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• AIDS Knowledge among Health Professionals in China
• Integrating Aids Prevention Into Family Planning Program In Southern Yunnan, China
• STD/HIV Prevention among Female Sex Workers in Natural Settings In Yunnan
• Reduce HIV infection by reducing drug use in Longchuan, Yunnan
• HIV/AIDS/STDs Related Knowledge and Behaviors among Girl-attendants at Road-side Restaurants in Hainan Province: A Comparison of Two Surveys
• An Analysis on the Effect of Carrying Out the Health Education of AIDS Among Floating Waitresses
• HIV Infection Among Special Vulnerable Group in Rural Areas of China
• An STDs/HIV Intervention Program Among Long--distance Truck Drivers In Guangxi Province Part A--Condom Promotion Approach
• The Study on the Models and Effect of the Knowledge about the STD/AIDS Prevention Spreading by the Public Medium
• Evaluation of Effects of Health Education Methods on the Prevention and Control of STD/AIDS
• A Study of Community-based Health Education on AIDS Prevention in East China
• Laboratory Detection of Hepatitis G Virus in Injecting Drug Users with Human Immunodeficiency Virus Infection
• Analysis on the Results of Lanzhou Distract of Blood Donors and Medical Blood HIV Antibodies Detection
• Investigation on the HIV Infection in Baise City
• AIDS Knowledge Level of Chinese College Students
• Quantitative and Qualitative Study about the Influencing Factors of Health Care Seeking Behavior of Patients with STDs in Beijing and Jinan
• A Comparison of the Characteristic of demography and Initial Seeking for Medical Care of STD Patients Attending STD Clinics in Jinan and Beijing
• A Study on the Public Health Impact of Private Sector STD Services in Shanghai, People's Republic of China
• A Study of Clinic Provision for Sexually Transmitted Diseases In Beijing and Shanghai, People's Republic of China
• A Study of Sexual Behavior among Rural Residents of China
• An Investigation of Condom Usage Through Consultant Hotline about STD/AIDS

Zunyou Wu 1 , Keming Rou 1, Dapeng Jin 2, Lei Mong 3, Wei Liu 4, Xianlan Xu 5,

Xi Chen 6, Shili Zhao 7, Jiapeng Zhang 8, Zhe Wang 9, Gang Liu 10 and Bo Tao11

1 Chinese Academy of Preventive Medicine, 27 Nanwei Road, Beijing 100050;

2 Beijing Health Department; 3 Gansu Anti-Epidemic Station; 4 Guangxi Anti-Epidemic Station; 5 Anhui Anti-Epidemic Station; 6 Hunan Anti-Epidemic Station; 7 Shangdong Anti-Epidemic Station; 8 Yunnan Anti-Epidemic Station; 9 Henan Anti-Epidemic Station; 10 Sichuan Anti-Epidemic Station; 11 Neimengu Anti-Epidemic Station

 Objective: To assess the knowledge level of AIDS among health professionals in China

Method: An anonymous, self-administrated questionnaire containing demographic characteristics of subject and basic AIDS knowledge was distributed to and collected from health professionals in 11 provinces, cities and autonomous regions.

Result: Seven thousand eight hundred and seventy-one health professionals were surveyed. The percentage of correct answer to questions of basic AIDS knowledge among surveyed health workers were 81% for transmission route, 54% for the most efficient transmission route, 46% for vertical transmission, 74% for window period, 62% for incubation period, 12% for "Universal Precaution", 72% for mosquito not pass HIV, and 80% for STD increasing the risk of HIV infection. Compared with knowledge level surveyed in 1996, there is only a marginal improvement.

Conclusion: The basis knowledge of AIDS among health professionals in China are still relatively low. To train health professionals in all levels in China is urgently needed. The methodology and contents of training need to be improved and standardized. Anti-Epidemic Station

Zunyou Wu 1, Jiapeng Zhang 2, Changming Wang 3, Lelong Dong 4, Xiuquan Bi 2, Song Duan 5, Zhirong Li 4, Keming Rou 1, Sufeng Huang 5, Yi Zeng 1, Yunshen Wang 6

1 Chinese Academy of Preventive Medicine; 2 Yunnan Anti-Epidemic Station; 3 Longchuan Family Planning Program; 4 Longchuan Anti-Epidemic Station; 5 Dehong Prefecture Anti-Epidemic Station; 6 Yunnan AIDS Control Office

 The objective of integrating HIV/AIDS prevention into current family planning program in the Longchuan County, South Yunnan, China is to set a model on which HIV/AIDS prevention will be permanently included into the family planing services and which can be potentially expanded throughout China where one-fourth world population reside.

