The relationship between doctors and HIV/AIDS patients in China has come under spotlight since news broke of a man concealing his HIV-positive status in order to receive a surgical procedure that two hospitals denied him.

As Xiaofeng, the pseudonym of the 25-year-old patient who lives in Tianjin, rested at home after his surgery, discussion raged on how to eliminate the discrimination that HIV/AIDS patients often encounter when seeking medical treatment.

China has an estimated number of 780,000 people living with HIV/AIDS. While this isn't a large percentage of the country's 1.3 billion people, many people have still felt compelled to eliminate the discrimination.

"The illegal behavior of some medical care workers aroused public concern," said Li Dun, a professor with the Research Center on Contemporary China of Tsinghua University as well as the director of the Legal and Policy Committee of the Chinese Association of STD/AIDS Prevention and Control.

As media reports and public discussion have heated up on the case of Xiaofeng, Li Dun wrote an open letter to Minister of Health Chen Zhu on Sunday, calling for a thorough investigation into hospitals that have denied treatment to patients with HIV/AIDS.

The letter requested that the ministry announce penalties for these hospitals as a warning to the entire medical industry and suggested reducing risks borne by medical care workers treating HIV/AIDS patients.

TWO SIDES OF ONE COIN

"My own experiences and others' experiences have told me: it's normal to be rejected (for medical treatment)," said Jinxing, a 21-year-old HIV-positive man who preferred that his real name be withheld.

Jinxing said he was denied a minimally invasive surgery many times, and doctors who had initially agreed to perform the surgery changed their minds after learning that he is HIV-positive. "In doctors' answers, I only find that they would rather postpone any surgery as long as possible when my life is not threatened."

However, although Xiaofeng's story came as no surprise to HIV/AIDS patients, many doctors were shocked.

Yin Liangjun, a doctor with the Second Affiliated Hospital of Chongqing Medical University, said behaviors like Xiaofeng's dishonesty may endanger doctors' lives.

If an HIV/AIDS patient conceals his or her condition, it increases the chances of a doctor being exposed to the disease, and the patient will not get the proper treatment if doctors do not know his or her infection status, said Yin, who has an abundance of experience in treating HIV/AIDS patients.

At the same time, other patients' risks of exposure can also be increased, as cross-infection can occur when doctors do not know that a patient is HIV-positive, he said.

"Distrust grows. I have a question mark in my head when reading other hospitals' reports on HIV tests ahead of my surgeries," he said.

Chen Wei, another doctor who has been treating HIV-infected people for more than ten years, believes the media almost always blames doctors but doesn't give them a chance to explain their side of the issue.

"In fact, many doctors would not (deny medical care to an HIV/AIDS patient). They treat patients with HIV/AIDS as well as others in accordance with the law," said Chen, assistant director of Department of Parenteral and Enteral Nutrition of Peking Union Medical College Hospital.

Chen does not believe in portraying doctors and patients as opponents. "Patients and doctors are like two sides of a coin. Both have their own rights and concerns, some are contradictory and some consistent. The interests of both groups are based on information transparency."

SYSTEMIC FLAWS

"The problem lies in neither patients nor doctors. It is in the deficiencies of government regulations," Chen said.

Chen pointed out that the government's guide on how hospitals should receive HIV/AIDS patients is not clear enough and it has flaws that allow hospitals to abandon their responsibilities to HIV/AIDS patients.

Government regulations allow doctors to redirect HIV/AIDS patients to other hospitals designated to treat those with infectious diseases, and this actually gives them an excuse to pass the buck, Chen said.

Most designated hospitals are specialized hospitals that only deal with infectious diseases and are not qualified to perform some major surgeries, he said.

Fu Wenhao, deputy director of the medical service office of the medical administration department of the Ministry of Health, said the designated hospitals exist only as an alternate option for when general hospitals are not equipped to take on HIV/AIDS patients.

However, the ultimate goal is to enable HIV/AIDS patients to receive safe and effective services in all medical institutions, Fu said.

"Regulation is limited by uneven techniques and resources. With the development of medical technologies and public awareness, adjustments will be made according to the situation," Fu said.

Moreover, doctors' rights cannot be fully guaranteed, as no criteria have been established on preventive measures, especially in remote areas, said a surgeon in a county hospital in southwest China's Yunnan Province who declined to be named.

Some hospitals lack facilities and some doctors lack awareness and good habits, the doctor said.

JOINING HANDS, SOLVING PROBLEMS

Xiaofeng never expected to be the center of such a rough-and-tumble debate, said Li Hu, who released Xiaofeng's story on his microblog on Nov. 13.

Li Hu, who is also HIV-positive, got the opportunity to express his expectations to Vice Premier Li Keqiang on Monday, after the vice premier publicly requested on Nov. 21 that medical practitioners offer equal treatment to people with HIV/AIDS and protect themselves in the course of treatment.

Li Keqiang asked the Ministry of Health (MOH) to guarantee the right to medical treatment for people living with HIV/AIDS and emphasized that people with HIV/AIDS should not be discriminated against. He urged that a new mechanism be created to resolve the current dilemma.

Various suggestions have been raised to solve the designated hospital issue.

A mechanism should be built to let doctors from infectious disease hospitals and general hospitals work together -- a move that may offer the ideal treatment scenario for those with HIV/AIDS, said Jiang Hui, office manager of aibai.com, a website that provides services and resources for the lesbian, gay, bisexual and transgender community.

"One-stop" medical treatment could also be achieved if doctors in general hospitals receive more education on treating HIV/AIDS patients and protecting themselves while doing so, Jiang said.

Meanwhile, until adjustments are made, those living with HIV/AIDS need to figure out for themselves how to obtain the best treatment.

Instead of concealing information, they should share information on doctors who willingly and knowingly treat HIV/AIDS patients, said Li Yan, an HIV-positive 28-year-old volunteer with the Qinghai Sunshine Care Association Panel in Xining, capital of northwest China's Qinghai Province.

The panel set up a medical service department to collect information on doctors across the country, as they believe HIV/AIDS patients nationwide find it difficult to find doctors willing to treat them.

"Our information guides people to travel across provinces for medical care," Li said.

Meanwhile, laws still offer strong protection for HIV-positive patients.

After confirming that Tianjin Tumor Hospital denied lung surgery to Xiaofeng, the Tianjin Municipal Health Bureau announced that it would penalize those responsible based on the Regulations on the Prevention and Treatment of HIV/AIDS.

"After having been through the whole thing, Xiaofeng plans to face the media soon but is not yet prepared," Li Hu said.

"I have been encouraging Xiaofeng to speak for his peers. The time is right," he said.