State Council Office Document 2001-40

China's Action Plan for Reducing and Preventing the Spread of HIV/AIDS (2001 - 2005)
Ministry of Health Communicable Disease Control Division June 2001

China's Action Plan for Reducing and Preventing the Spread of HIV/AIDS (2001 - 2005)

Over the past several years every region and involved department has been conscientiously implementing the "Chinese Long and Medium Term Plan for Preventing and Controlling the Spread of HIV/AIDS (1998 - 2010) (State Council Document 1998-38). (This document will be referred to below as the "Plan"). Every region and involved department has vigorously promoted health education and behavioral intervention campaigns. Therefore, there has been some progress in the nationwide work to prevent HIV/AIDS and sexually transmitted diseases. Yet today HIV/AIDS and STD prevention work in China is still very difficult. The AIDS epidemic is spreading rapidly and the number of people who have developed AIDS is increasing rapidly. The very rapid spread of HIV among intravenous drug users has still not been brought under control. The transmission of HIV through the collection or transfusion of blood has still not been stopped. Illegal manual blood plasma collection methods along with the illegal collection of blood plasma have still not stopped despite repeated prohibitions. The oversight and management of blood products needs to be further strengthened. In some regions government leaders do not understand well enough the grave threat of a large scale HIV/AIDS epidemic to China and the great harm it could bring to China's social and economic development. The implement of the Plan has been uneven. There has not been enough overall coordination in work to prevent HIV/AIDS and STD's. In order to solve these problems and to ensure that the objectives and tasks set forth in the Plan are achieved on schedule, the State Council has formulated "China's Action Plan for Reducing and Preventing the Spread of HIV/AIDS (2001 - 2005)" (referred to below as the Action Plan).

Implementation Principles for the Action Plan
1. The government has primary responsibility, but participation from society at large must be strengthened;
2. Prevention is the key, but public education and comprehensive treatment are also critical;
3. Concentrate on the epicenters of the epidemic, while strengthening health education and behavioral intervention;
4. Provide differentiated guidance according to the situation, strengthen oversight and guidance, strictly enforce the law, and evaluate overall performance.

Goals and Guidance of Work

I Goals

Take active and effective measures to stop the rapid increase in the AIDS and STD epidemic and bring down the HIV and STD infection rates. By 2005 bring down the rate of increase in the number of people infected with HIV and STD's to ten percent or less. The HIV infection rate due to clinical blood transfusions should be brought down to 1 per 100,000 or less and in regions with a high incidence of HIV down to 1 per 10,000, 1 per 50,000 or less.

II Guidance of Work

The following work objectives should be completed by the end of 2002:

1. Resolutely close down all illegal blood collection and blood plasma collection stations. Test all clinical blood supplies for HIV. Eighty-five percent of all clinical blood should be supplied by legal blood collection organizations. Hospitals will be allowed, with special permission, to collect on their own the blood they need to meet the needs of their own hospital. The raw material used to make all blood products must be collected by legal blood plasma collection organizations that use machines to collect blood plasma.

2. All medical workers should receive training about HIV/AIDS and STD's. Seventy percent of the general hospitals, contagious disease hospitals, Chinese traditional medicine hospitals, and other medical organizations at the county and city level and above should be capable of providing standardized diagnosis, treatment, advice and preventive health services for people infected with HIV or have developed AIDS. Eighty-five percent of the medical institutions at the county and city level and above should be able to provide standardized diagnosis, treatment, advice and preventive health services for people infected with STD's, and fifty percent of the township and village health stations should be able to provide advice and preventive health services to people infected with or suffering from HIV/AIDS and STD's.

3. At least fifty percent of the people throughout China who are infected with HIV or who suffer from AIDS should people able to receive treatment and care in their homes and communities.

4. Build an HIV/AIDS and STD information network linking prefecture and cities nationwide and national comprehensive surveillance and laboratory testing network systems.

5. Formulate policies to reduce risky behaviors by people in high-risk groups. Establish insurance funds to cover blood transfusion infection risks and the accidental transmission of HIV to medical workers. Provide treatment and welfare assistance to people infected with HIV or suffering from AIDS.

