A Big Shift for China's AIDS Fight: Condoms for Those Who Need Them
By NICHOLAS ZAMISKA and GEOFFREY A. FOWLER

BEIJING -- AIDS, which has long thrived quietly on the fringes of Chinese society among drug addicts and recipients of tainted blood donations, is on the verge of going mainstream here.

One major cause is prostitution, a booming industry in China that has helped make sex the most common form of AIDS transmission in China.

China's hopes of stopping the disease from turning into the country's next health crisis may rest with the efforts of people like Guan Baoying, a 56-year-old activist who has defied standard government attitudes about high-risk groups such as prostitutes.

As a Beijing health bureaucrat until last year, Ms. Guan managed to convince the government to support regulations that require hotels to supply condoms to their guests -- with the result that even in five-star hotels, condoms are a standard part of the minibar. Today, she leads the charge as the head of a nongovernment organization that helps fund outreach work with backing from the Bill & Melinda Gates Foundation.

China has a condom problem. A recent survey of six major Chinese cities by the Joint United Nations Program on HIV/AIDS, known as UNAIDS, found that just 54% of Chinese would use a condom if they had sex with a new partner.

UNAIDS estimates that about 700,000 people in China carry the HIV virus, though accurate figures are difficult to come by. "The epidemic is starting to generalize," says Li Dongliang, a district director of the AIDS program of the Center for Disease Control and Prevention in Beijing.

To fight the tide, Ms. Guan embraces an approach already proven to work in other countries: give condoms to the very people at high risk of spreading the disease. Tens of thousands of massage parlors and karaoke bars double as brothels, where businessmen and migrant workers can contract the disease and carry it to their hometowns and families.

"These sex workers are disadvantaged people in society," says Ms. Guan. "No one cares about them."

Ms. Guan has become a regular at brothels such as one near Beijing's Wangfujing shopping district. She is friendly with Sun Jie, a 37-year-old procurer who employs the other male prostitutes here. Above the bed in his tiny, cigarette-strewn hotel room hangs a framed photo of him and the matronly AIDS worker.

"We have learned a lot from Ms. Guan," he says. He holds up a box of Partner brand condoms and a yellow bottle of lubricant, which helps prevent breaks in the skin that allow infection.

Ms. Guan's first experience with AIDS came in the mid-1980s. As a member of Beijing's Center for Disease Control, she visited a patient dying from the disease -- one of China's first such cases. Fearing infection, she returned home from the hospital, stripped naked and sent her clothes to be cleaned.

Guan Baoying

As the years went by, Ms. Guan grew bolder in her approach to tackling the disease's spread. She visited detention centers in Beijing where arrested sex workers were held, and instructed women on how to protect themselves against AIDS. In July 2004, she rallied support from 12 government departments for a regulation that would expand the availability of condoms in Beijing. All of the bureaus signed a commitment, she remembers -- except for the Public Security Bureau, China's police.

"For the Public Security Bureau, their mission is to crack down hard on selling sex in society," she says. "This was a total conflict."

The bureau refused to offer formal support for Ms. Guan's plan, she says, but it didn't block it either. An official at the Public Security Bureau in Beijing who gave his name only as Mr. Zi declined to comment on the incident except to say the police have "nothing to do with condoms."

In March 2006, a regulation issued by China's State Council began requiring government-designated public places, including hotels, to install condom vending machines or otherwise provide access to condoms. This May, the city of Beijing went a step further, requiring that condoms be placed in all public places, including restrooms, karaoke parlors and big construction sites.

"It is by no means easy for Beijing to take this step, and I am very happy to see it happen finally," says Ms. Guan.

Her gains represent a significant shift in a country where, for decades, prostitutes were sent to re-education camps en masse.

Much of the country has yet to adopt Mr. Guan's focus on harm reduction, but her efforts received a big boost in 2007, when Bill Gates met with her while visiting a health center in Beijing. Impressed by the official's work, the Gates Foundation decided to adopt her model of prevention and outreach and replicate it in major cities across 12 provinces.

Ms. Guan retired last year as the head of disease control at the Beijing Municipal Health Bureau and today leads the Beijing office of the AIDS program of the Global Fund, an international public-private health charity that's partly funded by the Gates Foundation. She steers the process of awarding grants to grass-roots organizations in Beijing working to prevent the disease through education and other activities.

"We have done our best to make people aware of the importance of wearing condoms," says Ms. Guan, "but it's hard to judge how many of them will actually do it."

-- Marilyn Chase in San Francisco and Sue Feng in Beijing contributed to this article.