The project consists of two components: a training workshop and integration in action. The training workshop on reproductive health and prevention of HIV/AIDS had been given to about 65 trainees selected from staffs working at family planning services and reproductive health care settings in Longchuan County, Yunnan, China. The integration had focused on disseminating messages on HIV transmission routes and prevention measures and promoting condom use among young men and women. There were two parts in the integration. Part one, all trainees who attended the workshop were encouraged to include HIV/AIDS prevention into their routine services. Their performance were evaluated 3 and 6 months after the workshop. Part two, two out-reach teams were trained and sent out to reach young men and women in 10 selected villages in which the prevalence of HIV infection among young men aged 20 to 39 years is more than 10 percent. The out-reach program were assessed by conducting both process evaluation and out-come evaluation.

Evaluation surveys showed that AIDS prevention has been fully integrated into routine services of Family Planning Program. Knowledge of HIV/AIDS and condom use rate has increased dramatically in 10 selected villages after implementation of the program.

Zunyou Wu, Jiapeng Zhang, Yunshen Wang, Yunhua Kang, Manghong Jia, Song Duan, Yijun Duan, Lelong Dong, Guiling Yang, Yuebo Liang, Jing An and Sufeng Huang

1. Chinese Academy of Preventive Medicine; 2 Yunnan Anti-Epidemic Station; 3 Yunnan AIDS Control Office

Objective: To evaluate the feasibility of implementing a comprehensive STD/AIDS prevention program among female sex workers in Yunnan to increase their knowledge of and awareness of STD/AIDS and to increase their condom use in their routine sex works.

Method: Eighty-seven establishments in three counties were selected for the intervention study. It consists of 5 steps: focus group discussion (FGD) with establishment owners and female sex workers separately, baseline survey, development of IEC materials based on FGD and baseline survey, implementation and monitoring intervention activities, and evaluation. IEC materials were distributed to sex workers free. Condom use were highly emphasized in all activities.

Result: After 3 months intervention, the knowledge of HIV/AIDS increased significantly and condom use in last sexual intercourse and last 3 sexual intercourse increased dramatically.

* P<0.01, ** P<0.05, + P>0.05

Conclusion: Under natural work settings, it is feasible to implement STD/AIDS intervention programs among female sex workers and it is effective in increasing AIDS knowledge and increasing condom use rate.

Zunyou Wu 1 Jiapeng Zhang 2 Roger Detels 3 Jianhua Li 4 Virginia Li 3 Lelong Dong 5

Zhirong Li 5 Qiqiang Duan 6 Songfeng Pan 2 Song Duan7 Sufeng Huang7 Keming Rou1

1 Chinese Academy of Preventive Medicine, 2 Yunnan Anti-Epidemic Station, 3 University of California, Los Angeles, 4 Yunnan Institute of Drug Abuse, 5 Longchuan Anti-Epidemic Station, 6 Longchuan Health Department , 7 Dehong Prefecture Anti-Epidemic Station

 OBJECTIVES To reduce the annual incidence of new drug users, the annual incidence of injecting drug users among young male drug users, the prevalence of sharing equipment among drug injectors, the annual incidence of new cigarette smokers among young males and to increase condom use rate among sexually active young males in intervention communities

METHODS To mobilize community efforts to create a community "norm" in which drug use is unacceptable by: a) creating awareness of the drug use problem among young males, their parents, grandparents, spouses if married, village leaders, village health workers, and school teachers; b) training parents, grandparents, spouses, peers, village leaders, and school teachers to identify new drug users and refer them to village health workers for assistance; c) detecting early youths who have begun experimenting with drugs and initiating appropriate counseling to prevent adoption of drug use

To empower young males with resistance skills to counteract encouragement of cigarette smoking and drug use by peers through introduction of anti-smoking and anti-drug information into the elementary school health education curriculum as well as through family-based and community-based programs

To enhance self-care ability to prevent the transmission of HIV by: a) teaching all confirmed drug injectors how to clean equipment and not to share it with others; b) increasing condom availability in the intervention communities by coordinating existing family planing organizations in the communities and by disseminating knowledge about places for getting condoms by family planning workers and village health workers; c) teaching young males and their wives, if married, that condoms can prevent sexually transmitted diseases, including HIV/AIDS as well as pregnancy, and demonstrating them how to appropriately use condom

To compete leisure time by poverty alleviation and entertainment activities.

