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HIV in China: Facts and Figures

China's 2012 AIDS Progress Report can be downloaded from the UNAIDS China website here.

China at a glance

 

Total population

1,347,350,000 (2011)

Annual population growth rate

0.48% (2010)

Population aged 15-65

1,002,830,000 (2011)

Percentage of population in urban areas

51.3% (2011)

Crude birth rate (births per 1,000 population)

11.9 (2011)

Under-5 mortality rate (per 1,000 children)

19 (2009)

Human development index (HDI)-Rank/Value

101/0.687 (2011)

Life expectancy at birth (years)

73.5 (2011)

Adult literacy rate (%)

94 (2009)

Ratio of girls to boys in primary and secondary education (%)[1]

103 (2010)

GDP per capita (PPP, US$)[2]

7,599 (2010)

Per capita total health expenditure (Int. $)[3]

221 (2010)

 

Overall HIV prevalence in China remains low – estimated at 0.058 per cent (0.046-0.070%) of the total population – but with pockets of high infection among specific sub-populations and in some localities.

 

HIV Estimation

     By the end of 2011, 780,000 (range 620,000-940,000) adults and children were estimated to be living with HIV, with 48,000 (range 41,000 – 54,000) new infections taking place in this year. Of the 780,000 people estimated to be living with HIV, 154,000 (146,000 – 162,000) were estimated to be living with AIDS. In 2011, there were an estimated 28,000 (25,000 – 31,000) deaths from AIDS-related causes.

     Of the estimated 780,000 people living with HIV, 63.9% were infected through sexual transmission, with 46.5% infected through heterosexual transmission and 17.4% through homosexual transmission. 28.4% were infected through injecting drug use; 6.6% were infected through contaminated blood transfusion; and 1.1% were infected through mother-to-child transmission.

     Of the estimated 48,000 new infections taking place in 2011, 81.6% were infected through sexual transmission, with 52.2% infected through heterosexual transmission and 29.4% through homosexual transmission. 18% were injected through injecting drug use and 0.4% through mother-to-child transmission.

     Of the estimated 780,000 people living with HIV, 28.6% were female.

 

HIV Reporting

     In 2011, the total reported number of new HIV infections was 39,183.

     In 2011, the total reported number of AIDS-related deaths was 21,234.

     Among reported cases, the proportion of cases resulting from sexual transmission increased from 33.1% in 2006 to 76.3% in 2011. The proportion arising from homosexual transmission increased from 2.5% in 2006 to 13.7% in 2011.

     By end-2011, the cumulative total reported number of PLHIV stood at 445,000.

     The cumulative reported number of AIDS cases was 174,000 and the cumulative reported number of deaths was 93,000.

 

Key At Risk Populations (KAPs)

 

 

Men Who Have Sex with Men

 

Epidemic

     Nationwide HIV prevalence amongst MSM was 6.3% in 2011, up from 5.7% in 2010 and just 2% in 2007;

     Of the estimated 48,000 new infections in 2011, 29.4% resulted from homosexual transmission;.

     A nationwide survey in 61 cities during Apr. 2008 to Sep. 2009 showed that the overall prevalence among MSM was 5% with big variations in different regions, i.e. up to 20% in some south western urban cities, 5-11% in Shanghai and its neighboring cities, 4.3-10% in Shenyang and its neighboring cities, and 4.6-8.3% in Beijing and Tianjin. The overall prevalence of syphilis, a marker for HIV risk behavior, has also been around 10%.

     HIV prevalence rates increased rapidly in some cities. For example, HIV prevalence in Chengdu increased from 0.6% in 2003 to 1.0% in 2004, 1.3% in 2005, 4.6% in 2006, 10.6% in 2007 and 12.9% in 2008; while in Chongqing, it increased from 10.4% in 2006 to 10.8% in 2007, 16.3% in 2008 and 19.2% in 2009.

     Cohort studies on MSM revealed that the annual HIV incidence rates are alarming high in some cities. For example, it reached 10 per 100 person year in Chongqing, 4.92 per 100 person year in Liaoning province. The syphilis incidence was as high as 27.58 per 100 person year in Liaoning.

 

Risk behaviors

     85% of MSM reported having engaged in sexual activity with multiple homosexual partners during the past 6 months;

     Only 43% of MSM report consistent condoms use during anal sex.

 

Prevention

     The China Country Progress Report 2012 reported that 76.7% of MSM had been covered by some form of preventive intervention in 2011, up from 75.1 in 2009.

     50.4% had received an HIV test during the past 12 months and knew their result, up from 44.9% in 2009;

     74.1% reported the use of a condom the last time they had anal sex with a male partner.

