INVITATION  AIDS ASIA e FORUM.

Hi,

If you are already a member of this FOURM please forward this message to your
colleagues who may find this FORUM useful.

[AIDS ASIA eFORUM] is an e- forum committed to the development of an Asian
perspective on AIDS prevention and care issues. HIV/AIDS does not recognize
national boundaries. As Asia- pacific countries are increasingly interconnected
through migration and trade, it is imperative to generate a regional perspective
on HIV/AIDS related issues.

A forum for critical analysis of issues, events and programs, which has
implications on, our ability to address HIV/AIDS prevention and care issues
across the region. More than 7,500 subscribers are using this FORUM.

Strategic HIV information and communication support to promote the capacity of
Asian leaders, activists and people living with HIV/AIDS, to facilitate their
engagement and networking, to highlight their experiences and the solutions they
are offering to address HIV/AIDS issues in this region.

A cross cultural discourse on issues and concerns of Asia- Pacific countries
(regions): Afghanistan, Australia, Bangladesh, Bhutan, Brunei, Cambodia, China,
East Timor, Fiji, India, Indonesia, Japan, Kiribati, Laos, Malaysia, Marshall
Islands, Micronesia, Mongolia, Myanmar, Nepal, New Zealand, North Korea,
Pakistan, Palau, Papua New Guinea, Philippines, Samoa, Singapore, Solomon
Islands, South Korea, Sri Lanka, Taiwan, Thailand, Tonga, Tuvalu, Vanuatu and
Viet Nam will be presented and promoted on this forum.

Please review the archived messages on the following url

http://health.groups.yahoo.com/group/AIDS_ASIA/

Dr. Joe Thomas
Editor
AIDS ASIA e FORUM
http://health.groups.yahoo.com/group/AIDS_ASIA/

AHRN has been invited to join the upcoming civil society consultation meeting
with Dr. Peter Piot, UNAIDS Executive Director, scheduled for 6 March 2007 in
Bangkok, Thailand.

Thai civil society organizations (CSOs) and selected Regional Networks have been
invited to this meeting organized by UNAIDS Regional Support Team and Thailand
UNAIDS Office. In total, approximately 20 Thai NGO representatives and partner
networks will attend this meeting.

Given this opportunity to provide feedback to UNAIDS, we now invite you to take
a few minutes to complete the survey below. The input you provide will be
compiled by AHRN and presented to Dr. Piot during the meeting. Please send your
responses to pascal@... before Thursday ,1 March 2007.

We look forward to reading your feedback.

AHRN Clearinghouse
e-mail:  <info@...>
_________________________
General


In which country are you located?
Are you currently aware of the mandates and responsibilities of UNAIDS Thailand?
Are you currently aware of the mandates and responsibilities of UNAIDS Regional
Support Team?
Have you participated in any of the meetings and consultations relating to
Universal Access?

Thailand

In your opinion, what should be UNAIDS Thailand’s priority for improving
coordination and communication of national activities?

How do you feel about the progress made on Thailand’s Universal Access plan
until 2010? Think about timeframes, resources, monitoring, stakeholders’
involvement, targets, challenges, opportunities?

What are the key challenges for Thailand’s response to HIV and AIDS?
What role is there for UNAIDS and civil society in addressing those priorities?

Has civil society involvement in the response to HIV and AIDS been satisfactory
according to you? How can civil society further contribute to the response? What
role should civil society be playing in the Thai response to HIV and AIDS?

Regional

In your opinion, what should be UNAIDS Regional Support Team’s priority for
improving coordination and communication of regional activities?

How do you feel about the progress made on Universal Access plan until 2010 for
the Asian region? Think about timeframes, resources, monitoring, stakeholders’
involvement, targets, challenges, opportunities?

What are the key challenges for Asia’s response to HIV and AIDS? What role is
there for UNAIDS and civil society in addressing those priorities?

8th International Congress on AIDS in Asia & the Pacific

ABSTRACT DEADLINE - NOW EXTENDED TO 10th MARCH, 2007

The Local Organizing Committee (LOC) of the 8th ICAAP has decided to
extend the deadline to 10th March, 2007 for the submission of abstracts and
proposals in order to allow greater participation from the region.

We welcome both scientific and experience based abstracts as well as
proposals for Skills Building Workshops and Cultural Performances. For
more information on submission guidelines and to submit an abstract or
proposal please visit our website

(http://www.icaap8.lk/absMain.html).

