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MSF in China, 2005
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In China, an estimated 840,000 people are living with HIV/AIDS, although the actual number could be higher because only a small percentage of them have actually been tested and diagnosed as HIV-positive. Access to HIV/AIDS care is difficult for many due to China's market- oriented, fee-for-service approach to health care as well as ignorance, stigma and political sensitivity related to the disease. MSF provides care to HIV-positive individuals as well as emergency medical services for other vulnerable populations in China, including street children and flood survivors.
In early 2003, MSF began a comprehensive HIV/AIDS-treatment project in the city of Xiangfan in Hubei province. An estimated 45,000 people in this part of central China were infected with HIV through selling blood to illegal blood banks in the 1990s. At Xiangfan clinic MSF provides HIV-positive people with voluntary counseling and testing, care for opportunistic infections such as tuberculosis (TB), and treatment with life-extending antiretroviral (ARV) medicines. MSF is working closely with the Xiangfan Center for Disease Control to establish a model of care that can be replicated in other parts of China. As of July 2005, more than 300 patients were receiving care through the MSF clinic, and more than 90 of them were getting ARVs.
MSF is working to reduce stigma in the community and to improve support for HIV-positive people through the use of peer educators, support groups and community meetings. MSF staff are also helping to improve care for HIV/AIDS patients at area hospitals.
MSF also runs an HIV/AIDS project in the southern city of Nanning in Guangxi province. In operation since December 2003, the project had enrolled more than 400 patients, including 210 receiving ARVs, by August 2005. MSF offers comprehensive care including counseling, ARV treatment, care for opportunistic infections and specialized care for HIV-positive pregnant women and children. The MSF team is working actively with city and provincial health authorities to improve methods of diagnosis, treatment and management of HIV and related opportunistic infections. In conjunction with its HIV/AIDS projects in China, MSF is trying to remove barriers and improve access to essential medicines through advocacy and analysis.
Despite China's policy of providing free ARVs to rural and poor urban populations, access to certain drugs remains problematic. One impediment is that intellectual property laws block the use of three-in-one ARV fixed-dose combinations (FDCs) which MSF uses widely in other countries. These combination pills are among the main tools used in AIDS programs to simplify treatment, improve adherence and reduce the risk of resistance. Access to FDCs for treatment of TB is also difficult, so patients coinfected with TB and HIV can be faced with a large number of pills that must be taken at specific times every day. Moreover, most pediatric formulations of ARVs are not yet available. Difficulty in obtaining the right tools for treatment makes it harder to provide patients with an acceptable quality of care. An MSF team consisting of a pharmacist, government-relations liaison and a Chinese staff member works full-time to document and conduct advocacy about these issues.
Since March 2001, MSF has run a crisis center and shelter for children in Baoji, Shaanxi province, in collaboration with Chinese authorities. Some 20-30 children stay in the center at a time. Most of the youngsters have come to the center off the streets, where they collected plastic bottles for money and begged to survive. Abandoned by their families, sold into forced labor or left at a busy railway station, these children have been physically and psychologically abused or neglected. They arrive in need of psychological care and support, as well as food, shelter and medical care. After four years of operating the project, MSF has reached its program objectives. For example, authorities have altered laws that persecuted street children and are more aware of their problems. MSF will transfer responsibility for the project to another nongovernmental organization in January 2006.
In July 2005, MSF responded to flooding in the southern provinces of Guangxi and Guangdong, along the South China Sea. After a quick evaluation, the team found that most medical needs had been covered but that the local population desperately needed housing and emergency supplies. MSF staff distributed hygiene kits, cooking utensils, building supplies, plastic sheeting, clothing and blankets to more than 1,240 families.
MSF has worked in China since 1988.