This article deals with a global public health problem: the HIV/AIDS epidemics, in the Xinjiang Uighur Autonomous Region of China. This region is dominated politically by the Han nationality, but 60% of its population is composed of ethnic minorities, in particular the Uighurs, Kazakhs, and Hui. The violent conflicts which explode repeatedly between the Han and the national minorities tend to exacerbate the strong nationalist feelings, in particular among the Uighurs. Not only are they stigmatised because of their ethnicity, but they are also labelled by Beijing authorities as ‘political agitators’, as well as a risk group for HIV/AIDS and for ‘deviant behaviours’ in the Xinjiang region. The authors of this article rightly underlines the important geostrategic position of Xinjiang, in particular as a major nod of the drug trade, with connexions with the two main roads of drug trafficking: one coming from Afghanistan through Central Asia, the other from the Golden Triangle in South East Asia. Many risk factors are cumulating so that an epidemic develops exponentially. The situation is similar to the one prevailing in ex-Soviet Central Asia. The main high risk groups are intravenous drug users (IDUS), who account for about two thirds of the infected persons, and are usually young (below age 35 years), followed by commercial sex workers (CSWs), who have unprotected intercourse and who also are often intravenous drug users. Furthermore, the so-called ‘floating population’, viz. unregistered migrant workers from China (estimated 140 millions in China in 2004, 7 million in Xinjiang only), are also considered a high risk population, given their great mobility, their precarious economic situation, their young age, and their lack of information and prevention.
The authors briefly mentions the stigma attached to the ethnic Uighur populations, as well as the stigma associated with other ethnic minorities who are marginalised and ostracised in Xinjiang by the Beijing authorities. The authors could have developed this aspect in more details, in particular the way the Chinese authorities use the HIV infection as a symbol in the conflicts between the Han and the minorities in Xinjiang. The article discusses well the international policies and programmes for fighting HIV and other sexually transmitted diseases (STDs), the substitution therapies for heroin drug users, as for instance methadone, which has been authorised in Xinjiang, whereas it is still forbidden in ex-Soviet Central Asian countries (except in Tajikistan, where it has be recently authorised in 2010). However, the authors touch upon only briefly and incompletely the collective responses developed by the international community, by the health care system, by medical personnel as far as prevention and health care are concerned. They do mention the existence of anti-retroviral therapies (ARTs), however without explaining whether these treatments are properly delivered and, if yes, under which conditions, and for how long. In all, this article sheds light on the obvious evolution of the HIV/AIDS epidemic, and the threats that it causes for the whole population. It also allows the readership to pursue reflection on the socio-political aspects of this highly stigmatised infection, on the construction of social norms, and on the political construction of forms of deviant behaviour by an authoritarian regime which is facing a new paradox: how to reconcile the fight against HIV/AIDS in an international perspective, while keeping a way of functioning deeply rooted into the ancient system, which has led to the exclusion of infected people from the society.