If you require hardcopy submission forms please contact
secretariat@... or call +94 11 5668570-3, +94 11 4947878.

SCHOLARSHIPS PROGRAMME DEADLINE - NOW EXTENDED TO 10th MARCH, 2007

The 8th ICAAP is committed to increasing the participation of those who require
a voice in order to bring about "Waves of Change - Waves of Hope".

Through the award of a substantial number of scholarships it is hoped that the
following objectives will be achieved:

1. Greater community participation in decision making
2. Active, committed leadership and not just tokenism
3. Balance between science and community needs
4. An all inclusive process to combat HIV/AIDS

In order to allow people more time we have extended the deadline to 10th March,
2007.

IMPORTANT - please remember to post or courier your Letter of
Recommendation to reach us by 10th March. Scholarship Applications
without a letter of recommendation will NOT be considered.

For more information on scholarship categories, how to apply for a
scholarship, download the letter of recommendation form and preview the essay
questions please visit our website

(http://www.icaap8.lk/scholarshipsMain.html)

If you require hardcopy application forms please contact
secretariat@... or call +94 11 5668570-3, +94 11 4947878.

EXHIBITIONS & SATELLITES

The 8th ICAAP will provide a unique opportunity for organisations
involved in the local, regional and global response to showcase their
programmes, experiences, products and services through commercial and
non-commercial booths. Non-Governmental and Community Based
Organisations, PLWH groups, International NGOs, foundations/trusts, CSR
projects, academic institutions, donors, government and political
bodies, pharmaceutical companies will all be eligible to participate.

For information on booking an exhibition space or a satellite meeting
please visit our website (http://www.icaap8.lk/ExhibitionsMain.html) or email us
at exhibitions@... or satellites@... respectively.

Symposia - deadline 31st march, 2007

We encourage organisations to submit proposals for symposia sessions.

These sessions would be open to all delegates and should deal with
critical issues that defy simple solutions. Focusing on a single,
clearly defined topic or issue, speakers and delegates should share
experiences, contribute relevant research findings and brainstorm ideas to
identify opportunities and strategies to create "Waves of Change - Waves of
Hope" and possible ways forward.

A single page outline should be forwarded to secretariat@... specifying
the session title, brief synopsis, overall objective, expected outcome, proposed
chair and speakers (if already identified).

8th ICAAP Secretariat

320/1 Union Place,
First Floor, Galaha Building,
Colombo 02,
Sri Lanka
Tel: (94 11) 5668570-3, 4947878
Fax: (94 11) 2478455
Email: secretariat@...
Website: http://www.icaap8.lk <http://www.icaap8.lk/>


Anarkali Moonesinghe
e-mail: <anarkali@...>

"The consultation will address a range of policy, operational and ethical issues that will help guide decisions about where and how male circumcision can be best implemented, promoted and safely performed," the UN World Health Organization (WHO) and the Joint UN Programme on HIV/AIDS (UNAIDS) said in a statement today.

"Male circumcision has major potential for the prevention of HIV infection," WHO HIV/AIDS Department Director Kevin De Cock added. "These findings are a very important contribution to HIV prevention science."

The detailed findings of two trials undertaken in Kenya and Uganda to determine whether male circumcision has a protective effect against acquiring HIV infection were published today in the British medical journal The Lancet.

Funded by the United States National Institutes of Health, the trials support the results of the South Africa Orange Farm Intervention Trial, funded by the French National Agency for Research on AIDS (ANRS), published in late 2005. Together the three studies, which enrolled more than 10,000 participants, provide compelling evidence of a 50 to 60 per cent reduction in heterosexual HIV transmission to men, the statement said.

When preliminary results were published in December showing a 50 per cent reduction, UN agencies gave a guarded welcome, warning that circumcision should never pre-empt other preventive measures such as the use of condoms.

Proper guidelines "will be necessary to prevent people from developing a false sense of security and, as a result, engaging in high-risk behaviours which could negate the protective effect of male circumcision," they said then, noting that circumcision does not provide complete protection, and circumcised men can still become infected and, if HIV-positive, infect their sexual partners.

They also stressed that any recommendations would have to take into account cultural and human rights considerations; the risk of complications from the procedure performed in various settings; the potential to undermine existing protective behaviours and strategies; and the fact that the ideal and well-resourced conditions of a randomized trial are often not replicated in other settings.

http://www.un.org/apps/news/story.asp?NewsID=21656&Cr=hiv&Cr1=aids

China AIDS activists laud documentary Oscar
Mon Feb 26, 1:23 AM ET

BEIJING (Reuters) - A film about Chinese orphans of

AIDS victims won an Oscar for best documentary short film, which a
prominent AIDS activist in China said showed people still cared.

