by David Cowhig
Chinese physician Dr. Wang Shuping predicted the HIV epidemic among Henan peasant blood sellers and eventually raised the alarm all the way to Beijing when local and provincial authorities ignored the rapid spread of HIV among the sellers. This heroic and far-sighted woman became my most important informant on the HIV epidemic when I worked in the Environment, Science and Technology Section of U.S. Embassy Beijing 1996 – 2001.
Wang, for several years assistant to Professor Zeng Yi, chairman of the PRC National Committee on HIV/AIDS, was the single most important source for U.S. Embassy Beijing reporting on the devastating epidemic. She provided rock-solid, highly sensitive internal information about the HIV epidemic and the Chinese leadership’s disappointingly weak response. That in turn seized the attention of the Clinton White House (esp VP Gore) and drove more U.S. engagement with China on HIV/AIDS.
I met Dr. Wang Shuping at an HIV/AIDS education presentation in late 1996 on the eve of December 1 World AIDS Day, several months after beginning my Beijing assignment.
During my five years at U.S. Embassy Beijing I translated and shared widely many articles on the HIV/AIDS epidemic with the idea that, although my diplomatic reporting had a limited audience, I could in my own small way help increase pressure for things to move in the right direction. I also found I could help the international media reporting on HIV in China without violating State Department media rules this way. Nothing wrong with just sharing a translation from the Chinese media! In addition, I often responded to journalists who were looking into the same questions we covered in the Embassy Beijing Environment, Science and Technology (EST) section. We were also able to share unclassified versions of much of our diplomatic reporting on the EST section of the U.S. Embassy website (usembassy-china.org.cn), which is now preserved for posterity on the Internet Archive. [https://web.archive.org/web/20011031151810fw_/http://www.usembassy-china.org.cn/english/sandt/sandtbak-hp.html#AIDS ]
Protecting sources
Wang helped me a great deal with her explanations and suggestions about what was important. Usually I didn’t tell anyone who my contacts were and my bosses didn’t ask. In China I practiced a somewhat paranoid style of reporting — I was always afraid for my sources. I generally took no notes. I covered a wide range of issues in the science section and so shifted my focus as targets of opportunity presented themselves. A reporting trip to examine environmental issues in Xinjiang became a mostly human rights reporting trip – something that the political internal chief had urged me to do before I set out.
I always shared the information I got from my contacts and extensive reading in Chinese sources with colleagues in other Embassy sections. They in turn didn’t mind my occasional forays into political and economic reporting as long as I cleared everything with them.
In cables I characterized my sources’ backgrounds to establish their credibility. Using my Chinese reading skills, I often integrated what I gleaned from books, medical journals and the press and used that as a springboard to get clarifications from experts and to get their advice about the credibility of what I was reading.
Blood plasma centers spread the virus
Dangerous methods and poorly-trained workers at Henan province’s Health Bureau-run blood plasma collection centers spread the virus to tens of thousands of people from 1994 onwards. Frustrated by inaction at the Henan Heath Bureau, Wang Shuping jumped over their heads, taking 80-some blood samples to the Institute of Virology in Beijing. She was prepared to spend all her savings to confirm her findings that these samples from peasant blood donors contained HIV. However, Professor Zeng Yi, the chairman of the National Committee on HIV/AIDS, ordered that the samples be tested at official expense.
(A translation of Wang’s 1995 report warning of the rapidly spreading HIV/AIDS epidemic is available at https://gaodawei.wordpress.com/2019/08/11/henan-1995-warning-of-coming-blood-donation-spread-hiv-epidemic/ )
Once the tests were confirmed, officers from the central government went to Henan and made some arrests, ordering testing of blood sellers for HIV and closing temporarily some blood collection stations until they could re-open safely. PRC government investigators found alarming levels of HIV among peasants in some Henan villages but the reports were labelled top secret.
Wang Shuping shared this top secret report from the files of the Ministry of Public Health with me at great personal risk. Although in 1997 official blood plasma collection centers using dangerous methods were closed, some continued to run privately—and illegally. These illegal centers were particularly prevalent in China’s most populous and most impoverished province, Henan. The history of the Henan HIV epidemic in Henan is recounted in the anonymous 1999 article “The Blood Wound”, which both Wang Shuping and another prominent AIDS activist, Dr. Gao Yaojie strongly endorsed. [https://web.archive.org/web/20010618055451fw_/http://www.usembassy-china.org.cn/english/sandt/henan-hiv.htm ]
Chinese public health workers, including many government and Communist Party officials, were frustrated and some white-hot with anger by the cover-up and official inaction. At conferences on HIV/AIDS that foreigners were allowed to attend, I always sat in the middle of Chinese health workers rather than at the seats of honor at the front reserved for foreigners. There, I listened to the grumbles of Chinese physicians and asked questions. I learned a lot from the whispered criticisms, commentary, and answers to my questions from Chinese experts sitting near me.
Chinese medical journals were filled with clues to what was really going on. I asked the author of one article why he had an alarming conclusion that the body of his article did not support. He answered that, although there was much confidential information justifying his conclusions, he could not put it in the article! Some Chinese journalists published stories about “HIV villages” in Henan province, where peasant blood sellers were dying of AIDS, leaving behind many orphans. Some were fired for this, including a journalist at Henan’s Dajiangbao.
