Battling stigma key to anti-HIV campaign

By Sultan Ahmed (China Daily)/ Updated: 2008-12-01 07:37

China has remarkably scaled up its HIV prevention and mitigation work
over the last few years. With increasing funding support from its
government and external donors, it has expanded HIV prevention,
treatment and care activities across the country.

The establishment and easy access of HIV testing services have
encouraged many Chinese who have already been infected to reveal
their HIV status; and they can start early medication.

In fact, since 2004, the HIV prevalence rate in China has
unexpectedly increased due to increasing access to HIV testing
services and an improved surveillance system. By the end of October
last year, the cumulative number of people reported to be living with
HIV in the country was 223,501, including 62,838 AIDS cases.

Along with the easy access to HIV testing services, the government is
providing free Anti-retroviral Therapy, which has prolonged the lives
of many Chinese people who have already been infected. Hospitals that
provide treatment and care services are now better prepared than five
years back to manage HIV and AIDS cases because of their mounting
experiences.

Overall, the country has managed to extend its treatment and care
services to a large number of people who terrifically need of these
services. The HIV prevalence rate among adult population (aged 15-49)
in China is still considered to be low (0.1 per cent) compared to the
prevalence rates of other nearby countries.

But a simple truth about HIV is that today's low prevalence does not
guarantee tomorrow's low prevalence. This can be particularly true
for China, where there is a great deal of culture of silence about
HIV; and HIV infection among the people most at risk is increasing.

One possible threat for China is that the people most at risk (mainly
sex workers, clients of sex workers, men having sex with men,
injecting drug users) can be a bridging factor for spreading the HIV
virus to the general people. Many countries in Africa and some
countries in Asia had gone through this experience. So the concept
of "low prevalence" can be tremendously misguiding and misleading for
some people.

One important point is that we must learn from our mistake. In many
counties in Africa; the fight against HIV and AIDS has failed due to
lack of political support and commitment. For many years, the leaders
in African countries failed to understand the importance of political
commitment in the fight against HIV, and the cost of failing to
understand this truth was enormous.

This probably may not be an issue for China as the country's central
leadership has already shown its strong commitment and support in the
fight against HIV and AIDS. The government has taken many pro-people
policies and steps to prevent and mitigate the impact of HIV and
AIDS. A significant change in government outlook on the disease came
in 2003 when Premier Wen Jiabao became China's first senior leader to
openly shake hands with a HIV-infected person.

Despite good policy and strong commitment from the government, one
key challenge in HIV work in China is to reduce misconception and
stigma surrounding HIV and AIDS. Till today, stigma is the key
barrier to HIV prevention, care and support work in China. Because of
the stigma, many HIV-infected people still do not seek treatment and
do not want to know their HIV status.

A survey conducted in March by the Renmin University of China shows
alarming results about knowledge, attitudes, behaviors and practices
regarding HIV and AIDS in six cities in China. The result shows 83.4
percent of interviewees had never searched for information on HIV and
AIDS on their own initiative.

About 31 percent of the interviewees thought people with HIV and AIDS
deserved their disease because of their sexual intercourses or drug
abuse. And nearly 48 percent would be unwilling to eat with an HIV-
infected person and about 41 percent would be unwilling to work with
a person infected with HIV.

The study clearly shows that the average level of knowledge on HIV
transmission is relatively low and there are serious misperceptions
and stigma surrounding HIV among the people in China. The study is
probably a warning for all AIDS services organizations in China.

It plainly shows that there is a weakness in the existing HIV
prevention strategies, and it needs to be changed without any delay.

One important question in relation to this weakness is how the
messages on HIV and AIDS including anti-stigma and discrimination are
being delivered.

HIV is an issue closely linked with human sexual behavior and
practice. Since each human being has a unique way to express sexual
desire, the approach that targets individuals, and not the masses, is
more effective to bringing change in individual sexual behaviors.

But for the Chinese people, the electronic and print media are the
main sources of information on HIV and AIDS. There is no doubt that
the media plays an important role in HIV work, particularly to create
the enabling environment for HIV work and to reduce stigma and
discrimination surrounding HIV. But to reduce individual risk
associated with HIV needs humane and motivated behavior change
communication (BCC) approach.

The Red Cross Society of China (RCSC) is a good example for BCC
intervention. Since 1994, the RCSC has been implementing BCC program
with the help of its huge number of volunteers. The RCSC has about
1.1 million volunteers across the country. A large number of these
volunteers have already been trained on HIV and AIDS, and are
involved in community based HIV prevention work.

From the RCSC experiences, the sincerity, commitment and dedication
of volunteers are the important factors for good HIV work in China.
Since young people are mostly affected by HIV, the involvement of
young people in the fight against HIV is an important strategy.

The attitude of service, voluntary spirit and personal commitment of
the young volunteers can be a true driving force in the fight against
HIV and AIDS in China.

The author is the China HIV delegate of International Federation of
Red Cross and Red Crescent Societies

(China Daily 12/01/2008 page4)
http://chinadaily.cn/cndy/2008-12/01/content_7254678.htm