|
|
Part Three. Working Experience Relating to AIDS Intervention
Condom Promotion: Targeting High Risk Population
Jiaxi Zhang Meizhe Xin
China Preventive Medical Association
In order to seek a suitable method of condom promotion to prevent AIDS and STD in China, the project was divided into three parts: KAP survey of AIDS and STD in long distance drivers and conducting health education; peer education in long distance driver and the owner of small restaurants along the road; distributing health education material and condom at toll gate. Drivers were trained and surveyed at truck company garages. The owners of small restaurants trained and surveyed by the epidemic prevention station staff and distributed condom at their small restaurants. The result shown that target population LDTDs were 528, 60.2% of them were 21-35 years old, 9.7% of them admitted they had extramarital sex, 3.2% had STD before, 1.9% transmitted STD to their sexual partner. 40.9% got their STD/AIDS knowledge score at medium level, 24.1% did it at poor level. The majority of education level for 86 owners of small restaurants was primary and junior high school, it was 20.9% and 51.2% respectively. The dominant age composition was 41-50 and 31-40, which was 39.5% and 27.9% respectively. 48.8% of owners deemed there were commercial sexual action around their house, so they would be leader of peer education. We deemed that peer education should be one of the best methods for LDTDs to prevent STD/AIDS. The owners should be selected as the leader of peer education and the distributors of health education materials and condoms, but the profit may discourage the owners to attend the project. So we are trying to use the social marketing to provide condom.
AFAO and HASCSP partnership train the trainer program
on HIV/AIDS education in Sichuan province
HIV/AIDS Surveillance Center of Sichuan Province
In order to reduce the impact of HIV/AIDS on the people of Sichuan Province and neighboring areas of China, the Australian Federation of AIDS Organizations(AFAO) and HIV/AIDS surveillance center of Sichuan Province(HASCSP) have conducted a two-year partnership train the trainer program on HIV/AIDS education in Sichuan from June 1995 to May 1997. A coordinated training system has been developed to provide HIV/AIDS educators with a variety of knowledge, skills, strategies to educate groups perceived to be at greater risks of HIV infection , to minimize the potential spread of HIV among sexually active young people, to create a public climate in which discussion of HIV/AIDS is able to take place and people living with HIV/AIDS can exist without fear of discrimination. Three training sessions have taken place, and the partnerships have been taught in the way of group discussion, role play, development of materials, working out plans, on-the-spot practices and being a host (hostess) at meetings. When the partnerships went back to their local cities, they taught other health educators and worked with target groups practically. Through evaluation, we can see that the participating health educators have much better skills and abilities to contact with target groups . we can come to a conclusion that this project is very successful, it has been playing a very important role on the prevention and control of HIV/AIDS in Sichuan and it should be expand to other cities and provinces in China as a standard model.
Evaluation Report on the National Drug Demand Reduction
and HIV/AIDS Prevention Program
Li Dingda
The Office of Yunan Provincial Narcotics Control Committee
In 1991, the United Nations Economic and Social Commission for Asia and Pacific(ESCAP) and the Chinese National Narcotics Control Commission(NNCC) launched a community based Drug Demand Reduction and HIV/AIDS prevention project in Ruili in China’s southwestern province of Yunan. This project was a success. Based on the rich experience of the project. ESCAP and NNCC signed an agreement in 1995 for implementing a national drug demand reduction and HIV/AIDS prevention program in five urban communities in Kunming City, Chuxiong , Dali, Baoshan, Dehong prefecture. Long term targets of the program covered reducing the number of drug addicts and increasing the number of drug free ex-users step by step and preventing new drug abuse, et al; short term targets of program included developing community based drug demand reduction and HIV/AIDS prevention activities and increasing community’s activities knowledge of drug abuse and HIV/AIDS prevention and improving community’s treatment, rehabilitation of drug addicts, et al.
