Monday, March 7, 2011



“Since the first AIDS case was reported in 1985, China has moved into second place for the fastest growing epidemic in Asia, behind India, and had declared close to one million infections by the end of 2004. However, health experts estimate that at least one million poor farmers alone were infected in “botched” blood selling schemes in Central China” (Hyde, 3). The deadly outcome is entire villages suffering from AIDS, dispersed across the central provinces of China.  The World Health Organization estimated that by 2010 there would be as many as 10 million HIV/AIDS cases. China’s response to the HIV epidemic was too little too late and it has caused irreversible consequences for the social and political life in China.



The main focus of my research is on the outbreak of HIV/AIDS in the rural, central provinces of China. This is where the epidemic initially emerged, resulting in the highest concentrated rates of infection. In order to understand the pattern of HIV/AIDS in China, an extensive analysis of the socioeconomic, cultural, and political determinants at work is essential. Using this discourse, I will track the circulation of HIV/AIDS in Henan Province, a region where economic instability and poverty fueled the breeding ground for HIV/AIDS. My research proves that China’s accelerated post market reforms gave rise to the establishment of blood collection sites, where blood and plasma became a valuable commodity. The blood economy appealed to poverty stricken provinces where individuals willingly donated blood for compensation and to gain status in the market economy. Finally, due to the government’s mismanagement and failure to implement proper health regulations at the collection sites, contaminated blood circulated within the rural provinces. The aftermath resulted in the formation of AIDS villages.


The politics of the blood economy

 In the early 1990’s the HIV epidemic in China became apparent, and by 1994, was existent in every province of China. Henan Province, one of China’s poorest provinces has the highest localized rates of HIV infection due to unsanitary plasma collection methods. During China’s post social reform era, privatization and modernization were key components to economic expansion. In response, China’s health care system developed new services in order to generate income. Due to the advancements of medical technology in this era, the potential uses for human blood and plasma proliferated. Provincial health bureaus recognized the commodity for blood and as a means to increase their income, developed blood collection sites. “In 1992 the head of Henan Provincial Department of Health set up a biological pharmaceutical company where blood was more than just raw material for biotechnology, but had become a form of venture capital”(Anagnost 516).  The blood collection units preyed on economically disadvantaged regions and therefore, Henan Province became a place where mass quantities of plasma were extracted.




The obsession with consumerism fueled the desperation for poor villagers to sell their blood so they would be viewed as consumer citizens instead of being useless, as many urban elites categorized them. “Selling blood reflects the process of self-objectification at the macro level in the global spread of the promise of biotechnology to provide the motor for rapid economic development”(Anagnost, 524). Economically disabled villagers fell subject to commodity fetishism and modernity, so exploiting their blood for money was desirable. The individuals received anywhere from 20 to 200 Yuan per blood donation, 166-1660 in U.S dollars. Procedures involved in the extraction of plasma at the blood banks were highly unsanitary. The process of blood pooling was thought to prevent anemia amongst donors, the result of excessive red blood cell loss from repeated donations. In this process, blood from multiple sellers was pooled where the desired amount of plasma was separated and the remaining portion consisted of red blood cells. The cells should have been transfused back into the original donor, but instead were injected into individuals with the same blood type. So if one donor is infected with HIV, then the infection is spread to all donors of the same blood type, as well as wives or husbands, and often to children. It has been estimated that over one million Henanese alone could have been infected with HIV at the cost of blood pooling (Hyde, 5). 

Blood as a vital body essence

According to traditional Chinese medicine, “blood is considered an essential life force, a vital bodily essence and when lost, long term decline in health and vitality result” (Erwin, 145). This value of blood and blood health is partly why many Chinese were resistant to donate their blood and in response, blood shortages occurred. In the extreme case, a portion of individuals were terrified that even a small amount of blood loss would compromise their long-term health. 
When urban Chinese people received word that rural poor individuals willingly sold their blood, they were “disoriented and saw this as an act of desperation and even backwardness” (Adams, 410-415). China has a history of chronic blood shortages and as mentioned previously, blood markets operated in the countryside on a small scale for decades. The commercial blood centers had the highest activity between 1992 and 1995 and their operations were not a secret in China, yet the government failed to take immediate action once the HIV epidemic became the resulting crisis. It was not until 1995 that a Chinese news agency “reported that Chinese and Western health experts fear the AIDS virus is seeping into the nation’s blood supply as a result of commercial procurement practices” (Erwin, 147).  The majority of self-donors were urban migrants and the villagers of Henan, Anhui, and Shanxi, faced with the coercion of poverty (Erwin, 148). Donors were so desperate that the “substance most Chinese view as essential to life and health, blood, became simultaneously a lifeline and a deathline. HIV infection as the deathline is the tragic outcome” (Erwin, 148).


