Last January, one of Western China’s foremost HIV/AIDS advocates was arrested by the People’s Republic of China on charges of “endangering state security.” Human rights activists say no one has heard from—or about—him ever since.

The man who disappeared was Akbar Imin, one of the country’s 11-15 million Muslim Uyghur minorities, a Turkic-speaking ethnic population located on the fringes of secular Chinese society. Born in the Xinjiang Autonomous Region in China’s far Northwest, Imin had been working since 2009 for the PRC government’s Development Research Center in Beijing, tasked with gearing up drug abuse and HIV/AIDS prevention strategies among Uyghur migrants in the nation’s capital up until he was thrown in jail.

Official reports about Akbar Imin’s detainment didn’t even come out until two full months after his arrest, Greg Fay, project manager at the Washington D.C.-based Uyghur Human Rights Project, told Hopes&Fears. Fay, who has been researching Imin’s case for months, still doesn’t know where he is, what he did, or when exactly when the Muslim activist will get out of Chinese prison. “It’s an issue that I think will come up over and over again as you work on this story,” said Fay. “The lack of transparency and difficulty getting information in China [around HIV/AIDS].”

"Capitalism-loving disease": Western China's hidden HIV epidemic. Image 1.

Casey Halter




What’s going on with China’s HIV/AIDS epidemic in Xinjiang? Why are Uyghur people getting arrested for their public health work? And why is nobody reporting on this?

Raising community awareness of HIV/AIDS in China, 2006. Photo: AusAID via Department of Foreign Affairs and Trade, Australia


"Capitalism-loving disease": Western China's hidden HIV epidemic. Image 2.

HIV, the "capitalism-loving disease"

Xinjiang is an autonomous province that holds a wealth of national resources and acts as a buffer zone between China and other Central Asian states. It’s bordered on its south by Tibet, another one of China’s three “autonomous” territories; like Tibet, Xinjiang sustains a strong separatist movement—mainly comprised of an ethnic Turkic, Sunni population—that claims a 4,000 year history with the land. Also like Tibet, the area has recently experienced harsh military crackdowns by the Chinese government, a comprehensive strategy of Han “re-population” and intense discrimination of its ethnic minorities. The majority of Xinjiang’s non-Han cultural community is known ethnically as Uyghur and makes up nearly 45% of the region’s population.

Xinjiang and its Uyghur people also have a longer history with HIV/AIDS than the rest of the country. In fact, until the early 2000s, reports show that China pointedly referred to the epidemic in the region as “a Uyghur disease,” an “evil from abroad”, and “Àizībìng” (艾滋病)—a pun on  “Àizībìng” (爱资病), which means a “capitalism-loving disease”—in its national media.

The Chinese Ministry of Health was also known to say that, thanks to the “superior [Han] immune system” and their “Neo-Confucian values,” most Chinese would not be affected by the disease. “The government inaction surrounding the HIV/AIDS epidemic in the Uyghur community certainly reflected the low status of the Uyghur people in the eyes of the government,” says Fay.

Dr. Anna Hayes, a leading researcher on the region’s HIV and heroin epidemics, reiterates Fay’s warning that accurate, cohesive information about China’s HIV/AIDS epidemic in Xinjiang is hard to find. “The levels of data in these reports are not enough,” Hayes tells Hopes&Fears. “You want statistics that drill down to county levels and it just isn’t available. Numbers, modes of transmission, comparing trends across years, it’s all missing.” Hayes pointedly notes a time period of about four years where China’s “official” numbers on the HIV/AIDS epidemic didn’t change by a single case—a highly suspect claim.

Xinjiang (新疆‎‎ in Mandarin, شىنجاڭ in Uyghur) means “New Frontier. Annexed originally in 1884 by the Manchu Empire, the province went through two successful uprisings to become an independent state (what local ethnic populations still call “East Turkestan) before the Chinese government re-took a firm, military hold of it in 1949.

A 2012 Chinese-language report published in the country’s Bulletin of Disease Control and Prevention shows that in 2011, HIV prevalence in Xinjiang was the fifth highest in China, with prevalence rates more than triple the national level. Uyghurs ages 20-39 were shown to make up the overwhelming majority of such infections. Another 2012 report from the Chinese Ministry of Health shows that in 2011, more than 50% of intravenous drug users (IDUs) in Xinjiang’s Ghulja district tested HIV-positive.

Different Studies, Different Numbers: A report by the Ministry of Health of the People’s Republic of China published in 2012 says that by 2011, the number of people living with HIV/AIDS in greater China had reached 780,000. But a UNAIDS report published in 2013 estimated that just 437,000 Chinese people were infected with HIV/AIDS. At the same time, estimates from several NGOs operating on the ground say the number of infections is closer to around 1.5 million people.

Begging, theft and survival sex

“There is no national safety net in the form of welfare [in China]," Hayes explains, “so the economically vulnerable have very few options aside from begging, theft and survival sex.” That’s why the heroin trade is often seen as an alternative way that many Uyghurs think they can take up to hopefully get rich quick. “These grand illusions sometimes [even] cause them to introduce heroin into their circle of friends so they can establish a customer base,” Dr. Hayes writes in an exchange talking about the links between Uyghurs and HIV/AIDS.

