Although positive steps have now been taken by the Chinese government in combating HIV/AIDS, numerous challenges remain. One issue is the structural inadequacy of China's current health care system that was graphically revealed during the SARS outbreak (26) . Tuberculosis offers another pertinent example of how these shortcomings may compound the situation. China now has twice the level of multi-drug resistant tuberculosis of other countries (7) . Providing affordable and accessible health care to the general public has also become increasingly difficult following the introduction of free-market reforms in 1978. In this manner, the rural health cooperatives that once provided health insurance and affordable health care have now been effectively abolished (7) . Furthermore, the 'middle tier' community hospitals which formerly dispensed a great proportion of total health care have also disappeared (27) . Such facilities will be essential to the success of any future HIV treatment and prevention programs. Social inequalities are also problematic, as increasing numbers of Chinese hospitals now charge fees for services, thereby excluding those who cannot afford to pay. Drug users, prostitutes and itinerant workers represent important HIV-affected sub-populations that have limited capacity to pay for medical care and drug treatments.