This is a special collaboration between Ruby Wang at ChinaHealthPulse and Peking Hotel, to mark World AIDS Day, December 1.
We are thrilled to welcome Professor Joan Kaufman, one of the world’s leading experts on HIV/AIDS and China. Joan has spent her career at the intersection of public health, policy, and social justice, working across the United Nations, philanthropy, and academia. Her work has profoundly shaped how the world understands health, human rights, and China’s role in both.
Joan first moved to China in 1980, working with the United Nations when China’s health system was just beginning to reopen to the world. In the 1990s, working for the Ford Foundation in Beijing, she pioneered work on women’s rights, reproductive health, and HIV prevention. From 2002 to 2012, she led China programmes for the International AIDS Vaccine Initiative, building bridges between Chinese scientists and global vaccine efforts.
In academia, Joan has held senior roles at Harvard, Columbia, Brandeis, and Tsinghua. She founded Harvard’s AIDS Public Policy Project, directed Columbia’s Global Center in Beijing, and taught global health and social medicine at Harvard Medical School for many years. Today, she serves as Senior Director for Academic Programmes at Schwarzman Scholars, where she mentors emerging leaders to think critically about China and global health.
Today, Joan joins us to reflect on her life’s work, especially when it comes to her interactions with China’s HIV response over the decades.
For quick navigation to the specific sections:
Joan’s AIDS-fighting journey from UN to Harvard and Ford Foundation in Beijing
Leo: Joan, to get us started, what’s up with the poster behind you?
I began my career in China working for the U.N. Population Fund (UNFPA) from 1980 to ‘84. One of our big projects — and a big reason that Deng Xiaoping invited the UNFPA into China — was a scientific census to get a proper count of the Chinese population.
One of the goals in the early ‘80s, at the beginning of the reform and opening-up period, was to quadruple the GDP [per capita] by the year 2000. In order to do that, you needed to know the denominator, which was the total population size.
It was a really interesting time to be in China, right after the Cultural Revolution. Many people were traumatised, and distrusted foreigners — especially Americans. Those early days were pretty isolating. After the trial of the Gang of Four, there was a collective “opening-up” — emotionally, and in terms of more people coming in, more activities happening, and people being more relaxed.
China said “we don’t have any HIV/AIDS” for the longest time.
I wasn’t working on HIV/AIDS then. There was little discussion or even acknowledgement. Those were still the early years of the HIV epidemic globally. China said “we don’t have any HIV/AIDS” for the longest time, until the epidemic exploded among injecting drug users in the late ‘80s and early ‘90s in Southwest China, in the Golden Triangle area in Yunnan bordering Laos and Myanmar.
I left UNFPA in 1984 to do my doctorate at the Harvard School of Public Health. I got involved in the global HIV/AIDS response, managing a project on sex workers and HIV Prevention in Thailand, Mexico, and Ethiopia with the AIDS and Reproductive Health Network at the Harvard School of Public Health. That was a collection of epidemiologists and social scientists from around the world. I was also consulting to the WHO Global AIDS programme in Africa.
By the time I went back to China in 1996, for the Ford Foundation, I was aware of the exploding AIDS epidemic in China and the need to get organised quickly in order for it not to get out of control — even though China was in full denial. I started working with the donor community there — UNAIDS, and with several of the other donors, like DFID, that were meeting together as a donor group — to try to mobilise the Chinese on what was going on with AIDS and put in place effective prevention programmes.
Ruby: As one of the few people on the ground in the ‘80s and ‘90s, could you share with us what it was like? What kinds of partnerships and conversations were possible? What were the challenges?
The ‘80s were early days for the reform and opening-up period. The donor community was pretty small — it was mainly the diplomatic community. Few U.N. agencies were represented in China.
I traveled a lot for UNFPA in the early ‘80s. We had about twenty projects. We had a project with UNESCO on sex education in middle schools. I traveled to 10 middle schools in rural counties around China, in Hunan and Shandong and Hubei. Often, I was the first foreigner anybody had seen in a long time.
It was a different period of time, when China was receptive to development assistance.
