Fighting HIV/AIDS in the Village
Behind her engaging smile, Li Lun represents a potent new weapon in the People's Republic of China's (PRC) battle against HIV/AIDS.
Going from hill to hill, door to door, in Linxiang District, Lincang prefecture of the mountainous Yunnan province, Li Lun is on a mission to mobilize people to take control of the risk of HIV/AIDS in their lives, in the lives of family members, and the community as a whole.
Sometimes walking three hours to reach a village deep in the mountains, Li Lun says she is just “trying to make her life more meaningful.”
She is not alone. Li Lun, a former rural doctor who managed her own small clinic, is a member of the grassroots AIDS/HIV awareness and prevention program Total Control of the Epidemic (TCE), a scheme developed by international non-governmental organization (NGO) Humana People to People (HPP).
Traditionally, inhibitions in Chinese culture regarding discussing sexual topics have limited how parents discuss the topic with their children and how comfortable adults feel about seeking information. Before beginning their intensive grassroots work, TCE field officers receive a one-month training course and in-field practice, equipping them with skills to talk about safe sex and HIV/AIDS with people in their areas. This training is crucial to the success of the project.
The TCE model (developed by HPP in Africa) has been adapted to the PRC context and piloted in Yunnan in cooperation with Asian Development Bank (ADB) through a sub-project on Sustainable Networks for Local HIV/AIDS Prevention under an ADB regional technical assistance for Fighting HIV/AIDS in Asia and the Pacific. The source of the assistance is funded by the Government of Sweden. The implementing agency is a joint project office managed by the Foreign Capital Project Management Center of the Yunnan Poverty Alleviation and Development Office and HPP. Other partners include the China Preventive Medicine Association (CPMA), provincial- and local-level poverty agencies and bureaus of health, family planning associations, and women’s federations.
Since end-March 2007, Li Lun has visited more than 1,000 homes, talking to around 5,000 people, making a difference in the community where she grew up.
Lincang prefecture is located in south-east Yunnan, a critical border area between the PRC and Myanmar for an epidemic that knows no boundaries, and consists of eight counties with 17 minority groups. Lincang is a major entry point for smuggling of drugs (a major risk factor in the HIV/AIDS epidemic) into the PRC. By the end of 2006, there were 3,637 registered people living with HIV/AIDS among Lincang’s total population of 2.2 million. Last year, 48% of new infections were transmitted sexually and 33% through blood, mainly needle sharing.
The Government has increasingly recognized the need for decisive action to avert a spiraling epidemic. However, gaps in fiscal and human resources—especially at lower levels like counties and villages, and in poorer areas—pose key constraints. New initiatives and cooperation models are needed to turn back the spread of HIV/AIDS.
“Particularly since late 2003, the PRC Government has taken concerted action to address HIV/AIDS, with support from the highest levels of leadership,” says Chris Spohr, a Social Sector Economist at ADB’s Resident Mission to the PRC. “At the same time, the front line in this battle is communities and individuals, who are often hard to reach via the state’s own resources.”
While there are limitations to purely grassroots approaches, including challenges for sustainability and scaling up such projects, Mr. Spohr says this project takes new approaches to tap civil society as a partner within government-led efforts.
The TCE model is premised on the idea that “only people can liberate themselves from the epidemic.” The Lincang pilot adopts an interactive approach, delivering services to the general population by engaging local field officers to mobilize, educate, and train local communities.
“Their approach is widely welcomed by the public, especially the high-risk groups such as sex workers, intravenous drug users and migrant workers,” said Zhou Zhuangsheng, Director of Lincang Poverty Alleviation and Development Office. “These people are able to tell their personal concerns to the field officers without feeling embarrassed.”
Dr. Cai Jiming, Vice President and Secretary General of CPMA (a Beijing-based NGO working with ADB here in Yunnan and a sister pilot in Xinjiang), agreed, saying: “Chinese NGOs are an indispensable component in the HIV/AIDS prevention and control on the mainland, and have effectively dealt with many sensitive health education areas that government authorities have felt reluctant to handle directly.”
Such pilots are not alone. According to a China Daily report, the PRC’s launch last December a first round of public service announcements to promote the use of condoms and safe sex to fight HIV/AIDS marked a key new approach, with three video clips by using well-known Chinese celebrities hitting screens in airports, buses and trains, and on the Internet.
The latest figures from the Ministry of Health show that unsafe sex is the main mode of transmission for HIV. The PRC now has 700,000 people living with HIV/AIDS, up from about 650,000 in 2005. More than half the estimated 50,000 new HIV infections last year were reportedly infected through unsafe sex. A majority of the cases involved those aged 20 to 39 years old.
Initiatives such as the ADB-supported pilot in Lincang aim to help stem that tide, by assisting the PRC to explore new ways to mobilize civil society in the battle against HIV/AIDS.
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