Su-su Liao, Qi-ya He, Min Liu, et al.

Department of Epidemiology, Peking Union Medical College

Provincial Anti-epidemic Station of Hainan

To assess changes of HIV/AIDS/STDs related knowledge and behaviors of girl-attendants at road-side restaurants in Hainan provinces, we compare results of two questionnaire-based surveys conducted among girl-attendants in the province: one was performed among 106 girl-attendants at Y town in 1995; the other was among 221 attendants in F town in 1997 (both Y and F towns are in the same county). Two groups of participants were similar in age and marital status, but girls surveyed in 1997 had lower education than those in 1995. Nearly all girls interviewed in 1995 were from mainland, whereas one fourth of girls in 1997 survey were from Hainan and most of these local girls were from minority ethnic group. No remarkable differences in knowledge were identified between two surveys. However, more girls reported using a condom in lifetime in 1997 than in 1995 (53% vs. 35%, P<0.01). 30% of girls used a condom in the very recent sex in 1997 survey, which was slightly higher than that of girls interviewed in 1995 (22%, P>0.05). But the girls who reported frequently using condoms in sex were few in both two surveys. This indicates an urgent need to improve risk perception and promote condom use among these girl-attendants.

Key words: STD/AIDS related knowledge, Condom use, Female sex worker

He Qiya et al

Epidemic Prevention Station of Hainan Province, Haikou

In order to evaluate the effect of carrying out health education of AIDS and STD among floating waitresses, we gave pre-investigation and post-test to the floating waitresses of tour and service department to find out their knowledge(K),Attitude(A),Belief(B) and Practice(P, KABP) of AIDS and STD. The result of baseline investigation indicated that 73-78% of them knew how the AIDS spread, 44.3% of them knew what was safety sex and 19.2% of them used condoms in their sex to prevent diseases. After carrying out health education their knowledge about AIDS increased 11.3 to 18.8 percentages and their knowledge about STD increased 2.5 to 13.3 percentages(Details showed in table 2 and 3). The percentage of them using condoms raised 5 to 9. The result showed that once intervention education had some effect, but it was very little.

Chen Xu 1, Zunyou Wu 2, Yuntong Zhang 1 , Yi Zhao 1, Naiming Hong 3,

Keming Rou 2, Yi Zeng 2 , Roger Detels 4

1 Fuyang Anti-Endemic Station; 2 Chinese Academy of Preventive Medicine; 3 Fuyang Health Department; 4 University of California at Los Angeles

 Objective: To determine the prevalence of HIV infection among a special vulnerable group in rural areas of China.

Method: Villages which have considerable proportion of young migrant laborers in three counties in east China were selected for the study. Subjects who had ever moved out for laboring and their family members were requested for the survey. Demographic information, drug using behaviors, sexual behaviors, history of medical care including transfusion, surgery and dental care, history of donation of plasma or blood, history of diagnosis of hepatitis C were collected by an interviewer administered questionnaire. The Hema-strip were used for on-site HIV screening and were confirmed by the Western blot.

Results: One thousand five hundred and eleven subjects were interviewed. Among them, 180 were temporary migrant laborers, 105 (6.9%) reported being told carrying hepatitis C virus, 84 (5.5%) reported having pre-/extra-marital sex of which 40% reported using condoms in pre-/extra- marital sex, 2 reported having used drugs, and a considerable number of people were tested HIV positive. Migrant laborers had a higher prevalence of HIV infection than those who were not (P=0.004). People who had been told they were carrying the hepatitis C virus had a higher infection rate of HIV than those who had not ( P<0.001).

Conclusions: The prevalence of HIV infection among surveyed group has unexpectedly high. Intervention programs target at these groups must be initiate as soon as possible.

Li He , Zhang Konglai

Dept. of Epidemiology, School of Basic Medicine, Peking Union Medical College

 With sexual services along the high-way, long-distance truck drivers are under high risk in contracting STDs/HIV. Guangxi province is bordering Vietnam and sex business involving Vietnamese girls in the borders where foreign trade flourishes, is prevalent.