We did a lot of good work, and I made many good friends at the ministry level, with people who went into more senior roles and with whom I reconnected when I came back for the Ford Foundation in 1996. That allowed me to start with trusted relationships on some of the Ford Foundation projects that helped move China forward in many ways.
It was a different period of time, when China was receptive to development assistance. That may not be true for the Ford Foundation today, but at that time we were warmly welcomed. I made many grants — small grants, $20,000 or less — that were highly impactful in China. A small amount of money went a long way. I had a large budget — probably $2, $3 million a year — and was able to bid on more. It was a rich time for the Ford Foundation as well.
Ruby: When you say the China side was receptive, can you describe what that was like? How did they speak with you? What kinds of partnerships were you building?
I came in as the second programme officer for my portfolio at the Ford Foundation. The reproductive health programme was gaining steam globally. There was a big New York part of it and 14 field offices, many of which had reproductive health programmes. It was in the years leading up to the International Conference on Population and Development in Cairo (ICPD) in 1994, which was a significant every-ten-years global population and development conference.
The Ford Foundation’s China Office opened in 1988. The reproductive health portfolio began in the early 1990s because of the one-child policy and the need to look at reproductive health and rights within the population policy. That was a lot of what my portfolio was about. I also began the work on HIV/AIDS.
Ruby: After working for the U.N., you left China and came back to work for the Ford Foundation, an American philanthropy organisation. What were the differences between those two organisations, and how did Chinese counterparts receive you differently as a result of who you represented?
At the Ford Foundation, in those years, nobody really questioned the judgment of the programme officers, who had been selected for their expertise. It was a great job. We had a lot of independence to decide how to move on our issues based on our own programme strategy.
That’s not true anymore. It has changed a lot over the subsequent years. In that sense, I was probably in the golden period of the Ford Foundation in China. Now it’s much more centralised and organised, with a different approval process. But the U.N. was nothing like that — the U.N. is a big bureaucracy and works directly with a government counterpart for every project.
Leo: I can’t help but hear echoes from history. There is a long tradition of Americans doing health-related work in China, from Peter Parker building the eye hospital in Guangzhou in the 19th century, to Yale’s Xiangya medical school and hospital and the Rockefeller family founding the Peking Union Medical College. Did you see yourself as part of this historical lineage?
I did know a lot about it, because I was a “China wonk” before becoming a global health person. I did two degrees in Chinese studies and then I did a doctorate in public health. I’ve written quite a bit about the Chinese health system and medical history, including the Rockefeller Foundation — which incidentally funded my PhD research. I felt like I was evolving in a tradition.
Ford was the first foundation to establish a field office in China in the late ‘80s — predating the Gates Foundation by 12 years or more. We played an interesting role in that evolution of health assistance. Ford was focused on community-based approaches, including the development of civil society and an NGO community.
We were explicitly building — with government support — a set of genuine civil society actors on women’s rights.
It was an open period. In the 1990s, China allowed the development of civil society. We were explicitly building — with government support — a set of genuine civil society actors on women’s rights. There were many women’s NGOs that were established with the support and assistance of the Ford Foundation in preparation for the Beijing Women’s Conference in 1995. Those became some of the leading women’s rights organisations in China.
Similarly, in the HIV/AIDS field, my portfolio played an important role in building groups like the China Association of People Living with HIV/AIDS and the Positive People’s Network — those were patients, HIV-infected people that were playing a role according to the UN/AIDS GIPA Principle of “greater involvement of people living with AIDS” so that the affected communities were at the table for discussion. And we helped connect that group in China with the global network of people living with HIV/AIDS.
A lot of the work over the years was connecting the transnational civil society networks, sending Chinese organisations to the regional AIDS or women’s conferences, and then connecting those global civil society actors with the new organisations in China for strategy, for networking. That still exists even though many of those organisations are no longer in China because of the 2016 Foreign NGO law.