The following work goals should be completed by the end of 2005:

1. The proportion of people understanding how to prevent the transmission of HIV and about voluntary blood Alternative Treatments should reach or exceed 75 percent in the cities and 45 percent in the countryside. The proportion of people understanding these matters should reach or exceed 80 percent. This proportion should reach or exceed 95 percent among people in drug detoxification centers, re-education centers, prisons, and education through labor.

2. The use of condoms among high-risk groups should reach or exceed 50 percent.

3. In ninety percent of the county and city general hospitals, contagious disease hospitals, Chinese traditional hospitals and other medical facilities and in fifty percent of the public health stations in areas with a high prevalence of HIV, standardized diagnosis, treatment, advice and preventive health educational services should be provided to people infected with HIV or suffering from AIDS. Seventy-five percent of the township and village hospitals and fifty percent of the medical facilities that provide premarital health examinations should be able to provide advice and preventive health services to people infected with HIV or suffering from AIDS.

4. One hundred percent of the people involved in HIV/AIDS preventive health education, doctors and nurses working in a clinical setting and technicians involved in testing and in the collection or transfusion of blood shall have on-the-job training.

5. Take advantage of work on the construction of a national health information network to improve the national county and city level HIV/AIDS and STD information system.

III. Action Measures

1. Ensure the safety of blood and blood products and prevent the transmission of HIV/AIDS by means of the collection or transfusion of blood.

Strengthen the compliance with the law on the part of organizations involved in blood collection and blood transfusions. Create a complete and up to standards network of blood collection and transfusion organizations. Conserve blood resources by using blood rationally and according to scientific principles. Establish provincial level blood centers. By the end of 2002, make the necessary changes in prefectural and city blood centers that do not meet standards. Establish blood centers in prefectures and cities that do not have centers for the collection and transfusion of blood. By the end of 2005, establish grassroots blood centers or central blood banks for those remote counties that cannot be covered by blood centers. By the end of 2001, where grassroots medical institutions in remote areas still need to collect blood for their own use, make use of rapid HIV virus blood screening tests and perform HIV virus testing on all blood that will be used clinically. By the end of 2002, all technicians and other people involved in HIV testing at blood centers must pass a qualification examination. A professional qualifications system will be established for everyone involved in the collection and transfusion of blood.

All the present blood plasma collection stations must be brought into compliance with the "Basic Standards for the Collection of Blood Plasma" and the "Blood Plasma Station Management Rules". During 2001, the Ministry of Health is organizing professional examination of blood plasma stations throughout the country. All blood plasma collection stations that do not meet standards are being closed.

Control the overall size of the blood products industry and strengthen oversight and management. Beginning in 2001, no more licenses for blood products companies will be granted. The "Blood Products Management Regulations" will be enforced with respect to all the blood products companies in China. In particular, the State Drug Administration will organize inspections of blood plasma stations and of organizations that purchase blood plasma which have "Blood Plasma Permits" and quality responsibility certificates. Organizations that do not meet standards will be ordered to come into compliance within a short, defined period.

Establish a system for annual reports and auditing for the collection of blood plasma and for the production of blood products. Strengthen the oversight and management of the collection of blood plasma, the sale of blood plasma and the production of blood plasma products. Every provincial (and autonomous region and municipality directly under the central government) public health administrative department shall provide each year to the Ministry of Health a report on that province (or autonomous region or municipality directly under the central government) on collection of blood plasma by blood plasma collection stations in its administrative region. Every company that manufactures blood products must periodically report to the State Drug Administration the quantity of blood products manufactured as well as the origin and quantity of the blood plasma used. Every company that collects or uses blood plasma in production must regularly report to the Ministry of Health on its sales and consumption of blood plasma. The Ministry of Health and the State Drug Administration shall periodically audit reports of quantities of blood plasma provided, on the consumption and sales of blood plasma, and the quantity of blood products manufactured. Work units and individuals that violate the "Blood Products Management Regulations" shall be fined.

Strengthen oversight and management to ensure that disposable equipment for injecting fluids into the body (for transfusions and injections) etc. are manufactured, distributed and used under sterile conditions and disposed of properly after use. Crack down on the illegal manufacture and recycling of disposable medical equipment. The Ministry of Health and the State Drug Administration shall as appropriate organize and carry out enforcement and inspections.

