Be aware of the dangers of high-risk behavior, actively look for the blocking drugs, get advice for well-intentioned people, and have the financial ability to fly to resource-rich cities in a short period of time – Xu Peng’s experience was partly due to luck, but not everyone has such luck.

When Xu sought medical advice in 2018, China did not have technical guidelines for HIV post-exposure prophylaxis(PEP). According to data compiled by volunteers at the time, China only had 30 hospitals who prescribed PEP for patients with non-occupational exposure. There was no way to seek medical advice in many regions.

It wasn’t until November 2020 that the Chinese Center for Disease Control and Prevention’s (the China CDC) National Center for AIDS/STD Control and Prevention issued the “Technical Guidelines for HIV Post-Exposure Prevention (Trial),” which included the population applicable, inclusion criteria, applicability evaluation for post-exposure prevention, as well as covered the importance of compliance training and technical support.

However, this document does not change how inaccessible HIV post-exposure prophylaxis in China is. An expert engaged in research on HIV prevention in China and the United States told Wainao, “In fact, prevention after exposure to HIV is not a difficult thing. Many doctors know how to work without this document, but hospitals often do not prepare these medicines.”

The “medicines” mentioned by this expert do not refer to one or two specific drugs, but a variety of drugs that can be combined, including but not limited to lamivudine, abacavir, emtricitabine, and other HIV antiretroviral drugs paid for by the Chinese government and provided for free to patients living with HIV. Since 2002, China has gradually started providing some HIV antiretroviral drug combinations free of charge. Now local CDCs around China distribute drugs to patients with HIV and stock post-exposure prophylaxis drugs.

The expert also told Wainao about a unique phenomenon in HIV post-exposure prevention in China: some places have a doctor but not the medicine, while other places with the medicine do not have a doctor. Hospitals and the CDC are two different administrative entities. The CDC does not have the authority to formulate treatment plans and prescribe drugs; infectious disease hospitals and doctors do. Also, drugs can only be prescribed for free to patients who are diagnosed HIV-positive; they cannot be sold to those who are HIV negative but want to do the post-exposure prophylaxis treatment.

This complicated situation has led many to find other ways. For example, Xu Peng listened to people who suggested that he lie about having hepatitis B to buy hepatitis B antiviral drugs (because some can be used as HIV antiviral drugs) so he could start the course of preventative medication after HIV exposure in time. Even though some medicines can also be purchased online at Chinese pharmacies in recent years, due to factors like logistics and service time, prevention within 72 hours after exposure cannot happen every time.

In 2018, the number of newly diagnosed HIV infections in the United States fell by about 7% compared to 2014, while China’s data for the same time period increased by about 48.6%.

According to data from China’s National Health Commission, between January and October 2019, there were 131,000 newly diagnosed cases in China, and 958,000 existing infections. Although the HIV epidemic in China is at a low prevalence level, with an infection rate of about 9 in every 10,000, which is lower than many countries including the US and India, the number of newly diagnosed cases every year is increasing. The increase of HIV infections among young people and the elderly in China has been particularly noticeable. A report in Science magazine pointed out that in the past few years the annual growth rate of Chinese college students diagnosed with HIV is between 30% and 50%. A societal misconception equates HIV infections with gay ment, but official statistics show that heterosexual transmission accounts for the majority of sexually transmitted HIV infections.

HIV and AIDS are not the same thing. After testing positive for HIV, taking medicine on time and keeping the virus content per milliliter of blood (viral load) low will keep the virus at an extremely low level, or even undetectable. However, if the disease is not treated in time or the viral load cannot be controlled, the virus will erode the immune system. AIDS is diagnosed when the CD4 T-cell count drops below cells/mm3.

Based on Chinese CDC public data, Weinao estimated that the number of new AIDS diagnoses in China in 2019 creased by about 40% compared to 2015年. There were around 4.4 people suffering from the disease, and the death rate had increased by about 50%.

In 2007, China cooperated with the Bill & Melinda Gates Foundation on an HIV prevention and treatment project. The Gates Foundation invested $50 million to conduct six years of work centered on testing and treatment. In order to improve the problem of lower detection rates of those with HIV, the project purchased and sent daily sundries and asked citizens to get tested. Later on they were criticized for “only testing, not dealing with the social problems caused by it.” The expert previously mentioned told Wainao that with the Chinese government’s increased control of foreign NGOs, many organizations have withdrawn from China, and those who remain tend only to cooperate with organizations with government backgrounds.

After this “breaking up” with a large number of international charity organizations, China has carried out HIV prevention, testing, and treatment at its own pace. “Treatment is prevention” is part of China’s HIV prevention program, which refers to when the viral load is controlled and at an undetectable level, that HIV is untransmittable thus controlling the spread of infection. However, the side effects of the free drugs, drug resistance of patients, and discrimination and stigmatization of those with HIV by Chinese society make treatment more difficult than expected.