1. Introduction

Acquired immunodeficiency syndrome, also known as AIDS, is caused by human immunodeficiency virus (HIV).HIV damages body’s immune system by destroying white blood cells which help us to destroy invaded pathogens. When HIV enters a white blood cell, it may remain dormant. However, once it is activated, it infects another cell to produce many new HIVS. After a certain period of time, the white blood cells are destroyed and leading to a loss of function of the immune system (Y.K. Ho,2004). People infected by HIV will turn out to have AIDS. Infected people are very weak to fight off other infectious disease and soon they will die.
According to the data and statistics of WHO, global summary of the AIDS epidemic, 2009, the number of people living with HIV is around 33.3 million and AIDS death in 2009 is around 1.8 million. How about China situation? We couldn’t find much data about China situation. Therefore, we have to explore the situation from other sources.

2. Current Situation of AIDS in China

According to the ministry of health of the people’s republic of China, the number of people living with AIDS is about 370 thousand and AIDS death is about 60 thousand. The figure is much different from the prediction of United Nations (UN), UN predicted that there will be 10 million people living with AIDS at the end of 2010. So, which figure is more reliable? I would suggest the UN one and the following is my reason.
In the early 1990s, the Chinese leadership launched a blood drive and paid donors for their plasma (Alice Park,2004), this is so called the “plasma economy”. Especially in Henan province, many blood stations appeared in a short period of time. Farmers believed that they could earn a lot of money by donating plasma and so, they can get rid of poverty. However, the government did not do much to monitor those stations, many people infected with AIDS in the process of blood donating. At, that time, more than 100 thousand farmers were infected; nearly 10 thousand of them died. Predicting the trend, it is difficult for China to have only 370 thousand people living with AIDS as the Chinese government just want to hide the fact and did little to deal with the current situation.
This essay will state the factors leading to such condition in detail. And also criticizes the policies or measures that applied by the government. At the end, there will be some suggestion to resolve the issue.
3. Factors that lead to the condition