China’s initial response
The Chinese government had the power and resources to enforce proper regulation requirements and standard health protocols on the blood collection units, but failed to do so. Instead of immediately responding to the HIV crisis when it first began, the government waited several years before showing any sign of real action. A stronger national fight and campaign for the prevention of HIV/AIDS was crucial in the beginning when the disease was less rampant. China recognized blood selling as a societal failure, yet why did it take almost six years for local governments to shut down the illegal blood and plasma centers?
In critiquing China’s disoriented state-decision making ideas and policies surrounding HIV/AIDS prevention, it is important to examine the concept of governmentality, a concept discussed by Sandra Hyde in her ethnography on the “Cultural Politics of AIDS”.  Hyde discusses that “Foucault’s notions of governmentality and by extension, biopower are particularly useful for moving beyond the dichotomy between state and society, because in controlling an epidemic, social institutions and informal networks function within regimes of power that shape individual people’s thoughts and practices”(Hyde, 21). She then argues, “China is a multifaceted system composed of individuals whose agendas reflect the personal goals and desires of both themselves and the institutions where they work”(Hyde, 22). The HIV/AIDS crisis in China is a major public health concern and as Hyde notes, the personal goals and desires have influenced policy making by Chinese officials and employees of NGOs, and created problems when fighting the spread of HIV/AIDS.


In the early stages of the Chinese HIV/AIDS epidemic, the collection of survey data along with statistics was appealing. Statistics are cautionary because they are appealing and relied upon by public health organizations, and can be manipulated and misused to legitimize a health crisis. “Statistics allow governments to expand their moral and material authority over the citizens. Nation states have a fetish for numbers”(Hyde, 38). The processes involved in the collection of survey data can create additional conflict. Survey data can form a code for the relationship between the Chinese state’s role in the control of infection and the NGOs prevention policies (Hyde, 38). At first China used an epidemiological framework to define patterns of HIV/AIDS, which grouped people together by survey and statistical evidence, without identifying the behaviors, beliefs and attitudes that may have led to individuals contracting HIV/AIDS. Statistical numbers are not necessarily a lie but this type of data alone leaves out important vectors leading to HIV transmission. 

Education is the most important method to prevent the spread of HIV, but also can be a difficult task. For example, accessing education materials that can be understood by illiterate populations proves to be a challenge. Leading peer education programs are a more effective way for HIV/AIDS prevention.  In the mid 1990’s China brought in international NGOs to assist them with HIV/AIDS prevention. However, these NGOs were not independent and the Chinese government monitored their policy planning. Provincial government officials were at the forefront in developing new HIV/AIDS policies but were always under scrutiny by the larger government powers of China. These policies combined an array of discourses and modes of power and were unclear, therefore creating further political subjectivities and contradictions. China’s health prevention policies are affected by the pressures of financial independence, and as a result have caused local anti-epidemic stations in Chinese provinces to lose money and the manpower to lead effective prevention campaigns. The stations do not have the time or resources to devote their entire energy on the prevention of HIV/AIDS. Instead, they have become testing sites where vaccines and HIV tests are sold, rather than a source for public education. In their attempt to generate income, the local stations have failed to meet any policy and prevention requirements put in place by the Ministry of Health. 
The policies of HIV/AIDS are influenced by local and transnational modes of governance. Officials take part in relationships that spread across China’s outward borders and return back to local borders. This type of cycle results in the inability to determine where power resides and where it resists (Hyde, 99). Health care policies that focus on HIV/AIDS in China typically consist of small, individual projects. However, large-scale efforts with a uniform discourse can reach the most outstanding success in combating the spread of HIV. Officials who are part of HIV/AIDS prevention planning need to control their own feelings, morals, and their political ties to the post-socialist state in order to prevent a system of policy that benefits personal ideologies and power rather than the greater population of China. 



