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

Social stigma against PLHIV is common in China. Misconceptions about HIV transmission and prejudice towards PLHIV are widespread among the general population. HIV-positive individuals are often denied employment, education and necessary medical services [41] and are thus more likely not to disclose their HIV status [42, 43] . A recent study by Zhou in 2008 shows that the healthcare expenses for HIV-positive individuals were greatly elevated by social discrimination, and their available social resources were substantially reduced in the presence of social stigma [44] . The study further indicated that PLHIV often perceive healthcare institutions as an indispensable source of social support and one of the few places where they may be willing to disclose their HIV-positive status [44] . However, a separate survey among health workers in hospitals demonstrated that HIV stigmatisation remains as the major health-seeking barriers for PLHIV in China [45] . According to a UNAIDS study in 2009, 15% of surveyed participants indicated that their HIV status was disclosed by health-care professionals to others without their consent [46] . According to the latest available statistics, there have been 326,000 cumulative HIV/AIDS cases in China, including 54,000 deaths, by the end of 2009 [23] . This accounts for only 44% of the estimated number of PLHIV at that time. The percentage of undiagnosed cases cannot be improved upon if the barrier of stigma against PLHIV from health institutions is not removed. In addition, PLHIV that belongs to at-risk groups, especially MSM, are subjected to greater social stigma due their identity and sexual orientation. Recent study indicated that only 14-45% of Chinese MSM underwent HIV testing in the past 12 months during 2007-2009 [2, [47] [48] [49] [50] [51] [52] [53] . Also, it is estimated that only 12-15% of HIV-positive MSM are diagnosed based on an estimate among MSM in Yunnan province in 2009 [54] . Due to the hidden nature of MSM, sentinel surveillance targeting MSM was also required to substantial scale-up. Although the number of sentinel surveillance sites targeting MSM has increased from 4 in 2006 to 25 sites in 2009 [1, 14] , both epidemic and behavioural surveillance for MSM remains insufficient and limited in many parts of China. Reducing social stigma and discrimination is necessary in improving HIV surveillance in China.