A 2005 survey conducted in Chengdu, Suzhou and Guangzhou by the China Foundation for Hepatitis Prevention and Control found that 37% of respondents were still “unwilling to work or study with Hepatitis B carriers,” despite the very wide prevalence of the disease, according to the Foundation’s spokeswoman Zhang Jianmin (张建敏).

China’s medical authorities estimate that fully half of China’s total population has been infected at some point with the Hepatitis B virus (HBV) which, like HIV, is found in blood and other body fluids and is spread through mother-to-child transmission, infected needles and unprotected sex. It is also believed that the highly infectious virus may pass between small children living in close contact, via cuts, grazes and mucous.

Most people who contract the virus develop antibodies and recover, but some remain infectious, developing chronic hepatitis. This often causes liver cancer or cirrhosis which together claim half a million Chinese lives each year.

China is thought to have 130 million sufferers from chronic hepatitis—even though they may be without symptoms for many years—and each one is a carrier of the disease.

Chinese HBV carriers frequently encounter open discrimination. In a recent example that drew local media attention, university authorities in Xinjiang last November ordered 156 students, diagnosed as HBV positive in their matriculation health check, to suspend their schooling “for the sake of public health”. Students formed an action group, which also drew support from people who were not HBV positive, circulating 5,000 fliers to protest the unfair treatment, and one student started legal proceedings against the university authorities.

The Hepatitis Prevention and Control Foundation, established in 1998 on the initiative of the late Minister of Health, Dr. Chen Minzhang (陈敏章), has to date mainly concentrated on public education and prevention efforts but is also now working to overcome stigma and discrimination.

“HBV positive people have the right to live a normal life, enjoying equal opportunities,” says Zhang Jianmin. “We are learning from the experience of HIV/AIDS. The two diseases have a lot in common—transmission methods, treatment regimes, and also the way that they result in serious social isolation.”

Zhang, who recently joined the Foundation, continues also to serve as a moderator for Gandan Xiangzhao (肝胆相照, a Chinese idiom suggesting close friendship and understanding). This is an online forum (bbs.hbvhbv.com) that was founded in 2002 by HBV carriers and rapidly developed an informal network of more than 180,000 members across the country.

In late 2003 core members of the forum submitted to the Standing Committee of the National Peoples Congress and State Council Legal Affairs Office an appeal signed by 1,661 Chinese citizens calling for a review of regulations that prohibited the recruitment of HBV positive civil servants. This action was partly in response to the dramatic case of a Zhejiang University graduate, Zhou Yichao (周一超), who was sentenced to death after stabbing officials in a dispute related to recruitment barriers for HBV positive people.

China’s Ministry of Personnel and Ministry of Health eventually introduced new, national standards for health checks on public servants, lifting the ban on
recruitment of HBV positive people. An Infectious Diseases Prevention Law and the Chronic Hepatitis B Treatment Guidelines, both published in 2005, formally outlaw discrimination. However, some provinces have not yet to bring their practice into line with the national guidelines.

In 2005, according to the Foundation’s General Secretary, Su Chong’ao (苏崇鳌), the Hepatitis Prevention and Control Foundation saw a doubling of its income to CNY 10 million (USD 1.25 million), mainly derived from domestic pharmaceutical companies, foreign private foundations and international research institutions.

In 2000 the Foundation began a hepatitis vaccination programme for children, using vaccines donated by local companies. Over a two year period the project reached 600,000 newborns in fifteen provinces.

In 2003, the Ministry of Health integrated HB vaccination into its national Expanded Programme of Immunisation. The Global Alliance for Vaccine and Immunisation has provided USD 38 million, matched by central government funds, to support the programme in twelve western provinces, aiming each year to reach five to six million children living. Better-off, eastern provinces support the programme out of their own resources.

The Foundation has continued its own vaccination programme, however, covering twelve ‘Project Hope’ schools in Sichuan in 2004, and reaching 68,000 children in poorer areas of Guangdong in 2005. The latter project was carried out in partnership with an Asian Liver Centre attached to Stanford University.

HBV presents the most serious, long-term health risk to unborn children and infants. Research shows that fully 90% of children who become infected at birth will go on to develop chronic hepatitis and 60% of children who become infected aged 1-5 will become chronic sufferers, whereas the chronic form of the illness affects only around 10% of adults who become infected.

According to the Asian Liver Centre, 2 billion people worldwide have been infected with HBV, and 400 million of them have chronic infections. Prevalence in Asia is markedly higher than in other parts of the world, and China has the greatest burden of chronic infection and liver cancer. In Asia, most infections are contracted in childhood, “from infected mother to child at birth, from child to child contact in household settings, and from reuse of non-sterilized needles and syringes in poor healthcare facilities.”

Report by Tina Qian and Nick Young, February 17, 2006