Continue strengthening the management system and technical standards in order to guarantee the safety of the blood supply. Strengthen quality assurance for blood and blood products, diagnostic reagents, and AIDS-prevention pharmaceuticals. Improve the quality of tests and surveillance. Every company that manufactures blood products must establish a "testing period" for raw blood plasma before it is used in production. For clotting factor and other blood products a two step elimination or sterilization process must be used. By the end of 2001, all blood products must receive state certification before they are marketed. By the end of 2002, a nucleic acid test should be used on blood plasma and mixed blood plasma after it has been used in production.

Establish a reporting system and strengthen enforcement against the illegal collection and distribution of blood plasma. Health and drug management departments must work closely with public security to strike hard against the illegal collection, purchase, and sale of illegal manually collected blood plasma. The "Blood Plasma Collection License" of any organization collecting blood plasma by this illegal method shall be cancelled. Any company that purchases manually collected blood plasma for use in the manufacture of blood products shall be punished as a manufacturer of counterfeit and poor quality pharmaceuticals. Its permit to manufacture shall be cancelled according to law. In a criminal case, the manager with direct responsibility and other responsibility persons will be subject to criminal persecution. The Ministry of Health and the State Drug Administration shall each year organize inspections of plasma collection stations and of blood product manufacturing companies. The Ministry of Health and Ministry of Public Security shall as appropriate organize and carry out actions against the illegal collection and distribution of blood plasma and whole blood, close down illegal blood collection organizations, strike hard against "blood heads" [NOTE: people who organize blood sellers. END NOTE] and when a crime has been committed, prosecute those responsible. The State Drug Administration shall fine according to law any biological products company that purchases manually collected blood plasma.

2. Strengthen Health Education, Make Widely Known Information About HIV/AIDS Prevention and Voluntary Blood Alternative Treatments

The propaganda and education departments along with the mass media should spread widely health education information and make widely known information about HIV/AIDS prevention and voluntary blood Alternative Treatments. The first channel of the central and provincial level television and radio stations should broadcast a public service announcement or program on HIV/AIDS prevention or voluntary blood Alternative Treatments at least once weekly. Central and provincial (including autonomous region and municipality directly under the central government) level newspapers shall at least once each week report on a print a public service notice on HIV/AIDS prevention or voluntary blood Alternative Treatments. The more influential central and local periodicals should also as appropriate publish articles or print public service notices about HIV/AIDS prevention and voluntary blood Alternative Treatments.

All the concerned departments, labor unions, communist youth leagues, women's associations, Red Cross societies, and other organization should bring into play their special capabilities and assume responsibility for training workers and other related groups on HIV/AIDS prevention and voluntary blood Alternative Treatments. Townships and villages as well as street committees should make HIV/AIDS and STD prevention health education along with spreading information about voluntary blood Alternative Treatments a theme in their "create a cultured community" goal. Grassroots population schools should provide training on the prevention of HIV/AIDS and STD's and promote education on reproductive health. Special emphasis should be placed on giving young people and children more knowledge about puberty and sexual health, about HIV/AIDS and STD's, about voluntary blood Alternative Treatments, and anti-drug education. Vocational secondary schools and upper level middle schools should give to students upon entrance information about the prevention of HIV/AIDS and STD's, educational materials, and lectures. Ordinary middle schools will integrate the information above into their health curriculum.

In airports, bus stations, docks and other transportation nodes as well as in other public places such as clinics where many people congregate, open information windows and provide educational materials. At commercial places of entertainment, make available educational materials and carry out educational work on HIV/AIDS prevention and voluntary blood Alternative Treatments. Provide information and advice on HIV/AIDS and STD prevention to people travelling abroad such as laborers and tourists.

3. High Risk Behavior Interventions to Reduce Risky Behavior of Some Groups

Strengthen the construction of socialist spiritual civilization. According to the law strike, out against prostitution, drug use and drug sales. Work with the "Drug Free Community" concept and put a great deal of effort into anti-drug educational work and into eliminating drug abuse. Vigorously teach about and promote healthy life styles and behaviors, reduce harm, and reduce risky behaviors in high-risk groups.
Use the social marketing method, establish a health market services network, place automatic condom vending machines in public places, use the family planning services and work networks and preventive health networks to vigorously spread knowledge about the correct use of condoms. Vigorously promote needle social marketing and promote the use of clean needles in order to reduce the harm that the use of shared needles causes by spreading HIV/AIDS.