We were also working with academic researchers to fund important behavioural research on HIV/AIDS — about what was happening with the public emergence of a gay men’s community, and about HIV/AIDS and sex workers. We funded a lot of the behavioural research at Renmin University — the Institute for Research on Gender and Sexuality, Pan Suiming’s group (China’s leading sociologist and sexologist). The fabulous set of studies that came out of that were influential in shaping the HIV response in China.
And we worked directly with the government, with the Ministry of Health. We worked in partnership with UNAIDS and other organisations on the Global Fund for HIV/AIDS and TB. We’d sit at a table: the donor community with the Chinese Center for Disease Control and Prevention — China’s CDC — and draft the Global Fund proposals. It was a collaborative effort to get more money into China in the early 2000s to address the AIDS epidemic.
When the people who were getting infected with HIV/AIDS were not just stigmatised drug users or gay men, it exploded into the open.
The policy changed in 2003 after SARS. That was largely a result of the donors working with the National Center for AIDS Prevention and Control at the Chinese CDC to take advantage of the post-SARS environment, so that China need not be in denial about the AIDS epidemic and could urgently put in place a prevention and treatment programme.
When the AIDS epidemic moved from Southwest China into Central China — Henan and the surrounding provinces — in the 1990s through a paid blood donation scheme, a lot of villagers were infected with AIDS and passed it on to their kids. It left a lot of AIDS orphans. It was a time of denial. When the people who were getting infected with HIV/AIDS were not just stigmatised drug users or gay men, it exploded into the open and became a catalyst for the policy change in 2003.
The “unfinished business” of health reform in China
Ruby: Joan, you mentioned HIV as a catalyst. Could you talk more about that? HIV/AIDS has been framed as a kind of “pivot point” for China’s health system reform, forcing it to confront civil society and transparency and rights in new ways. Whether the stigma or the disease itself, what has made AIDS different from other health crises in China?
It forced the government to not just treat it as a medical issue. That was the story of AIDS globally — you had UNAIDS come into being, coordinating all the other U.N. development agencies around the social determinants of health and creating an enabling environment for the AIDS response.
There were debates about access to essential medicine — about providing life-saving antiretroviral drugs to the people who were dying of AIDS in Africa — that were resolved around the late ‘90s by global actors and pharmaceutical companies.
The enabling environment issue — the way in which stigma affects people self-identifying and coming forward for testing and treatment — got on the global screen for the first time. Along with U.N. General Assembly meetings and the creation of the Global Fund for HIV, AIDS, TB, you had this active agency, UNAIDS, that put AIDS on the map and kept it on the map.
Sex workers, gay men, drug users — you need representatives of those groups to be able to actually reach their constituencies.
We saw echoes of that in the pandemic. There should have been some more lessons learned from the AIDS epidemic — the discussion of “you can’t just treat this as a medical or a tech fix.” You’ve got to look at how to create an enabling environment.
And about civil society: sex workers, gay men, drug users — you need people who are representatives of those groups to be able to actually reach their constituencies. You need community-based organisations made up of like people to reach and access those communities with HIV prevention, messaging, and technologies, and to get people into testing and treating.
HIV is a chronic disease these days, especially now that there are once-a-month or once-a-year injectables. We’re moving quickly toward making it a manageable chronic disease, but the first step for getting people to test and treat is to get stigmatised and marginalised communities to reach out through peer messaging and peer approaches.
That’s why civil society was and remains important in the AIDS response. We see that the new wave in China is young gay men, who are not being reached with HIV prevention messaging. Which is tragic, because treatment is free and available. How do you get the International Labour Organization to work to protect labour rights for people with HIV and hepatitis? Those efforts through other sectors didn’t really happen until the AIDS epidemic. Why do people not self-identify? It’s because they don’t want to lose their job.
I left China in 2001, and I felt my “unfinished business” was to work on getting all those international best practices in place in China. The AIDS Public Policy Training Project was very much that. I had a team of ten faculty members at Harvard, working with a counterpart faculty in China, where we were doing training at the municipal and provincial level for government officials and multi-sectoral groups about these policies and practices for the HIV response.
Leo: It’s astonishing looking back and realising how long the government welcomed and allowed foreign NGOs in China. The Chinese government’s Foreign NGO Law around 2016 was the end of a two-decade period of openness.
