New Estimate in China Finds Fewer AIDS Cases

BEIJING, Jan. 25 — China countered the long-held suspicion that it has undercounted the number of people with H.I.V. and AIDS by releasing a new, more extensive estimate on Wednesday that found the opposite: that the country had actually overestimated its number of cases.

 

The new estimate, conducted with the World Health Organization and the United Nations AIDS program, lowered the country's estimated number of H.I.V. and AIDS cases to 650,000 from the official figure of 840,000 released by the government in 2003. Many experts and AIDS workers have long believed that China has at least 1.5 million cases, possibly far more, and some expressed skepticism that the new figure was any more reliable than past estimates.

 

At a news conference on Wednesday morning, Chinese and international health officials endorsed the new findings but also warned that while the overall number of cases is less than previously believed, the rate of infection is still rising, with 70,000 new cases in 2005. Drug users and prostitutes are transmitting H.I.V., the virus that causes AIDS, in most of the new cases, but the report also found that the disease is now spreading from such high-risk groups into the general population, raising the risk of broader infection.

"Almost 200 people are infected every day in China," said Wang Longde, a vice minister of health. "The situation is grave."

With AIDS and H.I.V. having already devastated large swaths of Africa, experts have feared that China and India, the world's two most populous countries, may become the next epicenters of major outbreaks.

 

The lower estimate in China, if accurate, would place it in a far more enviable position than India, which is estimated to have more than five million people living with H.I.V. The Indian government has been criticized for failing to respond swiftly and effectively to the disease.

China is still trying to regain its credibility on AIDS. Not too many years ago, top leaders denied that the country had an AIDS problem and tried to cover up an outbreak in central China caused by a tainted, government-sponsored blood selling program. Since late 2003, China has mounted an aggressive nationwide campaign against AIDS and introduced pilot programs that provide free condoms, free methadone and even free antiretroviral drugs.

 

The joint effort by China, the World Health Organization and the United Nations AIDS program, Unaids, in drafting the new study reflected the improved openness of Chinese health officials on AIDS. But that collaboration also underscores the fact that the outside world would most likely be skeptical of any study conducted solely by China. Some Chinese health officials had privately fretted that the study would be regarded as a whitewash.

Henk Bekedam, head of the W.H.O.'s office in Beijing, warned that China still faced a major AIDS problem and needed to raise public awareness about H.I.V. while expanding prevention and treatment programs. But he endorsed the new estimate "as a more accurate portrait of the epidemic" and described China's H.I.V. status as "low prevalence."

Ray Yip, the Beijing representative of the United States Centers for Disease Control and Prevention, did not attend the news conference on Wednesday but said his office had provided technical assistance for the new study. He said the new figure represented a far broader sampling from across China. "It's a more robust and more complete number," Mr. Yip said in a telephone interview. "But by all means, it is an estimate."

 

Some AIDS experts in China expressed doubts about the lowered estimate. Chung To, chairman of the Chi Heng Foundation, which helps AIDS orphans in central China, questioned the reliability of the raw data used in the estimate. He noted that local officials often hid the true prevalence of the disease, while many H.I.V.-positive people lied about their condition to avoid social stigma.

"To me it is hard to believe they are revising downward," he said. "It is certainly not what I see as a front-line, grass-roots AIDS worker."

 

Another advocate, Odilon Couzin, also was skeptical about how accurately officials were able to count infected people among groups like prostitutes, drug users and gay men, all of whom are loath to reveal their H.I.V. status in China.

"Frankly, in all of my experience, the quality of the data and the accuracy of the information here is not high enough to have confidence in this new estimate," said Mr. Couzin, who runs China AIDS Info, an AIDS information and advocacy group based in Hong Kong.

 

Officials involved in the study say improved methodology and a bigger sampling of data have made it more accurate than the earlier one. The 2003 study estimated 840,000 cases, based on samples drawn from 194 "surveillance" sites around the country. By comparison, the new study used 329 national sites and several hundred other sites operated by provincial governments.

A key difference between the two studies is the revised estimate of the number of people infected by the tainted blood selling operation in the 1990's. Some doctors in Henan Province, a center of the blood selling operation, estimated that more than a million people had been infected in that province alone. The 2003 study estimated that the blood program had infected 199,000 people. By comparison, the new study estimates that only 55,000 former blood donors are infected with H.I.V.

 

To some degree the lower number of infected blood donors may be partly because many of them have died. The study found that nationally, 25,000 people died of AIDS last year. Of that figure, 10,000 were former blood and plasma donors, the estimate found. Over all, Chinese health officials estimate that fewer than 100,000 people have died of AIDS in the country.

The study found infection rates varied greatly in different regions of the country and could be broken down into six major groups: drug users, prostitutes and their clients, former blood and plasma donors, gay men, partners of H.I.V.-positive people, and infants infected in the womb by H.I.V.-positive mothers.

 

Drug users living with H.I.V. or AIDS accounted for 288,000 people, or 44.3 percent of the estimated total. Nearly all of them live in seven southern provinces. Prostitutes and their clients accounted for 127,000 cases, or 19.5 percent.

A large majority of those infected in China still do not know it. The estimate found that only 141,000 of the estimated 650,000 cases have been detected through testing.

China still faces enormous challenges on AIDS. Efforts to distribute anti-retroviral drugs have created a host of problems, while local officials in some regions still try to deny the presence of H.I.V. Some public security bureaus continue to arrest infected drug users rather than steer them to treatment.

 

Joel Rehnstrom, the coordinator in China for Unaids, said the new figures provide "a better picture" of the problem in China but should not be interpreted as meaning the situation is improving.

"This is good news, but there is still a long way to go," he said.