People are inflexible to change their beliefs, and even more stubborn to change their behaviors. Now the Bush administration tries to conquer this hurdle.

Bush advocates abstinence from sex in teenagers to prevent sexually transmitted infections (STIs) which includes HIV infection. Many schools already have sex education. However, the abstinence-only education programs are way too insufficient. Researchers found that those curricula distorted information about the effectiveness of contraceptives and/or misrepresented the risks of abortion. In particular, it blurred religion and science, as it is well known that Bush firmly rejects the abortion idea based on his religious belief.

Furthermore, supporters to “abstinence until marriage” idea believe that teaching young people about “safer sex” is an invitation to have sex. This is ridiculous. CDC has reported that 61% high school seniors have already had sex. For those adolescents whose knowledge is limited to abstinence, they may lack skills to protect themselves when they become sexually active.

Recent FDA decision on plan B pills also reflected this ridiculous idea. Plan B pills can prevent unwanted pregnancy even after sex.Conservative people believe that making Plan B pills over the counter will tout careless sex among young people. They never think about those teenage mothers who have to discontinue their education to raise children. Almost all female headed families are below or close to poverty level. A large percent of them are black women. I don’t think they want to be poor.

Psychologically speaking, people’s beliefs and behaviors can be changed if social norm changes. Bush’s “abstinence from sex” campaign may have some merits on this. However, focusing on abstinence only is insufficient if not misleading.

When I first heard of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) 20 years ago, I paid no attention to it except fear. I believed that HIV infection was a dirty disease (as many people still believe this even now). The first AIDS case in Shanghai many years ago was a young lady from Yunnan province who was a former illegal drug user and prostitute. During her visit to the department of dermatology in a teaching hospital, she calmly informed the attending nurse that she was an AIDS patient. This caused a panic in the clinic. Although everybody knew what AIDS was, no one knew how to appropriately deal with her. After consulting with the Department of Health, they prescribed some drugs to her and very professionally did some biopsy. After a brief quarantine, the patient took train back to Yunnan. I was fortunate to see the photo of Kapasi sarcoma taken from that lady. Luckily, HIV won’t transmit to other people by taking train together.

Two years ago, a young popular male singer was died of Pneumocystis carinii pneumonia (PCP ????????). It is a typical AIDS pneumonia. Although his attending physician didn’t announce that the singer had AIDS, everybody knew that he had AIDS. This clearly illustrated the stigmatization of HIV infection and AIDS among Chinese. China had let go a good opportunity to educate lay men what HIV infection and AIDS are.

The first wave of research on HIV were mainly carried out in Yunnan and Guanxi provinces, led by Chinese Academic of Preventive Medicine in 1980s. One person told me that they only surveyed those illegal drug users in rehabilitation centers, nothing preventive was done among general population. However, recent studies started to look at prostitution in China.

In a 2001 survey, 95% businessmen and traders confessed that they had at least one commercial sex recently. Among more than 120 million migrating workers (the “floating population”) who live under stress, most migrating men are also sexually deprived. This will lead them to seek a temporal relief from prostitutes, but most of them have no knowledge of safe sex. Relevant data were unavailable. Nevertheless, an HIV infection chain from prostitutes—workers—wives—children may lead to an epidemic in rural areas where public health services are almost none.

Women may be three times more likely to contract HIV infection due to their anatomically receptive nature. Therefore, prostitutes unwillingly become HIV reservoirs. The prevalence of HIV infection among prostitutes in China was about 2% based on rehabilitation center data, but may be underestimated. More than 80% of them didn’t know condom can protect HIV infection.Till now, safe sex education targeting prostitutes are limited because prostitutes are invisible in most people’s eyes. Consequently, the government adopts the strategy “out of sight, out of question”. Chinese government should face the reality and advocate the “100% condom usage among prostitutes” campaign as Thailand has successfully implemented.

The next example is the saddest and widely known, but I recorded here to remember these poor people. In Henan province, many rural peasants contracted HIV when selling their plasma, a procedure involving transferring blood back after plasma were extracted from blood. The bloods were usually pooled with bloods from other people. Syringes were also shared among them. Official data reported that more than 25,000 peasants were HIV infected. Many scholars thought the total blood transfusion related cases could be a million in China. The blowout of this tragedy in 2002 struck the whole world and eventually forced Chinese government to take HIV seriously.

In the above example, those peasants have nothing to be blamed. It is the poverty and the social insecurity that drove them to sell their bloods. This should not happen again.

A striking statistic: by 2003, 840,000 HIV carriers, including 80,000 AIDS patients in China.