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Sunday, May 20, 2007 - Page updated at 12:00 AM

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Gates charity's focus on HIV in China could face hurdles

Seattle Times staff reporter

The Bill & Melinda Gates Foundation is preparing to make its first foray into China, focusing on HIV prevention at a critical stage in controlling the epidemic.

The world's largest charitable foundation has opened an office in Beijing and hired a former director of the U.S. Centers for Disease Control and Prevention to head the program.

While China's government has made progress in addressing HIV and AIDS recently, it remains to be seen how readily it will accept expertise and resources from Seattle.

The Gates Foundation could face major challenges in a country where many non-governmental organizations are mistrusted, and the country's top AIDS activists are routinely put under house arrest.

The Gates Foundation is still working out terms of a partnership with the Chinese government and discussing a major grant. In the meantime, it has hired Dr. Ray Yip, former China director of the U.S. CDC and senior adviser to UNICEF China.

Yip has been in China for almost 10 years, assisting China's Ministry of Health and the Chinese CDC in health-system reform and HIV/AIDS prevention efforts.

So far the foundation has been keeping a low profile. The new office in Beijing has no sign on its door, and the foundation is providing few details about its plans there.

"For some time we have been exploring opportunities to help support the response to HIV/AIDS in China. We have not reached any final decisions about new funding," said Jenny Sorensen, a foundation spokesperson. "We're delighted that Dr. Ray Yip, a distinguished AIDS expert, will be joining the Gates Foundation in July to help lead our work in China."

Bill Gates visited China last month to help improve relations between Microsoft and the Chinese government. Less noticed was a visit he paid to a district health center in Beijing to learn about its HIV/AIDS prevention work.

The positive image of Bill Gates himself, who is consistently ranked in polls among the most admired people in China, is one of the foundation's key advantages as it establishes operations in the world's most populous country.

Besides cooperation on HIV, the foundation needs China's help on other global health priorities such as developing treatments for malaria and fighting drug-resistant tuberculosis.

The AIDS crisis in China wasn't publicly disclosed by the government until 2001, more than 10 years after the first cases were discovered. In the 1990s, thousands of people became infected in rural Henan province after donating blood plasma at collection centers that used contaminated equipment.

Gao Yaojie, 80, the doctor who traced the infections and exposed the problem, was harassed by local officials, placed under house arrest and prevented from leaving the country to receive an award. She was allowed to travel to the United States for the award in March only after international pressure.

The total number of HIV infections in China has been hard to pinpoint, but officials estimate the number at 650,000.

In late 2005, China concurred with a United Nations prediction that the country could have 10 million HIV-positive people by 2010 if it didn't take urgent measures.

But more recently, China has revised both the number of current infections and the forecast downward, saying it could limit the number of people with HIV to 1.5 million by 2010.

But China is in the midst of unprecedented social and economic change, including mass migration to cities and the unraveling of traditional mores.

If the rate of new infections among drug users and sex workers isn't curbed, the virus could spiral out of control, Yip said in a May 3 article in the New England Journal of Medicine. (The article was written by Bates Gill, a China scholar at the Center for Strategic and International Studies, who said he received support from the Gates Foundation.)

While HIV is in its early stages in China, "if you don't control the epidemic in the next five years ... the sheer increasing numbers of people who engage in high-risk behavior can fuel the fire," Yip said.

About 70 percent of the people estimated to be infected haven't even been identified, according to the article, so they wouldn't know they could be spreading the virus.

Fighting HIV in China also means dealing with a broken health-care system that is failing many people in rural areas.

"China has one of the most fragmented health systems that I've ever seen," said Jim Kim, a Harvard University health expert who traveled to China as head of the World Health Organization's AIDS programs.

There is little or no connection between village hospitals, district hospitals and national health authorities, a problem that exacerbated the SARS (severe acute respiratory syndrome) crisis a few years ago, he said.

Nevertheless, China has shown it can make major progress when it wants to, Kim said. New policies mandate free antiretroviral drugs and treatment for the poor, and strengthened training and intervention programs over the next five years.

"They just decreed overnight that every single person in China by 2008 would have access to needle exchange and methadone treatment," Kim said. "I've just never seen anything so effective when they decided to turn on that particular issue."

However, outside efforts to assist in HIV/AIDS work might be hampered in China at a time when foundations and other charitable organizations are seen by authorities as a potential threat, fomenting grass-roots democracy à la the Orange Revolution in Ukraine and other efforts in the former Soviet Union.

Christopher Plante, director of environment programs at the Asia Foundation, said foundations are under intense scrutiny now in China. His advice for the Gates Foundation was clear: Proceed "very, very carefully."

"We have walked a tightrope that has gotten increasingly more difficult to tread," he said. "If you do the wrong thing, you could just be out."

Kristi Heim: 206-464-2718 or kheim@seattletimes.com

Copyright © 2007 The Seattle Times Company

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