In order to understand the knowledge, attitudes, beliefs, practices about and the prevalence and incidence of STDs/HIV among truck drivers in those areas, a study including intervention program was carried out in Guangxi province from May to September, 1997.

Baseline results showed that the prevalence for gonorrhea, syphilis and HIV among the truck drivers were 10.96%, 0.66% and 0% respectively. The rates of self-reported pre-marital sexual experience and extra-marital experience were 43.13% and 30.48%, respectively.

The baseline results showed that although the rates of correct answer on the knowledge of "condom can prevent STDs/AIDS", "condom has contraception effect" among truck-drivers were ranged between 46.43% to 75.00%, the rate of "use condom every time or frequently when they visit prostitutes" was 12.90% only. The rates of condom use for: "preventing from contracting STDs", "preventing from contracting AIDS" were 69.23%, 29.23%, respectively. The rates of not using condom as "It will decrease sexual pleasure", "not comfortable" were 39.32%, 41.03%, respectively. Hence, it is urgent to promote truck-drivers to practice condom use.

An intervention program was carried out. Education materials include: 1. watching vedio-tape; 2. listening to cassette tape; 3. reading the little-book, phamlets; 4. answering their questions; 5. discussing some questions; 6. peer education; 7. condoms were distributed to them; etc. Second survey was carried out 2 ~ 2.5 months after the intervention. The results showed that the knowledge about STD/AIDS prevention in the intervention group was higher than that in the control group. The rates of correct answer to "condom can prevent STDs/AIDS", "condom has contraception effect" in the intervention group were 89.81%, 92.59%, comparing to 49.60%, 80.00% in the control group. The rate of condom use in the intervention group was reported higher than that in the control group, the rate of "use it every time or frequently" in the intervention group was 28.00%, comparing to 11.11% in the control group. The rates of condom use for: "preventing from contracting STDs", "preventing from contracting AIDS" in the intervention group were 85.00%, 75.00%, comparing to 75.00%, 31.25% in the control group. The rates of not using condom for: "will decrease sexual pleasure", "not comfortable" in the intervention group were 47.83%, 52.17%, respectively. But the rates of not using condom for: "will decrease sexual pleasure", "not comfortable" in the control group were 48.57%, 45.71%, respectively. So the intervention program had some effects on the drivers.

Liu Jing Ceng

Qingdao Dermatological Hospital

 Through local newspaper, broadcasting, TV, we strengthened education propaganda about STD/AIDS prevention to 11,500,000 people living in Qingdao for one and half year. The following results were achieved. The main factor of spreading model was that professional sectors cooperated actively, governments intervened properly, spreading department organized positively and the public involved strongly. Medium involvement was changed into active, concentrated condition from passive, scattered one. Times of spreading increased from 217 in 1995 to 449 in 1996, at the same time, the rate of coverage of newspaper, broadcast, TV was 17.23%,20.63%,17.10% respectively. There existed significant difference about correct answers of KAP before and after intervention. In 1996 the amount of retailing medicine on STD treatment decrease 6.24% to 35.9%. The amount of retailing condom increased 55.49%. The number of people who brought books on STD/AIDS prevention increased 48.72%. People who went to barber shop to shaved their face reduced 16.43%. In 1996 ,16.88% of STD patients in the clinics sought medical care within the two days when the STD symptom appeared. Of 51.59% STD patients took condom by themselves. In 1996 the yearly increasing rate of STD in Qing Dao was 4%, which was lower than the rate three year ago and also less than the rate of Shangdong province and that of the whole nation .

Ren Xianwu

Jiangsu Institute of Dermatology

This study assessed the impact of health education on STD/AIDS prevention and control among different population and investigated the correlation between health education techniques and their effects. A total of four thousands subjects of various groups(including general, high risk and special population) from different areas were covered in this study. They were divided into experimental and control group. Folding picture and lecture were chosen as two types of research methods for health education. Changes in knowledge, attitude and behavior among several populations was measured by pre and post tests with anonymity, and effect of different health education methods for delivering education was assessed. The result showed that folding picture was the most effective way for health education. High risk population was the best subject to be educated and we should put stress on these people.

