On the eve of World AIDS Day on December 1, the Chinese government announced it will register and grant financial assistance to more than 1,000 NGOs working on HIV/AIDS awareness and prevention. Vice-premier Li Keqiang also met with some patients and representatives of NGOs last month.
The initiative sounds good but doubts remain, mainly because of the lack of democracy and transparency in China’s political ecology.
As it is undemocratic, people cannot join the government in the formulation and implementation of policies but can only be selected partners.
As it is not transparent, people cannot have sufficient knowledge on the regulations so as to monitor its implementation, including NGOs’ registration and service-buying from the government.
Take Li’s meeting with the representatives: the groups that are going to be approved for registration and granted financial support will merely be a result of government selection that lacks a fair, just and transparent set of rules.
Such selection not only leads to corruption but also spawns NGOs that favor government interests, which affects the independence and integrity of NGOs.
When the development of NGOs is restrained, they cannot speak freely for the people, and they fail to monitor and put pressure on the government. Civil groups will thus become limbs of the government. They can engage in the work but cannot correct government mistakes.
Worse, some of these groups may collaborate with the government. You can find in various places examples of the in-charges of these groups at the officials’ mahjong game table.
HIV/AIDS has been a critical issue in China for 27 years. The government has upheld the working principles of “organized and led by the state, executed by various departments, and participated in by the whole society.” However, the effort paid to fighting AIDS has led to grievous mistakes under government leadership.
In the late 1980s, the government adopted a closed-door policy, prohibiting the import of blood products and restricting HIV-positive people from entering the country.
As a result, Chinese people mistakenly thought that the epidemic was only transmitted among foreigners. Individuals and the public health sector therefore lost awareness on prevention and finally led to a widespread epidemic due to contaminated blood transfusions in the mid-1990s.
Covering up of the AIDS crisis in Henan province and the silence of the provincial government blurred the deaths of hundreds of thousands of AIDS patients. It is indeed an evil result of the lack of democracy and transparency.
The first AIDS conference in China was convened in 2001. Amazingly, no others have taken place since then.
Hosting the conference, the Chinese Association of STD/AIDS Prevention and Control required that academic papers “must be censored with endorsement from relevant departments, and additional approval from the provincial health department is needed if it mentions the widespread instances of HIV caused by blood transfusion.”
Censorship guaranteed the continued cover-up on the truth of the contaminated blood transfusion cases. The Henan provincial government keeps persecuting medical professionals, journalists and members of rights groups, preventing them from revealing the genuine picture of AIDS prevailing in the province.
Being indifferent to socially marginalized groups was another consequence of the lack of democracy. Yunan was the first province discovering the epidemic. Since most of the infected were drug addicts struggling along the state border, the government turned a blind eye to their medical needs. Many of them were not even told about their infection and unknowingly transmitted the disease to their families and friends.
According to a Yunnan yearbook on AIDS prevention work, there was no record about major prevention efforts on combating the disease between 1989, when the province first discovered the epidemic, and 2004 when the central government started to provide free treatment.
The Chinese government now spends billions of yuan annually on the prevention of HIV/AIDS. Since there was no transparency regarding the cash flow, problems appeared in the process of implementation of the policies and related projects – for instance, the lack of AIDS education in schools, absence of provision of condoms in entertainment venues and the negligence of care for children of parents living with HIV/AIDS.
Meanwhile, bureaucracy has dragged down the government’s efficiency when officials at all levels pay more attention to responding to their superiors but ignoring the AIDS-affected community. They either do not execute the policies or fail to catch the point when they execute.
The effort to combat AIDS in China urgently requires a more democratic and transparent approach.
Wan Yanhai is a medical doctor, an AIDS activist and director of the Aizhixing Research Institute in Beijing. Since 2010, he has lived in the United States