Hospitals In China Find Profit In AIDS

The AIDS crisis has exposed how local profit-seeking is undermining central government initiatives. Until recently, AIDS was a taboo subject, with many doctors refusing to diagnose it. Prevention work was minimal because of discomfort with discussing sex and the Communist Party's unwillingness to acknowledge an explosion in prostitution.

But in the past two years, President Hu Jintao and Premier Wen Jiabao have made high-profile visits to AIDS patients in hospitals, and educational billboards are increasingly visible. Backed by a $95 million grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the government launched the drug program, aiming to supply 30,000 people with free anti-retrovirals by the end of the year.

About 2,000 of the 19,000 patients who have received free drugs have stopped taking them because of side effects such as low blood pressure, insomnia, and nausea, according to medical experts. In many areas, the campaign is encountering resistance from doctors who would rather prescribe expensive medicines than give away something for free.

"The reform process has made hospitals into clubs for the rich," said Zhang Ke, an AIDS specialist at Beijing Youan hospital. "If the hospital is focused on making money, why would they tell anyone about these free drugs? There's a basic conflict of interest."

The effort here in the southwestern province of Yunnan is a test of the state's resolve. Near the meeting point of Burma, Thailand and Laos, a major source of opium, Yunnan has many intravenous drug users. The sex trade has flourished here with the growth of organized tourism. Yunnan was among the first provinces opened to foreign aid groups such as the Clinton Foundation, which is dispensing free anti-retroviral drugs to children.

Until this year, Cai, who agreed to speak on condition she be identified by her last name alone lest she jeopardize her access to care, knew little about AIDS. In April, she landed in the hospital with pneumonia. On the way out, one of the doctors took her aside.

Was she a drug user? No. Had she had a lot of sex partners? No. She was 34 years old and married, the mother of two boys. She ran a stall selling clothing. She had no insurance. She had tested positive for HIV, the virus that causes AIDS.

"I collapsed," she said. "I couldn't breathe."

Her husband confessed that he had been cheating, she said. She left him, but he forced her to give up the children, she said. An aunt reluctantly took her in, though Cai was not allowed to use the bathroom or eat with the family.

On May 25, Cai went for treatment to the Number Three People's Hospital special AIDS ward. She received an X-ray and an ultrasound. The radiologists whispered that they should not touch her. "She's got that disease," she heard one doctor say.

She surrendered a $375 deposit, nearly all the money she had. They gave her a bed in a room with three other women. The toilets were filthy. Bowls of rice contained sand and worms. Trash piled up. Bed sheets went unchanged.

After a week, the hospital told her that her money was used up and demanded more. She told them she couldn't afford to stay.