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asijustwitnessedduringmyrecentvisithere,chinahasmadesubstantialprogressincheckingthespreadofhivbutthereisstillalongwaytogo.fromaninfectionunknownonly27yearsago,aidshasbeetrulyglobalized.today,33millionpeoplelivewithhivaroundtheglobe,and25millionmorehavedied.
thesefiguresaresobering.however,itisimportanttonotethatwehaveenteredanewphaseinrespondingtoaids-aphasethatwillultimatelybefarmorechallengingthananythingwehavedonesofar.
now,forthefirsttime,theaidsresponseisproducingrealresults.
in,fewerpeoplegotnewlyinfectedandthenumberofpeopledyingofaidsworldwidedropped,mainlythankstobetteraesstoantiretroviraltreatment.
inchina,over34,000peoplearenowtakinghivdrugs,upfrom5,000in.but,wecannotslowdowninourvigilance.whereassubstantialprogresshasbeenachievedinthiscountry,thenumberofpeoplereceivinghivdrugsisstilllessthanhalfthenumberwhorequirethem.theepidemiontinuestorunaheadoftheresponse:foreverytwopeoplewhostarttakingantiretroviraldrugs,anotherfivebeenewlyinfectedwithhiv.
manyofthoseinfectionsourinsituationsthatareillegaloroutsideofmainstreamsociety.thesegiverisetoapparentcontradictionsbetweenrespectforthelawandprotectingthehealthofpeoplewhoinjectdrugsoraresexworkers,betweensexualityandmorality,betweenneedsofpublicsecurityandpublichealth,drugcontrolandsafeinjections.indeed,toconfrontaidsistoconfrontcontradictionsinsociety.
oncloserinvestigation,however,mostofthesecontradictionsprovetobefalsecontradictions.ascientifically-basedaidsresponsecansolvethemforthegreaterwellbeingofmorepeople.
drugabuse,forexample,isbadforanindividual'shealthandforthemunityheorshelivesin.hivinfectionsareparticularlyhighamongpeoplewhoinjectdrugs.lawsagainstdrugsmustberespectedtoprotectsociety.
ultimately,though,thebestwaytoprotectboththewiderpopulationanddrugusers,andatthesametimereconcilepublicsecurityandpublichealthconcernsistoadoptthe"harmreduction"approach.scientificevidence-includinghereinchina-showsthatprovidingdruguserswithsubstitutiontherapyandcleanneedlesreduceshivtransmissionandsupportsenforcementoflawsagainstdrugabuse.
similarly,workingwithsexworkersandtheirclientstoencouragecondomusereduceshivamongthesegroupsandinsocietyasawhole.whensuchprogramsarebackedupbypovertyreductioneffortstoreducewomen'sneedtoengageinprostitution,theirimpactisevengreater.
itisissuessuchasthesethatmakeaidssuchaplexproblemtodealwith.plexproblemsrequireplexsolutions.theyalsorespondbesttocollectiveapproaches.workingwithmunitygroups,forexample,cangreatlyincreasetheimpact-andeffectiveness-ofaidsstrategies.infact,giventhatmostinfectionsarehappeninginsituationsoutsidethemainstreamnorm,itisoftenverydifficultfovernmentalooreachthosewhoneedtobereached.
itisencouraging,therefore,tonotethattherehasrecentlybeenanincreaseinthenumberofmunityanizationsworkingonaidsinchina.manyofthesegroupsaredoingincrediblework.
thejointassessmentreportpublishedlastyearbythegovernmenttogetherwiththeunitednationssystemclearlyhighlightstheneedfreaterinvolvementofmunity-basedanizationintheroll-outofprogramstoreachpeoplewithrelevantservices.
currently,therearenoeasywaysformunity-basedanizationstoregister.withoutregistration,therecanbenobankaountandthusnoeasywaytoreceivefunding.manyofthegroupsihaveseenaredoingagreatjob-buttheirworkisbasedonvolunteerism.thisisneitherefficientnorsustainable.
chinahassolidpoliciesinplaceandhasmadesignificantprogressinthefightagainstaids.itistimenowtousethetremendousarrayofresourcesatitsdisposaltobuildonthatprogress,andtotacklenew,toughchallengeslikeharmreductionandincreasingcivilsocietyinvolvement,
aschairmanmaosaidmorethan60yearsago:"wemustnotbeeplacentoveroursuess.weshouldcheckourplacencyandconstantlycriticizeourshortings,justasweshouldwashourfacesandsweeptheflooreverydaytoremovethedirtandkeepthemclean."