HIV is spreading from the so-called high-risk groups, such as drug abusers and prostitutes, to the general public, officials and experts have warned.

The main channel is unsafe sexual contact between prostitutes and their clients, who will then bring the virus to their families or to other people.

According to the surveillance statistics collected from 247 monitoring sites around the country, the HIV infection rate among prostitutes has increased from 0.02 percent in 1996 to 0.93 percent in 2004.

In some seriously stricken areas, such as Southwest China's Yunnan Province, the infection rate among pregnant women has increased to the current 0.26 percent from zero in 1997.

By the end of last September, among all the 135,630 registered HIV carriers in the country, 40.8 percent had been infected through drug abuse, 23 percent through blood transmission, and 9 percent through sexual contact.

Experts said most of the rest, or 23.4 percent, who get the virus for unknown reasons, also are infected through sexual contact.

Therefore, intervention with high-risk groups, especially prostitutes, has become vital in preventing the virus from spreading among the general public.

Intervention measures

However, how to do the intervention including distributing condoms at entertainment venues and doing education and even HIV tests among prostitutes has been a big headache for health authorities.

Commercial sex service in China is illegal, so prostitutes, who are afraid of being identified, just do their business secretly.

Since 2003, the country's public health authorities and experts have started pilot intervention projects in dozens of counties.

In these places, the health authority and public security bureaux, which are in charge of fighting prostitution, have reached an agreement on allowing health workers to do intervention at the entertainment sites.

Among these pilot sites, Wugong County of northwest China's Shaanxi Province, where 15 HIV/AIDS cases have been found since 1999, has got some interesting and effective experience.

The work is mainly done by a special team organized by the local centre for disease control and prevention (CDC).

The team, one of 2,686 currently in China, is joined by five male workers of the local CDC of the county, aged between 30 and 40.

"We selected male workers because they can be accepted by prostitutes easily and have chances to speak to prostitutes," said an official of the local CDC, who refused to be identified.

If a female worker were to go directly to an entertainment place and tell people there what she wants to do to the prostitutes, she would be absolutely refused, the official said.

Neither the bosses nor the prostitutes want to admit they are doing commercial sex service.

The first thing the team did was try to understand how prostitutes in the county do their jobs.

They did their investigation mainly by entering into those places as health workers, asking help from people familiar with the places, and visiting the places as a supposed client.

Brothels are banned in China, but barber shops, massage parlours, bathrooms, Karaoke clubs, various bars and hotels usually act as fronts.

Members of the team went to these sites, asking the bosses or the employees whether they have "special service," which is synonymous to asking for sexual contact in China.

Then they had chances to meet with the boss and the women there.

"The key is to make the people there want to talk to our workers," the official said. "And then our workers have a chance to tell them what we can do for them."

The investigation works

Through field investigation, the team acquired a good understanding of necessary information to intervene further, such as what HIV/AIDS prevention knowledge the prostitutes had.

In the county with about 400,000 residents, there are at least 30 places with about 150 women providing sexual services.

Most of them have no good personal hygiene habits and venereal diseases are not uncommon among them. The women there seriously lack the necessary knowledge to protect themselves against HIV. Many prostitutes, in fact, do not use condoms at all, either to make their clients feel more comfortable or get more money from them.

The most important task for the team is to persuade these prostitutes to use condoms whenever they provide their service.

Among employees of these places, the team also recruited some volunteers to do education among their counterparts.

The team and these volunteers also will teach the prostitutes some techniques of HIV prevention, and how to judge whether the clients have any sexually transmitted diseases before they have sex.

In the past two years, the condom usage rate among these prostitutes has increased from 56 percent to 85 percent.

(China Daily December 1, 2005)