The contents of program were as follows: training course at national level was conducted, four persons from each of the five communities participated in the training course; the KAB questionnaires specially designed by ESCAP were used when the baseline and evaluation survey were carried out in five pilot project communities and five control groups, other surveys were designed to target key informant and drug abuser; from March to May in 1996, the five target communities respectively conducted a planning workshop and two training courses; project community signs were put up at road crossings and on streets to give residents a sense of pride and confidence and increase their awareness of drug abuse and AIDS prevention. The signs were also a deterrent to drug traffickers; the addicts were also told to receive detoxification and rehabilitation; Each project community had activities for HIV/AIDS prevention by means of slogans, prosters, pamphlets, meetings et al; project were expanded and evaluated. The data given above showed that community based approach to drug demand reduction and HIV/AIDS prevention effectively reduced drug abuse and control the spread of AIDS. Before the program started, there were 58 drug abuser in the target communities, accounting for 1.23% of the total population, 56 drug abusers in the control communities, accounting for 1.14% of the total population. After 18 months of intervention, the number of drug abusers in the targeting communities was reduced to 23 in targeting population and 54 in control group, in both groups there were no new HIV positive persons. The results of the two surveys showed that the community based approach of prevention increased the community members’ awareness of the danger of drug abuse and AIDS and improved their knowledge of prevention. Suggestions: more funds will be needed to make the results of the program sustainable by follow up actions and evaluations. As the community based drug demand reduction and HIV/AIDS prevention projects have proved to be effective, the government departments should appropriate more special funds for prevention.
Women's Reproductive Tract Infection Disease and AIDS Prevention
Fang Jing
YRHRA
This presentation analyzed the relationship between women’s reproductive tract infection and AIDS prevention and identified that some RTIs are the most common diseases among Chinese women with the morbidity as high as 50-70% which is a substantially potential risk factor for AIDS transmission. Therefore, the prevention and treatment of RTIs is closely related to AIDS prevention. The suggested intervention is to provide RTIs diagnosis, treatment and prevention service for general women and integrate AIDS prevention with the RTIs services.
Reproductive Health Care and STD/AIDS Control
----STD/AIDS prevention and care in reproductive health settings: a critique
Zhao Pengfei
Shanghai Institute of Planned Parenthood Research
STD/AIDS has been pandemic worldwide and become an important reproductive health issue in most countries, and especially so in developing countries. Sexually active men and women are no longer only concerned with avoiding pregnancy, but have s closely related need to protect themselves from debilitating and sometimes life-threatening diseases. The WHO has proposed and the ICPD endorsed a new concept of reproductive health which includes 4 major components: family planning, material & child health care, sexual behavior and sexual health care and control of STD/AIDS. The ICPD Program of Action accords special emphasis to the links between family planning and STD services. At an operational level, however, the specifics of implementing linkages between these services have yet to be worked out. Promoting of integrated services of family planning and STD will absolutely play an important role leading to the improving of reproductive health status for both men and women.
Reviewing the latest research progress and trend of international efforts in promoting this integration and combing national explorerary trials and achievements, the author herewith makes a critique on the following specific topics:(a) Needs, feasibility and implications of integrating STD/AIDS service into reproductive health settings;(b) Models and trade-off of the integration of family planning and STD services;(c) Analysis of typical cases of integration in selected countries;(d) Findings from some isolated programmers of integration in China.
HIV and Prostitution: Ethical Perspective
Qiu Renzong
Institute of Philosophy Chinese Academy of Social Science
To prevent and control the HIV epidemic in China is one of the major responsibilities of the society . Scientific studies show that the potential transmission of HIV through prostitution is greatly possible. It cannot be precluded that this route of transmission will become the main one in China in the near future. So it deserves to be paid sufficient attention and is necessary to adequately understand and assess the actual role of prostitution in HIV epidemic and work out an efficient, ethical and feasible measures according to the ethical principles of beneficence, respect, justice and solidarity. First, we have to be faced with a reality that for a variety of reasons, prostitution exists now and involves a great number of people and produces considerable output in China. Secondly, it is necessary to seriously and deliberately investigate and address the causes and influencing factors about the selling and buying sex, for example, under the condition of commodity economy and openness to the outside world and existence of inequality between men and woman is it possible to eradicate the prostitution thoroughly in the near future? Thirdly, it is necessary to protect women’s rights and beneficence. Fourth, the implementation and consequence of the law and policies involved should be regularly assessed. Fifthly, it is suggested that a comprehensive countermeasures can be taken to regulate the prostitution and HIV prevention, in which will be integrated with all activities including community economic development, shaking off poverty and building up the fortune, construction of spiritual civilization, reproductive health, sex education for adolescents et al.
