For most HIV/AIDS sufferers in China, the free medication scheme initiated last year brought a ray of hope.

Yet for others, the strong side effects triggered by the medicine eroded their enthusiasm for the government’s effort to combat the deadly virus.

Last July China started to provide free anti-retroviral drugs that hold AIDS at bay for all HIV/AIDS sufferers in rural areas, and for those in urban areas who are not covered by medical insurance and lack the economic means to pay for treatment.

At present, more than 6,000 HIV carriers are receiving regular treatment, said Hao Yang, with the HIV/AIDS division of the Ministry of Health.

“It is a rare practice in the world to provide free medicines for HIV/AIDS patients,” said Zhang Ke, an HIV/AIDS doctor from Beijing You’an Hospital, who has been engaged in related clinical treatment and training in Henan villages since 1999.

In Henan’s Xincai County, where the virus has claimed about 40 lives, only six people died last year after the government began to provide free medicine.

Side effects

Despite the possible benefits the free medicine could bring, Wang Xiuling, an HIV/AIDS carrier in Shuangmiao Village, Henan Province, decided to stop the medicine completely after only 15 days.

Wang and her husband were identified as HIV carriers three years ago.

A total of 474 people have been confirmed as HIV carriers in Wang’s village, and all of them began receiving free antiviral medicine last June.

However, the majority of them stopped treatment after one month, according to Zhu Yuanwei, the village doctor.

“The taste of the medicine is quite bad. Before taking it I could still do farming work. But after I took the medicine I became so uncomfortable that I could not do anything,” an unnamed villager said.

In many HIV/AIDS patients’ homes, bottles of drugs given free by village doctors are collecting dust.

The side effects generally include headache, blurred vision, numbness in the limbs and diarrhea.

Now the 42-year-old Wang is seriously ill because of the lack of treatment.

“According to my investigation, about 40 percent of HIV/AIDS patients in Henan have completely quit the antiviral treatment, and most just take medicine for less than one month,” said Zhang Ke.

There are more than 10,000 HIV/AIDS sufferers in the province, according to an official report.

It is normal for people to feel ill when they begin taking antiviral medicines, according to Gui Xi’en, a HIV/AIDS expert from Central China’s Hubei Province. However, maintaining the treatments is the only effective way to save peoples’ lives. After a short time the side effects become weaker and patients feel much better anyway, Gui noted.

In fact, many people who persist in taking the medicine recover from the side effects and have even been able to resume farming.

Follow-up treatment

However, without proper counseling and follow-up service, farmers usually cannot bear the early suffering and just give up, Gui said.

In Henan, “health authorities just gave the drugs to the village doctors, who have few AIDS treatment skills. And then the drugs are put in the hands of AIDS victims,” said Gui.

Doctors at the grassroots give free medicine to every person who is HIV positive without considering whether it is proper for the patient to take the medicine.

No efficient mechanism is available to monitor whether the drugs have been taken or not, and follow-up treatment is not available to help patients overcome the painful side effects, Gui said.

One potentially disastrous result of this situation is that the HIV virus might become drug-resistant, said Gui.

Moreover, if the patient infects others, the treatment for those people will become more difficult than ever.

It is therefore very urgent for health authorities to reform the present medical service system for HIV/AIDS patients at the grassroots level, Gui noted.

The treatment should not depend merely on village doctors whose knowledge of AIDS treatment is limited.

Due to economic limitations there is no definitive test for judging whether or when a rural HIV/AIDS patient needs antiviral medicine. Generally, only urban disease control centers have the capacity to carry out such tests.

During the course of treatment, such tests should be repeated regularly in order to adjust the dosage.

Many Chinese AIDS patients have missed the effective window of opportunity for taking the medicine. For many it’s too late, and for some it’s too early, Zhang Ke said.

Meanwhile, efforts to educate and persuade these patients to take medicines properly must be improved, Gui said. Follow-up supervision is imperative.

The practice in the past several months has shown while providing free drugs is a vital step, it is only a small first step on the way for the country to treat its AIDS patients properly, Gui said.

Except for providing free drugs, the health authorities have to do much more work to make the medical treatment effective, instead of doing it just as a gesture, Gui noted.

Official estimates put the number of patients with full-blown AIDS in China at 80,000. There are an estimated 840,000 HIV/AIDS-positive people throughout the country.

Positive examples

Thanks to effective follow-up, the antiviral treatment has done very well in Suizhou City, one of the HIV/AIDS-stricken areas of Hubei, another province in central China.

Out of the 83 AIDS patients in Suizhou, only 10 have dropped out of the medication program after showing strong side effects.

“I feel I have become stronger and the herpes sores on my legs have also disappeared. But I am still too weak to do any farm work,” said Xia Hongchu, who was bedridden for months before taking the free drugs.

Suizhou, about 300 kilometers from the provincial capital of Wuhan, is among the first of 51 pilot programs set up to explore a more comprehensive care system for the country’s HIV/AIDS sufferers.

The program, launched by the Ministry of Health, distributes drugs from a special clinic called Warm Homestead at nearby Junchuan Town, where Xia reports on his health to doctors and undergoes a check-up.

The clinic also provides free health counseling and life assistance for people with HIV/AIDS.

(China Daily April 22, 2004)