In community therapeutic institutions establish carry out experimental drug therapy for drug abusers. The work of these centers should be carried out with great care and strictly managed. Working guidelines and management regulations for the management of these centers will be formulated and then, after approval by the Ministry of Health and the Ministry of Public Security, implemented.

4. Improve the health services system and raise the quality of preventive health and medical services provided to HIV-infected people and to people suffering from AIDS

Establish a complete HIV/AIDS preventive health and medical therapeutic services network. Make full advantage of Chinese traditional medicine to carry out both AIDS treatment with traditional Chinese medicine and with a combination of Chinese traditional and western medicine. Preventive health and therapeutic institutions at the provincial level as well as in cities and counties having a high HIV/AIDS prevalence shall provide preventive health, clinical diagnosis, and therapeutic services. By the end of 2001, prefectures/regions and city level cities as well as cities and counties having a high HIV/AIDS prevalence shall designate at least one therapeutic institution or a department within such an institution that is prepared to provide treatment to people infected with HIV and AIDS sufferers.

Establish a community based HIV/AIDS prevention, treatment and nursing system. Establish a core cadre of community experts and volunteers who create a generous environment suitable for people with HIV and AIDS sufferers, implement therapy and caring, improve management and reduce disruptions.

For pregnant women who are infected with the HIV virus, use drug therapy and other interventions, including surgical abortion and feeding infants with formula to reduce the risk of mother to infant HIV transmission. Reform the STD diagnosis and therapy market, implement a system of anonymity in clinical visits, standardize STD clinic work and improve the quality of STD services.

The capacity to provide medical therapeutic services to treatment to people infected with HIV and AIDS sufferers shall be strengthened. Greater concern should be given to their treatment. People infected with HIV and AIDS sufferers who are covered by urban workers basic medical insurance should receive their benefits just like anyone else. Medical treatments costs covered by basic health insurance should be paid according to regulations. The establishment of commercial insurance and popular movements to raise money is encouraged. Labor unions, communist youth leagues, women's associations, Red Cross societies etc. and charitable organizations can establish AIDS social relief funds.

5. Establish a Complete AIDS and STD Surveillance System, Information System and Evaluation System

Establish a comprehensive AIDS and STD surveillance network and carry out biological, demographic, behavioral, and sociological surveillance. Establish a complete laboratory testing network and quality control system. Promote HIV testing in order to assure the safety of blood and blood products. Make the construction of an AIDS/STD information network part of the project to construct a health information network. Gradually establish and improve information networks so that they are fast, comprehensive and responsive, and kept up to date. Improve policies and continually revise prevention strategies and technologies.

6. Strengthen Training in HIV/AIDS and STD Prevention Information and Skills

Organize experts to formulate a training program for various types of medical and public health workers, to write various kinds of training materials. Make use of various types of training such as medical school classes, on the job training, postgraduate education and medical continuing education in order. Vigorously promote the training of all medical workers in AIDS and STD prevention. Specialized training should also be provided to people working in areas such as AIDS and STD preventive health, health education, clinical nursing, testing and examinations, blood collection and transfusion, and management.

Strategies and methods for the prevention and control of HIV/AIDS and STD's should be included in the training course offered at Party and administrative schools at the Center and at the various local levels. The administrative management departments should combine on the job training into the study of the formulation of administrative policies and evaluation methods.

7. Promote Basic and Applied Research to Prevent AIDS

AIDS prevention research shall be a state key research project in order to accelerate basic and applied research on blood transfusion, clinical therapy, drug development, and vaccines as well as their transformation into products. Promote Chinese and foreign scientific methods and measures for AIDS prevention that are suitable to China's level of development. Support the work of scientific and technical institutions and drug testing research organizations in the research and production of AIDS tests reagents and high standard test reagent standard products. Improve the quality of HIV testing. Evaluate effective AIDS therapeutic methods at Chinese traditional hospitals and at hospitals that combine Chinese traditional and western medicine. Promote the development of new anti-AIDS drugs. Promote the development of AIDS vaccines suitable to the HIV virus types prevalent in China and their use in China. Put great effort into basic research work aimed at strengthening the elimination of viruses in blood and to safety in blood transfusions. The Ministry of Science and Technology, the Ministry of Public Health, and the State Drug Administration shall formulate and implement China's research and development of anti-HIV medicines and vaccines as well as their production and plan for using these drugs and vaccines.