China's progress?

Although rates of HIV infection continue to increase throughout China, important progressions have occurred since 1995 in the fight against the HIV epidemic. China’s first reaction to HIV/AIDS presented it as a foreign disease; therefore, the government dismissed the growing concern for action. However, by 2001 international pressures increased and there was abundant evidence that this infectious disease blanketed China. In response, the Chinese government has substantially made changes in their public health care policies. Because of their increased efforts, China has gained further international support. To begin, a promotional and educational effort for the use of condoms has been widely acknowledged. Condoms are more readily available and accepted due to government encouragement, collaborative initiatives by international agencies, and action by Chinese businesses and the voluntary sector (Gu, 89). Unfortunately, preventative measures are slower to reach some communities of small villages and smaller towns. In the last 25 years China’s income inequality has doubled, causing significant implications for access to health care provision such as the ability to travel to HIV/AIDS treatment centers or access drug therapy from ART specialists (Gu, 92). 
Villagers in Henan Province waiting in line for free ARV drugs


An important turning point in China’s fight against HIV was the launch of a nationwide program called “Four Frees, One Care” which included: free HIV testing, free counseling and anti-retroviral for patients in rural regions, free medication for all pregnant HIV carriers, and care for impoverished AIDS patients (Lancet, 694). The distribution of free ARV treatment by the government is also seen as an action of “damage control rather than a genuine effort to save lives”(Jing, 537). When ARV drugs were passed out, efficient medical services were not present. Therefore, the treatment was not properly monitored and side effects were not controlled or understood by HIV patients. The measure of the program’s success was based on a three-year survival rate of 50 percent, which actually is the same survival rate without treatment (Jing, 537). Because many villagers were uneducated about the side effects of ARV drugs, they believed the government provided them with free drugs in order to accelerate their deaths so they no longer had to deal with the HIV/AIDS tragedy. As a result, the dropout rate for ARV treatment was high amongst rural villagers.


The rural health care systems lacked infrastructure and began to collapse during the reform era. ARV treatment was not delivered to rural “AIDS villages”, where participation declined the most. These “AIDS villages” attracted journalists, AIDS activists, NGOS, and pharmaceutical companies searching for the cure for the epidemic. “Large scale research hospitals recruited clinical trial subjects from these villages to fill their purchase orders from pharmaceutical developers”(Jing, 556). Villagers became bodies of research for the development of pharmaceutical drugs. Once again, HIV infected individuals became part of an economic market rather than a treatment program that was supposed to improve the lives of HIV victims. 

Who is to blame?



 Fluid Labor and Blood Money: The Economy of HIV/AIDS in Rural Central China by Shao Jing is an ethnographic account of several villages in Henan. Her research provided me with a new perspective on the relationships between journalists, activists, and NGO workers and the villagers infected with HIV. Jing observed that each side felt betrayed. On the villagers account they “felt that they had been used by powerful outsiders who were able to garner considerable resources for themselves. The outsiders believed they had courageously rendered a moral service by uncovering the epidemic and bringing to light the suffering that villagers had endured but were stung by the demands for compensation by the villagers”(Jing, 537). The part that struck me was Jing’s account of a few journalists who stated that the HIV epidemic was due to laziness and greed from the rural people. This supports the ideology behind a “geography of blame”, where a location of people are blamed for the spread of disease, who are typically minorities or people of a lower economic status. In the case of China, we see the rural provinces inhabited by poor villagers as the source of blame for the HIV crisis. However according to the government, the bad guys are the “blood heads” who acted as human agents against the spread of the virus. The blood heads recruited donors, transported them from one collection site to another, and brought illegal plasma harvesting into villages. Some activists pointed their fingers at the head of the Bureau of Health in Henan, who was personally responsible for the promotion of commercial plasma collection in the province. The Health Bureau received a private document from an AIDS activist who placed the blame on “intravenous drug users from border provinces in the southwest for contaminating the pristine pool of donors in China’s agricultural heartland” (Jing, 554). As you can see, no one wants to be blamed for the devastating outcomes of the HIV epidemic and out of fear will accuse others. The new policies implemented by China in their fight against AIDS have not been completely clear and are also distributed unevenly across China. In 2007, ARV therapies were currently available to 20,452 people infected with AIDS (Hyde, 200). China’s progress in combating HIV/AIDS has improved in the last ten years but takes a great deal of time to become more widespread.