Sexuality, Marriage, Family and AIDS epidemic
Pan Suiming, Director
Institute for Research in Sexuality and Gender
Renmin University of China
Following the economic reformation began in 1979, especially after 1985, sexuality appeared again in lectures and scientific books. Today, most people know there is a "sex revolution" in China.
Part one . What are reasons of the change?
A. Since 1980, Chinese government's "one child policy" had made five outcomes in the field of sexuality.
1. People's basic valuation on sexuality had changed from seeking for reproduction to seeking for pleasure.
2. The one child policy promoted contraception and abortion. Thus, the society had lost its main method to find out and to punish non-marital sex.
3. Having only one child in whole life made Chinese younger women have more time, more energy and less fear to make love.
4. The one child policy made the child become as the VIP in a family consisted of only three person. Parents can hardly control their sexual behavior.
5. Every kind of sexuality minority, will gain more many reasons to exist in China.
6. Popularly using IUD reduced the condom use.
B. The Marriage Law published in 1980 made love as the first reason and evaluation standard of marriage. Divorce and pre-and extra marital sex increased.
C. Ideology crises made the traditional morals lost but the new one still was not built up.
Part two. Sex Revolution in China
A. Sexuality became more important in its inter relationship with marriage and love.
B. The sorts of sexual behavior increased up. A nation wide survey showed that found: 41% of the respondents use only one sort of behavior to make love; 42% changed their behavior some times, 8% often change (Liu Dalin, 1989). A snow-ball sampling survey of 1279 person, 7% of them had done anal sex(Pan Suiming, 1991).
C. Sex came from the close contact
Part Three. Non-marital Sex
A. The prevalence of pre-marital sex with non-prospective spouse was 4% in Beijing City (Li Yinhe, 1989). Among those who married after 1980, it was 9%(Pan Suiming, 1989). Among the non-sampling nation-wide survey, it was around 10%(Liu Dalin),1989). Among college students of Beijing (1991,1995)and whole China(1997), it was 10%, 8% and 10%(Pan Suiming, 1997)
B. These who had extra-marital sex was around 6% in the non-sampling nation-wide survey. Among the snow-ball sampling survey, it was 11%. In the population of Guilin, Guangzhou Haikou(1994), the percentages were 5%, 8% and 16%(Pan Suiming, 1994).
Part Four. Gaymen
A. We do not know the percent of people who are gay in the Chinese population. The non-sampling nation-wide survey showed it was 0.5% of urban married people and 3.5% of rural married people who red bisexual behaviors. In the survey on male college students, 12%-17% had at least touched with men sexually, 4.2% had both behavior and live.
B. of 165 male homo-and bisexuals, 48.5% had anal sex.
C. of them, 19.4% had paid form making love, 18.2% were paid.
Part Five: CSW
A. most data and researches on this topic were on these who had been arrested
B. According to Pan’s survey in Guangzhou City(1994),about 5% of CSW and customers were really arrested
C. 1994 in Guilin, Guangzhou and Haikou, 1.7% and 0.7% of the populations had paid for and were paid for sex (with cash or expensive gift).
D. CSW worked in more and more places and with more and more patterns, such as massage, company, room service, washing feet, red-light areas, Mami(female leaders of CSWs), the second wife(being paid periodically) had appeared in some areas. Specialization appeared. Prostitution-like service increased.
E. Anal sex was NOT few in prostitution.
F. People’s attitude was changing to mind your own business. They did not believe more and more that the prohibition of prostitution will be carried out on.
Running Telephone Hotline by Volunteers
---Experience of the Hong Kong AIDS Foundation
Lin Oi-chu
Chief Executive, Hong Kong AIDS Foundation
A. The Issue:
Is it feasible and appropriate to run telephone enquiry service by volunteers?
B. The experience of the Hong Kong AIDS Foundation:
1. Hong Kong AIDS Foundation has been running a telephone enquiry service by the volunteers since 1992. The service objects are:(a) to provide the public with information about HIV/AIDS and to make referral service;(b) to provide immediate active listening, support and counseling for people affected by HIV/AIDS, and with referral service arranged when needed;(c) to make risk assessment on HIV infection and arrange HIV antibody blood test service to people in need.
2. The present service delivery system include recruitment, screening and training of volunteers, implementation of service, maintenance and reinforcement.
