Nurses confided that they were afraid to touch patients with HIV/AIDS. The only people that got tested where those who were incarcerated, mostly IV drug users and prostitutes. Chinese health department officials in Hangzhou insisted that there were at most 20 gay men in a city of six million people.
So when a handful of people from Chicago's Howard Brown Health Clinic were able to begin anonymous testing this April in a gay bar just blocks from important government buildings in Zhejaing Province in the company of Chinese government officials, it was a little short of miraculous to those involved.
'They're where we were in the 1980s. There's tremendous fear, denial and almost no public health education about HIV/AIDS,' said Scott Cook, an HBHC staff member who is part of the China project.
In an effort that began in fall 2002, mainly based on personal relationships between the public health department in the region and HBHC Executive Director Keith Waterbrook, HBHC officials were invited to China to begin educating the Chinese about how to combat the spread of HIV/AIDS.
After three trips to the country, visits to gay bars and brothels, or 'recreation centers' in China, and countless e-mails about outreach, the first round of anonymous testing has begun in China, part of a five-year plan for increasing testing and awareness.
The goal is to have the Chinese running a program that does not require any Western help, according to HBHC staffers.
Because China does not have epidemology to help suggest where health workers should begin combatting the virus, HBHC and Zhejaing Province officials are targeting populations that are traditionally at-risk—and on the very fringes of Chinese society—gays, sex-workers, and drug users.
The tale of Waterbrook, an out gay man running a nonprofit health clinic in Chicago, being able to convince Chinese officials to tackle HIV/AIDS using outreach methods never used before in China is particularly novel considering the country's current perception of HIV/ AIDS.
The country has no official, accurate estimate of how many people have HIV/AIDS, according to Waterbrook.
According to CNN statistics, Chinese government data showed 30,000 people suffering with HIV in 2001. But UN estimates suggested that about 1.5 million Chinese had AIDS during that period.
'We just don't want this to be another Africa,' Waterbrook said.
Even going for an HIV test is a risky decision in the minds of the Chinese, who fear that their jobs or the government could have access to their medical records. Those who do test positive often are disowned by their family and basically have to start over in another province to avoid the stigma that comes with the disease.
'There's virtually no confidentially when it comes to medical records in China. It's a totally foreign concept,' Cook said.
For female sex-workers, an HIV test with a positive result could mean either the end of their livelihood or the continuation of transmission of the virus to men who will in turn bring the virus back to their communities. 'And no one there uses condoms,' said Waterbrook.
Treatment and diagnostic opportunities are slim. They have some drugs, but not ones that allow them to mix and match to form potent cocktails, said Dr. Leigh Roberts of HBHC, also part of the China Project. There is no way to test for viral load—a basic procedure used almost universally by doctors treating HIV to establish the progression of the virus through the body.
The Chinese health officials are slowly beginning to realize that they have the cusp of an epidemic on their hands and know if they don't do something to educate the public, the results could be particularly dramatic in a country of over a billion people.
Enter Waterbrook, or 'China-Tong,' a name given by the Chinese to foreigners who understand Chinese culture. Though he doesn't speak Chinese, he's traveled to China nearly 40 times, instructing doctors and public health professionals on all kinds of health conditions.
'So much of what happens in China is based on relations. And they trust me implicitly because of all I've done here,' said Waterbrook, who came to HBHC after running the University of Massachusetts Hospital and the University of Arizona's hospital.
Yet Waterbrook represents what many Chinese choose to ignore. He's an out gay man working amongst some of the most powerful public health officials in a province that is much like the California of China—wealthy, influential, and cosmopolitan.
After 40 trips, the foreign affairs officials know Waterbrook is gay. At first they were in shock. 'They would say, look at what Keith has done. He's married. He can't be gay,' Waterbrook said.
The disclosure is one that comes slowly to those Chinese who are unaccustomed to dealing with open homosexuals. At times, homophobia almost got in the way of the project, but HBHC staffers learned to recognize potential hazards.
For Cook, the sign that American-style outreach would work was when Chinese health workers in a gay bar previously unknown to them [though it was 'right under their nose'] were able to get gay Chinese men to talk to them about their sexual behavior.
HBHC staffers and Chinese health officials set up shop in a gay bar—with counselors and rapid test kits—just the same way that HBHC would do in a bar on Halstead.
'We've found that people are pretty open and really want to know about HIV/AIDS. But no one's really told them,' Cook said.
So far, about 100 people in the province have been tested and efforts are being made to expand the project. In August, a handful of Chinese doctors will come to HBHC to learn about treating HIV/AIDS.
The one positive test result so far—a 24-year-old young man—and his subsequent disappearance to public health officials, signals a need for better case management. 'He's probably scared out of his mind,' Cook said.
HBHC staffers said they are encouraged by a changing atmosphere regarding the virus and public knowledge as well as what the five-year plan means for the recognition of homosexuality in Chinese culture.
On his last trip, Waterbrook was approached by the leading Chinese scholar on homosexuality. With a tear in his eye, the professor thanked Waterbrook for raising consciousness about HIV and homosexuality in China, saying 'Thank you for doing so much for gay men in China, treating them as individuals and not outcasts.'