Ruby Yang and Thomas Lennon won the Oscar for "The Blood of Yingzhou
District" which tells the story of traditional Chinese obligations of
family colliding with the fears of AIDS in impoverished Anhui
province and the fate of those left behind.
"I hadn't heard of the film, but it's a good thing people care about
this,"

HIV-infected AIDS activist Li Xige, from the adjoining province of
Henan, told Reuters.

"Because this problem has been going on for so long and sometimes I'm
afraid it might be forgotten."

An estimated 650,000 people are living with HIV/AIDS in China, and
health experts say the disease is moving into the general population.
Henan was the center of an AIDS scandal in the 1990s in which people
sold blood to unsanitary, often state-run health clinics, making the
province the center of the nation's AIDS epidemic. Such schemes are
also common in Anhui.

Li was infected through a transfusion, not by selling blood.
China's Xinhua news agency quoted Yang as saying backstage at the
Kodak Theater in Los Angeles that it was "a very emotional journey
for me" to make the film in China.

Yang said she and Lennon "also had a hard time in the editing room
because there were so many sad parts, and they had many shouting
matches about what to let go and what to put in," Xinhua said.
Chung To, a friend of Yang and founder/chairman of the Hong Kong-
based Chi Heng Foundation, which supports some 4,000 AIDS orphans in
China, said little had been done "artistically or in terms of
documentaries" to publicize the issue.

"I think the award really raises awareness about AIDS in China and
especially the plight of AIDS orphans. When we talk about AIDS
orphans people really usually think of Africa, but in China this is
still a very serious issue."

He said China officially estimates there are 76,000 AIDS orphans and
says the number will grow to 260,000 by 2010, but Chung says that
probably underestimates the problem.

http://news.yahoo.com/s/nm/20070226/hl_nm/oscars_aids_dc_1

On South Pacific island, Korean fishermen again looking to buy sex
Prostitution on Kiribati on rise again after end of ban on Korean
boats

Prostitution involving Korean fishermen and local women in the
Pacific island nation of Kiribati, an issue serious enough for the
island to ban Korean ships from docking there two years ago, is on
the rise again.

The Ministry of Maritime Affairs and Fisheries announced on February
23 that the National Youth Commission traveled to Kiribati, north of
Fiji on the equator, in December 19-29 of last year to study the
problem, and confirmed that Korean sailors are again buying sex in
the small country. Of the 24 Kiribati women who in the most recent
study said they had sold sex to Korean men, seven were under the age
of 18. One was as young as 14.

In 2005, the problematic behavior of Korean fishermen became so
serious that Kiribati authorities decided to prohibit Korean ships
from docking there. The decision came after the head of Kiribati's
Roman Catholic Church urged the government of President Anote Tong to
step down if it could not solve the prostitution issue in the country.

Youth commission investigators found that when the Kiribati
government again began allowing Korean ship workers to go ashore and
Kiribati women to board Korean vessels in 2006, the activity
continued just as before. Local Kiribati activists estimate that
between 40 to 50 Kiribati women are engaged in prostitution with
Korean men there on port calls, and that every year the women engaged
in such activity are getting younger.

Investigators said the Korean government needs to do something for
the children born as a result of the activity, noting that,
currently, two women are pregnant after sexual contact with Korean
men and that another woman is already raising a child born through
such contact.

Investigators also noted that the problem is gradually becoming an
international embarrassment for Korea. The South Pacific section of
UNICEF issued a report last December critical of "prostitution with
Korean ship crews."

In addition, an article in Pacific Magazine last November quoted a
Kiribati nurse who said that HIV/AIDS incidence was on the rise on
the island. According to the article, the HIV/AIDS clinic at Tarawa
General Hospital, Kiribati (population 92,000) had 43 confirmed AIDS
cases at that time, of which 26 had died.

The officials with the youth commission and maritime affairs ministry
say they are working on ways to give ship crews "preventive
education" in the hope they stop sexually patronizing Kiribati women.

The commission said it was also coming up with ways to help the women
and children caught in the cycle of prostitution.

Besides the 2005 ban, Kiribati authorities also prevented Korean
fishing boats from calling to port during a period in 2003 because
crews consistently tried to buy sex there.