3. Recruitment methods include use of leaflets, advertisement on newspaper or newsletter and during publicity events. Basic and specialized training would be offered to equip volunteers with the basic knowledge on different aspects of AIDS and skills in rendering effective telephone enquiry/counseling. Interviews are arranged to screen suitable volunteers. Volunteers are requested to provide adequate sessions of service in a month. We have about 30 volunteers taking part in this service and about 50% of them are active participants. Professional social workers are available for advice and assistance when they face difficulties in handing the calls. To maintain the standard of service and to sustain the morale of volunteers, backup support are provide. This includes helpline manual as reference, formal sharing session among the hotline operators, group social activities, on-going consultation and advice, refresher course/advanced training, information updating and updates on AIDS. As a recognition, we have outstanding volunteers award organized annually.
C. Limitations of the service
Two major limitations of such service method are observed: (a) the service provided is less professional;(b) there are difficulties in maintaining the motivation of volunteers.
D. Merits of the service
We discover that the mobilization and involvement of volunteers in manning the service have some advantage. They are:(a) more cost-effective. We can render the enquiry service to wider community at lower cost as less paid-staff are involved. With adequate training and on-going professional support and assistance, the volunteers are competent in providing the service to the general public. (b) the service delivery system is in itself a process of preventive education to the volunteers who come from all walks of life. During training and the provision of service, volunteers are exposed to different aspects of AIDS, hence they can acquire more understanding on the issue. (c) on an individual level, volunteers, through the participation, and achieve personal development and growth. This may cause positive impacts on their friends and relatives.
E. Conclusion
Given there are appropriate professional services for referrals, and fundamental professional support, using volunteers to provide telephone enquiry service, which offers basic information on AIDS and basic support to people affected by HIV/AIDS,
is a feasible alternative of service provision for the general public.
The Need to Involve HIV Positive People in AIDS Education
Susan Paxton
Australian Representative, APN+
WHO Key Center for Women's Health,
Faculty of Medicine, University of Melbourne, Australia
Aim: To evaluate the role of HIV positive people who speak out to young people in schools.
Method: This is a longitudinal, non-randomized, control study using both quantitative and qualitative methods. A standardized questionnaire addressing attitudes towards HIV/AIDS is administered to young people before, immediately after, and three months after a talk by a positive person. Answers are correlated with age and gender of the respondents. Focus group discussion are conducted with students after the talks. In-depth interview are conducted with positive speakers from Asia, Australia and Africa.
Results: Young people are more comfortable discussing sexuality issues with an anonymous person rather than their classroom teacher. The real life experience of meeting an HIV positive person results in greatly improved attitudes towards vulnerability to infection.
Conclusion: Face-to-face meeting with positive people who share their experiences of living with HIV strongly influences young people’s attitudes to protective behavior. Articulate HIV-positive people who have good support are a powerful force in AIDS education.
Multidisciplinary Participation in HIV/AIDS Prevention:
a path-breaking experience of YRHRA
Zhang Kaining
Yunnan Reproductive Health Research Association(YRHRA)
Reproductive health(RH) has emerged as a new and broader concept. In response to the demand for a better understanding of it, the Multidisciplinary participation in research, training and action in RH, a non-profit organization(NPO),the Yunnan Reproductive Health Association(YRHRA) was established in Yunnan, China in 1994. YRHRA members come from more than 30 institutions including universities, Academy of Social Science, health and family planning institutes. They are mainly middle-age and young scholars from various research fields with a wide range of backgrounds. The overall goal of this organization is to promote research, training and action in RH, encourage integration of social and health science, to better understand the social, culture and economic factors influencing RH, with a broader programmatic focus that could bring needed attention to such issues as STDs/HIV/AIDS prevention.
YRHRA members meet once a month in Kunming to share information and experiences in research and action. They produce a newsletter, organize lectures, public speeches & dialogs, and press briefings, translate articles and books into Chinese, produce the Series of Translation in Social Science and Reproductive Health, and discuss and probe issues related to RH.