If we’re trying to get into the minds of your Chinese counterparts, especially those in government, why did they come to allow this whole field of uncontrolled foreign actors working with activists and civic-minded Chinese who are not necessarily the most obedient to the state? What was the logic there? How come this whole field got to take off for as long as they did?
During that early period of 2000 to 2010 — speaking specifically about HIV/AIDS — the government recognised two things.
One, that they needed the peer groups and the NGOs to reach the affected groups. Once the AIDS program was put in place, starting in 2003, they couldn’t do it without access to the communities that were at the most at risk for HIV/AIDS. That required engaging with these civil society groups, no matter how much they didn’t like them. It was a pragmatic recognition. That’s the story of the AIDS epidemic everywhere, not just in China.
The other part — which is more important — was to get the money from donors and the development assistance. They had to do it. The Global Fund had a requirement for civil society representation. Even if they had to fake it, they had to do it in order to get the money.
But there was a genuine understanding — certainly by the bodies that were developed during that period of time. The State Council AIDS Working Committee Office, the SCAWCO, was a progressive organisation made up of people who knew what the global experience was, and knew what they needed to do in order to get on the right side of the AIDS epidemic.
The only USAID money in China was for AIDS, which was a huge amount of money and required civil society representation. I can’t remember how many rounds of Global Fund money came into China, but it all had an explicit requirement for civil society. The China Society for AIDS Prevention and Control — or whatever the para-statal NGO was — acted as the umbrella agency to receive the money, and then distributed it to the smaller, “real” NGOs. It worked to some degree.
The China of the 1980s is a completely different country than the China of 2025. You can no longer do any of the stuff we did.
There were other organisations I worked closely with, including a group called Friends Exchange, started by a doctor in Qingdao, Shandong province. It was a magazine for gay men that had been mimeographed and distributed since before the AIDS epidemic. It was the only organising body for gay men in China, and it had a lot of HIV prevention information in it.
An outside organisation that funded a lot of work on HIV for men who had sex with men, called Barry and Martin’s Trust, also came into China and started supporting the Friends Exchange network. Then Ford Foundation took it up and it became an official publication. In a way it was embraced by the government, because it became an important access point for an important community that needed to be reached.
It was a golden period before the NGO law came. Since the political leadership started evolving around 2012 or so, there has been much more of a reflective process of the role and risk of civil society in funding the colour revolutions in Eastern Europe.
The current leadership in China reasserted its distrust for civil society and its potential for peaceful evolution. It came out with a set of don’ts, which included civil society and rule of law and many other buzzwords that closed down the space for the kinds of rich activity that happened with the HIV/AIDS organizations during the late ‘90s and the early 2000s.
A gaping void in global health aid
Ruby: I wanted to build on that — this changing global health/international development landscape. In my last podcast episode, I spoke with Sid Chatterjee, who’s the UNRCO for China. He talked about how the U.N. engages with China today, which is different from when you started with UNFPA, or later with the Ford Foundation. How do you reflect on your past and think about this current engagement?
I do think that the China of the 1980s that I arrived in working for the UNFPA is a completely different country than the China of 2025. You can no longer do any of the stuff we did. It’s a changed political environment. Many of those organisations still exist, but they don’t have the foreign partners and they certainly don’t have foreign funding. Many of the donors exited China, because they felt that Africa or other places needed donor assistance more than China did.
China has come up. It is middle-income, with lots of cash reserves, and it is a development donor itself. China has adequate resources to fund its own health and development programmes. But that doesn’t mean China doesn’t need technical assistance to improve what it’s doing and how that money is delivered.
I regretted what I saw happen in the early 2000s, when all the donors either reframed their programmes as “China for the world.” The U.N. agencies, the Gates Foundation, and the Ford Foundation all reframed their own portfolios so that it wasn’t about “China for China,” but about what China could do for the world. Yet there are a lot of unfinished agendas in China to say the least, including in the HIV/AIDS world.
The global system has changed so much in the last ten years. It’s harder to collaborate on global issues.