A societal epidemiological approach to 


HIV/AIDS

The majority of studies on China’s HIV/AIDS epidemic use an epidemiological approach to examine the epidemic. An epidemiological approach studies why an individual becomes ill but does not examine why certain groups or sectors of populations are more vulnerable to contract diseases, such as HIV/AIDS. This type of approach fails to analyze other economic and social contexts that have contributed to the spread of HIV/AIDS in China. Societal epidemiology is a holistic approach to understanding the causality of HIV/AIDS in China. It examines the causal pathways of HIV at the societal level instead of at the individual level. 

A successful health campaign

China was successful in its national health campaign to promote safe blood donation. The strategies used in this campaign effectively marketed blood donation as a “public good in ways that made cultural sense to Chinese donors”(Adams, Erwin, 411). These campaigns were conducted in urban areas and attempted to diminish the public fear of blood contamination. With the high rates of contaminated blood, health officials focused on strategies to eliminate vectors of HIV transmission and also sustain an adequate blood supply. China’s Public Health Bureau required increased screening of blood, and the purchase of new sterilizing equipment. Voluntary blood donation was promoted as a “glorious and patriotic gesture that was safe to the body, despite the traditional belief that it could harm one’s health”(Adams, Erwin, 416). This public health campaign overcame the culturally engrained idea that the loss of blood damaged one’s health and managed to develop a willing group of donors. The success of this national public health campaign relied on its ability to create a system of methods, resources and strategies that coincide with China’s cultural context. China should conduct further health programs like this in their fight against HIV/AIDS and perhaps they will see a decreased rate of HIV infection.














What needs to be done?
It has been proven that the Chinese government failed to rapidly react to the HIV epidemic but new polices and health programs are in place. Although the question is whether their progress is too little too late? Throughout China there are effective smaller scale projects, but these little projects do not have enough force to eradicate an epidemic like HIV. Small health projects need to be implemented on a large scale where the highest form of governance and leadership can be accessed. National funding and support for a nationwide public health system has resulted in an unequal access to health care. This is a crucial obstacle for China to overcome in order to provide equal distribution of health services to HIV infected individuals. When developing prevention projects “behavioral change models will not succeed if not accompanied by the political will for socioeconomic change” (Hyde, 206). China has a history of success in the surveillance and control of HIV/AIDS but provides only one aspect of the epidemic. Qualitative research leaves out the complexities of the individual’s lifestyle including their behavior, cultural practices, and belief systems. The HIV epidemic in China is interrelated to the social, economic and political forces in place. The success of China’s fight against HIV/AIDS relies on their ability to develop public health projects that address current social, economic, and political factors that China faces.

Recap

The persisting HIV/AIDS crisis in China is unique and complex. Beginning in the 1990’s the epidemic became known, but unfortunately the Chinese government failed to immediately respond and fight this grave disease with full force. The post-socialist economic reform and the nationwide goal of modernization opened up the opportunity for new commercial enterprises to develop. Perhaps the most problematic market reform was the formation of a market economy to procure and resell blood for urban and international markets. Provincial health bureaus took advantage of this market in order to generate income. Consequently, their entrepreneurship contributed to the establishment of unregulated blood collection stations and the circulation of HIV infected blood. We saw this tragedy unfold in Henan Province, where poor villagers willingly sold their blood in exchange for money and the chance to take part in a market economy. Unfortunately, this was not their destiny. Instead the villagers became infected with HIV, which would determine their fate. Henan Province has been devastated by HIV, resulting in entire villages of AIDS infected people. In addition, 200,000 AIDS orphans are dispersed throughout central China. 







THE FACES OF HENAN PROVINCE








An elderly man cries beside his dying son, named Sun, on Jan. 28, 2002. Sun, 34, has been suffering from AIDS since he sold his blood at a local hospital in Dongguangcun, in central China’s Henan province in 1999.