Key Word Health Education Method and Effect

Sun Xiaoming, Wen Yong HUANG Caiying, Kyung-hee Choi, Jeffrey Mandel

Nanjing College for Population Program Management, Nanjing, China

Kunshan Family Planning Commission, Jiangsu, China.

Center for AIDS Prevention Studies, University of California, San Francisco, U.S.A.

From April 1996 until April 1997, a representative sample of young adults(18-30) were recruited by using a two-stage cluster sampling procedure at two townships in Kunshan county, Jiangsu province(N=800). The two townships were randomly assigned as one experimental group(N=400) and one control group(N=400). A baseline survey, educational intervention and a 12-month follow up survey were conducted. A self-administered questionnaire about KAP of AIDS was conducted before and after intervention for both experimental and control group. A comprehensive educational intervention on AIDS prevention was offered to the experimental group through the local family planning service system.

Among the total recruited young adults, 710(89%) completed both baseline questionnaire and post-intervention questionnaire. The post-intervention survey showed that the knowledge and attitude related AIDS had been changed remarkably in the experimental group. Comparing with the baseline survey, the average proportion of the right answers related AIDS transmission were greatly increased from 68% to 95%( the routes that HIV can be transmitted) and from 44% to 93%( the routes that HIV can not be transmitted). The proportion of young adults who consistently used condom as their contraceptives was also increased from 3.1% to 8.5%. However, it was kept no change on AIDS knowledge and attitude and decreased from 8.3% to 4.8% on condom use in the control group.

This study confirmed that the integration of AIDS education and family planning services, which conducted by family planning services system is a sagacious and realistic choice to impede AIDS epidemic in China.

key word Community-based Health Education AIDS Education China

Ma Yicai et al

HIV/AIDS Surveillance Center of Sichuan Province, Chengdu

In order to investigate if injecting drug users with HIV are also infected with HGV, EIA was used to measure the anti-HGV antibodies for the samples of 42 injecting drug users with HIV from two different regions. Of the 42 sample, the positive rate of anti-HGV antibodies was 19.05(8/42). For the individual sample group of two different regions, the positive rates of anti-HGV antibody were 20.83%(5/42) and 16.67%(3/18) separately, which were not significantly different. Our study showed that there is a high prevalence of HGV in the injecting drug users with HIV. As the additional infection of HGV, HIV positive patients may be faced with a more difficult survival situation.

Key word Hepatitis G Virus Injecting Drug User with HIV

Chen Bing et al

Gansu Blood Center

HIV antibodies of 35695 blood donors and 66404 medical blood samples were examined with ELISA method in past 4 years. The result was 19 positive by ELISA, but none is positive with WB method. This expressed that medical blood in Lanzhou had not been infected by HIV, but it is necessary to detected HIV antibody for ensuring high quality of blood in the future.

Liu Wei et al

Guanxi Anti-epidemic Center

The HIV epidemic was found among IDUs in Baise city in Guanxi province in August 1997, the infection rate of IDUs reached 77.2%, which suggested that this place has become one of the highest HIV affected areas in our country. The result of investigation shows that most of the HIV positive people are citizens in urban area and the sex ratio is 2.8:1. At the same time the sexual transmission of HIV has been noted because the infection rate among prostitutes in Baise is 0.43%. So it is urgent to carry out the intervention program among IDUs and prostitutes in order to decrease the HIV transmission in Baise city.

Pan Suiming

Institute in Sexuality and Gender in Renmin University of China

With a nation-wide multistage sampling, 2936 students in 446 departments in 150 formal colleges and universities were drown. When the confidence level was 95%, the largest sampling error was 2.5%, our samples could represent the population, including all 1,426,000 students in 638 colleges and universities in China. The percentage of effectively answered questionnaires was 66.4%.

With single factor analysis, the outcomes were made below.

1) About 93% of the sample knew that sharing needles and having sex without condom can transmit HIV. However, about 40% of the sample made wrong answer to giving and receiving blood transfusion. 2) About 45% of the sample said that kissing can transmit HIV. 3) About one third of the sample perceived that skin contact can get HIV. 4) There were 11 kinds of possible transmission routes in the questionnaire, those who correctly selected the only three ways were as less as 10.7%. 5) Those who selected three routes of transmission, regardless of answering right or wrong, were only 20.3%. These data showed that there had been an "HIV/AIDS scare in Chinese college students.