China is an active global donor through the Belt and Road, especially during the COVID pandemic, making its vaccines available to many countries in the world. It has a lot of really educated public health professionals who’ve been educated abroad, educated in China — Tsinghua, Beida (Peking University), Fudan — who’ve worked at global agencies like the WHO and come back. China has a lot of its own health expertise, and is extending its own power out there in the world, especially to Africa.
But I do think there are continuing challenges — the NGO law, the weakening of the U.N. system in this current geopolitical moment. The U.N. is engaged with China, but the global system has changed so much in the last ten years. It’s harder to collaborate on global issues.
To some degree, the U.N. and the multilateral system are engaged with China, but the U.S. certainly isn’t, and Europe less so as well, as the world aligns around big powers and new conflicts. It’s harder to get the collaboration we need globally for pandemics or anything else.
With the demise of USAID, I worry deeply about a resurgent HIV/AIDS epidemic. Many foundations and big donors have stepped up to fill some of the gaps on the most important issues, like immunisation and parts of the PEPFAR program. But USAID was the biggest donor. It provided $12 billion of global development assistance for health. The next biggest donor was the Gates Foundation with $1.2 billion — it’s an order of ten at least. The absence of that money in the global space is hugely impactful.
I worry about what this means in sub-Saharan Africa, where many of the organisations have been dismantled that are the frontline of providing HIV/AIDS care — prevention of mother-to-child transmission, antiretroviral treatment, and working with young women who are at risk of AIDS because of the social determinants of health and the lack of an enabling environment that supports them refusing risky sex.
I just worry about the world right now.
Leo: You mentioned the dismantling of the American aid system under the current administration. Trump complains that it hasn’t been good for American soft power, and so we might as well just dismantle aid because it’s not bringing in political perks.
As China looks at this, I can see them thinking: given all that’s happened, maybe it’s not a good idea to do humanitarian aid; better to just focus on the soft power piece. The U.S. is stepping away, but is China going to step in and take the same role that was once filled by Western development aid and development professionals? What would a China-led global development landscape look like?
I don’t think China is going to fill the void in the global space. It’s transactional to some degree.
The term “soft power” has many meanings. People look at the PEPFAR program, in particular, as an extension of American soft power because it was providing a huge amount of money for AIDS relief for sub-Saharan Africa. You could say it was in the U.S.’s interest to prevent the explosion of AIDS in Africa in terms of global stability. But that was kind of a secondary issue. It was still much more of a humanitarian effort.
Global health assistance is unlike other soft power — like Hollywood or the transmission of ideas and values through the media. Global health assistance is humanitarian aid first and foremost, and I come to it in my career very much as a health social justice person. I’m not an international relations realist person who’s looking at “what do you get in return from the geopolitical point of view?”
A lot of development assistance money has gone into defense because of the potential for war in Europe.
But this does to some degree shape the way governments approach it. Certainly, Trump doesn’t see any value in it. But that’s wrong. China is playing a role on the humanitarian side. But it is also building up its own credibility and importance in the global space, especially as the U.S. recedes, providing money to U.N. agencies like the WHO. It’s not making up for the U.S. shortfall, but making a significant contribution, and also trying to play a role in bilateral development assistance on key issues like with the Africa CDC or malaria — always with the interest of China in the first place.
We’re in a complicated world. A lot of development assistance money has gone into defense because of the potential for war in Europe. Many of the big donors — Great Brittain, France, other places — are all shifting funding from health, education, charity programmes, or humanitarian programmes into defense budgets. USAID has gone away, and the U.N. system is taxed, so there’s just a lot less money available for development assistance. The golden age of global health is over. There’s no question about it.
I watched not enough money go into global health for much of my career. And then the HIV/AIDS epidemic shifted the donor space in a massive way so that much more attention was paid to global health and it spilled over into things like immunisation programmes and maternal and child health. Those days are over, and that money is going to have to come from somewhere else.
The foundations are stepping up to some degree to fund GAVI — the Global Alliance for Vaccines and Immunisations — and putting money into some of the other key assistance programmes. But the money that we saw over the last decades is never going to be the same, in my opinion. Governments are being pressured to fund more of that out of their own domestic health budgets. It’s a changed world.
