Describing the Chinese HIV Surveillance System and the Influences of Political Structures and Social Stigma

Zhang, Lei; Fung Chow, Eric Pui; Zhang, Jun; Jing, Jun; Wilson, David P

Second, a fragmented authoritarian political structure inevitably leads to a fragmented information system with little openness and systematic mechanisms for synthesis. As Fig. (2) . Change of political relationship between institutions at the same and different administrative levels in China prior to, and post, economic reform. previously analysed, lower-level CDCs can only access HIV information within its own jurisdiction, which represents only a subset of the information pool of the higher-level CDCs. As there is little information sharing, even between neighbour CDCs on the same level, these information subsets become isolated information islands which can only be integrated by their superiors. In this way, the central China CDC at the top of the administration pyramid has the ultimate authority of data collection, assembling, analysis and distribution. Hence, information openness is strongly and solely dependent on the decision of central China CDC and there exists little monitoring mechanisms to ensure the accuracy of both the reported and published information. In the current political structure, all levels of government are only accountable to their upper-level administrations, but not to the general public. The absence of genuine engagement of civil society groups, including the media and the scientific communities, and the expectations and pressures from higher-level authorities, often results in a results-oriented policy implementation, such that local officials tend to manipulate nonscientific and arbitrary results to satisfy their superiors perfunctorily [40] . In this view, ensuring the accuracy of reported disease information should be a high priority in the future development of HIV surveillance in China.