Governing HIV

Political transition has also played a key role in the management and reporting of HIV in China. In 2002, a major change in the Chinese political landscape facilitated renewed commitments to health among high level party leaders. An important leadership transition occurred when the stewardship of the country shifted from Jiang Zemin to Hu Jintao. Although Jiang was known for his continuation of Deng Xiaoping’s (1904—97) reforms and ideas about creating a middle class (xiaokang) society, Hu became known for his attention to a harmonious society (hexie shehui) (Chan 2009: 821—25). Among other areas, health policies, access to care, and health systems reform were identified as key factors affecting social stability (wending shehui) and governance (guanli), which are major concerns of the Chinese leadership. Thus, the transition in leadership was followed by a transition in how health, and therein HIV, was managed. In order to demonstrate that China needed to take HIV seriously, on World AIDS Day in 2003 Premier Wen Jiabao shook the hands of several HIV positive sufferers in a Beijing hospital. Although ‘just’ a handshake, it was a major achievement and symbolic of the recognition the state was prepared to give to the HIV issue. The handshake was also one of the first instances where HIV was used as a public relations tool. Now Chinese leaders regularly espouse the international rhetoric of care and recognition of China’s HIV positive. They continue to demonstrate their commitment to HIV through revealing policies and making handshakes on key dates, such as World AIDS Day on 1 December, and they spend time with HIV sufferers during the Chinese Spring Festival (Wen Jiabao yu aizibingren huojiachang 2005; Chen 2005: B12, 2013: 5; Rao 2008: 1-2).

The Severe Acute Respiratory Syndrome (SARS) epidemic was also marked by secrecy, inadequate public health communication, and gross mismanagement. This experience was also

important in the shift in how HIV was managed by the Chinese government. The SARS experience led to major changes in the government’s attitudes to the management of HIV (Jing 2007). Leaders learned of the need to respond rapidly and effectively to infectious disease policy and public health management. As a result of this disaster and the leadership transition, in the year following SARS, the government passed the ‘four frees and one care’ (si mian yi guan’ai) policy, which provides free access to education, lifesaving medication, and reduced taxation for poor families with HIV-positive members. Subsequently, other legal protections for HIV positive citizens were passed regarding employment rights, which have been hard to enforce, and later those regarding medical treatment, which have been equally problematic and the subject of increasing social debate (Jacobs 2010; Gui et al. 2012; Zhang Xuhong 2012; He 2013).