|
An
introduction to the China-UK HIV/AIDS Prevention
and
Care Programme
http://www.tsinghua.edu.cn/docsn/shxx/site/xsjl/1.htm
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.
|