With double factors analysis, the following outcomes were made.

1)There was not a significant interrelationship between the students' special learning field and their AIDS knowledge, including the medical students. 2)What kind of the heterosexual contact the sample had (from general friend to sexual intercourse) was not interrelated with their AIDS knowledge). 3)Their knowledge on homosexuality paid related influence upon their AIDS knowledge. 4) Gender was the most important factor. The female’s right answers were significantly less than the male’s. The female also needed AIDS knowledge much more strongly than the male.

These who thought more than two third of prostitutes and their clients had been transmitted with STDs were only 10.7%.2) Near 75% of the sample said they needed AIDS knowledge. However, among the 8 kinds of sex knowledge, only 3.5% needed knowledge firstly, which ranked as the last second among the 8 kings of sex knowledge.

Wang Ying Zhang Konglai

Peking Union Medical College

As HIV/AIDS has been worldwide problem, more attention should be paid to the role that health care seeking behavior of patients with STDs plays in the prevention and control of STD/HIV. However, in contrast with the researches focusing on diagnosis, treatment, risk behavior and epidemic tendency of STDs, few theoretical and empirical work has been done to study the health seeking behavior of patients both at home and abroad. With the resurgent of STDs in our country since 1977, health care seeking behavior of STD patients has been seen in the Chinese literature recently, but thorough and theoretical research about it has not been carried out yet. Under the challenging of such background with the remarkably increasing incidence and new cases of STDs and HIV reported in our country, a quantitative study combined with qualitative one has been conducted to elucidate the patterns and influencing factors of health care seeking behavior about STD patients in Beijing and Jinan of Shangdong province. Three routes of seeking medical care for STD patients were included:(1) the special clinics and general hospital, (2) 9 illegally private clinics and 15 persons visiting such clinics for the treatment of STD and suspected STD, (3) 4 drug stores and clients purchasing the drug for the treatment of STD, methods used to collect data were personal interview, in-depth interview, non-participant observation, et al. Since the health care seeking behavior with STD patients involves the sensitive topics about sexual behavior, multiple sexual partners and social norms about sex, it was difficult to collect above data.

The quantitative study showed that of 445 STD patients through personal interview in Beijing, 48.1% of them selected special STD clinics, dermatological and STD clinics in hospital where they got orthodox treatment at their initial seeking behavior, 35.3% of patients reached state-run hospitals, 14.2% took medicine by themselves, 2.5% visited illegally private clinics from the ads along the streets. The qualitative study discovered that both STD patients and suspected ones had the possibility to go to drug store and illegally private clinics for further treatment and counseling before and after they selected the state-run hospital for medical help. The result of quantitative study combined with qualitative one suggested that the pattern of health care seeking behavior of STD patients in Beijing was to seek mixed STD treatment according to different ways and hierarchical hospital unless they got satisfied treatment at their initial visit. 278 patients surveyed at Shangdong special STD clinic in Jinan presented the same pattern, but higher proportion of visiting illegally private clinics, lower self medication, taking longer time to get orthodox treatment and more times to visit different places to seek medical care than that of patients in Beijing.

Health Belief Model, one of psychosocial theories, which is widely used abroad to understand the health behaviors related to the prevention and control of disease was first introduced to the study of health seeking behavior of STD patients in our country to find out the factors that will cause the behavior changes. The result of logistic regression combined with the variables offered by Health Belief Model indicated that factors influencing the patients to get orthodox treatment of STDs at their initial visit were whether they had the susceptibility to get STD by judging the symptoms and sexual history, whether they knew where to get appropriate treatment when the symptoms occurred, whether they were reluctant to visit hospitals for fear of indulging the situation, whether they understood the complication and sequel of inappropriate treatment of STDs and where they got first treatment. The factors that exerted an effect on the length of time to get orthodox medical treatment for the patients were whether they knew the places and hospitals to provide such medical service, whether they knew the complications and sequel of untreated STDs, the number of sexual partners, marital status and types of STD. Since gonorrhea begins with more acute onset than CA, the patients with gonorrhea sought medical care sooner than those with CA. The differences between those who selected special STD clinic and STD clinic in hospitals was that patients who got higher knowledge scores on STDs and knew the existence of special STD institutes were more likely to selected special STD clinic at their first visiting . Patients who wanted to get convenient treatment at nearby hospital were more likely to go to general hospital for the treatment.