According to the public health model, health status is not only relying on individual and form a biological perspective. It also related to the interaction with the social or physical environment. Therefore, when analyzing the factors that lead to the severe AIDS problem in Henan, where the famous “AIDS villages” located in China, we should consider comprehensively, include the scientific, economic and social perspective.
 Scientific perspective
In this case, the epidemiologic triangle can be used to describe the rapidly transmitted AIDS disease. The triangle is composed by three parts: pathogen, host and environment. This part will focus more on pathogen and host; environment will be further discussed in economic and social perspective. A common pathogenetic feature underlying is the deficiency of the immune system caused by HIV, which primarily infects and destructs specific cells of the immune system (CD4+ lymphocytes) (Alexander Krämer, Mirjam Kretzschmar and Klaus Krickeberg,2010). Human is the host in this triangle. Furthermore, Giesecke(1994) proposed that, a pathogen maybe transmitted to a susceptible host in many ways, direct transmission includes direct skin to skin contact and close contact that permit transmission via droplet and aerosols. AIDS is belonging to direct transmission; it is a blood – borne disease.
There are few direct transmission ways of AIDS, include having unprotected sex with a person carrying HIV, breast-feeding from a mother who has HIV to her baby, sharing needles, syringes, or other drug injection equipment that are contaminated with small amount of blood from someone who has HIV and having transfusions of HIV infected blood or blood product. Henan’s cases are mainly cause by the last two transmission ways. However, the China government insisted large numbers of cases are due to visiting prostitutes and having unprotected sex with a person carrying HIV. Actually, it is easy to verify the announcement of China government had a leak.
Dr. Gao Yaojie who pay a close attention to AIDS problem in China. She visited
The “AIDS villages” in different province and discover that most of the patients are farmers, workers and children, they didn’t visit any prostitutes. However, either they or their family members (children’s mother or their life partner) had the experience of plasma donating. Many of them are even frequent donors (Gao Yaojie,2009). Thus, this proved that AIDS spread rapidly is due to insecure plasma donating instead of visiting prostitutes.
 Economic perspective
In a village, farmers earned money by selling their crops in low price. The income was too low to earn a living, farmers and their families always in a situation of malnourished. Therefore, in early 90s, the Henan Province Government promoted “selling plasma” as an economic industry. The target groups were those poor farmers. The profit was very big; “selling”800 cc of blood could earn $70-80 dollars, which was a very considerable income to poor farmers. Government said that, people who donate plasma should not donate again in 15 days but most people and blood stations omitted obeying the rules. With reference to the record of Dr. Gao(2009), everyday , there were at least 200 people, normally 400 to 500 people donated plasma. Each of them can earn $70-80 dollars once; some people sold their plasma 13 times in a month and most of them sold 5 to 6 times a month. Dr. Gao had also interviewed a family to see why they were so keen on selling plasma, they said that their family had 5 members, selling plasma can earn 40 thousand dollars a year, they are poor indeed, they need money. Consequently, people sold their plasma too frequent and increase the chance of getting AIDS.
Besides, the profit of “plasma economy” is very high. In 2004, Dr. Gao has been to the illegal blood station, farmers sold their plasma between 1200am to 0600am. The same as above mentioned, they sold 800cc of blood for $80 dollars. However, the price that hospital purchased 100cc blood was no less than $100 dollars, 800cc blood was no less than $800 dollars. That means, the head of illegal blood station earn nearly ten times more than the farmers, they would not easily give up the business. Moreover, some of the ethical conduct of doctors was very bad. They persuaded some patients to have blood transfusion which they indeed not need so that the doctors could earn commission. Some patients were transfused with blood containing AIDS.
 Social perspective
Dr. Gao (2008) claimed that the blood plague was difficult to control. The first reason is that the demand of blood was extremely large in hospital. The phenomenon of temporary selling blood and blood transfusion was prevalent. Especially those hospitals that located far away from the blood bank, the transportation cost and conservation cost are high. When facing some emergency cases, doctors usually drew blood from the blood donor directly. Than, proceed blood transfusion to patients. Doctors did not carry out any test for the blood and patients may infect with AIDS in the process of blood transfusion. Also, some of the blood banks did not eradicate contaminated blood and it’s by- product. Thus, many patients got AIDS and lead to the large scale of blood plague.
The second reason is that, there were a lot of illegal blood stations, without monitored but crude tools. To build up a blood station was very simple, a board showed it was a blood station, two nurse to drew blood and one accountant (Gao yaojie,2009). In the process of blood donation, an unsterilized syringe was injected to one person’s blood vessel and then extracted and injected to another person’s blood vessel. Blood in same type was mixed together and stored in the same container. After centrifuged, plasma was extracted and the remaining blood content was transfused back to the donors. At the same time, a number of cross infection occurred.
The third reason is there were volunteer blood donors. The blood donating law no.6 of the people’s republic of China claimed that, “government organization, army, social organization, enterprise …should arrange people of the right age to donate blood.” Some cadres afraid of donating blood would affect their health so they recruited farmers as volunteer blood donors to replace themselves. If the farmers were AIDS patient, they would affect much more people.
To sum up, AIDS transmitted rapidly in Henan is not only because of the pathogen and host. A favorable environment enhances its transmitted rate. In this case, the favorable environment is based on the economic and social factors.

