An introduction to the China-UK HIV/AIDS Prevention and Care Programme

William Stewart, National Technical Cooperation Officer, China-UK HIV/AIDS Prevnetion and Care Programme

1.       Background to the project

HIV/AIDS is an emerging epidemic in China.  Although reported statistics show incidence as relatively low (when compared to the worst affected countries), actual numbers are far higher and are increasing rapidly.  Unless urgent action is taken, China will face continued rapid increases in numbers infected.  The Ministry of Health estimates that 10 million people may be infected with HIV by 2010 unless effective countermeasures are taken speedily.  Because of the absolute numbers and the relatively high costs of care involved, even modest rates of infection amongst the general population will have huge effects on social and economic development.

The Government of China has recognised the urgent need to tackle the problem, and has set out policy objectives and strategies in the Medium and Long Term Plan for AIDS Prevention and Control (May 1998).  The HIV/AIDS Prevention and Care Project funded by the UK Department for International Development has been designed to help China in its efforts to tackle the growing threat of an HIV epidemic.  The project purpose is to develop replicable models of HIV prevention, treatment and care in two pilot provinces for high-risk and vulnerable groups in order to inform and develop the national policy framework.  This project will seek to build on international experience in tackling the spread of HIV/AIDS, but in doing so will endeavour to ensure that such experience is suitable for - and where necessary adapted to - the Chinese context. 

The project memorandum of the HIV/AIDS prevention and care project recognises that for HIV - as with any other development issue - a broad range of perspectives need to be taken into account in design of activities, including not just technical issues but also the economic rationale for the programme in terms of its effect on poverty, the institutional context of government and non-government agencies in which the programme will take place, and the social issues which will not only affect the success of the project but will also influence the way in which project activities are planned. Therefore the project memorandum includes a number of annexes which provide these different perspectives. The project activities will unite these different perspectives in a coherent plan of action.

2.      Project approaches and activities

The project has three main areas of activity.  These are:

a.      Strengthened strategic planning and management

This area of the project concentrates on the capacity of key government agencies and their partners to plan for efficient use of resources to develop HIV control work in China.  It includes also the development of policies supportive to implementing this work, and support to the improvement of surveillance systems to give better quality data for planners to use in their assessments.  Specific areas of work include:

-         In-country study tours and training for key government and non-government partners to improve understanding of successful HIV work in China and abroad.

-         Other policy development work, including research to identify alternative policy approaches to issues of key importance in HIV prevention, such as STD control or the reduction of risk of HIV transmission for those who use drugs.

-         Development of information, education and communication work through mass media and other channels

-         Evaluation of current provincial surveillance methods and piloting of new approaches for HIV surveillance co-ordinated with STI and behavioural surveillance.

-         Dissemination of the lessons learnt through project working to other agencies and provinces.

-         Research for the improvement of approaches to HIV and STD control in China

b.    Enhanced access of at risk groups to information and services for the prevention and treatment of STI and the prevention of HIV

This area of project working concentrates on the important work for the primary prevention of HIV and STI transmission through health education and information and through the promotion of condoms and safer behaviour for intravenous drugs users.  This area of working will also help to improve standards of care for sexually transmitted diseases for high risk groups, which since the presence of other STD can increase the probability of HIV transmission also acts as primary prevention for HIV.

It includes the following areas of work:

-         Improvements in standards of care for sexually transmitted infections among high risk groups including research on best practice for STI management nationally and internationally, the development of management models for STI care among high risk groups and training of health workers  to deliver these models

-         Needs assessment of sexual health care needs including epidemiological studies, research on risk behaviour and its determinants, on drugs use behaviour and on the cost of services.  This will also include and assessment on the quality of care for sexually transmitted diseases.

-         Improvements to provincial laboratory network in order to deliver the surveillance and STD management work described above

-         Pilot programme for the marketing of kits for the self treatment of STI through pharmacies and lower level clinics.