Xinjiang also sits at the intersection of both the Golden Triangle and Golden Crescent drug trades, making it a super convenient trafficking route for heroin making its way from the opium fields of Afghanistan to Russia and on to the rest of Europe.

China first reported about HIV/AIDS among Xinjiang’s IDUs in 1995, but several studies show it had already reached epidemic levels by 1996. Around the same time, the Chinese government launched their “Strike Hard” campaign, a nationwide crackdown on so-called “societal ills” like prostitution, separatism and drug trafficking, which formed the core of its early AIDS response. As part of its strategy, China completely ignored proven international approaches to curbing HIV infection rates among IDUs, such as needle exchange and methadone maintenance programs. Instead, any drug users found by the authorities were incarcerated, shipped off to labor camps or thrown into compulsory detoxification centers. “It was quite successful in reducing the amount of heroin available in Xinjiang,” explains Hayes. However, there was a massive unforeseen drawback to the solution: “The net result was that drug users changed their habit from smoking to injecting heroin. As soon as this occurred, HIV transmission via IDU (injection drug use) was guaranteed.”

Uyghurs left behind: treatment discrimination

To large extent, the Chinese government has left behind Uyghur heroin addicts, focusing instead on a multitude of Mandarin-centric public health initiatives. “[Today,] the HIV/AIDS response tends to remain Han dominated,” says Hayes. “In many respects, like economic investment in the region, I’ve seen examples of programs where it is believed the ‘trickle-down’ effect will mean this kind of information will reach the Uyghurs eventually.” Hayes’ important 2012 study points out that the overwhelming majority of HIV/AIDS prevention and information initiatives are publised in Mandarin only, effectively shutting out the Turkic-speaking Uyghur minority from participating in the next phase of national HIV prevention.

Specifically, Hayes points to several condom distribution programs that limit their outreach activities to ethnically Han sex workers in predominantly Han red-light districts. She claims the government was expecting that Mandarin-speaking women and girls would somehow educate their Uyghur-speaking peers on the outskirts of society about the importance of using prophylactics as part of practicing safe sex.

A 2007 study published in the Chinese Journal of AIDS and STDs shows that Uyghurs have by far the lowest level of HIV/AIDS knowledge compared to other ethnic groups in China.

Then, there is China’s population of men who have sex with men (MSM). According to the Bulletin of Disease Control and Prevention report, HIV prevalence among Xinjiang’s openly gay and bisexual men was reported to be an astounding 2.72% in 2011. AIDS researchers in the region note that because of cultural traditions in Xinjiang, many minority Muslim MSM citizens are still in hiding and nearly impossible to account for.


"Capitalism-loving disease": Western China's hidden HIV epidemic. Image 3.

Imans A Budukelimu ala Jidi, Abulati Kali and Yu San Jiang Kelimu, a few who spread the word about HIV/AIDS in the Mosque In Yining. China 2006. Photo: Lorrie Graham / AusAID via Department of Foreign Affairs and Trade, Australia

A slow, unfocused response

That’s not to say that China has had no response to HIV/AIDS in Xinjiang over the last few years. In fact, since the early 2000s, the PRC and its international allies have substantially picked up their pace in implementing anti-HIV efforts in the region.

In 2000, the World Bank Health Project launched a widespread initiative (active through 2008) that researched HIV/STI prevention strategies and intensified harm-reduction efforts across the province. In 2002, the Xinjiang HIV/AIDS Prevention and Care Project (active through 2009) was launched with help from the Australian Agency for International Development to expand needle exchange programs and introduce culturally sensitive approaches to combat the epidemic, such as recruiting Uyghur imams into their HIV/AIDS prevention model. And, the Chinese government does deserve some credit in these late-to-the-game approaches. By the end of 2011, Ministry of Health reports showed that HIV infection rates among IDUs in Xinjiang had dropped to 14.1%—down from an astounding 52.6% in 2002.

However, researchers like Hayes say much of these efforts were implemented about a decade too late. Hayes continutes, “They were only focused on drug users, sex workers and the emerging epidemic among blood donors. At that time, they did not consider women to be vulnerable group, and there was virtually no discussion of men who have sex with men.” By around 2006 (or 2011 according to Chinese reports), Hayes says that sexual transmission, not injection drug use, became the primary mode of HIV transmission not only in Xinjiang but across China as well.

a 2011 PRC report published in China’s Bulletin for Disease Control and Prevention shows HIV cases caused by sexual transmission had leapt to 65%  in the region. The PRC also reported that 36,159 people were infected with HIV in Xinjiang, 80.2% of whom were of the Uyghur ethnic background.

With Imin’s 2014 arrest, “The [Chinese] government really sent a strong message to Uyghur people,” says Fay, “even moderate dialogue about the issues affecting their community [including HIV/AIDS] is not tolerated by this government.” Imin’s case was not the first time that the Chinese government cracked down on Uyghur attempts at fighting the epidemic for themselves. In fact, the PRC has a long history of subduing even the most innocent grassroots movements in their minority communities.


