Evolving Challenges in the Implementation of China’s “Four Frees and One Care” Policy for HIV/AIDS

Abstract

In response to the HIV/AIDS epidemic, China initiated the “Four Frees and One Care” policy in late 2003. This policy provided free counseling, testing, and antiretroviral treatment for people living with HIV, while also offering support to affected families. While instrumental in advancing HIV/AIDS prevention, the policy faces evolving challenges. This study aims to analyze this challenge from multiple dimensions and, based on this analysis, provide effective recommendations for the Chinese government to address it, promoting the sustainable development of the “Four Frees and One Care” policy. The research found that reduced government funding has led to the decline of grassroots organizations, creating a disconnect between administrative and treatment systems. Additionally, advancements in medical technology introduce new antiretroviral drugs, complicating their integration into the healthcare system. In the current healthcare reform, updating the list of free antiretroviral drugs proves challenging. Adapting the policy to contemporary HIV/AIDS prevention should be a priority for the Chinese government. Balancing financial constraints, organizational sustainability, and evolving medical technologies will be pivotal for the ongoing transformation of the “Four Frees and One Care” initiative.

Keywords:

• Four Frees and One Care
• ART
• PLHIV
• China
• HIV/AIDS policy

Ethics Approval and Ethics statements

Ethical approval was not required for this study according to local law.

Acknowledgments

The authors are grateful to the staff of Jinhua Center for Disease control and Prevention, Jinhua Central Hospital, and volunteers from the social organization “Guan ai jia yuan (Caring Home)” for their help and support in this study.

Disclosure

The authors report no conflicts of interest in this work.