"Children in the orphanage 'Home of Care and Love' curl up against each other to sleep" (Lu, Guang) 
"A woman carrying her extremely ill grandson,implores the sky to prevent the devil of pain returning" (Lu Guang, World Press Photo) 













"Qi Guihua, here held by her husband, fell ill when she returned to the village from Beijing to celebrate the Spring Festival. She died two hours after this photograph was taken" (Lu, Guang, World Press Photo)




"Thirteen year old boy at his parents grave"



"Child Orphaned by AIDS"







Annotated Bibliography




1)             Adams, Vincanne, Kathleen Erwin, and Phuoc V. Le. "Public health works:             Blood donation in urban China." Social Science and Medicine 68 (2008): 410-            418.

            In this article Vincanne, Erwin, and Phuoc discuss China’s public health campaigns in response to the health crisis over the need for clean and adequate blood supply after the spread of HIV due to contaminated blood donation. They argue that national public programs have an important role in addressing health crisis. The authors outline how China’s strategies and public health campaigns were successful in combating the HIV crisis. In the 1990’s there was a rise in commercial procurement of blood but the blood was not tested for HIV and needles were re used. As a result, 22,000 of the 75,000 people living with AIDS in China were infected by contaminated blood. In response, the central government closed down many state run commercial centers and by 1998 outlawed commercial blood procurement. Authors discussed the most challenging aspect of China’s campaign, which was the elimination of paid blood donations without reducing the blood supply in a place where people feared contamination and a loss of vitality from blood loss. The public health campaigns used all aspects of the media to interject the idea that donating blood was glorious and patriotic. The campaigns were a success and donors were compelled to give and their actions were acknowledged as a personal sacrifice to the larger society. In this article the authors conclude that China’s health campaign regarding blood donation was successful. The success lied in the health program’s ability to focus their methods, resources and strategies in ways that are locally informed and understand the cultural context.

2) Erwin, Kathleen. "The Circulatory System: Blood Procurement, AIDS, and the             Social Body in China." Medical Anthropology Quarterly 20, no. 2 (2006): 139-            159 (accessed Feb 17, 2011).

            In this article, Erwin’s main argument is that when public health and social policy address China’s HIV contaminated blood procurement crisis, they must address the underlying social, cultural, and economic factors of the problem. Erwin critqually analyzes the stakes that arise when viewing the circulation of blood as a commodity, as a potential “gift”, and as the essence of vitality and life. Her analysis of blood donation includes its symbolic meanings and its institutional regulation. The physical body frames blood donation as a cultural, social and economic phenomenon. Erwin provides a historical overview of blood procurement and the increasing demand for blood and connects these to current disputes in anthropology and bioethics over the procurement and transplant of organs and other body parts. She also discusses blood and the body in Chinese Medicine, where blood is an essential life force and the loss or depletion blood is understood to be detrimental to health. This belief gives partial explanation for the low voluntary donation rates in China. The Chinese government has made efforts to eradicate blood selling and to promote voluntary blood donation without compensation. Erwin concludes the article by arguing that in blood donation there is a need to rethink basic assumptions between donor and recipient and the larger social body. What is at stake is the social contract that binds not just individuals, but also the inalienable parts of humans that flow through the circulatory system (Erwin, 153).

3)            Rosenthal, Elisabeth. "Ignorance as the Fuel, AIDS Speeds Across China." The             New York Times, December 30, 2001. Accessed February 20, 2011.

            In this the article Rosenthal discusses the rising AIDS epidemic in China and how many people at a high risk of contracting AIDS do not know how to protect themselves and some have never heard of HIV. In 2001, when this article was published, it was estimated that 600,000 people had HIV. In some villages of Henan Province, infection rates were approaching fifty percent, due to the selling of unsanitary blood. Rosenthal included an interview with a former blood seller form Henan Province, who had not heard of AIDS until he started suffering from AIDS related symptoms. There is a need for more aggressive education programs because there is clearly a serious prevention problem. Rosenthal also points out how the government tends to place blame on women for the spread of AIDS and that education needs to focus more on men. The previous efforts to provide HIV education have too often fallen short because of concerns about saving face and social conservation. In this article Rosenthal attempts to bring awareness to the public about the lack of HIV/AIDS education and that there is a need for more government action.

4)            Hyde, Sandra T. Eating Spring Rice: The Cultural Politics of AIDS in             Southwestern China. Berkeley: University of California Press, 2007.