The strongest evidence for this was 1997’s “Ghulja Massacre,” named after the city where it took place, in Xinjiang’s far Northwest corner. At the time, Muslim Uyghurs across the province had begun organizing Islamic social services, called “meshrep,” which were tasked with first-of-their-kind, community-based initiatives such as re-establishing religious morals, closing down Chinese-run liquor stores and getting addicts into recovery programs. Pro-Uyghur sources say the meshreps were highly successful in combatting the epidemic at a time when the Chinese government was all but ignoring it.

But they were dangerous for the anti-separatist PRC regime, too. In the direct shadow of the Han government’s attitude toward the Uyghur epidemic, meshrep groups blamed Chinese Marxism for shepherding in the loose morals that were supposedly fueling the epidemic. Then, on February 7, 1997 China banned the meshrep. Fay says human rights activists still aren’t sure how many people died in Uyghur uprisings related to the crackdown; official Chinese reports put the number at 30 killed, 100 injured and 3,000 to 5,000 arrested in the weeks following, but these should be taken with a grain of salt. Amnesty International’s report on the incident includes harrowing reports of tear gas, batons, horses, shootings, and dozens of executions in the aftermath of the meshrep shutdown.

A 2012 Report from the Chinese Ministry of Health shows that in 2011, more than 50% of injecting drug users in Xinjiang’s Ghulja district tested HIV-positive.

In Uyghur-dominated Xinjiang, grassroots coalitions of any kind are “regularly seen as a threat to the authority of the Chinese government,” says Fay. In fact, just this year, China passed a law that will make it increasingly difficult for any sort of non-governmental organization to obtain foreign funding. Their rationale, says Fay is this: by reaching out to an underserved populace and gathering it together to talk about the issues affecting its communities, NGOs empower local leaders to work outside of the confines of the government’s authority. Regardless of the depth of the Uyghur health crisis, China sees the empowerment of the Uyghur people as inherently more dangerous to state security.

In our interview, Fay recalls another time back in 2008, when he was a student at Urumchi University in Xinjiang. He knew another student who helped organize Snow Lotus, an HIV education organization geared towards Uyghur youth. It was shuttered almost immediately under pressure by the PRC (all Fay will say about the incident is, “I was briefly in touch with him, but the situation made me kind of nervous, to be honest”). 


"War on Terror" vs. the War on AIDS

Although China might be upping its HIV/AIDS education and prevention strategies, the country is still largely refusing to address any of the social, political, cultural or environmental factors contributing to the spread of the disease. And that goes double for China’s minority Uyghur population, many of whom are currently embroiled in fierce battles against the PRC government in their continued search of independence for East Turkestan. “The crackdown [on Uyghur minority initiatives] has been getting even worse since Xi Jianping assumed power in 2013,” explains Fay. Human rights activists in Xinjiang have documented an uptick in instances of police brutality and restrictive policies on religion and freedom of expression.

In many cases, like Imin’s, those who try to bring light to or speak out about minority-specific issues are quickly prosecuted or forced back underground. “Even talking about issues online can get Uyghur people in a lot of trouble,” says Fay. “That’s including any issue that includes an ethnic dimension, and HIV/AIDS certainly does. There’s even a risk for people within our group to talk about what’s happening back in China, for fear that what relatives we have there would be harassed.”

Such was the case of Radio Free Asia reporter Shohret Hoshur, who has reported relentlessly on Uyghur issues in China and subsequently had both of his brothers detained and harassed this year by secret police. “We experience all kinds of cyber attacks [at UHRP], and our organization is based outside of China,” says Fay. To him, Xinjiang is becoming an increasingly hostile environment where the reporting is difficult, information is incomplete, and even talking about HIV/AIDS issues in Xinjiang can get you thrown in jail.

Between 2013 and 2014, reports show China’s so-called “war on terror” in Xinjiang, waged overwhelmingly against its minority communities, killed between 656 and 717 people. Human rights groups outlined 125 incidents of Uyghur separatist uprisings, 89 of which turned violent. However, the Chinese government only reported 13 of these incidents and subsequently labeled three quarters of them as “terrorism.”

Perhaps that’s why, at the beginning of her 2012 report on Xinjiang, Hayes warns that the Uyghur health crisis is threatening to destabilize the region even further. “When you add a growing HIV/AIDS epidemic to this situation—going by what we have seen to be the economic toll of HIV/AIDS in regions like Sub-Saharan Africa—we know that not only will health rapidly deteriorate, but so too with the economic circumstances of those affected.” And that’s certainly scary for China. In our interview, Hayes warned: “At some point, the release valve has to give.”

Until then, Akbar Imin, anti-discrimination advocate, HIV/AIDS activist, Uyghur scholar, will sit in an unknown Chinese prison for 5 to 8 years, reflecting on his people’s struggle.


Casey Halter is a Brooklyn-based reporter who focuses intersection between healthcare and human rights with a degree in Middle Eastern & Islamic Politics from NYU. She is currently an assistant editor at POZ magazine, a freelance contributor at VICE and is in the process of launching her own webzine, Silica Mag.

Editor: Gabriella Garcia

COVER IMAGE via Carolyn Drake/Panos