To incorporate training into research, YRHRA selected some rural communities as association research and training sites. In these sites, women-centered and community-based RH studies were undertaken by members from various fields including public health, clinic medicine, sociology, anthropology, economics, women’s study, demography, psychology and other disciplines. Research teams also organized training workshop or short courses whenever they felt necessary. Special efforts have been made to improve RH services in very poor and remote rural areas. In addition to the long term follow up studies in YRHRA research and training sites, a number of case studies have been undertaken in various settings. YRHRA’s current research and activities include traditional culture and RH of various ethnic groups, women’s reproductive tract infections(RTIs) including STDs, reducing drug abuse and prevention of HIV/AIDS, RH services financing, provision and utilization, RH services for migrating population, integration of RH with poverty alleviation, community development, empowerment of the disadvantaged women, male’s participation and responsibility in RH, school-based sexual health education and HIV/AIDS prevention of adolescents and better understand traditional culture and HIV/AIDS epidemic.
This paper describes the rationales and setting up of and the major activities of this NPO in capacity building, public awareness raising , as well as research and actions to promote HIV/AIDS prevention in very poor areas in rural China, Challenges in Multidisciplinary participation are analyzed based on YRHRA experiences.
Key Words Multidisciplinary participation, reproductive health, NPO, HIV/AIDS prevention
Liu Wei
Institute for Health Science, Kunming Medical College
Background: During visiting the grass-root health organization in rural Yunnan Province, MSF (Holland) observed that sterilization was seldom fully and correctly practiced in many township hospitals and village clinics, and injection was over used. But due to the critical situation of the HIV/AIDS epidemic in Yunnan, incorrect and inappropriate medical practice without knowledge on HIV/AIDS prevention might enlarge the possibility of HIV/AIDS epidemic. Hence, it is very significant to train village doctors with general knowledge in preventing HIV/AIDS and provide them with basic sterilization skills.
Objectives: To train village doctors with updated knowledge and information on HIV/AIDS epidemic, prevention and provide them with basic sterilization skills. Sites and Participants: Training workshops were carried out for over 200 village doctors from 10 township hospital and 100 village clinics in Xichou County and Xundian County, Yunnan Province.
Methodology: After selecting some experienced trainers with the background of HIV/AIDS and education and teaching, a training of trainers workshop was held to train them with the participatory methodology on training skills as well as how to use sterilizes and the basic knowledge on sterilization. Then the trained trainers went to the grass -root level to facilitate several one-day workshops for village doctors with participatory methodology. The steps are as follows:
1. Pre-test: including the knowledge and skills in HIV/AIDS and sterilization, epidemic information, behavior and attitude.
2. Brainstorm: the trainer facilitate the village doctors to write ideas on HIV/AIDS, discuss in groups and chose one representative to present in the workshop.
3.HIV/AIDS training includes transmission, prevention, universal awareness and epidemiology with slide shows .
4. HIV/AIDS risk behavior game: ask the participants to put the risk behavior in the proper position: high, medium, low and no risk, lively group discussions would ensure participants defend their reason.
5. Practice using condoms: trainers demonstrate and explain how to use condoms properly, let each participant practice using a condom on the penis model.
6. Sterilization demonstration and practice trainers heat up the sterilizes and demonstrate the whole technique first , then let participants practice using sterilizes correctly.
7. Post-test: participants are asked to finish the post-test whose contents are the same as pre-test to see whether they have made any progress in the training .
8. Evaluation is aimed to get the feedback from the participants to improve the training and the learning of the participants .
Outcome of the workshop: all the participants agree that the training is useful and interesting, especially for the participatory methodology. They hope more training of this kind can be given in the future, for they believe the training can prevent them from improper medical practice and do better for the local people. It shows from the post-test that more than 95% participants have the correct answer on transmission , prevention and basic knowledge and skills in sterilization , but from the pre-test before training only 50% had the correct answer (p<0.01),However ,10% participants still did not have the correct answer for HIV/AIDS epidemic trend, which is probably related to the fact that two thirds of the village doctors got lower education than junior middle school. The suggestion is to add more time for training, more chances for participants to hold discussions and practice the learnt skills.
