The Role of NGOs in China’s AIDS Crisis
Original byJoan Kaufman
“The global AIDS epidemic continues to worsen and is one of the leading development challenges of our era.” Facing this global crisis, “NGOs have played a decisive role in the response, both for advocacy and for services”, such as providing voices for the underrepresentative groups, promote risk-reduction education, providing HIV testing and treatment, and advocating for policy formulation.
China witnessed AIDS epidemic in the early 1980s and is now estimated to have 650,000 HIV infections throughout all of its thirty-one provinces, municipalities, and autonomous regions, with an annual growing rate of 30 percent. “Half of new infections are sexually transmitted, mainly among commercial sex workers, sexual partners of injecting drug users, and men who have sex with men.” Separately, in the late 1990s, a retired doctor revealed to the media a severe epidemic among former paid plasma donors due to tainted blood donation practice in Henan province, central China, as well as the indecent cover-up by the local government. While little care is given to the notorious groups of drug users and sex workers, public sympathy gradually arose for the “innocent victims of AIDS”, the farmers who rely on blood donation to improve their poor life a little bit.
Learning from the failure of emergency preparedness and early response of SARS in 2003, China’s Center for Disease Control and Prevention’s National Center for AIDS Prevention and Control (NCAIDS) decided to take initiatives this time. To address the plight of AIDS-infected farmers of central China, “a free national AIDS treatment program was launched in 2003 by the Chinese government, called China Comprehensive AIDS Response (China CARES)”. China CARES not only “signaled the increase of political will to tack this problem”, but also increased funding substantially, put accountability on local governments and sent out intervention supplies. However, it soon realized that it was a mission impossible to resolve AIDS problems by the government alone, because “twenty years of fiscal decentralization and devolution of financing responsibility to lower levels has reduced the availability of social services, particularly health and education, in poorer areas”, thus opening up for the partnership with social organization or NGOs.
“China’s overall NGO sector is unlike its counterparts in other parts of the world. In China’s one-party state, the political space for NGOs to operate is still very restricted, and government remains the main service provider, even for services that in the rest of the world NGOs have traditionally played a major role in delivering. Paralleling the government service network, however, China’s mass organizations and government-organized non-governmental organizations (GONGOs) operate through vertical hierarchies to local levels paralleling the government system…There are probably about two million civil society organizations in China, including foreign NGOs, trade and science associations, charity groups, farmers’ organizations, and doctor’s organizations…The working environment for Chinese NGOs is still beset by a climate of distrust. “It follows that “Chinese NGOs fall more into the sociological than into the political definition of civil society in terms of their relative levels of autonomy from the state and their shared goals.”
“As with the overall context for NGOs in China, government remains the main service provider in the AIDS response, unlike in other countries, where NGOs play an important role in service delivery to marginalized groups. The government role has been mainly played by China’s Center for Disease Control and Prevention’s National Center for AIDS Prevention and Control (NCAIDS). The national CDC operates under the leadership of China’s MOH. At the provincial and local levels, the provincial health bureaus and their affiliated CDCs have led the AIDS response with designated responsibility for carrying out the official China CARES program of free testing and treatment provision and HIV prevention activities (with substantial financial support from GFATM and other international donor programs), and are the main government counterparts for most international AIDS funding programs. Even though local CDCs are bureaucratically accountable to their own local governments (through local health bureaus), earmarked vertical funding from the GFATM through the CDC and health bureau system has increased their resources and independence to carry out technical work.
However, because government-funded services such as public health education have been significantly weakened in the past two decades under China’s fee-for-service health system, which is focused on curative care, the need for greater local NGO involvement in China’s AIDS response is clear, especially to reach groups that avoid government scrutiny. And because the AIDS epidemic is expanding faster than the political space for NGOs at the local level, local CDCs have been engaging in pragmatic partnerships with grassroots NGOs and defending that work to local government, therefore pushing the boundaries of what might normally be allowed. These pragmatic partnerships between local CDCs and grassroots NGOs are helping to improve understanding of the value of NGO roles, possibly to the benefit of all local NGOs in China.”
On the other side, the diverse grassroots NGOs proliferate with specific focus on most at-risk populations like gay men, frequent migrants, youth, and on hard-to-reach populations. As we can imagine, some high-risk groups for HIV/AIDS, for example, drug users and sex workers avoid government services for fear of their illegal status and chances of being arrested. Unlike the government actions, NGOs are able to fill the gaps in need of most urgent services, to reach these marginalized subgroups, to provide outreach and education to gay men through hotlines and in bars and bathhouses, provide condoms to sex workers, exchange for needles and syringes, etc. In addition, online communities have been established and become an important “networking” mechanism in recent years “for groups with limited budgets for travel to conferences”. Undeniably, the value of grassroots NGOs have been more and more recognized by civil bureaus.
Most inspiringly, NGOs have blazed their political space and made their voice heard in China. The country coordinating mechanism (CCM) founded the Global Fund in 2002 to fight AIDS “with a mandated governance mechanism that required the establishment of a group made up of civil society representatives.” Especially, Global Fund Round 6 is “an important further mechanism to institutionalize the AIDS NGO role in China’s AIDS response”, with commitment to local ownership and participatory decision making. China’s main AIDS GONGO is the Chinese Association of STD and AIDS Prevention and Control (CASAPC). Since 2000, the China STD AIDS Association has held several AIDS NGO coordination meetings, uniting grassroots NGOs to combat AIDS financially.
Nevertheless, there is still space for improvement of collaboration between the government and NGOs for social service provision as follows:
(1) Weak coverage of rural areas. Unless contracted and understood by the local government, even AIDS NGOs feel hard to reach rural areas, where medical professionals and employer health insurance are scarce.
(2) Lack of operational funding. “Despite large amounts of donor funds for AIDS in China, little reaches the bottom”. To make things worse, “in-fighting between groups over funds, local ownership, and visibility has further inhibited needed coordination on advocacy and programs”.
(3) Government’s unwillingness to cooperate under some conditions of political sensitivity. A typical example is the blood scandal of Henan province. For a quite long time following the revelation of the scandal by a retired doctor, the local government was still unwilling to respond directly on this issue. It detained and monitored the retired doctor and some media, and “conflicts between victim/patient groups and local government agencies have created a climate of distrust”. Regardless of the story-publicizing and censuring of human rights organizations outside of China, it will be very difficult for the government and NGOs to negotiate and cooperate.
F0r more details see Chapter 8, The role of NGOs in China’s AIDS Crisis by Joan Kaufman, from Book State and Society Responses to Social Welfare Needs in China—-Serving the people, edited by Jonathan Schwartz, Shawn Shieh, Routledge, May 2009.
(Digested by Sheng Yongmei)
