"It never occurs to you that you might have AIDS," said Manchester.
Most people infected in China do not know.
The number of cases detected every year is rising. A few years ago, the average
number of new cases detected in Shanghai was between 60 and 70 per year. In
2002 there were about 100 and that almost doubled in 2003. By 2004, the number
of new cases was up to 239.
That is the number of known cases, said Pan Xiaozhang, an HIV/AIDS specialist
at Huashan Hospital in Shanghai.
"We don't know about most cases of infection."
He estimated there could be between 8,000 and 10,000 other cases in Shanghai.
"I think the situation is not good. Just according to my information, the
number of undetected infections is getting higher.
"I think transmissions through (unprotected) sex is the major road.
"The situation is different from Sichuan and Yunnan provinces where most people
were infected by intravenous drug use.
"In Shanghai, prostitutes and people who (use) prostitutes are most
vulnerable."
Although a large portion of China's infections were the result of tainted blood
donations or transfusions and, later, intravenous drug use, most new cases are
now the result of unprotected sex.
Condom use in China is still not common and prostitutes can earn up to 60 per
cent more money for providing unprotected sex, according to studies by UNAIDS a
United Nations project on HIV/AIDS.
The groups traditionally identified as vulnerable in China - migrants and
prostitutes as well as poor people who donate blood in exchange for money - all
have programmes in place to help curb the spread of the disease.
Fears the floating population of migrant workers might be the biggest threat to
China's cities first started to surface about a year and a half ago. There is
therefore a lot of work being done to control the spread among this group and
much of it is working,
But more affluent groups may be beyond the reach of such programmes. They are
rarely tested and, in all the literature available, they are seldom mentioned.
"The data never analyses this. I think it's a problem," said Pan. "I think we
should look at this question."
Awareness of HIV/AIDS in China is growing, if slowly, and the number of
programmes to help people living with the disease is growing every day. At the
same time, prevention efforts have gone a long way to largely keeping the virus
out of urban centres.
Since the first case of HIV was uncovered in China in 1985, the virus has
spread to every province. Still, in big cities like Shanghai, the reported
numbers have been relatively small.
In Shanghai, since the virus was first detected in 1987 up until 2004, there
have been 1,150 officially detected cases. Given a population that tops 12
million, the incidence is less than 0.01 per cent.
That's the number of known cases. But UNAIDS studies have shown about 90 per
cent of those infected in China are unaware.
Most of these affected people are migrants or prostitutes, but programmes
already in place to control the epidemic among these groups are already having
some effect. That leaves another open question.
"Everybody has been assuming that the big problem is the migrant workers moving
into the cities, but we disagree vehemently," said Manchester.
At the same time, it is the more affluent section of the community that is more
likely to have unprotected sex or buy the services of prostitutes.
Most of the data available on mobile men with money is anecdotal and the fears
among workers are educated guesses at this point, but it is difficult to ignore
the numbers.
Household surveys carried out by UNAIDS and Futures over the past few years
show that between 5 and 10 per cent of men in Asia buy sex.
According to UNAIDS's estimation, 20 per cent of some 6 million prostitutes in
China do not use condoms.
Men in the upper 5 per cent of income earners are 33 times more likely to use
prostitutes than people in the lowest 40 per cent, according to a study
commissioned by the Futures Group and carried out by Horizons research.
At the same time, said Manchester, data has shown that men who are away from
home more than five days a month are much, much more likely to use prostitutes.
"The propensity to use prostitutes shoots through the roof," he said.
Plenty of programmes are available for migrant workers but they are much less
likely to have the funds to use prostitutes than business people out for
meetings away from home.
At the end of a hard day's work, they want to be fed, they want a shower and
they want to go to sleep, said Manchester.
Business people, on the other hand, have late night dinners with colleagues
and, as often as not, cap those off with obligatory toasts that sometimes lead
to visits to massage parlours, KTV establishments or bathhouses where
prostitutes are available.
The lack of hard statistics is a problem. There is "no formal survey of this
kind of group," said Wu Zunyou, a doctor at the China Centre for Disease
Control and Prevention.
It is a highly sensitive topic and the government only knows about this group
through their use of sex clinics.
Mobile men with money are on virtually nobody's radar right now.
The responsibility for finding solutions may rest with the corporations that
employ many of these men.
A Global Business Coalition focusing on HIV/AIDS already exists. It uses
business resources to tackle the spread of the disease.
"Mobile men with money are usually working with somebody and, if they are
working for somebody why can't we get something going," said Manchester.
The coalition met representatives from the Ministry of Health in March. At the
time, a consensus was reached to work together to find ways to fight the
disease.
Efforts to unite the business community have been reasonably successful in
Beijing, said Bill Valentino, Bayer's manager of public relations and the
coalition point man in China.
"There's a lot more engagement in Beijing," he said.
What is needed, said Valentino, are corporate policies to protect employees and
give them the privacy they need to get tested without fear of repercussions.
"Here, when you talk to an employer, there is no guarantee of what may happen,"
he said.
"You don't know where the information is going. It's a very big issue."
