Post on 18-Jan-2016
Transport Against HIV/AIDS in China
Christopher R. BennettEASTE
28 November 2007
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Growth in HIV/AIDS in China
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China: HIV/AIDS Statistics
• Population: 1.3 billion
• Extent (2007): Adult (15-49) prevalence rate 0.05% 700,000 living with HIV/AIDS 50,000 new HIV/AIDS cases 20,000 AIDS related deaths
• Primarily in Yunnan, Henan, Guangxi, Xinjiang and Guangdong provinces
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Change in Sources
• 2005 Intravenous drug use: 62% Plasma donation: 9%Sexual transmission: 8%Unknown: 19%
• 2007Sexual transmission: 41% Intravenous drug use: 29%
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China: Need for Education
• 2003 national survey found17% of never heard of HIV/AIDS77% did not know condoms can prevent
transmission
• In 2000 estimated 4 – 6 million commercial sex workers<30% knew condoms protect<30% perceived themselves at risk
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• People at high risk (and their families) includeConstruction workers away from homeEmployees in long-distance transport People living along transport routesCommercial sex workers
42% of truck drivers report indulging in commercial sex while traveling; 33% of those who have casual sex don’t use condomsSurvey results, Poland and Lithuania border areas (World Bank, 2003)
Who is at Risk With Transport?
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Migrant Workers: China Overview
• Some 120 million
• Spend 48+ weeks away from families
• Working in hard conditions
• Construction workers stay in same sex dormitories/camp sites
• Little access to HIV/AIDS prevention information and services
• Easy targets for drug sellers
• Have ample opportunities to interact with commercial sex workers
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Migrant Workers: HIV/AIDS
• New HIV/AIDS cases disproportionately amongst migrant workers
• In some cities migrant workers are largest group of HIV cases:61% in Beijing61% in Xi’an66% in Shanghai
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Addressing HIV/AIDS in Transport
• Some TTLs included HIV/AIDS as part of environmental management
• Position strengthened with new Bank SBDs:HIV/AIDS education as part of ‘Health and
Safety’ clauses
• TTLs now have responsibility to ensure HIV/AIDS education programs are undertaken
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EAP - Modified SBD Clauses
• Bank’s HIV clauses adapted in EAP:Cater for (1) financed as provisional sum
and (2) grant projectsMade clarifications and simplified
• Translated, distributed to contractors and monitored in supervision missions
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Approach in China
• Clients do not see the need for HIV/AIDS education “road construction is my business not promoting
condoms”
• Unwilling to put major effort into activities
• Solution : obtain grant funding as ‘seed’ money Hire a provider to deliver training Ensures consistent standard of training throughout
project Minimizes efforts for highway agency (and TTLs)
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Work to Date
• 2005 – Shiman Highway ProjectFunded by $50,000 Global HIV/AIDS
Grant
• 2006 – Jiangxi III Highway and Inland Waterways V ProjectsFunded by $160,000 IDF Grant
• 2007 – Liaoning Urban Transport ProjectFunded by $20,000 UBW HIV/AIDS
Grant
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Shiman Highway Project
• Typical of expressway projects in China
• 107 Km Shiyan-Manchuanguan Expressway (SME) in Hubei, China
• About 11,000 Construction workers 99% males with junior high school education (at best) Under age of 40 Away from family 300+ days/year
• Over 140 “recreational places” along SME
• 500,000 residents in 21 counties and townships
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Worker HIV/AIDS Knowledge
At start of project:
• 16% of were aware of HIV/AIDS transmission methods
• 40% thought transmitted by mosquito bites
• 71% knew how to use condoms
• 35% never and 26% rarely used condoms
• 33% knew where to go for HIV/AIDS counseling and blood testing services
• 44% had stigmatized attitude towards HIV/AIDS carriers
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Three Phases
• Develop Program Co-ordinate with other agencies Develop materials
• Deliver Program Develop effective intervention plan Train Educators Set up VCTs for consultation and testing Conduct field visits
• Evaluate Results Semi-Annual monitoring Establish an HIV/AIDS strategy/operational
manual for replication in similar projects
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HIV/AIDS Intervention Activities
• Knowledge Transfer AIDS-related posters, booklet and playing cards,
educational board, movies, etc. Text messages to all cell phone users Face to face education to construction workers
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HIV/AIDS Intervention Activities
• Behavior Change Set up condom distribution sites & training on
proper usage Activities & trainings at local recreational centers 100% condom use pilot program Local VCTs & onsite - consultation and testing
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• Covered 100% of the project area
• Trained 9,034 construction workers and
administrative personnel11,897 village people in 132 villages
• Set up 7 VCT sites along the expressway
• Set up 83 condom sites and educational material sites
Coverage (end June 2007)
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• Distributed 49,031 copies of handouts17,286 brochures2,624 posters 1,682 AIDS playing cards235 banners and slogan173 copies of VCDs31,452 condoms80,000 text messages to all cell phone users
Coverage (continued)
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Testing Results
HIV/AIDS Tested 6,211
Positive 1
STDs Tested 7,101
Positive 1,692
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Program Outcomes (Census Data)
Year: 2004 2005 2006STD cases: 2344 1901 1172Decrease(%): 19% 38%
STD cases in Broader Project Affected Areas
23441901
1172
0
1000
2000
3000
2004 2005 2006 Year
No.
of S
TD c
ases
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Program Outcomes (continued)
HIV/AIDS Positive*:
• 2004: 3 (1 from other region)
2005: 7 (2 from other regions)
2006: 12 (4 from other regions)
*(These cases were all past infections,
referring to cases infected before 2004)
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Program Outcomes (continued)
• Increased general awareness among the workers and local residents – 71.4% in 2005 52.2% in 2005
• Condom sales up 10.4% in 2006 over 2005
• No significant change in stigmatized attitude
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Lessons Learned to Date
• Must include local health department
• Project must complement existing activities
• Target both workers and residents
• Means of intervention do matter – innovations (eg cards, text messaging)
• Window of opportunity is brief, get the timing and location right
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Lessons Learned (continued)
• Focus on behavior change
• Train ‘peer educators’ among highly mobile workers
• Get government and contractor’s buy-in early
• Set practical monitoring indicators – stigmatized attitude will not change overnight
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2006 – HIV/AIDS Seminar
• Held in Wuhan
• Involved 60 domestic and international experts
• Discussed ways to raise HIV/AIDS awareness amongst transport workers
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What Next?
• EAP Transport has adopted a regional HIV/AIDS strategyVision: every project have an effective
HIV/AIDS campaignDevelop standard approach and
education materialsAdapt to each country
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The End