A university sophomore in eastern China’s Zhejiang province was horrified when he realized that his sex partner had covertly slipped off the condom. Fearing HIV, he tested the man with a home screening kit, and sure enough, the result was positive. Fortunately, he immediately went to nearby Shanghai, and received a checkup and emergency treatment.
The anonymous poster shared his story on microblog platform Weibo, saying that after 28 days of medication, he remained HIV-negative.
For people who are accidentally exposed to HIV, post-exposure prophylaxis (PEP) is a four-week course of medication that can reduce the likelihood of infection by more than 80 percent if taken daily from within 72 hours of exposure, according to the World Health Organization.
Yet in China, timely access to PEP is not available to most people.
Though the formulation uses the same antiretroviral drugs that people living with HIV in the country take as treatment, according to national guidelines, local centers for disease control only provide PEP free of charge to health workers and police officers who have been exposed to HIV through occupational injuries.
For people who have been accidentally exposed through unprotected sex, there are limited official channels to obtain PEP. The few approved providers are big-city hospitals like Beijing Ditan Hospital and Shanghai Public Health Clinical Center. Treatment typically costs around 5,000 yuan ($750) — or about twice as much as Shanghai’s minimum monthly wage — including physical checkups as well as the four-week course.
But HIV seems to be increasing among sexually active young people. Party newspaper People’s Daily reported in 2015 that between 2011 and 2015, HIV rates among students aged 15 to 24 increased by 35 percent.
Zhang Jianpu, senior project manager at Shanghai Qing’ai Health Center, an HIV prevention organization, told Sixth Tone that the center has callers seeking advice about PEP every couple of weeks, including some from outside the city, though they only began promoting the medication in the last six months. Previously, the center was solely focused on encouraging condom use and HIV testing, but now they have come to see PEP as part of a holistic prevention strategy.
“We realized that this is actually a way to help people avoid getting HIV infections,” Zhang said.
Despite scant public promotion, there is a growing demand for PEP, according to Ma Tiecheng, the director of an HIV prevention organization based in Shenyang, the capital of northeastern China’s Liaoning province. He said his organization is receiving an increasing number of calls about the treatment. But with nowhere to obtain PEP in Shenyang after-hours — unlike in Shanghai, where the treatment is available 24/7 — some people turn to unofficial channels.
Ma said that some people purchase the drugs through their personal networks or through web forums such as Baidu Tieba, while others ask for a few pills from HIV-positive friends until they can find somewhere to prescribe a full course of medication. However, Ma said, he has also heard of counterfeit drugs circulating online.
Apart from the dangers of gray-market pharmaceuticals, taking even genuine medication without a prescription is not recommended, as patients have not been screened for additional risk factors or contraindications. Liver and kidney function tests in particular are necessary before being prescribed PEP, Zhang said.
Meanwhile, China has yet to publicize pre-exposure prophylaxis (PrEP), a daily treatment to reduce the risk of acquiring HIV for people who are at high risk for the virus — for example, those whose long-term partners are HIV-positive.
The drug used for PrEP, Truvada, was approved by the U.S. Food and Drug Administration in 2004 for use in treating people living with HIV, but it was not until 2012 that the administration approved the drug as a preventative treatment.
In China, PrEP has an even shorter history — and remains steeped in doubt and controversy.
Lu Hongzhou, a doctor at the Shanghai Public Health Clinical Center who specializes in HIV, told Sixth Tone that Truvada has been on the domestic market for four years, though it is only available in limited clinical settings. His colleague, Qi Tangkai, added that getting the medication is “very inconvenient.”
“We shouldn’t use it just because it exists; we have to see whether it’s any good,” said Zhang, the project manager from Qing’ai. “There is a possibility that heavily promoting it could lead to more unsafe sex.”
In 2012, Qing’ai assisted Shanghai’s Fudan University with a study on PrEP, but they were only able to find a handful of recruits willing to take the medication. “Some would argue, ‘I’m not sick, so why should I be medicated?’ or ‘If I adhere to using condoms, what’s the point of taking the drug?’” Zhang explained.
Ma, the director of the Shenyang-based NGO, added that for most, the cost is prohibitive for long-term use: A month’s course costs around 2,000 yuan. He said he hasn’t seen any government promotion for PrEP in northeastern China, and only a little for PEP — which “at most gets a passing mention,” he said.
Discrimination against gay people is an underlying factor that makes HIV prevention efforts more difficult, according to Lu Lu and Jiang Shibo, two medical professors at Fudan University. They said that efforts to popularize PEP and PrEP use among men who have sex with men, a group that is considered high-risk for HIV infection, are hampered by a lack of public support.
“[Without help or supervision,] it’s very easy to feel hesitant about getting treatment or forget to take the drug,” the pair told Sixth Tone via email.
For Ma, who has been in the HIV prevention field for 16 years, advocacy work is becoming more difficult, as recent laws governing foreign NGOs have restricted his organization’s access to funds from overseas foundations.
When it comes to running a civil society organization, Ma mused, “there are many uncertainties in China.”
Contributions: Qian Jinghua; editor: Qian Jinghua.
(Header image: A health care professional draws blood from a gay patient in Yuncheng, Shanxi province, Dec. 17, 2014. Chen Wei/VCG)