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Deadly Shadow of AIDS Darkens Remote Chinese Village

By ELISABETH ROSENTHAL

DONGHU, China -- The most striking things about people from this village are that their threadbare clothes seem way too big and that nearly all of them share a hollow, desperate look in their eyes.

Stooped and shuffling, frail before their time, farmers who should be in their peak productive years are unable to tend their wheat fields or to care for their children. In this picturesque central Chinese village of 4,500, every family is touched by gruesome maladies: fevers, chronic diarrhea, mouth sores, unbearable headaches, weight loss, racking coughs, boils that do not heal.

Dozens of relatively young people have died here in each of the last two years. In December, 14 people in their 30's and 40's died.

The culprit that has devastated not just the health but the very soul of this impoverished place is something that local officials here in Henan Province have generally insisted is not a problem: it is H.I.V., the virus that causes AIDS.

While hints of this secret epidemic first seeped out from remote areas of China's countryside last year, the depth of the tragedy and the staggering toll it has taken on villages like Donghu are only now emerging, as desperate, dying farmers have started to speak out.

In Donghu, residents estimate that more than 80 percent of adults carry H.I.V., and more than 60 percent are already suffering debilitating symptoms. That would give this village, and the others like it, localized rates that are the highest in the world.

They add that local governments are in part responsible. Often encouraged by local officials, many farmers here in Henan contracted H.I.V. in the 1990's after selling blood at government-owned collection stations, under a procedure that could return pooled and infected blood to donors. From that point, the virus has continued to spread through other routes because those officials have blocked research and education campaigns about H.I.V., which they consider an embarrassment.

"Every family has someone who is ill, and many people have two or three," said Zhang Jianzhi, 51, who gathered with others who have the virus here. "I would guess more than 95 percent of people over the age of 14 or 15 sold their blood at least once," said Ms. Zhang, still stout but suffering from fevers and malaise. "And now we are all sick, with fever, diarrhea, boils."

As China begins to confront its AIDS problem, the emerging evidence of virtually blanket infections in villages like this one has become a huge wild card, whose proportions are undefined.

Officially, the Chinese government says there are only 22,517 people in a country of more than 1.2 billion who have been registered as H.I.V. positive -- mostly drug addicts and prostitutes -- although health officials estimate that 600,000 carry the virus.

But some Chinese doctors who have worked in the province said more than a million people had probably contracted the AIDS virus from selling blood here in Henan Province alone, where the problem is most severe. They add that while the sale of blood has died out in the most severely affected villages, it continues elsewhere to a lesser extent, both in Henan and other provinces.

Clearly, tiny Donghu is an extreme case, but it is not alone in its desperation. Donghu villagers said there were probably a number of seriously affected villages just in the same county, Xincai. In the last six months, reports from Chinese researchers and farmers have also revealed high levels of disease in villages in Henan's Weishi, Shangcai and Shenqiu counties.

"I do not know how many villages have a very grave problem, but I know that it's a lot more than just a handful," said a Chinese doctor who works in the province. "I've been a doctor for many decades, but I've never cried until I saw these villages. Even in villages where there was no blood selling, you now can find cases." Such transmission occurred through migration, marriage and sexual contact.

In Donghu, there are sick grandparents, sick parents and sick children -- since a number of women who carry the virus have given birth and breast-fed infants in the last five years. There are no AIDS orphans yet, villagers say, but that will come soon, since several couples are already too ill to get out of bed, and in some families one parent has died and the other is ill.

Counting Off the Doomed

Dong Hezhou, 38, a sturdy man who never sold blood and is one of the few people his age not infected, has five former classmates who have died of AIDS since the beginning of last year. He uses his fingers as he ticks off the nicknames of others who are ill. "There's Erlu, Xiaoduo, Erduo, Xiajun, Xiaoqiang, Xuijing -- five have it in his family -- Hongqi, Zaohao -- his whole family has it too," he said. "And those are only the ones in serious condition. The light ones might not even know they have it yet."

Despite the long-playing tragedy, villagers said they had not yet been visited by health officials from Beijing, or even from the provincial capital, Zhengzhou. In fact, they have not even seen officials from the county seat, Xincai -- even though Donghu sits just at the edge of that dusty rural city, at a point where tiled buildings, tinny trucks and paved roads give way to mud-brick huts, oxen and dirt paths.