Prostitutes in Kiribati are referred to as "korakorea" because of the
nationality of their most frequent clients. There exists no criminal
provision for overseas child sex tourism and prostitution in South
Korea's laws, and no laws against prostitution in Kiribati.

Please direct questions or comments to [englishhani@...]

http://english.hani.co.kr/arti/english_edition/e_international/192618.
html

The Ford Foundation International Fellowships Program (IFP)

The Ford Foundation International Fellowships Program (IFP) provides
opportunities for advanced study to exceptional individuals who will
use this education to become leaders in their respective fields,
furthering development in their own countries and greater economic
and social justice worldwide. To ensure that Fellows are drawn from
diverse backgrounds,  IFP actively seeks candidates from social
groups and communities that  lack systematic access to higher
education.

IFP is the largest single program ever supported by the Ford
Foundation. By investing $280 million over ten years through 2010,
the Foundation intends to build on its half century of support for
higher education. Foundation programs have long promoted the highest
educational standards and achievement. Ford fellowship recipients
have become leaders in institutions around the world and have helped
build global knowledge in fields ranging across the natural and
social sciences as well as the humanities and arts. IFP draws on this
tradition and underscores the Foundation's belief that education
enables people to improve their own lives as well as to
assist others in the common pursuit of more equitable and just
societies.

General Guidelines
The International Fellowships Program provides support for up to
three years of formal graduate-level study leading to a masters or
doctoral degree. Fellows are selected from countries in Asia, Africa,
the Middle East, Latin America, and Russia, where the Ford Foundation
maintains active overseas programs. U.S. nationals are not eligible,
although Fellows may study in the United States.

Fellows are chosen on the basis of their leadership potential and
commitment to community or national service, as well as for academic
excellence. Fellows may enroll in masters or doctoral programs and
may pursue any academic discipline or field of study that is
consistent with the interests and goals of the Ford Foundation. The
Foundation currently works in fifteen fields to strengthen democratic
values, reduce poverty and injustice, promote international
cooperation, and advance human achievement.

Once selected, Fellows may enroll in an appropriate university
program anywhere in the world, including their country of residence.
The program provides placement assistance to those Fellows not yet
admitted to graduate school.

IFP support also enables Fellows to undertake short-term language
study and training in research and computer skills prior to graduate
school enrollment. In addition, new Fellows attend orientation
sessions, while current Fellows actively participate in learning and
discussion activities designed to create information and exchange
networks among IFP Fellows worldwide. Finally, the program strongly
encourages IFP alumni to maintain contact with the program after
completing the fellowships to help them remain current in their
respective fields through the expanding IFP network.

Because local requirements vary widely among IFP countries,
applicants should carefully follow the specific application
guidelines provided by the relevant IFP International Partner
organizations listed below, including deadlines for the submission of
applications.

Who Is Eligible?
Applicants must be resident nationals or residents of an eligible IFP
country.

In addition, successful candidates will:

*Demonstrate superior achievement in their undergraduate studies and
hold a baccalaureate degree or its equivalent.
*Have substantial experience in community service or development-
related activities.
*Possess leadership potential evidenced by their employment and
academic experience.
*Propose to pursue a post-baccalaureate degree that will directly
enhance their leadership capacity in a practical, policy, academic,
or artistic discipline or field corresponding to one or more of the
Foundation's areas of endeavor.
*Present a plan specifying how they will apply their studies to
social problems or issues in their own countries. Commit themselves
to working on these issues following the fellowship period. IFP
selects Fellows on the strength of their clearly-stated intention to
serve their communities and countries of origin, and expects that
they will honor this obligation.

IFP Fields of Study
IFP Fellows may choose to study in any academic discipline or field
of study related to the Ford Foundation's three grant-making areas,
which are:

* Asset Building and Community Development
* Children, Youth and Families
* Sexuality and Reproductive Health
* Work-Force Development
* Development Finance and Economic Security
* Environment and Development
* Community Development
* Education, Media, Arts and Culture
* Education Reform
* Higher Education and Scholarship
* Religion, Society and Culture
* Media
* Arts and Culture
* Peace and Social Justice
* Human Rights
* International Cooperation
* Governance
* Civil Society

The Application Process
All applications must be submitted to the appropriate IFP
International Partner listed below in the country or region where the
applicant resides. IFP International Partners determine application
deadlines and selection schedules in their region or country.
Applications are reviewed and final selections decided by panels
composed of practitioners and scholars from various fields of work
and study. The level and duration of awards are determined as part of
the selection process. Ford Foundation staff and their family members
may not serve on selection panels and are not eligible to apply for
IFP awards. Members of selection committees, staff of the
organizations managing the program in the various regions, and their
family members are also ineligible for IFP awards.

