Here is an example of how care for HIV disease can be delivered far from a provincial capital. And to people who are not citizens. One wonders what the cost to the patient is for services.

I can't figure out what Dr Li means when he calls some people 'vagabonds'.

Jamie

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Clinic on frontier of AIDS care
Shan Juan
China Daily
Thursday, July 10, 2014, 10:07

Every third month, A Yu (not her real name) an ethnic Chinese from Myanmar who has full-blown AIDS, drives for 45 minutes to visit a clinic in Ruili, Yunnan province, where she replenishes her supply of medicine and undergoes medical checkups.

The neatly dressed 33-year-old contracted the disease from her late husband, who died of AIDS in 2004, and she has been receiving free antiviral medication at the Better Clinic on Guomen Street, Ruili, Yunnan province, for seven months.

Ruili, a county-level city in Yunnan's Dehong prefecture, is a major crossing point between China and Myanmar and sits directly opposite the town of Muse on the other side of the border.

A Yu pays a toll of 2 yuan (32 cents) every time she enters China via the Ruili checkpoint. "The free treatment really helps because I can't afford to see the private doctor in Myanmar anymore. That costs 2,000 to 3,000 yuan a month. The staff members treat me well, so I'll continue to get my medication here," she said, speaking on the condition that her real name would not be used.

She's one of 47 AIDS patients from Myanmar being treated at the Better Clinic. The three-room clinic, on the second floor of the Guomen Community Health Center, employs five staff members; two doctors; a nurse; a daily operations manager; and a Chinese-Myanmarese interpreter. The walls are painted light blue and decorated with paintings depicting natural scenery, meaning the place looks nothing like a typical Chinese hospital.

Operations manager Ren Guoliang said the clinic is treating 93 HIV patients from Myanmar, and those like A Yu who have full-blown AIDS are receiving antiretroviral treatment. The local health authority pays a subsidy of 20 yuan per patient per month for the follow-up checks, which include tests for CD4 (an indicator of immunity levels) viral load (a measure of the severity of a viral infection), and HIV screening and counseling for patients' partners.

"People from Myanmar get the same service as the 68 Chinese patients at the clinic," Ren said.

Li Zhoulin, deputy director of Ruili's Center for Disease Control and Prevention, said that since October the Yunnan Provincial Health Authority has been providing free AIDS treatment and follow-up checks for patients from Myanmar who face financial difficulties.

The patients include the spouses of local Chinese, plus some injection drug users, or IDUs, and sex workers who cross the border frequently.

"In many cases, the treatment for patients works as a preventative measure for other people, too," Li said.

Initially, the services were only available to Myanmar nationals married to Chinese citizens, but since the start of the year the program has been extended to needy patients who visit China regularly, or work and live in the country.

However, there are concerns about the delivery of the checkup services and patient management.

"Some, particularly the IDUs and vagabonds, are hard to contact, and treatment compliance is very difficult to ensure," Li said, adding that poor compliance, which leads to heightened resistance to medicines, can be fatal.

Jia Manhong, deputy director of the Yunnan provincial CDC, said about 100 people from Myanmar are receiving free antiretroviral drugs in Ruili, and now other border towns and counties, such as Xishuangbanna, Longchuan, and Mangshi, are following suit.

Official figures show that Ruili has 7,700 people with HIV - the second-highest prevalence incidence rate in China after Liangshan in Sichuan province - and 53 percent of the sufferers come from Myanmar.

"Things appears to be getting worse," Li said, noting that of the 508 newly diagnosed sufferers in Ruili last year, 80 percent were Myanmar nationals who work in the city.

"We have to do something to reverse the trend. It doesn't matter that the people are not Chinese," he said.

Luo Guangju, a 34-year-old from Muse who married a Chinese man and moved across the border in 2005, said the services are essential and greatly appreciated.

Luo discovered she was HIV positive in 2007 when she gave birth to her daughter at a hospital in Ruili. The girl has a clean bill of health, so far.

"I've been on ARV drugs at the Better Clinic for six months. I gained some weight after the medication and feel OK now. I live in China as a wife and mother, so it's difficult for me to go back to Myanmar for treatment," Luo said, smiling diffidently.

Her husband, a welder, only tested positive for HIV in 2009, when their daughter turned 2 years of age, and has been on treatment since. "He didn't care, and we had unprotected sex," Luo said.

The couple makes about 4,000 yuan a month, according to Luo, who said, "China has better job opportunities, so I think we will stay here."

http://www.chinadailyasia.com/chinafocus/2014-07/10/content_15148095.html