In China today, vast numbers of rural people have never heard the term AIDS. But AIDS is among them. They call it the "strange disease" and "nameless fever" and they know it is deadly. Well over a million of them are believed to be infected. In China, HIV/AIDS spreads much as it does elsewhere. But in parts of the country, as Dr. Gao Yaojie has shown, most HIV-infected persons are victims not of unprotected sex or needle sharing but of an unscrupulously careless commerce in human blood.

In the 1980s and 1990s, a lively business arose in China to meet the demand of hospitals and medical-products companies for blood plasma: destitute villagers were paid cash for blood. At local collection stations, technicians drew blood from donors, combined it with that of others to extract plasma, and then reinjected the donors with the now-mixed red blood cells—to strengthen them for the next sale. This profitable and reckless business was conducted by health and military officials until the Chinese government banned it in 1998. Afterwards, underground "bloodheads" moved from village to village to tap plasma for a still-flourishing market.

Dr. Gao, a specialist in ovarian gynecology, was already retired from Henan College of Traditional Chinese Medicine when she encountered her first AIDS patient in 1996. She soon diagnosed the forty-year-old woman’s deadly disease and traced it to a tainted blood transfusion. The blood trade was rampant in rural Henan. Gao discerned the connection and sounded the alarm.

Having no materials to warn people about AIDS and its risks, she wrote a small book herself and distributed it at railroad stations and clinics. She then began to investigate AIDS in Henan’s crowded villages, recording medical histories and documenting them with photographs. As she did so, she uncovered a hidden epidemic. In Wenlou Village, for example, 65 percent of the villagers were HIV-positive. "Everyone sells blood here," the people told her. Gao eventually estimated that 20 percent of Henan Province’s population was HIV-positive.

Everywhere she turned, however, Gao faced ignorance about AIDS. She therefore mounted a campaign of her own. Marshalling funds from a few donors but relying mainly on meager personal resources, she published a stream of AIDS-related reports and brochures; she traveled to AIDS-impacted villages to treat and comfort patients and to instruct their neighbors; and, increasingly, she shared what she knew with reporters.

At first, officials in Henan ignored Dr. Gao’s eccentric crusade. But when newspapers began exposing Henan’s AIDS crisis to the country and the world, local officials reacted. They monitored her movements, tapped her phone, and opened her mail. They confiscated her photographs. They forbade her to speak to journalists. Meanwhile, the people themselves ejected her from clinics and factories and bars as she distributed AIDS materials. But Gao carried on fearlessly, and the tide began to turn.

The Chinese government has now begun to acknowledge the country’s AIDS crisis and, today, hundreds and thousands of Gao’s books are in open circulation. China has pledged to do better. But progress has been slow in Henan and Gao remains skeptical.

At seventy-six, Gao works from home and moves sprightly from one chore to the next. She is deeply concerned about China’s unwanted AIDS orphans, who suffer most from the disease’s stigma. She finds families for them and, in wary villages, holds them in her arms. Gao’s work is little more than "flipping spoonfuls of water onto a roaring fire," she says. But she is motivated by the suffering of her AIDS patients. Each of their photographs tells a sad story, she says. And she remembers every one.