Li Bing Wang Ying

Shangdong Provincial Institute of Dermatology

Health care seeking behavior differs in different regions on aspects of social environment, health service coverage and educational level of patients, et al. In order to compare the characteristic of demography and initial seeking for medical care of STD patients in Jinan and Beijing, 278 STD patients were collected from Shangdong provincial institute of dermatology in Jinan and 390 from STD control institute in Beijing. The result showed that there was no significant difference in marital status and sexual behavior. The first visit to non-government medical sectors after the appearance of symptoms of STD were 14.39% in Jinan and 15.90% in Beijing. The duration of going to STD clinic were 30 days for the patients in Jinan and 15 days in Beijing(P=0.0001).The Average time to visit doctors including those who were in illegally private clinics were 3 for patients in Jinan and 1 in Beijing(P=0.0001). Our results demonstrated that it is urgent to strengthen the health education for the STD patients of how to get appropriate health care at their initial visiting and to improve the quality of medical care services at all levels aiming to provide effective STD health care with the patients.

Key Word STD patient Initial Seeking of Medical Care

Qian Hanzhu, William Stewart

Shanghai Institute of Planned Parenthood Research

London School of Hygiene and Tropical Medicine

Object: In most province in China there are no private practitioners who are licensed to diagnose or treat sexually transmitted diseases. However, many unlicensed clinics still operate, attracting patients through advertisements posted on walls. The objective of the current study was to assess the service offered in such private clinics in Xuhui district, Shanghai, and to discuss how this service might impact on the epidemiology of STD in the city.

Methodology: A search of posters for private clinics gave 13 addresses. Four of these clinics were visited be two researchers as "simulated clients", who suspected themselves of having an STD. Three were visited as researchers and unstructured interviews were conducted. Six others had moved or would not participate.

Results: All practitioners in the clinics were migrants to Shanghai,had no medical training , and were using the provision of STD facilities as a means of income generation. Clinic facilities were poor, and hygiene standards were low. The only means of diagnosis was observation, and drugs which were prescribed were bought from illegal peddlers and were not usually suitable for the infection being treated. The (uninfected) researcher posing as a simulated client was diagnosed in every case as having an STD. However, the caseload of these clinics(mean 2-3 patients daily ) was found to be significant ,especially considering the large number of such clinics around the city.

Discussion: The omnipresence of such clinics in China poses severe obstacles to the control of China’s growing burden of STD. They are likely to impact on the epidemiology in three ways: patients are unlikely to be diagnosed or treated properly, kneading possibly to further complications and their continued infectiousness for their partners; hygiene conditions and lack of equipment in clinics raises the problem of iatrogenic infection; the use of drugs by untrained personnel may impact on antimicrobial sensitivity of bacteria strains in China. However, the willingness of patients to use these facilities raises indicates that structural barriers exist to accessing regulated state clinics. and changes to state facilities are called for to overcome these barriers. A discussion is made of possible approaches to dealing with this problem in the current Chinese context.

Qian Hanzhu, William Stewart

Shanghai Institute of Planned Parenthood Research

London School of Hygiene and Tropical Medicine

Objective: The study sought to map services for people with sexually transmitted diseases in Beijing and Shanghai, PRC, and to investigate the quality of care(from both medical and patient perspectives) in these services, as a background to understand better patient health seeking behaviors for STD, and to understand the effects of service provision on STD epidemiology in the study areas.

Methodology: Interviews were conducted with doctors in all clinics which see STD in a sample of state clinics in Xuhui district, Shanghai and Chaoyang district, Beijing; with all private practitioners in these districts, and with a sample of pharmacists. Additional information was drawn from other documentary and personal sources.

Results: Results indicate unstandard methods for diagnosis and treatment in the public sector, and no attempt to provide health promotion, but good provider attitudes and good systems of referral between practitioners. High levels of use of private(unregulated) practitioners(around 30%) and of self treatment for STD (greater than 50%) were estimated.

Discussion: The current situation indicates that stigma, fears of lack of anonymity and cost affect patient health seeking behaviors. Little opportunity is taken of clinic visits to attempt behavior change. High reliance on the private sector creates worries that ineffective treatment will leave many patients as infectious sources, and will contribute to increasing drugs resistance of some bacterial strains. Ways to improve clinic services for the prevention of STD are discussed.