-         Programme for the social marketing of condoms in project provinces, aimed particularly at high risk groups

-         Pilot programme for the social marketing of clean needles and syringes to intravenous drugs users for the prevention of HIV transmission

-         Pilot programme for training of trainers to promote risk reduction strategies in detention centres in project provinces

-         Study tours for key personnel to understand successful approaches used elsewhere in China and abroad

-         Fund for the development of innovative approaches to HIV prevention by public sector, and non governmental organisations

c.     Development of models for care of people with HIV

Although illness as a result of HIV is not widespread in China as a result of the comparative lateness of the HIV epidemic to the country, nevertheless it is important that China begins to make preparation for the care of people who are sick in order that when greater numbers of people with HIV become symptomatic, groundwork has already been laid.  Therefore, the programme will seek to develop accessible, appropriate and affordable models of HIV care in the project provinces to provide a reference for the future.  This component of work will include:

-         A review of existing HIV/AIDS care initiatives in project provinces and elsewhere in China in order to find out more about who is currently providing what kinds of care at present for people with HIV in China and with what results.

-         Pilot programmes for the development of appropriate community-based care models including social and psychological care for people infected with HIV within communities which are appropriate for them

-         Pilot programmes for the development of appropriate institutional care models including medical care for HIV and also for the most commonly seen opportunistic infections in China

3.     Social analysis within the programme

It is increasingly internationally recognised that social analysis plays an integral role in understanding and addressing the social processes and differences contributing to risk of infection from HIV/AIDS.  The programme included social analysis in its design as far as was able during the preparation of the project.  It will also allow the flexibility for new social information to inform the development of project activities as it becomes available.  The social annexe of the project memorandum sets out a number of social analyses, including the following:

Poverty

The project recognises that HIV/AIDS is not a disease of poverty. Nevertheless, it does flourish in conditions of poverty, where poor people are most vulnerable to infection because they have fewer choices concerning avoidance of risky behaviours such as unprotected sex.  Women who are laid off work or who lose other opportunities may have few choices other than to engage in sex work.  For sex workers, those for whom poverty is more close may have reduced bargaining power with their clients to encourage them to use condoms in order to protect against HIV. The poor are also more vulnerable to the consequences of HIV. Falling ill with AIDS may  plunge individuals and families into poverty.  

Gender

Many studies have demonstrated that women and men do not always have equal decision-making power when making choices about sex or contraception.  Promoting more balanced gender relations requires both informing girls and women of their rights, and simultaneously educating boys and men on their responsibilities within a sexual relationship.  One way of ensuring that gender-equitable protocol is translated into practice is to ensure that the needs and views of both women and men are taken into account in project planning and activities.  In its early stages the project will look at the extent to which current behaviour change messages could be made more gender specific, and explore issues within the health services such as the extent to which the sex of the service provider or their gender related attitudes affects use of sexual and reproductive health services.

Other factors of specific populations will also contribute to risk for HIV transmission and infection, including age, ethnicity, migrant status and broader factors within the wider environment, including changes in work patterns, migration patterns and the macro-economic climate will also affect behaviours which pertain to HIV.  Interpersonal factors including willingness of men or of couples to use condoms and ability of people to communicate about issues of sexuality will also affect behaviours.  Therefore the project will seek to encourage the greater production of social science data and the use of such data in order to better understand these factors so the most appropriate programmes can be developed.  Such support for social science will take many forms, including those set out in section four.

4.     Research within the China-UK programme

The project will assist in the development of information in a number of ways, including:

-         support to training on research methodologies, including training for the development of situational assessment methodologies of sexual health and training in social science methods, particularly participatory and qualitative methods

-         partnership between international researchers and national ones to allow for transfer of skills

-         support of specific research projects including the situational analysis of sexual health and a competitive fund for operations research

-         support of intervention projects which will also generate information through intervention development work and through evaluation

-         support to the better use of information in planning purposes, including the use of situational assessment in planning

-         support to increase the role of social sciences within the HIV/AIDS response in China, through a symposium on social sciences and HIV and through consultancy of social scientists to the programme

Social scientists and researchers generally are encouraged to actively seek to participate in the programme through the routes suggested above.


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