“Representing AIDS in China” by Serene Ng Yeuk Shu

The HP Series showcases excerpts from excellent Honours Projects by students from the Department of English Language and Literature. [Read all entries here.]

Supervisor: Dr Ruth Y. Y. Hung

“Not now! No one’s around to take pictures. Next week, we’ll book our best photographer: If every plasma station’s being shut down, a head must roll… This is insurance. If the media blackout fails, we can prove to the Central Government Henan Officials are furious and committed to justice. It’s a photo opportunity, with jail time. The stay will be brief. Afterwards, you’ll still be rich, with a nice job at the Ministry.”
—Frances Ya-Chu Cowhig, 2019 p. 83.


AIDS has long been a taboo in China. The incidence of “AIDS villages” in Henan, for example, is rarely addressed by sociologists or writers, let alone by literatures in the world. Historically known as a foreign disease, AIDS was not seen as prevalent in China until the late1980s (Jing, 2006). Before 1988, it affected only a small number of foreigners or Chinese who went abroad; from 1994 onwards, the number of patients rose rapidly nationwide due to interrelated reasons such as commercial plasma transfusion and mother-child transmission (cited in Hayes, 2005).

The Situation

Children pose to raise a red ribbon symbol during an AIDS awareness activity at a kindergarten in Hefei
Children pose to raise a red ribbon symbol during an AIDS awareness activity at a kindergarten in Hefei, Anhui province, November 30, 2007. REUTERS/Jianan Yu (CHINA)

China did not have a set of regulations equivalent to the USFDA until the Ministry of Health (MOH) acknowledged that “many units producing blood products had chaotic management and the quality of their product was poor” in April 1988. Respective guidelines had been issued, but the effectiveness remains dubious. By the 1990s, China saw the investment and export potential of the blood products industry, and in response to Deng Xiaoping’s “the entire people go into business” reform, medical and health services became part of the national business fever.

“Over 80 per cent of our [90 million] population are farmers; even if less than 3 per cent of them are willing to sell their blood once or twice a year, we would be able to create 100 million yuan… our country doesn’t have AIDS and boasts of clean blood should be desirable abroad,” claimed the director general of the Henan Provincial Health Department in 1993 (as cited in Yang, 2018). “It was then more lucrative doing blood plasma than selling illegal drugs” (as cited in Yang, 2018).

The boundary between donating and selling blood was smudged to facilitate blood supply. Officially, people donated blood to save lives, but concurrently, the government provided people with a heavy sum of “nutrition fees” that was almost the average monthly wage in urban areas. And with the introduction of plasmapheresis, a process where blood plasma is collected and remaining fluids reinfused into the donor, dramatically mitigated people’s fear of harming their bodies’ “qi”. Appeals for blood donations went from “giving blood is glorious and life-saving” to “give blood plasma and get prosperous”, and farmers would roam from station to station giving blood as often as two or three times a day with fake donation permits (Yang, 2018).

Single-use medical instruments were reused on different donors and only sterilised at the end of the day; other instruments such as centrifuges and tubes were tainted, causing cross-contamination during reinfusion (Adams et al., 2009; Yang, 2018). Despite the MOH’s efforts, the Henan Health Department did not exercise any restrictions in issuing permits for blood stations. At one point, all blood samples collected from the black market tested HIV-positive, and the blood head claimed that they could provide as many as 50,000 packs of blood per month. (cited in Yang, 2018). (Blood-heads were the people who roamed Henan in the 90s, offering farmers money for their blood and then proceeding to sell the plasma to hospitals for a much higher price [“Blood, sweat & fears”, 2006].)

The doctor who alerted the blood station that they needed to ensure blood donors’ safety was told that those measures “would increase costs” and was later fired for “undermining their business”. Three years later, she reported her HIV-positive blood results to the Henan Health Department and recommended mandatory HIV antibody screenings. She was told that “it would cost too much, and it could not be done”; she alerted the director of Zhoukou Prefectural Health Bureau, who praised her work but took no remedial measures. The Henan government soon turned against the doctor for drawing unwanted attention.

By the mid-1990s, blood donation and transfusion became the dominating causes for the spread of AIDS. Up to 80 per cent of the adult population in certain areas had been infected through this way (Adams et al., 2009). By the end of 2018, China reported 1.25 million AIDS patients, with over 400 diagnosed per day (“World AIDS Day 2019”, 2019), but it is suspected that the actual number is much greater. Till recently, there have been reports of illegal blood stations operating in Beijing and Nanjing, indicating the epidemic is possibly ongoing (Luo, 2016).

