The AIDS Bombshell

(FORTUNE Magazine) – A native of Taiwan who came to the U.S. as a teenager, Ho, 51, is executive director of the Aaron Diamond AIDS Research Center at Rockefeller University and coordinator of the China AIDS Initiative. He has made more than two dozen visits to China in the past three years.

THE AIDS EPIDEMIC is a real worry for China, although its magnitude is still unclear. The Chinese put the official total of AIDS cases at about a million. The reality is, the data are so poor that it could be half a million. Or two million. UNAIDS has called China's epidemic the "titanic peril" because it could blow up to ten million or 20 million cases by the end of this decade. To me, that's very frightening.

In years past the Chinese health authorities did not place a great importance on the disease. There was a level of denial, a belief that AIDS would not affect China in a significant way because China is intrinsically different. Of course, those of us who work on these diseases know that viruses, bacteria, and other microbes do not obey artificial boundaries created by humans.

There has been a dramatic turnaround in the past year. The SARS epidemic had a big impact. It was a wake-up call for China. SARS revealed deficiencies in the health-care system--a disease-surveillance system that was inadequate, a health-care system that was not sufficiently transparent--and it led not only to a catastrophe for the country but to an embarrassment in front of the nations of the world. Cities were paralyzed, and the economy was severely affected. In April 2003, the Chinese made a midcourse correction and dealt with SARS quite effectively. They got it under control by the summer.

As they reflected, Chinese officials realized that they had serious health-care problems. That includes HIV/AIDS. It includes a health-care infrastructure that has broken down, particularly in the rural areas, where 800 million people live. Most people don't have insurance, and the costs of health care are rising. If the AIDS epidemic spreads, it could overwhelm the health-care system.

This is not to say that China has found the correct course. At the top, there's the political will to do the right thing. But China is a huge country with many layers of bureaucracy, and when you move down to local levels there's a great deal of resistance still.

A lot of work needs to be done. Prevention efforts should be expanded. China has a chance to avert millions of cases of AIDS. The effort is just beginning to take off. Henan and Yunnan provinces are launching large-scale testing efforts. That's commendable. We have a series of public-service announcements that will air this fall with Magic Johnson and Yao Ming, together, sending very potent messages about awareness and nondiscrimination. But there's a window of only a few years to get that work done before the epidemic growth curve takes off exponentially.

Because resources are limited, a balance must be struck between prevention and treatment. Lately the emphasis has been on treatment. It's robbing Peter to pay Paul. China has to realize that AIDS is a threat to its well-being and prosperity in the long term. Greater resources must be committed to the effort. -- Interview by Marc Gunther