The missing civil society
Ruby: You mentioned that you’re deeply worried about the resurgence of a new HIV epidemic. Could you talk about HIV in China today? Because it’s not solved. What parts of the issues are enduring, whether that’s stigma, financing, data? Which responses and solutions have endured? And because diseases have no borders, what does this mean for the rest of the world?
The HIV/AIDS response in China is a success story in many ways, because once the policy changed in 2003, in the post-SARS period, you had these advocates waiting in the wing to make the case for transparency and direct action — and it happened. The government put in place a free testing and treatment programme — and included a certain amount of poverty alleviation and care for orphans — that has endured.
The treatment is not optimal. It’s not the most advanced medication, or the easiest to tolerate, but it is life-saving. China can do that. They can negotiate with the drug companies and get better medicines and medications.
There’s complacency among young gay men about HIV/AIDS, because they’ve grown up in a world where there is treatment.
But where’s the new wave of the epidemic coming from? It’s the young gay men. Everywhere in the world, there’s a certain complacency among young gay men about HIV/AIDS, because they’ve grown up in a world where there is treatment, and they can say they don’t think they’re going to die of AIDS. But you don’t want people getting infected with HIV.
There are things that China should be doing: rolling out full-scale actions to prevent people getting infected, but this isn’t happening effectively. There’s been a loss of attention away from HIV. China has the resources and the capacity and is providing the drugs, but they need more people to get tested and into treatment.
Globally, we’re looking at the possibility of a resurgence, especially in Africa, because of the weakening of the organisations there with the loss of development aid — and, probably, the reluctance of African countries to put the necessary resources into it through their own national health budgets.
Ruby: You’ve worked in the field in China, and you’ve gone back home to the U.S., teaching as well as running programmes. How did people back in the U.S. view your work in China? Were there any different perspectives or biases?
The moment for me was post-COVID, in April 2023, when I was planning to go back to China after three years of Zoom life with my colleagues at Tsinghua. The geopolitics of the relationship with China and the U.S. had changed so much that people said, “Aren’t you scared to go back? Aren’t you worried?”
China is my second home.
Over my career since 1980, I’ve lived in China for probably fifteen-plus years and gone back probably two, three, four, five times a year, every year. It’s my second home. Beijing is so familiar to me.
I wasn’t the least bit scared! I was looking forward to it. And it was so normal when I got there. But the whole environment has changed. Whereas before it was kind of cool that I was working on China, now it’s weird, because there’s so much anti-China sentiment in the United States. The view of China has changed so dramatically. Now there is much more suspicion and distrust.
Ruby: Yes, suspicion, even on global health technical collaborations.
Colleagues are more reluctant to engage with China, because they feel the risks that it brings to their institutions in the United States, or potentially to their professional careers in terms of being able to work with the U.S. government. That’s less so since Trump came to office than during the Biden administration. Things are softening, but there is still a reluctance to engage with China in any area of science and technology, because the security overlay is so intense and people fear the risk to future funding.
Leo: Despite the one-party state, China today looks a lot like America. It is a market-based system; China’s CDC is modelled after the American CDC; China’s National Medical Product Administration is modeled after the FDA; the lawyers are trained in the American legal tradition; Tsinghua was founded by Americans; and the stock market comes from the New York Stock Exchange.
This process of transformation from a Soviet model to an American model happened during the span of your career, one step, one grant, one project at a time. How much of China today is the product of American efforts?
The U.S. — the CDC, the NIH — trained up the Chinese health science side of things to an enormous degree: A lot of collaborative research grants, a lot of CDC-supported programmes such as the US CDC GAP (Global AIDS Programme). We trained up the China CDC and the Epidemic Intelligence Service programme. The Chinese system looks a lot like the American health agencies in important and good ways. The U.S. has been at the apex of health and medical research for decades. China has benefited from that.
We partnered with China to make China’s global health system better, and they’re probably going to just leave us in the dust because of all the science and technology funding that China provides now, and which we’re not providing at the moment. We’re giving up our lead position if the lack of funding continues.