AIDS in Literature

9248289Through the analysis of three chosen texts, Yan Lianke’s Dream of Ding Village (2005), Gu Changwei‘s Love for Life (2011)—which is a film adaptation of Dream of Ding Village—and Frances Ya-Chu Cowhig’s play The King of Hell’s Palace (2019), AIDS bears various literary meanings. AIDS is understood as an unspoken curse that not only kills humans but crushes such fundamental values as hope and humanity. Ultimately, it destroys place itself. AIDS also carries other significance, such as being a magnifying glass that allows readers to peek into the dark side of human nature; the catalyst of true love; and a mirror that reflects the unpleasantness of the bureaucracy in a corrupted hierarchical society. However different they may be, all three texts touch upon human desire and sacrifice, where AIDS can be understood as an invisible yet higher-level source of spiritual comfort where villagers willingly offer their bodies to it to fulfil their wishes.

In Dream of Ding Village, AIDS shows how far someone might go to reach their personal goals or what they can do when their minds are corrupted, egotistical and avaricious. In comparison to the untreatable disease, it is the horror of human nature that is more terrifying.

On the other hand, in Love for Life, AIDS leads the star-crossed lovers to realise what their initial marriages were like, brought the heavenly made pair together and rewarded them with the purest form of love. If they had not sold their blood or if the blood heads had followed the appropriate safety protocols, they two might never have got to know each other well, let alone get married and spend their lives together. Despite being separated for years due to AIDS, they ultimately wind up happy in their little cottage, penniless yet cheery.


And in The King of Hell’s Palace, AIDS can be seen as a mirror that reflects the problems of the bureaucracy in China. Issues are often covered up by the rich and powerful, while those brave enough to speak out or who are determined to deliver the truth are persecuted and punished. And not only are their own lives put at risk but those of their loved ones, and it is this fear that furthers social injustice.

Blood stations, state-owned or private, are the altars where people sacrifice themselves to fulfil their wants. For the public, it is an offering that they are willing to give for the tempting amount of quick cash that is practically free-flowing if there’s still blood running in their veins. AIDS is the unseeable higher power, a dark force that creeps into the lives of the villagers to haunt them for as long as they and their family members live. How people flooded into the blood stations, unaware of the risks, to offer themselves for spiritual and monetary comfort is somewhat like people in certain cultures who worship spirits or something possessing greater power to reach their goals despite being uncertain of the possible backlash.

Digging Deeper

Although political complications did not single-handedly bring about the AIDS villages in China, just as no one trigger caused the cultural revolution, their existence was irrefutably related to the governance of the time. Politics remains the major push factor. The cooperation between government officials and businessmen, the political climate in China, and officials protecting one other remain three dominant factors that were inimical to public health. This is a pyramidal situation wherein all aspects of society participate, from the grassroots to the very top.

Those at the base of society, especially peasant workers and farmers, were yet to be introduced to the idea of public health, let alone AIDS. They innocently walked into an early grave when all they wanted was a better livelihood, as sending a child to school or nursing a sick family member back to health can wreck a family’s finances (Gittings, 2001). They were deceived by the higher power and fell victim to China’s social norms or, more comprehensively, a mixture of these. The government misled the entire society into thinking there was no AIDS because it was a “foreign problem”; peasants and workers were not given proper information regarding the transmission or prevention of AIDS. Moreover, with the decreasing tolerance towards objections and doubts in public affairs alongside the rise of white terror, it became an unspeakable norm to believe in everything the government said.

In the middle were the blood-heads who can be vampirically ravenous when it comes to profit-making. Some blood-heads would do anything to maximise their profit, disregarding the possible consequences. They reused contaminated needles and plastic bags meant for storing vinegar to store blood without adequately sterilising them. Some washed the loads in the village pond, attracting swarms of mosquitoes; blood was also frequently pooled, divided and reinfused before being sold (“Blood, sweat & fears”, 2006; Rosenthal, 2000). These evil acts summoned AIDS to sweep through Henan in a blink of an eye. Although the greedy blood-heads were not the sole culprits, it is undeniable that their actions were the most devastating of all.

