Doctor Wages Lonely Battle Against AIDS in China

QINGDAO, China â€”  Shut up in his tiny, smoke-filled office, Zhang Beichuan sits hunched at his desk, editing a small but groundbreaking magazine.

It has an innocuous title--Friend Exchange--and an even more innocuous look. Articles are printed on plain white paper. There are no photos, no fancy graphics, no splashy ads. It’s about as visually appealing as an address book.

But inside every issue is a page that Zhang hopes will save lives. Its content is always the same: a primer for gay men on how to avoid AIDS. Use condoms. Don’t mix sex with drugs and alcohol. Fewer partners means less risk.

The advice sounds painfully basic to anyone from the West. But in China, for all the social change of the past 20 years, such information is scarce, fueling ignorance and misconceptions that experts fear may precipitate a health crisis in this country’s gay community.

The community is at high risk for AIDS but has been neglected by the government and the public, even as attention begins to focus on the spread of the disease in China.

Newspapers highlight the plight of needle-sharing drug users who contract HIV, hospital patients infected through blood transfusions and poor farmers afflicted after selling their blood at unsanitary collection stations. China’s top health official said recently that at current infection rates, the country could have 10 million people with HIV or AIDS by 2010.

But amid the media coverage, almost nothing has been said about acquired immune deficiency syndrome’s inroads among gay men. The taboo against talking about sex in general and homosexuality in particular remains a block against getting information to those in need.

Only a handful of people are trying to break the silence. Even the China Society for the Prevention of AIDS and Sexually Transmitted Disease, composed of officials, doctors and researchers, stays relatively mute on the issue of gays and the disease.

“The people in that circle know that gays are a high-risk group. But you won’t find 10 of them who are actually taking action and working with the gay community,� said Zhang, a physician who gave up a dermatology practice to promote AIDS awareness.

“I really do feel lonely at times,� he added.

No one knows how many gay men in China are infected with AIDS or with the human immunodeficiency virus, which can lead to the disease. Of all registered cases--which are but a fraction of infections--less than 1% are attributed to homosexual activity.

Infection Rate on Rise Among Gay Men

But no one doubts that the figure does not reflect the extent of the problem or that the infection rate among gay men is climbing, especially in major cities.

At the two hospitals in Beijing known for treating venereal disease, one-third of all AIDS patients are gay men, said a Western researcher with a foreign-funded AIDS project in the capital.

Last October, a measure of government recognition came when a senior health official acknowledged that homosexuals were at risk, adding that the number of gays in China was “alarming.�

Yet state-supported education and prevention efforts targeted at gay men is rare.

Zhang’s bimonthly magazine is the only publication in China directed at the gay community. Its modest funding comes from the New York-based Ford Foundation. Each issue contains articles, essays and letters on homosexuality--stories about coming out of the closet, scientific studies, news around the world affecting gays and lesbians.

At least 10 pages in every edition deal with AIDS, including the guide to safe sex directed at male readers. Lesbians in China, as elsewhere, have a lower risk then men of contracting AIDS.

“We’re still trying to put out basic information,� Zhang said one recent morning, the proofs of the latest issue of Friend Exchange cluttering his desktop. “Our volunteers tell us we need to keep repeating the ABCs.�

From his cramped, rather dilapidated office in Qingdao, the port city famous for its Tsingtao beer, Zhang’s journal rides the roads and rails to most of the nation’s major cities through a network of committed volunteers. Between 7,000 and 8,000 copies are distributed every other month and reach more readers than those numbers suggest, but still just a tiny sliver of a gay population estimated in the tens of millions.

Not everyone appreciates his work. A few months ago, some neighbors flung a bucket of human waste at his office door, apparently upset by the visitors and volunteers who come calling, whom they assumed to be AIDS carriers.

But a hutch in the corner of his office attests to the impact of Zhang’s magazine. Stuffed into drawers are thousands of letters from readers who are grateful to discover that they’re not alone, who vent their despair at their isolation--usually in China’s countryside--or who ask for medical advice. At least one is a suicide note that had Zhang phoning around in an unsuccessful bid to locate the writer. Zhang tries to answer every letter he receives.

“He’s doing a remarkable job. . . . He showed that it is possible� to reach gay men in China, said Dr. Emile Fox, the director in China for UNAIDS, a United Nations program. “Otherwise, there is very, very little being done.�

The lack of outreach is part of a larger pattern of, at best, piecemeal and superficial government efforts to combat the epidemic or, at worst, official indifference.

