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How the hukou system creates AIDS villages

For the past few days we’ve been looking at migrant workers, and issues surrounding the hukou system, including left behind children, and forgotten grandparents and wives.

In China’s medical system there are a number of drugs that treat chronic conditions (like TB and AIDs), that are given out to sick patients at little or no cost. While this in itself should be applauded, this program is unfortunately tied to one’s hukou and therefore restricts the person’s movement. If the person leaves their village, it will be incredibly difficult for them to receive their much needed medications.

I believe that this policy was created with the intention of controlling the spread of diseases (which is a good intention), but that this has had some very troubling results. In the past this system was used to isolate sufferers of leprosy, today its effects can be seen in the AIDS villages of rural Henan.

If you have been following China-related news over the last decade, then this story is probably familiar, but it is one worth remembering.

In the mid-90’s local governments were desperate to increase their GDP’s, and many farmers were struggling to catch up with the urban areas that were leaving them behind. At this moment foreign drug companies hired Chinese companies to collect blood in rural areas for clinical testing. These Chinese companies (which should have been more closely monitored) reused the needles in order to save a few cents on each transaction, and spread AIDS through the countryside.

The local governments tried to cover up the epidemic, since they had been promoting blood sales as a means of getting ahead. They were also worried that businesses would not want to invest in a region afflicted with AIDS and that their agricultural sales would slump (they did). As the cover up continued, it seemed as if the gov’t’s plan was to simply wait for an entire generation to die.

Finally in the early 2000’s the story broke, and the National gov’t went to work providing medical care for villagers who tested positive for HIV. My church also applied pressure to the local gov’t to allow us to build new homes and replace their crumbling school. Despite great strides in reducing the stigma attached to AIDS, many villagers still refuse testing, since knowing that they are infected would limit any future job opportunities as well as crushing their family (AIDS orphans are often denied access to schools, even after tests show that they are not infected).

Because their hukou ties their medical treatment to this single village, their future is limited. The medical center consisted of little more than two cement rooms with a single locker of AIDS medications, and a couple of hardwood beds. Regulations required that doctors give the patient their dose daily, and it was not allowed for the doctors to give the patient a supply. Because these patients cannot survive without these pills, it is incredibly difficult for them to seek further treatment in a facility that would be better equipped.

This is an aspect of the hukou system that is not often discussed, and the way that China has in some ways institutionalized AIDS villages disgusts me. It was these people’s lack of mobility that caused them to suffer for so long unnoticed, and this system of tying treatment to locality makes it easier for these abuses to continue.

Tomorrow we’ll be looking at the rationale of the Hukou system.


4 Comments

  1. Yaxue C. says:

    Tom, the same guy who made “Please Vote for Me,” Chen Weijun, also made a documentary about an aids family in Henan called “To Live Is Better Than to Die.” I don’t know if you have watched it. A heartwrenching story, and he made secret trips to that village and risked a lot to film it all alone on his own. It won a Peabody prize in 2003. He was here that year, I met him through a friend, and we chatted sitting on the National Mall.

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