IFP International Partner Offices: (in Asia)

India
United State Educational Foundation in India (USEFI):
www.ifpsa.org

Indonesia
Indonesian International Education Foundation (IIEF):
www.iief.or.id/ifp/ifp.html

Philippines
Philippines Social Science Council (PSSC):
www.pssc.org.ph/programs/ifp

Thailand
Asian Scholarship Foundation (ASF):
www.asianscholarship.org

Vietnam
Center for Educational Exchange with Vietnam (CEEVN)
www.acls.org/ceevn/ifpguidelines.htm

http://www.fordfound.org/news/more/11272000ifp/index.cfm

Comment. HIV/AIDS in China: the numbers problem

Therese Hesketh  a
The Lancet 2007; 369:621-623. DOI:10.1016/S0140-6736(07)60290-6

China has been widely criticised for its failure to respond to the
HIV/AIDS threat and for systematic suppression of information about
the size of the problem.1,2 Thus Zunyou Wu and colleagues' report in
today's Lancet of the way in which China has responded to HIV/AIDS
will surprise many.3 Their thorough review shows how much progress
has been made, and how, given the political and cultural context, the
Chinese response has evolved in a measured and mainly appropriate way.

Wu and colleagues show how early efforts emphasised enforcement of
laws against high-risk behaviour, but that later lessons from
effective interventions in other countries (eg, needle-exchange
programmes in Australia and condom campaigns for sex workers in
Thailand) have led to a more evidence-based approach. The process of
policy development might not have been as neat as that presented
because of tensions, particularly those between public-health
officials and the police and those within public security over the
management of illegal drug use and prostitution. However, the
recently announced AIDS Prevention and Control Regulations4 are a
good example of evidence-based policy, even if their implementation
is highly variable across China.

The most surprising feature of HIV/AIDS in China is how it has
attracted such attention and large amounts of external funding, given
that the proportion of the population with HIV/AIDS is only 0·05% and
that there are many other more pressing health issues in China. Part
of the reason for this attention is because predictions of the size
of the epidemic were substantially overestimated by several expert
bodies. In 2002, a UN-commissioned report, emotively entitled China's
Titanic peril,5 estimated that China had about 1 million cases of
HIV, and that it was on the brink of an "explosive HIV/AIDS epidemic…
with an imminent risk to widespread dissemination to the general
population". The report continued: "a potential HIV/AIDS disaster of
unimaginable proportion now lies in wait." A few months later, the US
National Intelligence Council estimated that 1–2 million people were
living with HIV in China, and predicted 10–15 million cases by 2010.6
The National Intelligence Council claimed that these figures were
more reliable than previous estimates because they did not rely on
official sources, which the National Intelligence Council
asserted "systematically understate the actual figures", but rather
incorporated assessments by academics and non-governmental
organisations working in the field.

Other reports at this time were similarly emotive and pessimistic:
from the Centre for Strategic and International Studies (Washington,
DC, USA), HIV/AIDS was referred to as China's timebomb;7 and from the
American Enterprise Institute as the AIDS typhoon.8 The latter report
emphasised the probable damage to the economy because HIV would
spread among young educated urban people. That China had a massive
potential HIV problem became received wisdom. However, as Wu and
colleagues note, by 2006 the number of people living with HIV/AIDS is
estimated to be 650000—a figure revised downwards by 200000 from
2005.9

Such wildly inaccurate predictions raise several issues. First, how
was the figure of 10–15 million cases by 2010 calculated? This
estimate assumes substantial spread of the virus from high-risk
groups to the general population, yet the few population studies and,
in particular, trends from sentinel surveillance of pregnant women in
high-risk areas show that such spread has not occurred.10–12
Therefore, these predictions were made on unfounded assumptions.
Second, the inaccurate predictions show how even well-respected
groups willingly accept and repeat a number (especially one that is
high and sensationalist) irrespective of the assumptions of the
underlying calculations, starting a cycle: repeat something often
enough and everyone believes it. Third, we should ask what the
effects of these high and inaccurate predictions have been. In China,
they certainly galvanised activity, attracting large funds from
domestic sources (beautifully illustrated by figure 5 in Wu and
colleagues' review), international sources (including bilateral
donors, notably the UK's Department for International Development and
the Australian Government's overseas aid programme, AusAID), and many
international non-governmental organisations.

