The prevalence of HIV/Aids in China has surged in the past 20 years, as improved treatment means people are living longer with the disease, according to official data.
Figures published in October by China’s Center for Disease Control and Prevention (CDC) showed that between 2002 and 2021, the prevalence rate of reported HIV/Aids cases rose from 1.09 per 100,000 people to 79.62, an increase of more than 7,000%. Improved treatment as well as better access to testing have contributed to the soaring prevalence rates, even as the mortality rate for HIV/Aids also increased for much of that period.
Between 2002 and 2018, the mortality rate for reported cases rose from 0.07 per 100,000 to 1.31 in 2018. Since then it has decreased slightly to 1.28 per 100,000 people in 2021.
More than a million people in China are living with HIV/Aids, which first emerged in China in the late 1980s. Analysing the latest data, the CDC researchers said that “China’s comprehensive HIV/Aids prevention and control strategy and its overlapping impact of pandemic control efforts” had helped drive down incidence and mortality rates.
But research suggests that the impact of the pandemic on HIV outcomes is worse than the CDC researchers suggest.
A study published earlier this year led by Lan Wang, Na Zhao and Yuliang Wang, researchers at Zhejiang University, Anhui Normal University and Nanjing Medical University, respectively, found that the average yearly mortality rate for HIV increased by about 14% in 2020-2022, compared with 2015-2019. “During the Covid-19 outbreak, access to essential, life-saving HIV drugs through hospital visits was severely compromised, exacerbating established HIV cases and increasing the risk of death,” the researchers concluded.
One area in which China has made striking progress in HIV surveillance and treatment is in testing. Annual testing increased from 45 million to 200 million between 2008 and 2018, as China tried to move towards the UN target of 90% of people with HIV knowing their status by 2020. And the scale and efficiency of China’s massive e-commerce industry means that self-testing kits are also more widely available in China than in many other comparable countries.
A study published in 2018 found that nearly 60% of men who have sex with men had never done an HIV test. But since then that share is thought to have fallen, because of the widespread availability of cheap, discreet at home tests.
However in recent years there has been growing concern that Beijing’s crackdown on civil society, particularly of LGBT+ groups, has hampered the ability of public health workers to reach groups most at risk of contracting the virus. Public health officials “cannot supplant the critical function of community organisers”, said Chuncheng Liu, a medical sociologist who studies HIV/Aids in China. “This isn’t merely because community members place greater trust in their peers, but also because maintaining a local community and conducting health outreach is a full-time commitment. It cannot merely be an added responsibility to the already packed schedules of public health officials.”
Access to HIV prevention methods, such as pre-exposure prophylaxis (PrEP), is also highly limited in China. PrEP reduces the risk of getting HIV from sex by about 99%, but only about 6,000 people in China are thought to be taking the drug, which was approved in 2020.