Key Words: Sexually transmitted disease, health care organization, service utilization, China

Hongjie Liu 1, Roger Detels 1, Jie Xie 2, WenZhou Yu 3,

Weisheng Song 2, Zhenya Gao, Zhixin Ma 3

1 Department of Epidemiology, UCLA School of Public Health

2 Yingshang County Anti-Epidemic Station

3 Anhui Provincial Anti-Epidemic Station

Objective: Although the spread of HIV/AIDS and other STDs in China have been strongly associated with sexual activities, there is little information about sexual behavior and variations that determine the spread of HIV in rural areas where the vast majority of the Chinese population lives and where recent reports suggest that HIV prevalence is highest. Hence, studies of human sexual behavior aimed at identifying high risk behaviors are needed to formulate effective prevention programs.

Method: A cross-sectional study design was used to measure sexual activities retrospectively and currently. The survey sample was drawn by a two-stage cluster method. A two-part anonymous questionnaire was used in this survey. The sensitive questions related to sexual behavior were administered using a tape recorder, ear phones and an answer sheet which included the number of the question, but not the text of the question.

Results: A total of 1057 subjects were interviewed. Reported levels of sexual activity were higher in men and younger age groups. Among 886 sexually active individuals, 7.67% reported having had more than one sexual partners, 22.79% reported having had premarital sex, 2.4% having had anal intercourse, 4.1% having had oral intercourse and 2.3% having had both. Less than 2 percent of them reported having had sexually transmitted diseases, and only 11.96% used condom for very sexual act. Logistic regression analysis indicated men were more likely to engage in risky sexual behavior than women (OR = 1.77), as wealthier persons (OR=1.78), people who had more than 2 coital acts per week (OR = 2.04), people who did not live with their spouse (OR=2.20), people who desired to have multiple partners (OR = 2.42), and people who had seen pornographic material (OR=1.66). High behavior also associated with young age at first sexual intercourse and older age at marriage. The earlier persons had sexual intercourse, the more likely they were to report high risk behavior. People who were married late were more likely to have engaged in high risk behavior. Conclusions: Sexual norms and behaviors in rural China are changing rapidly. The prevalence of high risky sexual behavior among the young rural residents increasing. Strategies to prevent HIV/AIDS should include extensive education to promote delayed onset of sexual activity, to promote safe sexual behavior and condom use, especially among those who temporarily migrate to cities.

Yang Ping

National Center for STD and Leprosy Control

In order to know the condom use in specific populations in China, an investigation through a STD/AIDS hotline hosted by the National Center for STD and Leprosy Control was made in l070 clients based on anonymous and voluntary manner. The results showed that the high risk behaviors such as prostitution and multiple sexual partners were found in 67.2% of the clients, which made this group a high risk one for getting STD/AIDS. The average condom use was 11% in this group. 85.7% of those clients who had multiple sexual partners, 83.3% who was bisexual/homosexual orientation ,76.% of clients engaged in extramarital affairs and 71.2% of those who undertook prostitution refused to use condom. Only one clients used condom in practicing anal intercourse. Furthermore, by the survey of different occupations, avoidance of condom use was 78.3% in private businessmen, 77% in salesmen and 66% in hotel attendance. There were eight reasons for avoidance of condom use, in which a number of clients thought "it didn’t¡°matter¡±(33.5%) and "didn’t know its function in prevention of STD/AIDS"(28.3%). The other reason included "didn’t believe it" and "didn’t know how to use it", etc. The later means that they usually put it on just before ejaculation. Some clients thought it was expensive and couldn’t afford them for a long time. About 39.6% of STD patients and 46.2% of students didn’t know it function in STD prevention. The proportion of the unmarried clients who didn’t know its function and didn’t know how to use it was higher than that of the married. In addition, those who were more likely to use condom were at the age of 30-39 and got married and cadres. A total of 90.6% of those using condom had high school and college educational background. The above results indicated that the health education on how to prevent STD/AIDS should be focused on high risk populations such as STD patients, students and those with high risk behaviors, especially on low educational level. Stress should be also put on the explanation of manipulation of the condom use and principle of prevention. Education should be carried out in regard to prevention role of condom in premarital check-ups and among students.