Such funding might have helped slow the spread of the epidemic.
However, a disproportionate amount of funding is being given to a
health problem for which the disease burden is low, drawing resources
away from areas of greater need. For example, China's burden of
disease from tobacco use is enormous.13 If similar resources were
devoted to tobacco-control measures, the effect could be huge. The
added irony: in a fee-for-service system, individuals can receive
free HIV treatment in many areas of China, whereas others have to pay
for tuberculosis treatment, drugs for hypertension, or for cataract
surgery.

Wu and colleagues call for a scaling-up of HIV/AIDS activities in
China. This effort should focus on high-risk areas. For most of
China, the prevalence of HIV remains low. Here, the focus of public-
health efforts should be on diseases with a higher burden.

I declare that I have no conflict of interest.

References
1. Asia Division, Human Rights Watch. Locked doors: the human rights
of people living with HIV/AIDS in China. Human Rights Watch 2003; 15:
1-95.

2. Ruger JP. Democracy and health. Q J Med 2005; 98: 299-304.

3. Wu ZY, Sullivan S, Wang Y, Rotheram MJ, Detels R. Evolution of
China's response to HIV/AIDS. Lancet 2007; 369: 679-690. Abstract |
Full Text | Full-Text PDF (730 KB)

4. China AIDS Info.
http://www.china-aids.org/english/aidsreg-2006-intro
(accessed Oct 26, 2006)..

5. Eldis gateway. HIV/AIDS: China's Titanic peril: 2001 update of the
AIDS situation and needs assessment report. UNAIDS, 2002
http://www.eldis.org/static/DOC9892.htm
(accessed Oct 26, 2006)..

6. National Intelligence Council. The next wave of HIV/AIDS: Nigeria,
Ethiopia, Russia, India, China. ICA 2002-04 D. September, 2002:
http://www.fas.org/irp/nic/hiv-aids.html
(accessed Oct 26, 2006)..

7. Bates G, Morrison SJ, Thompson D, eds. Defusing China's timebomb—
sustaining the momentum of China's HIV/AIDS response. A report of the
CSIS HIV/AIDS delegation to China, April 13–18, 2004. 2004:
http://www.csis.org/media/csis/pubs/040413_china_aids.p... (accessed
Oct 26, 2006).

8. American Enterprise Institute. Washington, D.C. Can Asia avoid the
AIDS typhoon?. Nov 11, 2002:
http://www.kaisernetwork.org/health_cast/hcast_index.cf...
(accessed Oct 19, 2006)..

9. Ministry of HealthPeople's Republic of ChinaJoint United Nations
Programme on HIV/AIDSWorld Health Organization. Update on the
HIV/AIDS epidemic and response in China. 2006:
http://data.unaids.org/publications/External-Documents/...
(accessed Oct 26, 2006)..

10. Hesketh T, Huang XM, Wang ZB, Xing ZW, Cubitt DW, Tomkins AM.
Using the premarital examination for population-based surveillance
for HIV in China. AIDS 2003; 17: 1574-1576. MEDLINE

11. Qu S, Sun X, Zheng X, Shen J. National sentinel surveillance of
HIV infection in China from 1995 to 2001. XIV International AIDS
Conference, Barcelona, Spain, July 7–12, 2002: WePeC6072 (abstr)
http://gateway.nlm.nih.gov/MeetingAbstracts/102250025.h...
(accessed Oct 26, 2006)..

12. Hong L, Mo LH, Liu H. Prevention of HIV transmission from mother-
to-child in Yunnan. Mod Prev Med 2001; 28: 68-69.

13. Wang L, Kong L, Wu F, Bai Y, Burton R. Preventing chronic
diseases in China. Lancet 2005; 366: 1821-1824. Abstract | Full Text
| Full-Text PDF (83 KB) | CrossRef


Affiliations

a. Centre for International Child Health, Institute of Child Health,
London WC1N 1EH, UK

The Lancet 2007; 369:679-690. DOI:10.1016/S0140-6736(07)60315-8

Public Health

Evolution of China's response to HIV/AIDS

Prof Zunyou WuMD a,   Sheena G SullivanMPH a d,   Prof Yu WangMD b,   Prof Mary Jane Rotheram-BorusPhD e   and   Prof Roger DetelsMD  c 

