In a population of nearly 1.4 billion, HIV/AIDS in China is growing steadily from a few isolated epidemics to an increasingly national concern, with cases of HIV infection now being reported in every province. Estimated overall infection rates that were until recently relatively low have now dramatically increased as the impact of blood contamination become clearer.

Official estimates put nationwide HIV prevalence at 0.07% of the adult population – around 600,000 people. Factoring in unofficial blood contamination estimates, these figures may increase to 1.7% and more than 2 million people. A collaborative UN assessment estimated that there could be 20 million people living with HIV/AIDS by 2010.

The extent of blood contamination only emerged in early 2001, though unsafe unofficial "blood harvesting" has been spreading HIV since the mid-1990s. Conservative unofficial estimates are that blood contamination has added around 1.5 million new infections, with initial indications that much are in central China, with Henan province being one of the worst affected. The nature of transmission means that most age groups are infected. Some villages are estimated to have up to 40% prevalence – among the highest in the world. Yunnan province experienced the first HIV/AIDS epidemic in China, among mainly injecting drug users in rural communities close to the borders with Myanmar, Lao PDR and Viet Nam. HIV/AIDS is spreading rapidly across the province and from minority national groups into the Han majority population. Outside Yunnan, several new epidemics have appeared, for example in Guangxi, Sichuan, Xinjiang and Guangdong provinces.

Injecting drug users (IDUs) still account for 72% of all reported new HIV infections, according to sentinel surveillance data. A far larger epidemic is looming, driven by sexual transmission, and affecting many more women and children..

China shares many of the conditions that have allowed major epidemics to develop in other Mekong countries: large populations living in remote regions but becoming increasingly mobile in search of work and opportunities, low levels of literacy, low HIV/AIDS awareness and rapid socio-economic change with increases in risk behaviours like injecting drug use, commercial sex, premarital and extra-marital sex. Reported cases of other sexually transmitted infections rose 37% between 1997 and 1999, to 630,000 cases, and the actual number is certainly much higher.

Yunnan Province

From 1996 to 2000, UNICEF HIV/AIDS programming concentrated on selected counties in Yunnan province. Yunnan is poor and underdeveloped, with a population that includes around 25 national groups like the Yao, Dai, Shan and Lahu, many of them with limited access to quality education, health and employment services and opportunities.

With UNICEF support, Yunnan developed a strong provincial HIV/AIDS response, with significant contributions from counterparts at provincial level and in specific counties. With the arrival of a major UK-funded project in Yunnan, UNICEF is maintaining limited support to Yunnan and focusing the majority of resources to help build capacity in provinces not covered by other international assistance, and successful projects and lessons learned in Yunnan are pointing the way.