China

© 2007 Alliance

An estimated 700,000 people are living with HIV in China. This is a small percentage of the total population (less than 0.05%), but still large in absolute terms.

The epidemic in China is concentrated in the southern and western provinces, and among key populations at higher risk, particularly injecting drug users, sex workers and former blood plasma donors. Without significant new efforts, UNAIDS and the Ministry of Health estimate that the number of cumulative HIV infections could rise to 10 million by 2010, with 260,000 children orphaned.

Injecting drug use and sexual contact are the principal modes of transmission, accounting for 44.3% and 43.6% of estimated HIV cases respectively. 7% of new HIV cases are estimated to result from unprotected sex between men (the prevalence rate among men who have sex with men is estimated to be 1.5%). China’s estimated 130 million migrants are also vulnerable to HIV, due to their limited access to community support, health services, condom supplies and information about HIV.

HIV has been detected in all of China’s 31 provinces, however it is growing at a varying pace across the country and is more heavily distributed in the poorer and more remote areas, particularly the southern and western provinces. For example, the average national HIV prevalence among injecting drug users is 8.3%, but almost 90% of infections acquired through injecting drug use are concentrated in the seven provinces of Yunnan, Xinjiang, Guangxi, Guangdong, Guizhou, Sichuan, and Hunan. HIV prevalence among China’s 3–4 million sex workers follows a similar geographical pattern.

The epidemic is beginning to spread from groups at higher risk to the general population and the trend is likely to continue unless there are significant HIV prevention and care efforts. Surveillance in Yunnan, Xinjiang and Henan has indicated rates of over 1% among pregnant women and people receiving premarital and clinical HIV testing – meeting the UNAIDS criteria for a ‘generalised epidemic’. It is predicted that in the next five years, the epidemic will grow in two main regions: in the southern and southwest provinces, and in the western province of Xinjiang, driven by injecting drug use and commercial sex.

The Government of China has implemented an ambitious plan for reducing and preventing the spread of HIV. The Four Frees and One Care plan commits the government to providing:

  • Free antiretroviral drugs (to rural residents and low-income urban residents with HIV)
  • Free voluntary counselling and testing
  • Free treatment for pregnant women and HIV testing of newborns
  • Free schooling for children orphaned by AIDS
  • Care and economic assistance to households affected by HIV

What we do

In 2001, the Alliance assessed China’s HIV situation with a view to identifying potential partners to support community involvement in HIV programming. After initially working with men who have sex with men in Beijing, the southwest was identified as a priority area and an Alliance office was established in Kunming in 2003. This was followed by a period of participatory community assessments to identify potential partners, followed by our first projects in 2004.

The Alliance now works in several sites in Sichuan, Yunnan and Guangxi to help communities affected by HIV (including people living with HIV, men who have sex with men, commercial sex workers and injecting drug users) to respond to the epidemic. Such support for community level action is relatively new in China but is consistent with the views of China’s Ministries of Health that this is an important opportunity to reduce the scale and impact of the epidemic.

We work to increase the organisational and technical capacity of a range of community-based organisations and their local government health institutes. Project activities include community outreach, running drop-in/service centres, peer education, developing and disseminating education materials, promoting condom use, making referrals to sexually transmitted infection testing services, antiretroviral treatment education and anti-stigma activities.

In Yunnan and Guangxi, the Alliance is one of a group of international non-governmental organisations implementing a USAID-funded programme to provide a package of key services to most-at-risk populations in significant geographical hotspots. The Alliance’s role in the programme is to support community-level capacity development and to establish models of good practice of community engagement.

In Sichuan, the Alliance supports the involvement of men who have sex with men, injecting drug users, female sex workers, and people living with HIV in programmes designed to reduce rates of HIV transmission. Supported by funding from the Levi Strauss Foundation we are developing a comprehensive HIV programme for injecting drug users, including needle and syringe provision, with a focus on putting clients at the centre of the response.

In 2007, we began our second project supported by Johnson & Johnson to build effective support services for HIV-positive women in Ruili, in the south of Yunnan province.

We are also working with grassroots networks of people living with HIV to support organisational development and networking skills, funded by the Ford Foundation.

Key achievements in 2007

  • Increasing work with people living with HIV in Guangxi province, with expansion to a new site. Continued capacity building with established organisations of people living with HIV.
  • Strengthening community based organisations and government health institutes in a range of sites, working with people living with HIV, men who have sex with men, injecting drug users and female sex workers. Finalising a toolkit to support community based organisations to work on HIV.
  • Completing a project addressing stigma and discrimination against people living with HIV with the distribution of a Chinese publication outlining personal stories and lessons learned.
  • Provision of HIV programmatic and organisational support to 44 organisations.

Goals for 2008

  • Establishing a pilot project to strengthen psychosocial support services for methadone treatment clinics.
  • Expanding HIV prevention services with men who have sex with men in Yunnan.
  • Sharing working models of successful community participation and constructive partnerships between government partners and community teams.
  • Expanding activities into further hotspots in Guangxi province.