            In this book Hyde discusses the politics of HIV/AIDS in China, focusing on governance, ethnicity, sexual behavior, prejudice, stigma and blame in the southern Yunnan Province. She points out that there is a discrepancy between global discourse, government ideology and local perception over HIV/AIDS. Her area of research takes place in the Jinjong village in Sipsongpanna, Yunnan Province. Members of the Chinese government singled out a former kingdom in Thailand (Sipsongpanna) and its indigenous group, the Tai Lue as carriers of HIV. They were blamed due to a history of stigma and prejudice and disputes over geographical borders. The main topic she explores is prostitution. Hyde outlines the social history of Sipsongpanna and how sex tourism and ethnicity are related. This book is ethnography and in her fieldwork she includes the voices of state officials, functionaries, villagers, and sex workers. She provides an analysis on the ways that sex workers and minorities were seen as the main carriers of HIV. One of Hyde’s arguments is that understanding an epidemic and HIV transmission requires a heavier focus on everyday AIDS practices.

5)            Rosenthal, Elisabeth. "Deadly Shadow Darkens Remote Chinese Village." The             New York Times, May 28, 2001. Accessed February 20, 2011.

            This article focuses on the HIV epidemic, which began to spread in remote areas of China’s countryside. Rosenthal discusses how local governments are partly responsible for the epidemic. Farmers in Henan Province were encouraged by local officials to sell their blood at government owned collection stations in which could return pooled and infected blood to donors. The virus has continued to spread other ways because the officials failed to conduct research and education campaigns about HIV because they were ashamed. Some doctors from the province suggest that more than a million people contracted the AIDS virus from selling blood in Henan Province. The sale of blood had died out in most of the heavily affected villages, it still is occurring elsewhere. There are AIDS cases even in villages where no blood selling took place due to migration, marriage and sexual contact. In the 1990’s Chinese biological product companies began to rely on China’s impoverished regions to get cheap, clean plasma. The health officials became middlemen and set up blood collection stations, and some of them profited personally from the trade. Rosenthal outlines the blood plasma collection methods and because they were so unsanitary, poor villagers were infected with HIV. Since the outbreak of HIV, local governments have not fully cooperated with the Beijing health officials and instead try to cover up the problems and ignore offers of help from government and international health groups. The article ends by Rosenthal pointing out that more recently Henan has appointed new high-level health officials and is willing to accept assistance.

6)            Erwin, Kathleen, Vincanne Adams, and Phuoc Le. "Glorious Deeds: Work Unit Blood Donation and Postsocialist Desires in Urban China." Body and Society 15, no. 2 (2009): 52-70.

This article analyzes the contradictions around blood donation in an ethnographic context of contemporary urban China. The authors focus on how the circulation of blood outside the body interfaces with its circulation in the Chinese social body. They represent how individual Chinese see their acts of donation. In the article testimonies from interviewees are included who describe their donation as voluntary and necessary in order to meet a social obligation. Their descriptions of the donation process represent the complexities of sociocultural change, described as a postsocialist China, a consumer culture and increased individual autonomy. The authors argue that the role of a socialist work unit has a role in defining Chinese citizenship and consumer culture. They frame the process of blood donation, where the economic and social value of blood is compensated financially another forms compensation as a form of socialist governance. With the high demand for blood people were willing to participate in blood drives which shows how the postsocialist ideas are fulfilled. The authors describe voluntary blood donation as postsocialist and present the idea that the ways in which bodily experiences, cultural practices and social relations are all remade.

7) Jing, Shao. "Fluid Labor and Blood Money: The Economy of HIV/AIDS in             Rural Central China." Cultural Anthropology 21, no. 4 (2006): 535-569.             Accessed February 20, 2011.