Yunnan/Australian Red Cross Youth Peer Education for
HIV/AIDS Prevention Project
Yunnan Red Cross with Australian Red Cross
The Yunnan/Australian Red Cross Youth Peer Education for HIV/AIDS prevention project is modeled on the peer education program developed by the Asian Red Cross and Red Crescent AIDS Task Force(ART). The Red Cross Society of China(RCSC), an ART member, is implementing the model in Xinjiang and Guangxi Provinces(during 1997) and plans to expand to Fujian, Guangdong, and Hainan Provinces in 1998. The Yunnan Project began in 1996, implemented by Yunnan Red Cross and Australian Red Cross. Core trainers, usually project staff, provides a five day training for Youth Facilitators(aged 15-30 years). The training includes HIV/AIDS technical knowledge and basic facilitation skills. After the training, the project provides regular in-service training and meetings for Youth Facilitators in order to increase facilitators' confidence and skills. After attending the five day training, Youth Facilitators work in teams of two to present two day workshops for other young people in HIV/AIDS and the life skills needed to make healthy life decisions. All workshops use participatory methodology and use a life skills framework to cover the following areas: HIV/AIDS prevention, adolescent health, STD, drug use, reproduction, et al.
The project is currently examining strategies to monitor and evaluate the extent to which HIV prevention knowledge is being disseminated into the community by the young people who attend the two-day workshop.
In addition to training and peer education activities, the project continues to increase the public profile of both the project and of HIV/AIDS prevention and to develop appropriate IEC materials to support the Youth-facilitated workshops. Also, the project works to build the capacity of Red Cross to implement and manage the project at county, township, and village levels. Finally, the project provides technical advice to the Red Cross Society of China’s national peer education program.
Outputs to date: 11 youth facilitators trained in Kunming City, 10 workshops held for 141 young people in Kunming city and Geiju, training manual protested and produced, IEC materials produced, workshop held for Kunming prefecture Red Cross staff.
Lessons Learned: 1 project success requires the active involvement of the local community in planning and implementation, as well as collaboration with government and non-government organizations. 2 planning processes, such as developing and protesting the training manual and IEC materials, can serve as valuable opportunities for young people to both practice facilitation skills and to gain HIV prevention knowledge.
Future Activities: implement project in five additional prefectures in Yunnan province, update the training manual, create Chinese and local language body chart and other teaching aids, evaluate project efficacy, output and impact, continue current activities such as support and in-service training for youth facilitators, technical advice for Red Cross Society of China, and capacity building for Yunnan Red Cross.
DKT/China and Social Marketing Approach
Jimmy Cai
DKT International Shanghai Office
1. DKT/China
DKT/China is one of the nine of offices of DKT International, a U.S. based, privately funded, non-profit and non-government health organization. DKT International has supervised and operated AIDS-prevention social marketing programs in Brazil, Cameroon, Ethiopia, Haiti, India, Indonesia, Malaysia, Nigeria, Philippines, Vietnam, and now, DKT is proud to be in China.
Ever since came to China in 1995, DKT/China has started China’s first social marketing program on condom promotion for STD/AIDS prevention. DKT/China promotes and distributes high quality and subsidized brand condoms with specific message of condom use for disease prevention. DKT/China has been conveying the prevention message through mass media, such as radio, TV, publications and through education/training programs.
DKT/China’s program is targeting low income groups and undeserved groups, such as floating population, teenagers, unmarried couples and prostitutes. And DKT/China is focusing on those untargeted and non-conventional areas, such as kiosks, convenient stores, grocery shops, supermarkets, hotels, motels and night clubs.
DKT/China is successfully working with many government and non-government organizations in the field of AIDS prevention. DKT/China is looking forward to having more productive collaboration.
2. Social Marketing Program
(1).Definition: Social marketing is using the proven tools of commercial marketing for high-efficiency, low cost delivery of vital social needs. This basic tool, proven in action over 25 years in developing countries around the world, applies highly-effective private sector business principles to humanitarian causes.
(2).Main difference with commercial marketing: social marketing calls for a social campaign to change public attitudes and behavior while commercial marketing’s objective is for a profit. Socially marketed products may be controversial and their purchase may involve a break with traditional values or behavior. Social marketing’s objective is the advancement of public health. Its only goal is improved public health. It is primarily a prevention and control strategy. Social marketing is complimentary to public and private health care delivery systems and, its objective is market expansion. While, commercial marketing is usually concerned with the battle for share-of-market.
(3). Future Outlook: DKT believes deeply that social marketing for condom promotion and distribution is the most effective and efficient way to bridge the gap between government programs and private sectors, and to complementary to both. DKT has great confidence in condom social marketing programs in China given the facts that China has a highly organized social structure and highly motivated commercial activities, which will ensure the programs sustainable and successful.