Doctors and nurses at Xincai's hospital dispense medicine to treat the symptoms of a disease they only poorly understand. "How is this spread?" a nurse there asked.

Patients here die painful deaths with minimal care. And with little understanding of the disease that has ravaged their village, they may well have spread H.I.V. not just to spouses and children but also beyond the province: China's main north-south truck route, whose roadside is sporadically dotted with women selling sex, bisects the most seriously affected part of Henan.

In the early 1990's, Chinese biological product companies -- some with foreign partners -- started relying on China's isolated, impoverished heartland as an ideal place to get cheap, clean plasma, the part of the blood that is used to make medicines like gamma globulin and clotting factors.

Health officials in the province often became enthusiastic middlemen, setting up blood-collection stations. Some profited personally from the trade, while others saw it as a harmless way to bring cash into a destitute region with few resources.

The poor villagers of Donghu -- who received about $5 for donating each 400 cc's of blood, a little under a pint -- regarded the small payments as pennies from heaven, a way to take part in China's economic miracle.

Henan is one of China's poorest provinces, and Xincai among Henan's most remote counties, a six-hour drive from the capital. Money from selling blood put roofs on mud- brick homes and paid school fees.

"There was no need to recruit people -- it seemed like a good opportunity," said Gu Yulan, 46, who now suffers from fevers and mouth sores. "Often the line was so long, it was hard to get a number."

A Blood Pool of Death

Three blood-collection stations operated in Xincai, villagers say, run by locals but backed as business ventures by government sponsors. One was run for the county hospital; the second was set up by the provincial power supply office; and the third came under the umbrella of the Chinese Army, which has long had business ventures. The stations were convenient to Donghu.

Chen Xuiying, 40, gaunt with AIDS in a pale green sweater, clutches two plastic passbooks emblazoned with the seal of the army's blood station in Zhumadian City, which document her blood-selling history. Each visit has a date, a hemoglobin level, the amount of blood withdrawn and her payment. In some months, there are entries about every 10 days.

Because of the plasma collection methods routinely used at the time throughout China, even those who donated only a few times ran a high risk of becoming ill, experts said. Blood from dozens of sellers was pooled and put into a "huge centrifuge," the villagers said, where it was spun to separate the desired plasma. The remaining fraction, mainly red cells, was divided up and transfused back into the sellers, who felt the process to be healthful because it limited the blood loss.

That highly unsanitary process meant that once one blood seller in a village was infected with H.I.V. or hepatitis, the rest were quick to catch the disease, since the viruses from other people's bodies rode along with the unwanted red cells back into their veins. Since the sellers were not losing red cells with each donation, which would have resulted in severe anemia, the method also disastrously meant that farmers could sell frequently -- raising their chance of infection.

The medicines made from the plasma were probably safe for patients, because the manufacturing process should have killed the virus, doctors said. But the poor villagers who served as human plasma factories unknowingly became infected with H.I.V. and hepatitis as well.

By the mid-1990's, they were experiencing terrifying maladies that the local hospital could not cure: colds that lingered month after month, diarrhea that would not go away. By the end of 1996, the villagers realized that there was a connection between selling blood and the strange disease -- and the practice tailed off. "We could see that people who sold a lot were the first to get sick," said Ms. Zhang, the AIDS patient.

Finally, a Diagnosis

But they did not understand that AIDS was caused by a virus, or that it could spread through intercourse, from mother to newborn, through nursing and even through the use of unsterilized syringes at medical clinics. So a second wave of transmission continued. Although some information has slowly filtered into this isolated village, up to now there has been no health education program.

In fact, it was not until last year that villagers stumbled upon the explanation for their maladies, after a relatively prosperous farmer named Wang Xiaohu began a quest for a doctor who could diagnose his disease.

He traveled first to Zhumadian, the nearest big city, and then to the provincial capital, Zhengzhou, but left unhealed and without an explanation. Next he went to Xian, China's major western city, where he underwent surgery for a tumor.

Finally, in Beijing, he received a diagnosis -- it was H.I.V. -- and returned home, where he died last year. "Before, we didn't know anything about it, and the local hospital didn't know what it was," said Mr. Dong.

Mr. Wang's quest has given a name to the suffering, but it has provided few solutions.