Leo: Earlier you mentioned that there is an “unfinished agenda” that many the global health professionals feel out of China over the past ten to fifteen years. What is the unfinished agenda, the parts China still hasn’t gotten to, and would it be in their own interest to get to them?
It’s the civil society piece. The contributions of the community groups and voices in the governance process are not optional. It’s a requirement for doing better, more targeted work, and for getting support from the communities that you need to reach. We saw it with the COVID response: the protests, the pushback against the Shanghai lockdowns and things like that. That piece needs to be part and parcel of the way we approach global health.
There should be a real acknowledgement of the enabling environment issues, which comes from more multi-sectoral engagement. Those are instrumental for lasting and effective health interventions. The important role of NGOs in civil society — I have seen it in my work, especially in the HIV/AIDS space.
Educating the next generation is just as important, or more important, than anything I’ve done in my life.
The other part of it is the global collaboration agenda, especially between the U.S. and China. You can have a certain amount of global collaboration without the U.S., but the two biggest actors in the world, with the biggest influence and reach at this point, need to be working together on the next pandemic, for example, or dealing with other types of risks that are going to spill over into the health area.
We need to find a way to get back to the table on these key humanitarian issues for which the whole world is potentially at risk. COVID was the prime example of why we need to be working together on emerging infectious diseases. We need to be working together with China, with the leading virologists in the world, on the One Health agenda. We have to find a way to get past the geopolitical tension. My hope for the future is that we can move to more collaboration on global health risks between the U.S., China, and the rest of the world.
Ruby: One final question for the 1st of December 2025. The first ever World AIDS Day was in 1987 — 38 years ago. You’ve worked through many World AIDS Days! Can you share any memories of how you celebrated this day, wherever you were — whether in China, the U.S., or somewhere else in the world?
It’s always been a big deal. In my professional career, I’ve participated in many programmes on World AIDS Day, with lots of different people at different tables. In China, in the early 2000s heyday of donor collaborations on AIDS, everybody would convene. We would have a huge public event in Zhongshan Park or someplace like that, with posters and activities, which everybody participated in. And I feel that these days it has way less visibility and prominence than it used to.
It’s become more routine. It’s become more just like any other disease. That “exceptionalism” of AIDS — it’s good that it’s not exceptional anymore, more mainstream. But I feel that within the public consciousness, even if it’s not a global calamity, we still have to pay attention to it and be aware of it.
Ruby: The paradox of public health — when you’re healthy and well, it’s silence. But when you’re ill, there’s noise. That is the difficulty with prevention in health care.
In my earliest days working with the UNAIDS office in China, in the late 1990s, I was close with the two people who were fabulous conveners of the donor community in China: Emil Fox and Sun Gang. We would regularly go off for beers and unpack the AIDS response in China — all the different actors, missteps, and things that weren’t happening before the AIDS response took off in 2003.
My most memorable recollections are of sitting around a table with those beers, just trying to spitball what needed to happen. And to the credit of them and to others, many of those things mobilised over the next 10 years to put in place an effective AIDS response in China.
I would like to finish by saying that what I’m doing now — educating the next generation — is just as important, or more important, than anything I’ve done in my life. I’m going to exit the scene. But it’s people like you, Ruby and Liu, who are going to take forward this important work in global health and U.S.-China relations in China and the world, including through our programme, the Schwarzman Scholars Programme. We need to build up the next generation of activists who understand history and can engage on their own social justice paths.
Recommended reads
Jennifer Ryan, Lincoln C. Chen and Anthony J. Saich, 2014, Philanthropy for Health in China, Indiana University Bloomington
About us
The Peking Hotel podcast and newsletter are digital publications in which Liu He interviews China specialists about their first-hand experiences and observations from decades past. The project grew out of Liu’s research at Hoover Institution collecting oral history of China experts living in the U.S. Their stories are a reminder of what China used to be and what it is capable of becoming.
We also have a Chinese-language Substack. We hope to publish more conversations like this one, so stay tuned!
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