Historical Foundations and Future Directions of China's HIV/AIDS Strategy

Though much progress made in past 30 years, with over 2.5 million infections and close to 2 million deaths each year, AIDS remains a big challenge. There is a striking overlap between the global map of human development index and HIV prevalence, which indicates that just tackling the epidemic’s surface with medical approaches without vigorously addressing its social and economical roots will not stop AIDS. In 1950s, China successfully conducted STDs eradication campaign with a dual strategy of combining medical approaches, such as diagnosing and treating all patients free of change, with strong social interventions, such as closing brothels, providing alternative jobs and community support for all prostitutes. In about 10 years, China had virtually eliminated STDs in the country with syphilis dropping from over 10 % to 0.004% in dermatology patients.

This comprehensive approach has lessons for contemporary HIV/AIDS prevention and control strategies nationally and globally.
Liangshan is a remote mountain ethnic residents region with the highest HIV prevalence in China. To better control the epidemic, we propose a new model of rural economical enterprise ( REE), where jobs in agriculture and manufacture will be provided through government subsidization and combine with centralizing healthcare at working place. We then build a mathematical model with basic reproduction number R0 matched to the local epidemiologic parameters and simulated it to representing the past epidemic. The mode is then used to test various control strategies and predict their results.

In REE model, economic reasons driving migration and contributing to poor compliance to antiviral treatment and drug abuse interventions are removed. The efficacy of existing care and interventions is greatly improved, while program running costs are significantly reduced. The R0 under current control strategy in Liangshan is likely between 2 and 3, indicating a sustained and growing epidemic. Under the REE model however, the number of new infections declined dramatically within 5 years and falling to baseline after 10 years. In REE model, no major difference is seen between immediate therapy or treatment at CD4 count 350.

In a survey conducted in 3 counties of Lianshan, 73.9% to 84.7% of the 1000 HIV positive and negative drug users are willing to work in REE and participate the prevention care program. With support from local and central government, the REE model is moving into pilot trial.