Beijing/Brussels - After four years of seeking permission to bring AIDS treatment to China's Henan province, Medecins Sans Frontieres (MSF) has found the door firmly shut by the provincial authorities.

Henan is particularly hard hit by HIV; between the mid-eighties and mid-nineties many poor farmers got infected in a poorly run commercial programme for blood donation and transfusion.

"Since 2002 we have carried out six assessments in various districts of Henan," says outgoing Head of Mission, Luc van Leemput. "Even if the Henan government is trying hard to deal with the epidemic as part of China's national AIDS response programme, many challenges remain. There have been many repeated requests for support from patients, local administrators and local health officials."

In Hubei province, bordering Henan to the south, the MSF team is providing integrated treatment and care for HIV-positive people together with the Centre for Disease Control in the city of Xiangfan. One-fifth of the patients in this project are from Henan and the demand from people in that province to be enrolled has been increasing significantly in recent months.

"For all of us, it is very frustrating that the provincial authorities are not allowing us to start a similar clinic in a province that is one of the hardest-hit in terms of HIV-infection rates," says Van Leemput.

"All the more so for our doctors, who see the patients come from Henan and have contact with their colleagues in that province, but are blocked from bringing treatment and care to the many people who cannot come to Xiangfan. We have trained doctors and other health workers in a comprehensive approach to AIDS, an approach that takes the needs of the patient into account and stimulates adherence to the treatment. But we are not allowed to put this approach into action for people in Henen who need it urgently and who are asking for our support."

MSF continues to provide treatment and care in Xiangfan as well as in Nanning, in Guangxi province. The projects go far beyond a technical approach. Patients are not merely administered anti-retroviral medication and drugs to fight opportunistic infections such as tuberculosis or pneumonia. Rather, the MSF projects allow for comprehensive care to the patients and the community, that also includes testing, individual counselling, setting up patient support groups and providing information to patients' families, health workers and the wider community.

Earlier, the national health authorities praised the MSF approach as an example of the kind of care that should be made available for China's HIV-positive population.