In a still relatively poor nation of 1.3 billion people, AIDS prevention and education programs remain pitifully underfunded and understaffed. The resources of the Ministry of Public Health have been stretched paper-thin as the nation’s once-sturdy social safety net unravels amid market reforms.

At the same time, the number of people infected with AIDS or HIV has soared. Unofficial estimates put the total at more than 1 million.

Last fall, the government recorded a 67% jump in reported HIV cases in the first half of 2001, compared with the same period the year before. In response, health officials pledged to spend $12 million a year on AIDS prevention and control.

By contrast, the United States allotted $767 million last year for prevention in a country with one-fifth the population of China. In addition, Washington shelled out more than $100 million for global efforts to combat HIV and AIDS.

To reach homosexuals in the U.S., officials can tap into a well-established infrastructure of gay organizations, support groups and publications.

In China, such a visible network does not exist. There is only a loose, informal sodality of friends and acquaintances who congregate in a few gay bars, saunas and public parks. Few men live openly gay lives for fear of ostracism.

At an AIDS conference in Beijing last October, some doctors expressed their willingness to work with homosexuals but said they had no idea how to recognize or find them. Of about 20 gay listeners in the audience, only one finally stood up and identified himself as a gay man, according to people who attended the meeting.

“Until a few years ago, a lot of people thought that China had no homosexuals,� said Xiao Ya, an activist who runs a nationwide hot line for fellow gays and lesbians.

Pamphlets, Seminars Help Spread Awareness

He and his associates do their best to spread the word on AIDS. They’ve printed up pamphlets and left them at bars. They hold seminars. Volunteers sometimes deliver free condoms to bathhouses.

Knowledge about AIDS seems to be spreading, Xiao said, but not everyone practices what they know. And some of what they know is downright wrong.

“A lot of people think that having sex with a foreigner is how you get AIDS,� Xiao said. “They think they’re safe because they’ve never been with a foreigner.�

In a small-scale study conducted in Beijing two years ago, Kyung-Hee Choi, a medical professor at UC San Francisco, found that half of the gay and bisexual men she surveyed did not practice safe sex.

Now, Choi is about to discover the consequences of such laxity, through a study of 500 gay and bisexual men in Beijing that will show the prevalence of HIV infection among them. The rate could turn out to be as high as 4% to 5%, say people familiar with the survey.

“I’m kind of scared to find the results of my study, to be honest,� Choi said. “I don’t really think that gay men in Beijing have a sense of crisis. They think that AIDS is a problem for IV drug users and farmers who give blood.�

Activists and researchers report a worrisome attitude among many gay men, an almost blase fatalism that sees no point in getting tested for HIV or modifying behavior. Free, confidential HIV screening is almost unheard of, and effective AIDS medications cost a fortune by Chinese standards, even after the price was slashed recently from about $1,100 a month to $365.

“I don’t know anyone who has the disease,� said Fei Yu, 25. “But my friends and I have all decided that even if we suspect we have it, we won’t go to the hospital. We’ll save the money for a little more fun in our shortened lives.�

Others fear going to physicians only to encounter judgment and hostility. Although homosexuality was declassified as a mental illness by the Chinese Psychiatric Assn. last year, old attitudes die hard. A recent newspaper article quoted a psychiatrist as calling gays and lesbians perverts.

Such prejudice was what galvanized Zhang, the Friend Exchange founder, into action.

In 1989, he watched in disbelief as his mentor, another dermatologist, suffered abuse and harassment from colleagues who had found out that he was gay. Zhang, who is heterosexual, knew little about homosexuality but considered his mentor a decent man and refused to take part in victimizing him. That in turn made Zhang an object of criticism.

Out of the experience, Zhang published a book five years later titled “Homosexuality,� a compilation of essays. He admits now that some of the book’s contents were somewhat negative--his views have evolved over time--but it did conclude that “our society must treat gay people equally.�

Friend Exchange was born in 1998, funded at first by three gay men who asked Zhang if he would do something to help combat AIDS in the gay community.

Now, Zhang runs his operation on the strength of a three-year, $120,000 grant from the Ford Foundation awarded in 2000--and on the stream of cigarettes he smokes.

“As long as there’s enough money, I’ll keep on doing it,� he said. “As a dermatologist, I made a difference, but I saw only a small number of patients. But as an AIDS expert, I can have an impact on a lot more people.