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By Donald G. McNeil Jr.
Tuesday, October 7, 2008

Infection with the virus that causes AIDS is spreading beyond China's original high-risk groups - heroin addicts in the south and blood sellers in rural central counties.

A new study finds that the virus has spread to all provinces, and cases are rising quickly among gay men and female prostitutes.

Heterosexual transmission is increasing. In Yunnan, the country's hardest-hit province, two men were infected for each woman as of 2006; 10 years earlier, the ratio was 13 to 1.

Although the number of estimated cases - 700,000 - is low for a population of 1.3 billion, it has risen 8 percent since 2005, according to the study, published last week in Nature.

"The epidemic is expanding, and more effective preventive measures are urgently needed," said the authors, who include seven scientists from Chinese universities and government agencies and Dr. David Ho from the Aaron Diamond AIDS Research Center at Rockefeller University.

Scientists believe AIDS entered in the 1980s with drug traffickers in Yunnan, which borders the opium "Golden Triangle" in Southeast Asia. It grew in Henan, where illegal blood banks pooled blood from indigent farmers, spun it to remove clotting factors and returned mixed red cells to all sellers.

The tracking of HIV subtypes suggests that the virus has moved along drug-trafficking routes, creating an outbreak in western Xinjiang.

To prevent spread to the general population, the study's authors endorse condom promotion among sex workers, exchange of clean drug-injection needles for used ones, methadone maintenance and free antiretroviral therapy.