 

 

People who Inject Drugs (PWID)

 

Epidemic

     The cumulative number of registered drug users in China increased from 70,000 in 1990 to 1.15 million in 2008. According to estimates from 2009, drug users account for 0.09% of the total Chinese population.

     2009 Size estimate: 2.26 million (range 1.5-3.0 million)

     HIV prevalence amongst PWID in 2011 stood at 6.4% in 2011, down from 6.9% in 2009 and 9.3% in 2009.

     In some communities, such as Yili city, Xinjiang, as many as 89% of IDUs were HIV positive.

     Cohort studies in Xinjiang, Guangxi and Sichuan revealed that the annual HIV incidence of the 12 month cohort was 8.8%, 3.1% and 3.2% respectively.

 

Risk behaviors

     In 2011, 66.1% of PWIDs reported using sterile injecting equipment the last time they injected drugs, down from 72.9% in 2010;

 

Prevention

     By the end of 2011, 738 methadone maintenance treatment (MMT) clinics had been established in 28 provinces.

     The total number of people receiving MMT treatment was 140,000 in 2011;

     HIV incidence amongst people on treatment fell from 0.54% in 2009 to 0.30% in 2011.

     A total of over 900 needle exchange sites have been established in 19 provinces (or autonomous regions, municipalities), issuing a total of more than 12 million clean needles each year.

     40.4% of PWID received HIV tests in the last 12 months and knew their results (2011);

     43.7% reported using a condom during last sexual intercourse;

     66.1% reported using sterile injection equipment during their last instance of injecting drug use.

 

     Closed settings: In reports dating from 2006 it was estimated that some 140,000 drug users were held in 746 Compulsory Rehabilitation and Treatment Centers or Re-Education through Labor Centers. Drug relapse rate after release from closed institutions is very high with the national average drug relapse rate reported as high as 95% in 2001. Available data indicate HIV prevalence rates from zero to 4.2%. More up-to-date figures are not available in this area.

 

Female Sex Workers

 

Epidemic

     Nationwide HIV prevalence rate in 2011: 0.26%.

     In selected areas where HIV epidemic so far was mainly driven by drug injection, HIV prevalence is over 1%. For instance, HIV infection rates in sex workers reached 5% in 3 counties in Yunnan province.

 

Risk behaviors

     32% of sex workers do not consistently use a condom (2011);

     60% of SWs are not able to maintain consistent condom use with every sexual act (2011).

     Street-based FSWs are at greater risk. A survey of street-based FSWs in Sichuan found that they served 14.1 male clients per week on average, reported using condoms with 36% of clients in the last instance of sex. Among them, 37.2% were using drugs.

 

Prevention

     The China Country Progress Report 2012 report reported that 81% of sex workers had been covered by some form of preventive intervention in 2011, up from 74.3% in 2009;

     87.5% reported using a condom during the last instance of sexual intercourse;

     38.2% had received an HIV test during the past 12 months and knew their result, up from 36.9% in 2009.

 

Clients of Sex Workers

     Estimates from 2009 estimate the number of clients of sex workers as 26.5 million (range 17.3-35.8 million) and estimate HIV prevalence amongst this population to be 0.46% (range: 0.24-0.68%).

 

Low-risk Migrants

 

     While up-to-date estimates of the size of China’s rural-to-urban migrant population are not available, government statistics show that approximately 230 million[4] people were living away from their place of household registration (hukou) in 2011. Rural-to-urban migrant workers are likely to account for a substantial proportion of this group;

     Less than 2% have unemployment insurance and 80% without health insurance.

     A 2007 study of 3090 workers in Yunnan, Guangdong and Anhui by ILO and USDOL found that:

     Knowledge is poor: 45% unable to identify all three transmission modes. 95% unable to name all 6 non-transmission modes. 85% unable to name four preventative measures

     Stigma is pervasive: 1/3 showed totally un-accepting attitude to PLHIV; 77% would not accept services from PLHIV; 74% would not share a room with a PLHIV

     Risk behaviors are significant: 17.5% had engaged in casual or commercial sex; 49.3% used condoms during last casual or commercial sex. Younger, lower educated migrants had highest rate of casual or commercial sex – up to 40.2%

 

Testing

 

     In 2011, 14,571 medical treatment facilities at various levels, across China, carried out 84,210,000 HIV tests, identifying 74,517 new cases of HIV.

 

Treatment

     The total number of people receiving ARV treatment in China increased from 65,481 in 2009 to 126,448 in 2011;

     The proportion of reported adults and children meeting treatment criteria who were receiving antiretroviral treatment increased from 67.2% in 2010 to 76.1% in 2011; the proportion remaining alive and on treatment after 12 months increased from 82.3% in 2010 to 86.9% in 2011;

     The proportion of the estimated number of adults and children eligible to receive ART who were receiving treatment was 42%;

     2322 children aged under 15 were receiving treatment in 2011

     The proportion of patients alive after 12 months of treatment and remaining on ART increased from 82.3% in 2009 to 86.9% in 2011.