At the top of the hierarchy were the government officials responsible for the administration and well-being of Henan. Instead of serving the community, they turned farmers into commodities and a fountain of quick and easy income because Henan was one was the poorest provinces, and new sources of income were welcome. Given the terrible conditions in the blood stations, together with the collaboration and corruption within the government, the situation soon worsened. Instead of solving the problem, the Henan local government and later the Central Government decided to deny and conceal the outbreak. “Big officials tell small officials to deny it’s here, and so people don’t get help”; they forbade the local news media and government health employees from discussing the issue, and studies were blocked (“Blood, sweat & fears”, 2006; Rosenthal, 2000). Those who fell victim to the blood scandal were obstructed from seeking justice. House arrest, physical abuse, detainment and harassment of the petitioners happened frequently (“China: House Arrests Stifle HIV/AIDS Petitions”, 2006; Tsuei, 2006). MOH claimed that blood dealers had been punished, but there is no supporting evidence, and paradoxically, some officials who covered up and profited from the scandal have been promoted. In a particular village, the biggest blood-head became the head of the village (“Blood, sweat & fears”, 2006). Very rarely, a few local officials and medics would help the patients through donations and improvised education campaigns. Still, with little support from the higher government officials, limited funds and knowledge, these good wishes often go in vain (Rosenthal, 2000). Instead of setting things straight, it is well documented that the entire Chinese government apparatus helped cover up the scandal and obstruct the innocent victims from getting justice.


Works Cited

Adams, V., Erwin, K., & Le, P. (2009). Public health works Blood donation in urban China. Social Science & Medicine68(3), 410-418. https://doi.org/10.1016/j.socscimed.2008.11.006

Blood, sweat & fears. South China Morning Post. (2006). Retrieved 24 February 2021, from https://www.scmp.com/article/557122/blood-sweat-fears.

China: House Arrests Stifle HIV/AIDS Petitions. Human Rights Watch. (2006). Retrieved 24 February 2021, from https://www.hrw.org/news/2006/03/11/china-house-arrests-stifle-hiv/aids-petitions.

Cowhig, F. (2019). The King of Hell’s Palace. Bloomsbury.

Gittings, J. (2001). The Aids scandal China could not hush up. The Guardian. Retrieved 23 February 2021, from https://www.theguardian.com/world/2001/jun/11/china.internationaleducationnews.

Hayes, A. (2005). AIDS, Bloodheads & Cover-Ups: The “Abc” of Henan’s Aids Epidemic. Australian Quarterly77(3), 12-16, 40. Retrieved 5 December 2020, from https://www.jstor.org/stable/20638337.

Jing, S. (2006). Fluid Labor and Blood Money: The Economy of HIV/AIDS in Rural Central China. Cultural Anthropology, 21(4), 535-569. https://doi.org/10.1525/can.2006.21.4.535

Luo, S. (2016). Whistle-Blowing AIDS Doctor Reflects on Roots of Epidemic in China (Published 2016). New York Times. Retrieved 6 December 2020, from https://www.nytimes.com/2016/12/01/world/asia/world-aids-day-china-gao-yaojie.html.

Rosenthal, E. (2000). In Rural China, a Steep Price of Poverty: Dying of AIDS (Published 2000). New York Times. Retrieved 24 February 2021, from https://www.nytimes.com/2000/10/28/world/in-rural-china-a-steep-price-of-poverty-dying-of-aids.html.

 Tsuei, H. (2006). Henan HIV/AIDS Victims Banned from Petition to Chinese Government. The Gospel Herald. Retrieved 24 February 2021, from http://www.thegospelherald.netdna-cdn.com/articles/33401/20060315/henan-hiv-aids-victims-banned-from-petition-to-chinese-government.htm.

World AIDS Day 2019. World Health Organization (2019). Retrieved 26 February 2021, from https://www.who.int/china/news/events/world-aids-day/2019.

Yang, D. (2018). The Politics of Blood Safety Regulation in China: The Blood Plasma Economy and the Making of China’s Blood Safety Regulatory Regime. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3299623


Serene Ng Yeuk ShuSerene Ng Yeuk Shu is a recent graduate (BA ENG & EDUC) of the Department of English Language and Literature. Passionate about literature and society, she sets out to continue her quest of knowledge and truth upon graduation.

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