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