China is experiencing one of the most rapidly increasing HIV/AIDS rates in the world, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). In 2009, China’s Ministry of Health admitted for the first time that China’s number one infectious disease killer is now AIDS. According...

Trailblazing HIV/AIDS prevention work

China is experiencing one of the most rapidly increasing HIV/AIDS rates in the world, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS). In 2009, China’s Ministry of Health admitted for the first time that China’s number one infectious disease killer is now AIDS. According to the United Nations (UN), by the end of 2009, China had over 740,000 HIV-positive residents, more than any other Asian country except India.

The Southwest China HIV/AIDS Strategic Initiative was designed to slow the spread of the AIDS epidemic in Yunnan by reducing vulnerability to HIV/AIDS among high-risk groups and communities. The SI strategically targeted border areas with heavy cross-border migration and large-scale infrastructure project locations (such as highways, railways, airports and dams) that attract thousands of migrant labourers from rural Yunnan villages and neighbouring provinces.


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Strategic Initiative

SECTOR

Health

TOTAL INVESTMENT

US$ 1,176,591

LOCATION

China

LIVES CHANGED

64,763

SOCIAL IMPACT INDEX

56.0 (out of 100)

AVERAGE COST PER LIFE

US$ 18.17

Expand All

SI Breakdown:

Key Achievements

  • Additional beneficiaries – This Initiative succeeded in directly benefitting 64,763 people – nearly double the expected 36,906 – and indirectly benefiting an additional 59,000 people.
  • Sustainable impact – A significant “train the trainer” component will result in sustainable impact, as more than 600 local health care workers continue with effective HIV prevention work.
  • Successful work of pioneering organisations – The Initiative made possible the work of six trailblazing organisations, often the only organisations working with certain population segments, such as AIDS orphans, commercial sex workers and IV drug users.
  • Health workers trained – The programmes made possible through this grant also trained over 600 health workers, including China Centre for Disease Control staff, rural doctors and community health educators, who are now equipped to spread the HIV prevention message to tens of thousands of Yunnan’s rural residents who otherwise would not have been made aware of the risks of HIV.

The Problem

China is experiencing one of the most rapidly increasing HIV/AIDS rates in the world, according to UNAIDS. In 2009, China’s Ministry of Health admitted for the first time that China’s number one infectious disease killer is now AIDS. According to the UN, by the end of 2009, China had over 740,000 HIV-positive residents, more than any other Asian country except India. Widespread intravenous (IV) drug use, increasing numbers of commercial sex workers, a boom in migrant workers, and a loosening of China’s traditional sexual mores have combined to make Yunnan the centre of the AIDS epidemic in China. In 1989, some of the nation’s very first cases of HIV infection were reported in Yunnan, which borders Myanmar, Laos, and Vietnam. Within the span of just a few years, the outbreak spread into a full-scale epidemic. Yunnan, which makes up less than four percent of China’s population, now accounts for nearly one-third of the country’s AIDS cases.

Solution

The Southwest China HIV/AIDS Strategic Initiative was designed to slow the spread of the AIDS epidemic in Yunnan by reducing vulnerability to HIV/AIDS among high-risk groups and communities. The SI strategically targeted border areas with heavy cross-border migration and large-scale infrastructure project locations (such as highways, railways, airports and dams) that attract thousands of migrant labourers from rural Yunnan villages and from neighbouring provinces as well. Often, local organisations funded through this Initiative have been the first to pioneer HIV prevention and care services in the areas where they work. The Initiative, which was expected to directly benefit nearly 37,000 people, took a multi-pronged approach to HIV/AIDS: funding prevention education for the general public, and prevention and harm reduction for high-risk groups; training key medical personnel and health care providers; caring for infected persons and for AIDS orphans; providing counselling and employment opportunities for women wanting to leave the sex trade; and reducing stigmatisation. Counties at high risk for the spread of HIV/AIDS were specifically targeted. This Initiative was made possible through a US $1,176,591 grant, US $1,124,540 of which was an investment by the Legatum Foundation.

Critical Analysis

Due to China’s lightning-fast economic and social changes, the massive rural-to-urban migration of 200 million-plus people, the sharp rise in drug use and drug trafficking, and an increased number of commercial sex workers (CSWs), the AIDS epidemic is dangerously poised for rapid growth in China. Yunnan is the epicentre of the AIDS epidemic in China. The timely Southwest China HIV/AIDS Prevention Initiative has had a real and lasting impact on HIV/AIDS in Yunnan. Grants made to six locally based organisations benefitted more than 65,000 people directly and an additional 59,000 people indirectly.

