­ were perceived not only as social deviants...