*EPF206 07/23/2002
U.S. Launches New Initiatives to Help China Combat HIV/AIDS
(One unprecedented effort covers five different projects) (1229)

By Nadine Siak
Washington File Staff Writer

Washington -- U.S. officials have announced two initiatives to combat what the United Nations calls the "Titanic" threat of HIV/AIDS in China. The initiatives involve both monetary grants and the sharing of expertise in controlling this deadly disease.

Many experts estimate that there are more than one million HIV-infected persons in China, which translates into a possible 100,000 people there developing AIDS every year in the near future. The Chinese Ministry of Health itself has estimated that a total of 10 million people could become infected with HIV by 2010 if countermeasures are not taken.

The first new U.S. initiative is a $14.8 million grant from the National Institutes of Health (NIH) through its National Institute of Allergy and Infectious Diseases (NIAID) to China's Center for Disease Control and Prevention (CDC). The grant is targeted at helping the Chinese government improve its infrastructure, research and treatment of patients with HIV/AIDS. This new five-year award is known as CIPRA, for "Comprehensive International Research on AIDS."

Dr. Rodney Hoff, a senior epidemiologist at the NIAID and the CIPRA coordinator, says that U.S.-Chinese cooperation on HIV/AIDS has been going on for some time.

For example, he says, "there's a long-standing research exchange program between U.S. and Chinese institutions," and there has been active Chinese involvement in a NIH-sponsored multi-site international clinical trials group called the HIV Prevention Trials Network. In addition, there have been individual U.S. grants and "a few scattered projects" set up by the U.S. government in China, according to Hoff.

"Programs like CIPRA," Hoff says, "expand that dramatically, making it a worldwide, international collaboration that the Chinese are now participating in a major way."

The CIPRA grant, however, is in a league of its own, Hoff says, because it covers five separate but related projects.

For example, one CIPRA project will compare different behavioral intervention options in China -- such as ways to encourage a reduction in the number of a person's sexual partners -- to lower the risk of infected people transmitting HIV. A complementary project will look at epidemiologic and transmission factors of HIV/AIDS in Yunnan and Shanxi provinces, and will focus particularly on the potential to spread HIV/AIDS from the high-risk groups into the general Chinese population.

Hoff says in China, just as in the United States, one of the most frequent modes of HIV transmission has been through the sharing of contaminated needles among intravenous drug users. Geographically, the worst affected areas are in the southwest of China, bordering the Golden Triangle, and along drug trafficking routes. This fact is why the southwest Chinese province of Yunnan was chosen for this study; according to the recent U.N. report, HIV is now found in all 15 prefectures and the 88 counties of Yunnan province. The rate of HIV infections among intravenous drug users there often reaches above 50 percent -- and in some parts, it even reaches as high as 80 percent.

Shanxi was chosen, Hoff says, because of a particularly Chinese HIV/AIDS phenomenon: HIV transmission through rural farmers selling their plasma to commercial blood processing companies.

Until recently, blood in parts of China was often collected from many donors and mixed; the pooled plasma was separated from the red blood cells, and then the red blood cells were re-injected back into the donors. If just one paid donor was infected with HIV, a large number of fellow donors would become infected at a single reinfusion session. It has now become widely known that many Chinese villagers, maybe hundreds of thousands, contracted HIV in this way.

According to Hoff, the CIPRA-funded epidemiological study of former blood plasma donors will be unique in exploring the potential of the spread of HIV to the general population through sexual transmission from those people infected through plasma donation.

What is particularly interesting, Hoff says, is that although some of the commercial blood processing companies were linked to local government officials, "this (study) was proposed by the Chinese CDC ... they wanted to try and address this issue" even though it is a politically sensitive one in China.

The CIPRA grant will also fund a basic clinical research study to examine the variety of HIV sub-types circulating in China and their natural history. It will also support development, and possibly production, of a HIV/AIDS vaccine in China.

Hoff notes that there are already vaccine candidates lined up for testing, some designed by Chinese researchers in conjunction with U.S. organizations such as the vaccine center at the National Institutes of Health (NIH).

The fifth CIPRA project will focus on drugs to treat those infected with HIV/AIDS. CIPRA, Hoff says, will "pilot" the introduction of antiretroviral drugs in China. Antiretroviral drugs are substances used to kill or inhibit the multiplication of retroviruses such as HIV. The project will also look at the interaction of these drugs with traditional Chinese medicine, both from a safety standpoint and an evaluation of their possible effectiveness.

The second new U.S. HIV/AIDS initiative with China involves the U.S. and Chinese Centers for Disease Control and Prevention. Two experts from the U.S. agency will be assigned to the Chinese CDC to help provide local governments with assistance in responding to the HIV/AIDS epidemic.

The long-term goal of this collaboration is to provide financial and technical assistance on HIV prevention, HIV/AIDS care and treatment, surveillance and capacity building. Early activities will include joint surveillance and laboratory assessments, consultation on HIV counseling and testing, and early planning for a national Chinese HIV/AIDS public health training system.

More information about CIPRA is available at: http://www.niaid.nih.gov/factsheets/cipra.htm

The complete U.N. report, released June 2002 and entitled "HIV/AIDS: China's Titanic Peril," can be found at: http://www.unaids.org/whatsnew/newadds/AIDSchina2001update.pdf


(The Washington File is a product of the Office of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)

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