See Editorial
See Comment

Summary

Introduction

Overview of the epidemic

Early control strategies

Information and communication networks

Scientific evidence for innovative policies

Reduction of transmission via injecting drug use

Sexual transmission

Influential forces

Programme scale-up

Planned programmes

Challenges ahead

Conclusion

References

Summary

Four factors have driven China's response to the HIV/AIDS pandemic: (1) existing government structures and networks of relationships; (2) increasing scientific information; (3) external influences that underscored the potential consequences of an HIV/AIDS pandemic and thus accelerated strategic planning; and (4) increasing political commitment at the highest levels. China's response culminated in legislation to control HIV/AIDS—the AIDS Prevention and Control Regulations. Three major initiatives are being scaled up concurrently. First, the government has prioritised interventions to control the epidemic in injection drug users, sex workers, men who have sex with men, and plasma donors. Second, routine HIV testing is being implemented in populations at high risk of infection. Third, the government is providing treatment for infected individuals. These bold programmes have emerged from a process of gradual and prolonged dialogue and collaboration between officials at every level of government, researchers, service providers, policymakers, and politicians, and have led to decisive action.

Back to top

Introduction

In March, 2006, the State Council of the People's Republic of China officially announced the first legislation directly aimed at controlling HIV/AIDS: the AIDS Prevention and Control Regulations.1 These regulations, together with the Five-Year Action Plan to Control HIV/AIDS (2006–2010),2 are an important step in the development of government policy related to the care and prevention of HIV/AIDS. Although bold, these regulations were passed more than 20 years after the first case of HIV infection was identified. The development of a coherent policy was the result of a long and unsystematic process that involved initial mis-steps, considerable domestic and international education, debate, iterative trial-and-error learning, and scientific studies. The new legislation resulted from communication and coordination among many agencies, including administrators, service providers, politicians, the scientific community, and policymakers. We describe the influence of scientific studies and other factors on the development of HIV/AIDS policy in China and provide a timeline of important milestones in the development of the current policy (figure 1). This review is intended as a general overview of progress in China and does not attempt to provide a detailed account of province-to-province variation in the evolution and implementation of HIV prevention and control strategies.

Click to enlarge image

Figure 1. Important events in China's HIV/AIDS policy development, 1985–2006

ART=antiretroviral therapy. MMT=methadone maintenance treatment. NEP=needle exchange programme. PMTCT=prevention of mother-to-child transmission.

Back to top

Overview of the epidemic

China's first AIDS case was identified in 1985 in a dying tourist.3 In 1989, the first indigenous cases were reported as an outbreak in 146 infected heroin users in Yunnan province, near China's southwest border.4 Between 1989 and the mid-1990s, HIV spread steadily from Yunnan into neighbouring areas and along the major drug trafficking routes, then from injecting drug users (IDUs) to their sexual partners and children. In the mid-1990s, the occurrence of a second major outbreak in commercial plasma donors in the east-central provinces became apparent.5 Plasma donors were paid to donate blood, the plasma removed, then the red blood cells reinfused to prevent anaemia. Reuse of tubing and mixing during collection and reinfusion led to thousands of new infections.6,7 At the same time, HIV was also spreading through sexual transmission. By 1998, HIV had reached all 31 provinces and was in a phase of exponential growth (figure 2),8 which, by 2005, had culminated in an estimated 650000 infections.9

Click to enlarge image

Figure 2. Reported HIV/AIDS cases by year, 1985–2005

Back to top

Early control strategies

Initially, the Chinese government focused its preventive strategies on stopping HIV from entering the country. Regulations were introduced that required foreigners who intended to stay 1 year or more and Chinese residents returning from overseas to have an HIV test.10–12 All imported blood products were banned.13,14 There were attempts to stop transmission within the country as well—eg, laws against drug use15 and prostitution16 were strengthened and authorities were allowed to isolate HIV-positive individuals.12 In much the same way as other countries, traditional public-health methods of containment and isolation of infectious disease cases proved ineffective.17 Containment policies occurred in the context of rapid social and economic change, in which there were increases in drug use and changing sexual mixing patterns. These early policies did little to stop transmission of HIV; in fact, they probably promoted concealment of risk activities and made identification of HIV reservoirs more difficult.18–20

Back to top

Information and communication networks

The attitudes of government officials shifted substantially over time, a result of increasing scientific evidence that Chinese people were becoming infected, the dramatic devastation caused by HIV/AIDS in other countries, and research in China that showed that HIV transmission could be reduced with targeted interventions.

