STRUGGLING families live with HIV The Liangshan Yi Autonomus Prefecture is one of the country's worst-hit AIDS areas. Doctors and government officials are working to spread awareness to slow the spread of the deadly disease, write Bai Xu and Yu Li.

Agenrimo from the Yi ethnic minority is only eight years old, but his father is already making wedding plans for him.

"I will build a house for him as a wedding gift," says his father Agenyouhei, a 34-year-old man in Liangshan Yi Autonomous Prefecture, Sichuan Province. Basking in the sun, the reticent man seems happy dwelling on the topic.

However, both have HIV, which could lead to AIDS, a potentially killer disease. No one knows if either will live to enjoy the "big day."

Agenyouhei's yard is beside a brook in Muer Village of the mountainous Butuo County. He keeps two pigs and a dozen chickens there.

Agenrimo and his five-year-old younger brother Agenritu (neither are their real names) share a cold steamed bun as their father squats on the ground, smoking.

"I was found HIV-positive in 2008 during a screening," recalls Agenyouhei.

Like many other men in the county, he went to work on a construction site in Yunnan Province in 1997, where he began taking drugs intravenously.

In 2006, he learned from doctors that sharing needles put him at risk of getting HIV. On hearing the news, he quit the habit, but it was too late.

"I guessed that I might have been infected, and I might have also given the virus to my wife by having sex with her," he says.

That proved correct. His wife gave the virus to their eldest son while pregnant or by breast feeding. The couple was saved from further calamity when their second son was born without the virus.

"Maybe it's OK to have a third one," he says.

His wife, 34-year-old Abimorizo is pregnant again and due to give birth in August.

Agenyouhei's family is not the only one to suffer such a cruel fate in Liangshan. The prefecture has 21,565 HIV carriers living there between the ages of one-and-a-half months and 87 years.

Liangshan Yi Autonomous Prefecture boasts a population of 4.73 million from 14 ethnic groups. Its prefecture seat, Xichang, is known as China's satellite launching base.

But the prefecture is also known as one of the worst-hit AIDS areas in the nation. Premier Wen Jiabao visited the area on December 1, World AIDS Day.

According to Yang Wen, vice director of the Sichuan Provincial Center for Disease Control and Prevention, drug abusers sharing needles is the main cause for the spread of the virus in Liangshan.

Yang says the Yi people in the prefecture are allowed to have three children, and many choose to use up the quota, even if they know they are HIV carriers.

"They are not fully aware of the harm of HIV/AIDS," he says.

Agenyouhei is no exception.

"I know the disease is serious, but I feel OK," he says. But his CD4 cell count, an index for the health of the immune system, had dropped to such a low level that he had to start taking medicine every day.

He was also confident of the health of his eldest son. Last year, he spent 30,000 yuan (US$4,615), 10 to 15 times his annual income, to arrange his son's engagement with a neighboring girl, who is healthy.

The second reason the Yi people choose to fill their family planning quota is they attach great importance to having children, sons in particular.

"If they don't have a child, they will be looked down upon," says Hu Yingqiu, head of the health care center for women and children in Butuo County.

Hu said they initially tried to convince HIV-positive pregnant women to give up having children. "They not only refused, but avoided seeing us again later," she said.

The situation is also grim in Zhaojue County, which neighbors Butuo.

Safe births

"Among the 156 pregnant women registered, only 18 chose an abortion while the rest all gave birth," says Laergaga, head of the health care center for women and children in Zhaojue.

Because of ignorance, HIV positive mothers often transmit the virus to their children. The transmission rate is on the rise, from 0.2 percent in 2008 to 0.5 percent in 2009 and 1 percent in 2010.

Among the three AIDS transmission channels, mother-to-child is the most cruel, said Hao Yang, deputy director of the Health Ministry's Disease Control Department. "These babies have just come into the world, but they are already doomed," he says, adding that the situation was extremely serious in Xinjiang Uygur Autonomous Region and Yunnan Province, in addition to Sichuan.

Since it is hard to dissuade HIV-positive women from giving birth, it has become paramount to ensure the health of their newborn babies.

According to Wang Linhong, vice director of the National Center for Women and Children's Health, a baby can be infected at three stages: pregnancy, delivery and breast feeding.

Village doctors are supposed to persuade HIV-positive women into taking medicine during pregnancy so as to reduce the chance of infecting their babies. They should start taking the medicine after pregnancy for 14 weeks to lower the amount of the virus in their blood.

Hospital deliveries are advocated so as to reduce the risk of infection.

Baby formula is encouraged to avoid infection during breast feeding, Wang says.

Such combined measures can greatly reduce the chance of newborns getting infected. "Without the measures the chances of infection during pregnancy, delivery and feeding are between 33 to 35 percent, but these measures reduce the chances to 8 percent," she says, noting that if used properly, the measures can further push down the risk to 2 percent.

Many non-government organizations have joined efforts with local governments in the campaign, like the China Red Ribbon Foundation, which is co-sponsored by the All-China Federation of Industry and Commerce and dozens of enterprises.

The China Red Ribbon Foundation started donating milk powder since January 2010. To date, more than 9,600 tins of milk powder have been offered to 1,230 households, says Ye Dawei, vice secretary general of the foundation.

Ye and his colleagues are also engaged in teaching the locals how to use milk powder.

"We conduct training for local doctors," he says. "After the training, they will teach the new mothers how to clean the bottles and how to boil hot water."

Still, Yi women often refuse to give birth in hospital.

In Butuo, the hospital delivery rate is less than 20 percent, she says. In Zhaojue, the situation is better but the rate still stands at just 30 percent.

To encourage women to give birth in hospitals, the local government offers an incentive of several hundred yuan, while the China Red Ribbon Foundation has promised to give 800 "delivery packages" to pregnant women in Liangshan this year. The packages include baby clothes, milk bottles, napkins, pillows, quilts, thermometers and so on, Ye says.

Thanks to the joint efforts, many HIV infected women have had healthy babies, like 32-year-old Aduaniu from Sikai Village in Zhaojue County. She had two children, neither of whom are infected. Now she is pregnant again.

"My husband has been infected, but the medicine has kept him in good health," she says. "Our children are healthy as well. I have confidence in the doctors."

But Anduaniu's optimism can't cover up that HIV infected women in Liangshan face huge challenges.

A shortage of doctors in the prefecture means women with HIV still have a relatively high risk of giving birth to infected babies.

According to Yang Zhaobo, vice head of Liangshan, the average number of gynecological and obstetric doctors in every village and county level hospitals is only 0.12. Among all the village- and county-level hospitals and clinics, less than 10 percent can provide birthing services.

The long and bumpy mountainous roads also put many women off going to hospitals. A trip from the village to the county-level hospital could take hours.

Even Aduaniu's healthy children still face more problems than most.

When asked what would happen to her kids after she and her husband died, Aduaniu became hesitant. "They may have grown up by then," she murmurs.