            This article is an ethnographic account of several villages in Henan Province of China during an AIDS epidemic. The epidemic was kept silent in the beginning because at the time those infected were unaware of the existence of HIV or thought of it as foreign geographically and morally. Many of those unaware were rural people who sold their own blood as a source of income. Once the Chinese government broke its silence they revealed that the commercial collection of plasma accounted for a quarter of all HIV infection in China. In Jing’s analysis of the distribution and pattern of HIV she recognizes that structural violence, inequality, socioeconomic conditions and political economy have reciprocal relationships with disease. She also demonstrates how these connections are embedded in historically, socially, and culturally specific contexts. Jing examines each market involved in the circulation of blood, the selling of plasma and blood products market, the market for migrating labor, the pharmaceutical market, and the consumption of antiretroviral therapy. In this article Jing sympathizes with the villagers because she saw first hand their sense of betrayal, where they were shortchanged in the market for their labor, blood, disease, and their suffering. Jing’s project in Henan Province was to build a political force among the HIV infected villagers who could use their knowledge about HIV and medical treatment available in order to further demand treatment and care. Jing concludes that the spread of HIV within the village populations is largely the result from the demands for economic development following the transformation of China’s health services into a marketized health industry.


8)            Anagnost, Ann S. "Strange circulations: the blood economy in rural China."             Economy and Society 35, no. 4 (2006): 509-529. Accessed February 21, 2011.

            Anagnost primary thesis in this article is the commodification of blood in the Chinese countryside in the 1990’s ultimately led to the rapid spread of HIV infection among rural villages in the Henan Province. She addresses the history of China’s economic reforms that widened the rural to urban income gap. The reforms caused problems for the rural economy in three aspects: farming income, rural infrastructure, and agricultural development. Anagnost includes her interpretation of the film, Ermo, which portrays the sale of blood in the 1990’s. In the film, Ermo sells her blood in order to purchase a large screen television. For Ermo the television is a symbol of peasant prosperity. Her enthusiasm to repeatedly sell blood represents the concept of commodity fetishism. Anagnost suggests that Ermo is initially empowered by the market but in such a way where she is subject to exploitation. Ermo represents the relationship between commodity fetishism and the blood economy. The increasing commodification of blood in Henan led to HIV epidemic in rural villages. Anagnost outlines the circulation of blood value as it transitions across various regions of China, from government offices, promoting biotechnical investment to local blood collection stations in Henan Province. She argues that blood is an object of exchange across lines of economic inequality by government policies. The blood economy took advantage of poor rural people willing to sell their blood for cash. This article shows the extent to which rural residents of China have been devalued.

9)  "China's evolving response to HIV/AIDS." Lancet 373, no. 9665 (2009): 509-529. Accessed February 21, 2011.

This article suggests that China still faces major challenges in combating the HIV/AIDS epidemic. In 2009 HIV/AIDS was China’s leading killer among infectious diseases for the first time. However, due to the history of under reported HIV/AIDS cases accurate numbers for the epidemic are not accessible. UNAIDS estimated that 700,000 people are living with AIDS in China. This article briefly outlines China’s resources and efforts to tackle the epidemic. For example in 2003, the four frees program was initiated to combat the epidemic. The “frees” were, free counseling, free antiretroviral, free medication for all pregnant HIV carriers, free education for AIDS orphans and care for impoverished AIDS patients. In addition, blood screening was introduced in order to prevent blood borne infections. The article ends by addressing the implications that China faces in combating HIV/AIDS. The size of China and population, as well as a decentralized system of government make universal access to testing, treatment, prevention, and communication of public health messages a challenge for China. Culturally sensitivity and stigma are also barriers to the prevention of HIV/AIDS.

10) Sutherland, Dylan. "Reform, Openness and Public Health: on the economic and social determinants of HIV/AIDS in China." Journal of Contemporary China 20,             no. 68 (2011): 509-529. Accessed February 22, 2011.

            In this article Sutherland proposes that the current epidemiology approach to understand HIV/AIDS needs to be revaluated. He suggests that considering broader social and economic determinants, which include income and gender, inequalities may better compliment our understanding of the HIV/AIDS epidemic in China. Instead of focusing on individual behavior it would be beneficial to tackle deeper social and economic structures of the epidemic. In the beginning of the article Sutherland provides a summary of the current literature on the social and economic determinants of HIV/AIDS. He then explores how these population-level determinants further the understanding of the HIV/AIDS crisis in China.  The article also discusses how increased inequality has caused increased rates of migration, which is a factor of the HIV/AIDS epidemic. In the conclusion he argues that information and education campaigns tend to target individual behavior, but will only partially solve the long-term fight against the HIV/AIDS epidemic. The broader social and economic determinants in China need to be further addressed. 

Additional Sources
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