The [him] moderator is loathe to post yet another ‘AIDS Road’ story: they often simpify the complex dynamics of epidemics. How does sex travel along a road? Why is Riuli labelled ‘ground zero’. And why is there no mention of the presence of Myanmar sex workers there? Read on anyway …

China combats spread of AIDS along historic Burma Road
Truck Routes In Africa, India Similarly Propelled Epidemic
Evan Osnos
Chicago Tribune
5 February 2006

RUILI, China - This ancient road has had many names: Old tea horse trail. The Burma Road. Route 320. But the label that matters most today is one that appears on no sign at all: the AIDS road.

Past truck-stop brothels and through disease-ravaged cities and villages in China's far southwest Yunnan province, this two-lane road carves the path of an HIV epidemic that is growing faster than international health officials previously thought.

This is the main road through the epicenter of AIDS in the world's most populous country, where a new national study shows that 200 people are being infected every day. It is a central artery through which sex, drugs and trade are spreading the virus into previously untouched swaths of the population, researchers say.

There are ominous precedents. Key trucking routes like this helped spread AIDS to tens of millions of people in India and Africa, the world's worst-hit regions, starting with drug users and prostitutes, then truck drivers and, ultimately, their families. As China's surging economy fuels the construction of thousands of miles of new roads, health officials, activists and front-line doctors are racing to curb the Chinese epidemic before a similar explosion occurs.

``Most Chinese people still think that only drug users and sex workers are affected,'' said Wang Jing, an HIV counselor in the provincial capital, Kunming, ``but the fact is that the disease has begun affecting everyone.''

In confronting the epidemic, China has made strides in embracing foreign aid, tackling drug abuse and providing medical care, AIDS experts say. But life along the road also illustrates how a shortage of state funds, the stigma surrounding the virus and widespread public misunderstanding of its spread into the wider population are threatening efforts to control the epidemic.

The largest-ever survey on AIDS in China, released Jan. 25, showed that the rate of infection is rising, with 70,000 new cases reported last year. More important, the joint study by China, the World Health Organization and the United Nations' AIDS program found that the disease is moving into the general population, with a growing share of infections in pregnant women and the spouses of men who visit prostitutes -- warning signs of a widening epidemic.

``Sex work is moving it toward the general population,'' said Henk Bekedam, the China representative for the WHO. The new infection rate, he said, showed the situation in China was ``more serious than we thought.''

Ground zero of China's AIDS epidemic is this remote border town, where Route 320 begins its 500-mile journey north to Kunming as an inconspicuous ribbon of dirt veering over the sleepy boundary from Burma, also known as Myanmar.

Ruili has a reputation as China's gateway to Southeast Asia, where explorers, armies and criminals have gravitated for centuries to swap jade, arms and poppies. Some of China's earliest AIDS cases were found here in 1989, and by the mid-90s the mix of Chinese and Burmese heroin addicts and prostitutes accounted for more HIV cases than any other city in the country. When the government vowed to strike hard against prostitution, police simply closed the karaoke bars and ``hair salons,'' sending sex workers into even darker corners of society and doing little to combat HIV.

But today Ruili illustrates China's efforts to stem the epidemic. The government has opened 10 methadone clinics to help wean addicts from heroin, and foreign-aid groups are now permitted to promote testing and condom use among prostitutes.

But China's challenge has moved beyond simply high-risk populations. The task today is educating a population that still misperceives the virus as the exclusive scourge of drug addicts and prostitutes.

The recent study estimated that China has 650,000 HIV/AIDS cases, revised from rougher estimates of 840,000. That change only reflects a better measure of how many people were infected in a limited outbreak tied to a blood-selling scheme. As the study's authors cautioned, ``those new numbers should not mask the fact that HIV infections are on the rise.''

That rise reflects in part the rapid growth of prostitution during two decades of economic reform, which have fueled unemployment and sent millions of peasants migrating in search of work. Chinese authorities estimate there are 3 million to 4 million women working as prostitutes in so-called karaoke bars, hair salons, massage parlors and truck stops.

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