Wang Shuping, the first to speak out about the threat of HIV/AIDS to blood sellers and to the blood supply, and another activist, retired professor of gynecology Dr. Gao Yaojie, sought to raise HIV/AIDS awareness. They visited and revisited AIDS villages doing what they could, often at their personal expense, to help villagers whose health deteriorated due to AIDS. Wang Shuping said she could make these regular visits undetected because Chinese officials hate going to the countryside. They much preferred drinking and eating at the county seat to visiting peasants.
CDC training
Dr. Wang had learned epidemiological skills from a Centers for Disease Control and Prevention (CDC) field epidemiology course taught by the CDC’s Ray Yip in Beijing to a group of Chinese physicians in 1988. That U.S.-funded training came into play a few years later, after Henan health officials realized that collecting blood plasma from peasants and selling it would be a big money maker. The blood plasma economy that rapidly developed in those years is described in the May 1993 article “The Eruption and Sudden Surge of [Paid] Blood Donations” [ https://gaodawei.wordpress.com/2019/08/07/1993-zhoukon-henan-the-eruption-and-sudden-surge-of-blood-giving/ ]
Enter Wang Shuping, who soon disrupted their plans for riches as she applied her new skills at a blood plasma collection center in her hometown of Zhoukou, Henan. She detected the spread of hepatitis C among blood plasma sellers. From there, she predicted that an HIV epidemic would soon follow due to the same contaminated equipment and poor practices that favored the spread of hepatitis. At the time, Henan blood plasma collection centers connected sellers of the same blood type to a tank that pooled their blood. Once the blood plasma was separated out using a centrifuge, the liquid fraction of the blood was pumped back into the blood sellers so that they could sell blood more frequently. Dr. Wang discovered that this dangerous practice was spreading hepatitis C, and she predicted that HIV would soon spread through the blood supply as well.
Dr. Wang spoke at many conferences of the Henan provincial health department, arguing that these profitable but dangerous blood collection methods would spread the HIV virus and must stop immediately. In response, the local authorities hired toughs to beat her up and had her fired from her job at the blood collection station. Barred from working in her home province, she found a place at the PRC National Committee on HIV/AIDS. Government harassment eventually forced her to leave China in 2001. She worked as a blood researcher in Wisconsin and later as a medical researcher at the University of Utah.
Digging for the facts
Many Chinese health workers educated me about HIV in China and pointed me to Chinese books, media reports and medical journals that often hinted at more than they were allowed to say. The big picture is easy to censor, but nobody can fake all the details because it takes considerable background and study to know just what to fake. Chinese physicians, outraged by the cover-up, wrote articles in such a way that careful readers understood that things were more serious than was being disclosed.
As a former science and technology translator before joining State in 1991, I could read Chinese medical journals and pick up many of these contradictions. At conferences foreigners were allowed to attend, I always sat with the Chinese, not with other foreigners, explaining, “It is more friendly this way.” I picked up the Chinese language as well as English language handouts. The Chinese language ones were more informative. Sometimes the Chinese language seems to act as a kind of security classification!
My embassy reporting on HIV/AIDS and public health in China helped the U.S. National Institutes of Health and the CDC work more effectively with Chinese partners fighting the HIV/AIDS epidemic. The official reporting cables I wrote helped Washington organize more effective cooperation on HIV/AIDS. Slightly sanitized versions of those U.S. Embassy Beijing reports, along with translations of Chinese articles, are still available on the embassy’s internet archive.
Wang Shuping told me at the time that the reports we posted on the embassy website were being read in the office of the Minister of Public Health, which considered the reporting excellent. Embassy reporting from our web page was also quoted by The New York Times, The Washington Post and other media. Some Chinese officials were happy with my criticisms of China’s response to HIV/AIDS. In 2002, when the head of China’s own CDC came to Washington on a visit, she saw me across a room, came over to me and said “David! Let’s have our picture taken together.”
Wang Shuping’s heroic willingness to buck the system, and bravery in sharing information with the U.S. Embassy, made foreigners more aware of China’s failing effort to fight HIV/AIDS. Embarrassment in front of foreigners combined with increasing public pressure from within China itself helped accelerate Chinese government attention to HIV/AIDS and funding for HIV work. One day in 2000 at a meeting of Beijing-based diplomats with a visiting UN official, the official asked about HIV in China. I responded “I have seen Chinese secret documents that show the Chinese government knew that HIV was spreading in Henan villages in 1995, but the report remained secret and a cover-up continues.” All the way down the table, diplomats from the various embassies were writing furiously as a I spoke.
I had never heard of a diplomat giving away host country state secrets at a meeting like that but then again, innovation can be a good thing. Wang Shuping asked me a few days later, “What have you done?” Officials at the Ministry of Public Health, she said, had worked 36 hours straight making sure that none of their secret files were missing. Wang continued, “Two days later the Ministry of Public Health, the Ministry of Finance and [a third ministry I don’t recall] met to triple central government spending on HIV/AIDS prevention.” Wang Shuping was pleased with what I had done. Sometimes she jokingly referred to me as a “spy for public health”.
Wang Shuping, who died September 21 at age 59, saved thousands of lives at great personal cost. China should one day recognize Wang Shuping as a hero of the Chinese people.
David Cowhig, a retired Foreign Service officer, served ten years in China in both Beijing and Chengdu. He also worked China issues for four years at the State Department’s Bureau of Intelligence and Research. David Cowhig’s Chinese translations blog is at http://gaodawei.wordpress.com; he is on Twitter as @gaodawei.
“The King of Hell’s Palace”, a play based on the work of Wang Shuping by David’s daughter, playwright Frances Ya-Chu Cowhig, was performed at the Hampstead Theatre in London this fall.