By ANDREW JACOBS, New York Times, Published: December 2, 2009

 (Abridged from artilce entitled “H.I.V. Tests Turn Blood Into Cash in China“)

 …Although not trumpeted in its promotional materials, the foundations (Gates Foundation) other goal is more far-reaching: to empower the small but growing crop of nongovernmental groups that stand a better chance of addressing the AIDS epidemic than Chinas lumbering bureaucracy does.

To carry out its mission, the foundation has linked up with the Ministry of Health, which funnels $20 million to about 200 nonprofits, many of which exist in a bureaucratic gray zone and are viewed suspiciously by Chinas authoritarian government.

The distrust flows both ways.

By compelling the government to work with privately run organizations, the foundation is hoping to foster a lasting relationship between them and over time contribute to creating more profound changes in Chinese society.

Dr. Ray Yip, who runs the foundations China effort, acknowledges problems with the program but likens them to growing pains.

We are experiencing some of the hiccups of a less-than-perfect arrangement, but we expected that, he said. If you look historically at arranged marriages, some of them last.

Dr. Yip, who is the former director of the Centers for Disease Control and Prevention office in China, embraces the Gates Foundations philosophy of bold initiatives and risk taking traits often lacking in government-run global health behemoths. He said that if some of the money ended up in the pockets of corrupt officials running fake organizations, it was the cost of doing business in China, where government malfeasance is endemic.

We dont expect every grant in every city to be spectacularly successful, he said. Thats like buying 30 stocks and expecting them all to go up.

Sun Jiangping, deputy director of Chinas National Center for AIDS/STD Control and Prevention, said the program had already had a positive impact on government attitudes toward private AIDS organizations, whose numbers have increased to more than 400 from just a few dozen when the initiative started. He said his agency was working to weed out illegitimate groups.

Compared with the rates in other developing nations, the prevalence of H.I.V. in China is relatively low, with fewer than a million people thought to be infected, according to government figures released last week.

But public health experts are alarmed by an infection rate among gay men that has been doubling annually. By the end of 2008, nearly 5 percent of gay men in Chinas largest cities were thought to be H.I.V.

positive; in some cities, that figure exceeds 10 percent. Health officials say gay men now account for a third of all new transmissions, up from 12 percent in 2007.

Advocates for people with AIDS say the government has been ham-handed in its efforts to prevent the spread of H.I.V., in some cases banning condoms in bars or hounding activists who become too vocal.

In recent years, organizations have sprung up to help those with AIDS who are refused care by hospitals. Many, like Deep Blue, a group that operates from an apartment on the outskirts of Tianjin, are largely financed by grants from abroad.

Deep Blues two counselors meet with the 50 people who come each week for an H.I.V. test.

If you have any questions, contact the volunteers with the red armbands, says one poster. You can stop the testing at any time,

says another. About 65 percent of those who test positive come back for counseling, said the groups director, Yang Jie.

Tong Ge, a veteran AIDS activist who has advised the Gates Foundation on its China program, said he was pleased with the foundations work, though he said he wished there was more of an emphasis on training government workers and less money spent on testing. His biggest regret, he said, is that the foundation chose to funnel the money through the government.

So much of the Gates money has ended up nurturing corruption in a place it didnt exist before, he said. Then, after a pause, he added:

But the truth is we cant blame them. The real problem is with China.

 (Orginal article available at http://www.nytimes.com/2009/12/03/health/policy/03china.html?_r=2)