4. Public health policy of Chinese government

 Primary prevention
According to the encyclopedia on public health, primary prevention involves the prevention of diseases and conditions before their biological onset. This can be done in a variety of ways, such as preventing environmental exposures, improving human resistance to disease, or education to diminish risk-taking behaviors (Robert B. Wallace, 2010). There is no vaccine to avoid AIDS so the Chinese government aims to propagation and ban the selling of plasma.
Dr. Gao(2008), said that the government over emphasize people taking drugs, having unsafe sex and misuse condom will easily infected AIDS. This lead to misconception of AIDS, people felt that AIDS patient equals to slatternly lives. When asking about the knowledge about AIDS, many people would say they did not take drugs and visit prostitutes so that they would not infect with AIDS. They avoid continuing to talk about this topic.
We can see that the focus of government was totally wrong, it emphasized the minor reasons but neglected the major reason – selling plasma and contaminated blood transfusion. The truth is that selling plasma caused cross infection. Transfusion of contaminated blood cause the large number of AIDS infections. In long term, the awareness of AIDS will not raise.
In 1997, the government proclaimed “the people’s republic of China blood donation law” and stated that, earning money from blood donation is prohibited. However, this was not an effective way to stop people from selling plasma. It is because the policy only made many “plasma economy” industry turned to underground. Actually, the policy can uproot some of the illegal blood station. However, the supply of blood band could not fulfill the demand of hospital. Therefore, illegal blood stations were still active in certain province. The policy is not comprehensive enough to eradicate all illegal blood station and promote blood donation without getting money.
 Secondary prevention
Secondary prevention generally consists of the identification and interdiction of diseases that are present in the body, but that have not progressed to the point of causing signs, symptoms, and dys-function. Examples of screening procedures that lead to the prevention of disease emergence (Robert B. Wallace, 2010). With reference to the news report on 2005, The Chinese government provide free tests and body check to people who had sold plasma in 1990s, especially for those who lived in Henan province. Tests and body check were only provided to a small portion of poor people. Absolutely, it was not enough.
As we all know, Henan was the fountainhead of blood plague, many villages had turned to be “AIDS villages”, but it was not announced by the government. Media from overseas exposed the fact but the Chinese government just wanted to conceal it. I wonder the above policy was only beneficial to those “AIDS village” that has already aroused much public concerned. Dr. Gao(2009) believed that there were still many “AIDS village” in Henan province. To maintain a positive image and reputation on the globe, The Chinese government used different methods to prevent others exposed the fact to the public, for example, giving relief, compensation and red pockets. This is not a rational preventive measure to help those AIDS patients.
 Tertiary prevention
Tertiary prevention generally consists of the prevention of disease progression and attendant suffering after it is clinically obvious and a diagnosis established (Robert B. Wallace, 2010). One of the measures is isolation, to separate those patients and healthy people, usually concentrate the patients in a village. In the village, patients can work and live by their own effort. The government did not do much in this aspect, maybe it is because the AIDS patients mostly came from the same village. And, in Henan, there were already many “AIDS villages”. They were naturally self-isolated.
Isolation lead to the problem of discrimination and government obviously did not deal with it. Due to the lacking knowledge about AIDS, many people associate AIDS patients with slatternly lives. AIDS patient could not face the disease positively. They shame on themselves (Gao Yaojei,2008).The “AIDS villages” seems to be a label of biological disaster instead of helping the patients to live on their own.

5. Suggestion to improvement

Hence, I would like to state some suggestion to resolve the issue. For primary prevention, government should put most effort in it. The Chinese government should deliver correct message and information to the public. Public have the right to know the fact that most of the AIDS infections were caused by selling plasma and contaminated blood transfusion. Provinces should make some booklet, leaflet and poster to let the public know what AIDS is and methods to prevent it. Besides, education is also important, children should learn about AIDS when they were young. These children grown up with correct knowledge and foundation, they can exert great effect on society.
For secondary prevention, free tests and body check should provide to all AIDS villages in different provinces. Also, the government policies only focus on those who sold blood in 1990s. The truth is that also large amount of patients got AIDS because of transfusing contaminated blood. Free tests and body check should beneficial to these patients too. It is important that the government should do something actually help the patients instead of maintaining its own reputation on the globe.
Last but not least, about the tertiary prevention. Isolation is a applicable measure but supporting policies are not all-round. This measure can prevent the disease spread out but the patients need to suffer a lot. Therefore, besides preventive measure, the government can also distribute livestock, farmland and seed to the patients. Therefore, the AIDS patients can rely less on others, they can live and wok themselves. The AIDS village can operate independently. Government can also arrange some social workers and psychologist to the isolated AIDS village, they can provide AIDS patients with counseling service which can help them to accept themselves and dispel prejudices.

6. Conclusion
To conclude, the central pillars of public health can explain the AIDS problem in China. Public health is composed of multidisciplinary knowledge, prevention and social justice. We could not interpret AIDS problem by only exploring the scientific perspective. Economic and social perspective also play am important role. Moreover, prevention can be divided to 3 levels, primary prevention is crucial to the issue, which is also most effective way to get rid of the problem. Tertiary prevention is the last line of defense, reminding the Chinese government should do something before it is too late. Lastly, social justice should be upholding in Chinese, this is the most critical aspect to see whether the AIDS problem can alleviate or not.