Strengthen China's capacity to prevent epidemics. Establish and gradually improve China's HIV/AIDS epidemiological analysis and prediction model in order to promptly and accurately analyze and predict AIDS epidemic trends. Economic analysis and applied research should be conducted on AIDS prevention measures and methods.

IV Implementation of Safeguards

1. Organize the leadership

Strengthen the State Council AIDS and STD Prevention Coordinating Committee system and the work of its office. Assign experts responsibility for coordination, direction and promotion of work, and checking on the implementation of the "Plan" and of the various decisions of the coordinating committee. These experts should also establish a cross-ministerial and interdisciplinary AIDS expert advisory committee in order to give advice and suggestions to national work on HIV/AIDS prevention and to provide input on the formulation of policies, laws and regulations on HIV/AIDS prevention.

The State Council AIDS and STD Prevention Coordinating Committee gave its office the responsibility to formulate and implement the "Action Plan" and to provide advice and oversight and auditing of the implementation of the "Action Plan". Beginning in 2001, the State Council AIDS and STD Prevention Coordinating Committee Office shall organize an annual examination and direction as to the implementation of the "Plan" and the "Action Plan" and convene an annual HIV/AIDS Control and Prevention Working Conference for reporting on work, summarizing and exchanging experience, and furthering the implementation of work on the "Action Plan". The departments and work units concerned shall according to the "Responsibilities of each state department, commission, agency (organization), in HIV/AIDS prevention and control work" do its work, the various departments taking special care with the specific tasks assigned to them. The various organizations should coordinate and cooperate in their work. They should all work together to successfully carry out work on the prevention and control of HIV/AIDS and STD's.

Leaders at every level of the local people's governments are responsible for the implementation of the "Action Plan" in their areas. In the spirit of the "Action Plan" and its implementation program, specific local implementation programs should be formulated and implemented. Responsibilities should be clearly defined. Leaders should provide guidance, directives and urge greater progress in work. All this will help ensure that the goals of the "Action Plan" are achieved on schedule.

2. Refine and make more complete laws, regulations and provisions and formulate relevant policies.

Do more survey and research work. Quickly formulate laws, regulations and provisions relevant to the control and prevention of HIV/AIDS and STD's so as to create a secure legal framework for work on the prevention and control of HIV/AIDS and STD's. Accelerate research on and formulation of intervention policies and measures on high-risk behavior groups. Give special attention to research and the formulation of policy on the insurance system that can address the situation of people who get HIV from blood transfusions or HIV/AIDS prevention and control workers who accidentally become infected with HIV. Revise current laws, regulations and provisions that inhibit HIV/AIDS prevention work.

Expand international exchanges and cooperation on HIV/AIDS prevention and control. Actively participate in international activities in this area so as to compare the Chinese and foreign situations and to take advantage of foreign experience. Take the initiative in introducing ant-AIDS medicines from abroad. Implement tariff reduction policies for anti-HIV pharmaceuticals donated to China for HIV/AIDS prevention work by international organizations and by foreign countries.

3. Government Investment is Primary but Also Create Multiple Funding Channels

Establish and perfect a multiple funding channel system in which government investment is primary. The central government treasury created a budget item for AIDS prevention that is part of the annual central government financial budget. This fund will be used for the prevention work of the concerned departments of the central government as well to subsidize regions in that are in especially serious difficulty. Local government treasuries shall, according to local AIDS prevention work requirements arrange for an appropriate level of AIDS prevention work funding that will become part of the local government budget. This budget should be periodically adjusted according to the increase in the economic strength of the country and the actual needs of AIDS prevention work. Actively seek out charitable contributions from Chinese society as well as from foreign donors so that there will be multiple channels for collecting funds. Strengthen the oversight and management of funds in order to use large amounts of capital more effectively.
[Note: This "Action Plan" does not include the Hong Kong and Macao Special Economic Zones and Taiwan Province.]
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