     By the end of 2011, 18,703 adults and 216 children were enrolled on second line treatment regimens.

     The proportion of people living with HIV and AIDS covered by follow-up interventions increased from 74.6% in 2009 to 91.9% in 2011.

     The proportion of PLHIV receiving CD4 testing increased from 54.2% in 2009 to 71.1% in 2011;

     35.6% of those reported co-infected with HIV and TB were receiving treatment for both HIV and TB in 2011;

     9.3% of those estimated co-infected with HIV and TB were receiving treatment for both HIV and TB in 2011;

     Drug resistance reached up to over 30% in provinces where free ARV treatment program began in 2003, for instance 30.3% in Henan province, 26.6% in Anhui province and 19.2% in Hubei province. It could be estimated that up to 8-10,000 patients would be requiring second line drugs in China.

 

Prevention of Mother-to-Child Transmission

     In 2011, HIV counselling and testing services were provided to over 8 million pregnant women, and testing coverage increased to 92.9%;

     The percentage of registered HIV positive pregnant women receiving ART for PMTCT stood at 74.1%;

     The percentage of estimated HIV positive pregnant women receiving ART for PMTCT stood at 35.6%, up from 13.5% in 2008;

     The proportion of HIV positive children receiving ART was 85.2%;

     HIV prevalence amongst children born to women living with HIV stood at 7.4%, down from 8.1% in 2009.

 

Stigma and Discrimination

     A high degree of stigmatization of people living with HIV exists in general population. A survey among 6000 people living in 6 Chinese cities in 2008 revealed:

     41.3% are unwilling or strongly unwilling to work in the same place as a HIV positive person.

     64.9% would be unwilling or strongly unwilling to live in the same room as a HIV positive person.

     47.8% would be unwilling or strongly unwilling to eat food the same place as a person living with HIV.

     63.6% would be unwilling or strongly unwilling to receive services, e.g. a haircut, from a person living with HIV.

 

     Stigma and discrimination experienced by people living with HIV is severe. The China Stigma Index survey conducted among more than 2,000 PLHIV in 2009 showed:

     32% of all respondents said that their status had been revealed to others without their permission.

     41.7% reported having faced severe HIV-related discrimination.

     More than 76% of all survey respondents said that their family members had experienced discrimination as a result of their HIV status.

     Since being diagnosed with HIV nearly 14.8% said they had been refused employment or a work opportunity because of their HIV status.

     Of those respondents with children, 9.1% said that their children, who were not necessarily HIV positive themselves, had been forced to leave school because of the HIV status of their parents.

     Termination of a pregnancy is regularly recommended to pregnant women living with HIV. 11.9% of women living with HIV who had partners since they were diagnosed with HIV had been pressurized into terminating a pregnancy by health staff.

     A substantial proportion of medical staff (26.0 percent), government officials (35.0 percent) and teachers (36.0 percent) changed their stance after learning of a person’s HIV positive status into a ‘discriminatory’ or ‘very discriminatory’ attitude.

 

     Institutionalised discrimination also constitutes an important obstacle to the AIDS response:

     China’s General Standards for Civil Service Recruitment Health Inspections stipulates that people diagnosed as HIV positive are automatically ineligible for employment as a civil servant.

 

Resources

     Available resources:

     Central government budget for AIDS response rose from 390 million Yuan RMB (~US$48.75 million) in 2003 to 2.2 billion Yuan RMB (~US$349.1 million) in 2011.

     Local investment increased from less than RMB 100 million (~US$12.5 million) in 2003 to 2 billion Yuan RMB (~US$317.4 million) during the period 2010-2011.

     External funding including funding for China’s AIDS response amounted to approximately 970 million Yuan RMB (~US$153.9 million) over the period 2010-2011.

 

Resource needs estimation:

     A total amount of US$2.8 billion will be required for a scaled-up, targeted and geographically prioritized AIDS response in China from 2010 to 2015 to cover 90% of MARPs (SW, IDU, MSM and migrants) with interventions and provide ARV treatment to 150,000 PLHIV. (Note: interventions for migrants, young people, the general population, and blood safety etc. are not included in this prioritized response).

     Available resources for 2010 to 2015 are estimated at US$2.28 billion.

 

 

[1] http://data.worldbank.org/indicator/SE.ENR.PRSC.FM.ZS

[2] http://databank.worldbank.org/ddp/home.do?Step=12&id=4&CNO=2

[3] http://data.worldbank.org/indicator/SH.XPD.PCAP

[4] http://www.stats.gov.cn/tjgb/ndtjgb/qgndtjgb/t20120222_402786440.htm

 

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