The story of this Initiative is not only ‘how many,’ but also the ‘who’ and the ‘where.’ In a country where civil society is still developing and where very few non-governmental organisations focus on the needs of society’s “outcasts,” the organisations funded through this programme served the most at-risk and often highly marginalised populations. Migrant workers, a group more susceptible to both IV drug use and visiting CSWs than the general public, were also a major focus of the programme.

The outcomes already mentioned were expected, but there were significant unexpected outcomes as well. Several partners have been asked by various government agencies to work more closely together, including Fu Hua who have been asked to expand their programme in schools and villages, and Ruili Centre, who were aided by the local government in gaining access to construction sites in Ruili city. Furthermore, there were over 5,000 people who participated in voluntary counselling and HIV testing – a much higher number than expected thanks to close cooperation between organisations funded by this Initiative and local government health departments. Finally, the international NGO, Health Unlimited, worked along both sides of the Myanmar-Yunnan border, managing to bring together officials from both governments to discuss how to better cope with HIV/AIDS in the border areas.

The NGOs in the Southwest China HIV/AIDS Prevention Initiative are pioneers, reaching communities in locations where, in most cases, they are the only organisations delivering the kinds of services they offer. At the same time, their work is helping to shape provincial, and in some cases, national policies on HIV/AIDS, while nurturing the idea of a civil society and volunteerism.

Lessons Learned

Successes:

Chinese NGOs can be both innovative and business savvy – Over the course of the three-year Initiative, we saw that although the Chinese-led NGOs were relatively young, they were professionally run and adaptive. Reports were thorough and on time, and senior staff were familiar with sector best practices. Innovations included using text messaging to provide follow-up HIV and health information to hard-to-reach migrant workers and providing rural villagers with cameras so that they could capture everyday life, and then use those photos to discuss behaviours that affect health, including HIV risk.

Foreign-led NGOs still play an important role in China’s nascent civil society – Two of the three foreign-led NGOs in this programme were modelling new approaches that we hope local NGOs will eventually emulate (one working in red light districts, the other offering alternatives to institutional care for HIV orphans). In a country with an immature non-governmental sector, these replicable models can help shape the development of the sector.

Support and cooperation of local government is critical – In 2008, many of the partners mentioned that the limited cooperation with government agencies and representatives was a challenge. By the end of 2010, most reflected that developing good working relations with government departments over time was critical to their achievements. Fu Hua, one of the partners, commented: “The most fundamental success we had was a good working relationship with the county health bureau. Because of this success, the rest of the work became not only possible, but also smooth.”

Challenges:

Stigma attached to HIV and high-risk groups – Working with IV drug users, CSWs, and migrant workers has its challenges: high turnover among peer educators, recidivism for both IV drug users and CSWs, lack of time for prevention education activities (construction workers), and constantly mobile populations. As HIV/AIDS has been largely ignored in China until recent years, there is still considerable stigma associated with the disease, which is itself a challenge to overcome. Similarly, as many beneficiaries stated when interviewed, stigma and prejudice attached to all high-risk groups means there is very little public support for the work of these pioneering organisations.

Political instability in border regions – Many of the project’s locations were along the Yunnan-Myanmar border. As Health Unlimited reports, “Political instability remains a critical constraint to carrying out activities in the project area, specifically relating to travel to local ceasefire group and central government jointly controlled areas.”

Identifying and retaining staff – Many of these projects are in remote parts of Yunnan. Pay is lower than in other parts of China, and living conditions can be much more basic. These factors can make finding and retaining qualified staff more challenging.

South West China HIV: Featured Projects

SII ScoreProject NameGrantLives ChangedCost Per LifeSector
64.60 Health Unlimited$295,34026,809$11.02
64.60 Eden$74,0001,175$62.98
64.60 Mother’s Heart$93,02442$2,214.86
53.20 Fu Hua (Bless China; Project Grace)$215,95022,723$9.50
49.40 Ruili Center for Women and Children$135,0248,569$15.76
39.60 Yunnan Health Research and Development$359,3735,445$66.00
Note: The Social Impact Index Score reflects the relative social impact of a given development project. The lowest possible score is 20; the highest possible score is 100.

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