Until recently, there was almost no access to medical treatment for people with HIV/AIDS in China. Those with access to one of the few hospitals in the country that will see AIDS patients and enough money to pay for expensive imported ARVs got drugs, but a lack of doctors with HIV/AIDS training and practical experience meant extremely few got anything like "good" medical care.

Last year, with much fanfare, China started producing copies of a number of ARVs. In all, four drugs - all of whose patents have expired or been relinquished by the original producers - are being produced in China: ddI; d4T; AZT; and NVP. However, what appeared a great victory last year – cheap, generic treatment – hasn't quite panned out. Desano Pharmaceuticals, for example, was tooling up to produce ARVs for tens if not hundreds of thousands of people. They had trouble getting rid of the 5000 person supply they did produce in 2003, and 2004 isn't looking much better.

So what happened? Why have the drugs not been a hot commodity in China? Aren't there a million or so people living with HIV, many of whom need treatment? There are a number of factors: China's medical system is largely profit-driven, and poor farmers cannot afford even generic ARVs; Very few doctors in China are familiar with the complex treatment regimens that HIV/AIDS patients need; Anonymous testing is still a problem in China, and with intense discrimination against people with HIV many do not dare be tested even if they suspect they might have engaged in "high-risk" behaviour; and last but not least, the generic combinations available in China are in fact, in the words of Shen Jie, the Vice-Director of the Chinese Center for Disease Control, "not very ideal".

The missing meds
"Not very ideal" is an understatement. China currently produces two combinations: ddI-d4T-NVP and AZT-d4T-NVP. Missing from these combinations is the drug that nearly EVERY other country uses in its first-line treatment programs, Lamivudine (3TC). In fact, the US NIH recently advised that ddI-d4T is NOT recommended as a combination due to severe toxicities. Indeed Chinese patients who went off the treatment have complained about side-effects. (viewNIH treatment guidelines pdf)

Access to essential medicines is a big issues these days, and the best documents on global prices of ARVs (which after all is one of the main obstacles to access) is from MSF (Medecins Sans Frontieres) (view pdf), also available in Chinese (view pdf). Note: This document does not yet include the latest round of price drugs negotiated by the Clinton Foundation.

In late 2002, a WHO expert team visited China and prepared a report on how China should "scale up" access to ARV treatment. Its report is an excellent discussion of the challenges facing China in providing treatment to people with HIV/AIDS. Basically, the report advised that China pursue compulsory licensing (view WHO report)

Scholars from ARNS (National Agency for Research on AIDS) were in Beijing recently. They worked with Brazil when that country took on the big pharmaceutical companies, and now appear to be advising China to do the same. Link to ARNS report on "Economics of Access to HIV/AIDS care" (http://www.anrs.fr/index.php/article/articleview/955/1/317 )

There are many issues surrounding 3TC, patents, and drug access in China. China AIDS Info has prepared a "ARV Access Fact Sheet" to try to clarify some of these issues, to explain how multinational pharmaceutical companies are preventing access through pricing and marketing strategies, and how China has the ability to produce the drugs at a fraction of the cost.
(view http://www.china-aids.org/english/factsheet-ARV.htm )

Compulsory Licensing
There is a lot of talk these days about compulsory licensing of HIV/AIDS drugs in China. The government has been negotiating for years with GSK and other pharmaceuticals, but is also taking its commitments to WTO rules quite seriously. It remains to be seen what course the top leaders will choose, and whether the mere threat of compulsory licenses will be enough to reduce prices to an 'acceptable' level, as happened in Brazil. A couple non China-specific links:
WTO TRIPS post-Cancun site (http://www.wto.org/english/tratop_e/trips_e/public_health_e.htm )
Consumer Project on Technology (http://www.cptech.org)

Testing and treatment centers
China is in the process of setting up a number of new testing and treatment centers. There are a number of hospitals in big cities around China that are meant to test for HIV and accept HIV/AIDS patients, but most people seem to have no idea where they should turn for testing, counseling, or treatment.
*National Center for STD/AIDS Control and Prevention at the Chinese CDC has links to a number of local CDC offices and testing centers in China available at (http://www.chinaids.org.cn/index_fwxx.asp )
*China AIDS Info page on HIV testing in China (view)

Global Fund
China's application for more than 98 million USD for HIV/AIDS work was recently approved by the Global Fund. The final work plan to use that money is now being prepared. The "China Cares" program will likely serve as a blueprint, but a more aggressive attitude among health officials may see much better plans overtake the original program.
*View China AIDS Info on China's global fund application (view)
*View China's original Global Fund application here (view)
*Link to National Center for AIDS Control and Prevention website (http://www.chinaids.org.cn )

Training for docs and staff
There is a huge need for training among front-line medical staff in China, both in terms of technical skills and in order to eliminate the discrimination that pervades the profession. While many have heard about ARVs and even understand their use in theory, very few doctors have experience actually treating HIV/AIDS patients, identifying opportunistic infections, and dealing with the side-effects of ARV regimens. It is this practical experience that is most needed in China, not mere 'book learning'.
*Global Fund plans include millions of USD for professional training
*Harvard doctor/admin training project (http://aids.harvard.edu )
*The government-run Hong Kong Red Ribbon Centre (http://www.info.gov.hk/aids/english/rrc/index.htm ) or http://www.info.gov.hk/aids/ ) is offering practical training to Chinese doctors on various aspects of HIV/AIDS, and is working with Hong Kong University on a certificate program in "HIV Management" (http://www.hku.hk/space/div_hs/progs_curs/hs40-102_103-00.html )

NGOs and others
Many NGOs, semi-government bodies, and government departments are doing a lot of treatment and training work, and we can expect to see a huge increase in such projects now that the topic is becoming 'safe' for government officials to address.