In the last year, health officials in Beijing have begun to pay more attention to the country's AIDS problem, developing strategies to contain it and allocating more money for the purpose. In mid-May, the minister of health announced that the government would redouble efforts to enforce a ban on buying blood and to regulate the blood- collection industry.

But local governments have offered only spotty cooperation, sometimes going to great lengths to cover up AIDS problems and ignoring offers of help from the government and international health groups.

In Wenlou, another Henan village where AIDS is common, a March inspection visit by high-level officials from the Ministry of Health turned into a gruesome charade.

Although hundreds of villagers wanted to tell the health officials their problems, the police blocked them. Only one person managed to slip through, and he was later criticized by the township government, villagers said.

At the hospital, the Ministry of Health team was shown four or five selected patients, who were told to say they were satisfied and were receiving free treatment. "They didn't get a real picture of how bad things are," said Cheng Jianfei, 38, a former blood seller in dirty and ragged clothes whose thin face bears the scars of a type of severe herpes infection, common among people with H.I.V.

Wenlou, in a less remote part of the province than Donghu, attracted national attention last fall after its H.I.V. epidemic was the focus of an article in one of China's most adventurous newspapers, The Southern Weekend. The problem came to light after a Chinese infectious disease specialist did clandestine H.I.V. testing in the area.

Since early this year, farmers and village leaders from Wenlou have tried to petition the central government for help in treating the hundreds of farmers with AIDS, despite pressure from some local officials to remain silent, villagers said. "Blood selling was something the government encouraged us to do here, so we think they should bear some responsibility," said Mr. Cheng, recalling that about a decade ago, the local government passed out leaflets calling the practice "glorious" and saying it "wouldn't harm health."

Now, Mr. Cheng's wife and 8-year-old daughter are also infected with the virus. He worries about who will care for his teenage son, who is not infected, when he and his wife die.

Mr. Cheng said he is now spending the equivalent of $125 a month -- more than his yearly income -- to cover medicines, mostly for fever and diarrhea. He has borrowed money, but is now too poor even to provide food and clothing for his family; his son has dropped out of school.

After the publicity last fall, the provincial government gave a sizable donation to the county to subsidize treatment, but those funds "came and went without lasting effect," said another villager who is also named Cheng.

Too Late to Help Village

Both Chinese and foreign AIDS experts have expressed frustration with China's seeming inability to deal with H.I.V. that results from the sale of blood in the countryside, but they have recently seen a glimmer of hope. Henan has recently appointed some new high-level health officials, and for the first time, a representative from the province recently attended a United Nations- sponsored meeting on H.I.V., suggesting that it would accept assistance. The experts note too that China has become more open in recent years in dealing with H.I.V. in drug addicts and prostitutes.

But in the meantime, villagers in Donghu continue to become infected and die, often in ignorance of how the virus spreads. Li Jiu, 30, the proud mother of a 3-month-old son, suffers from fevers and diarrhea. "I've tested positive, but he seems healthy," she said.

Cheap and effective medicines can vastly reduce the risk that a pregnant women with H.I.V. will pass it to her baby -- they are becoming more widely used in Africa -- but none are available here. And mothers here commonly breast-feed their infants, even those who are infected, despite the risk of transmission.

The exact scope of the problem is unclear since a number of adults and almost all children have not been tested. Testing costs $10, twice as much as farmers were paid for their blood, and there is no treatment available anyway.

Feng Chuanyun died in February, at 44, leaving a wife and four children. Although he was hospitalized for a short time before his death with severe headaches and fever, he was sent home to die. "They said there was nothing they could do," said his wife, Mei Yuerong.

But Ms. Mei recently noticed that she herself is losing weight and that her lymph nodes are swelling up over her body -- early signs of infection. She is still able to tend her fields, but sees her future when she looks at her fellow villagers.

Two of them, Li Xurong, 49, and her husband, are both painfully weak, barely managing -- the wife with boils and mouth sores that make swallowing excruciating, the husband with headaches and high fevers.

Feng Xiaosi, a grandmother whose gray hair is pulled back in a bun, said her daughter and son-in-law were bedridden with the illness, unable to farm or care for their children. "There are lots of people like that who don't come out all day," she said, people "who are too dizzy, sick and weak to get out of bed."

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