As early as the mid-1990s, Chinese officials began to organise study tours to learn from the successes and failures of other countries in combating HIV/AIDS and to bring back information about strategies for HIV/AIDS control that could be adapted for China. Tour groups including officials from the Ministries of Health, Public Security, Justice, Education and Finance, Commissions of Development and Reform, and Population and Family Planning, as well as law and policymakers from the State Council, visited many places, including Australia, the USA, Brazil, Thailand, Europe, and Africa. These tours provided an opportunity for officials to learn from their counterparts in other countries, as well as promoting relationships between the different Chinese government sectors that participated in the study tours.

Workshops that involved key government agencies were also held within China to further foster cross-sector communications. The organisation of Chinese government services is traditionally hierarchical and departmentalised, not directly cultivating cooperation and collaboration across sectors. This tradition made the organisation of multifaceted responses appropriate for HIV/AIDS control difficult. The WHO Global Programme on AIDS, and subsequently UNAIDS, together with other UN agencies in Asia and the Pacific, such as the UN Drugs Control Programme (now the UN Office of Drugs and Crime), had important roles in working with the government of China to organise and facilitate cross-sector discussions.

One workshop in particular was pivotal in pushing policies to support interventions that targeted high-risk groups in China. Held in 1997 and organised by the Chinese Academy of Preventive Medicine (renamed the Chinese Centre for Disease Control and Prevention [CDC] in 2002) and the University of California at Los Angeles, the workshop drew together scholars from sociology, ethics, public health, and education, as well as government officials and representatives of international agencies such as WHO, UN, and the World Bank. This workshop was the first open discussion of evidence-based but controversial intervention strategies that targeted those at high risk of HIV infection who were also highly stigmatised—eg, sex workers, IDUs, and men who have sex with men. Although controversial—pitting scientific, evidence-based prevention approaches against conservative, moralistic attitudes—the consensus acknowledged the possible benefit of the implementation of new prevention strategies.

Members of these various workshops and study tours have been responsible for the identification of effective strategies that have increasingly been at the forefront of HIV control policy in China. They have also contributed to the development of strategic documents, including the Medium- and Long-Term Strategic Plan for HIV/AIDS (1998–2010),21 the Action Plan on HIV/AIDS Prevention and Containment (2001–2005),22 and the AIDS Regulations.1 Other key documents warned of the potential epidemic in China and might have influenced the attitudes of policymakers. China's Titanic Peril,23 published by the UN in 2002, made the unsubstantiated prediction that China could have 10 million HIV-infected individuals by 2010, a figure that has been repeatedly misused in discussions of China's HIV future. A Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China (2004),8 developed jointly by UNAIDS and the State Council of China, estimated that China had 840000 people living with HIV/AIDS. This figure has been revised down to 650000 in 2005 in light of more representative data collection and more appropriate estimation methods.9 Although this figure represented a prevalence of about 0·05%, it was substantially higher than previous government estimates (300000 in 199821) and provided the impetus for immediate scale-up of prevention and control strategies.

Back to top

Scientific evidence for innovative policies

Concurrent with educational activities and network building for government officials, Chinese researchers identified the key risk groups, documented and predicted the course of the epidemic, observed successful programmes in other countries, and tested the effectiveness of behavioural interventions. HIV-related research projects were done by universities, hospitals, and community agencies, both independently and as collaborative projects with other domestic and international institutions. Most research and surveillance commissioned by the Chinese government is done by the National Centre for AIDS/STD Control and Prevention (NCAIDS) at the Chinese CDC. At the local level, almost all HIV research and intervention—whether done by the Chinese CDC or other research organisations—is done in collaboration with provincial and county CDCs, township hospitals, and village health workers. Research initiated by the Chinese CDC administrators, especially that commissioned by the Ministry of Health, is diffused and implemented faster than research done outside the existing government structure.

Back to top

Reduction of transmission via injecting drug use

Intravenous drug use represents the largest single cause of HIV transmission in China, accounting for 44·3% of infections at the end of 2005.9 Ministry of Public Security data suggests that the number of registered drug users has risen steadily at a rate of about 122% per year, from 70000 in 1990 to 1·16 million in 2005. The total number, including unregistered drug users, is thought to be much higher, with one estimate placing the figure at 3·5 million;24 the UNODC World Drug Report estimated that in 2003, 0·2% of 16–64-year-olds (ie, 1·7 million people) were opiate abusers.25 The most commonly used drug is heroin, which accounts for 85% of total reported drug use, although amphetamines are becoming more common, especially in urban areas.26 Many drug users begin heroin use by smoking, but later find it more cost effective to inject because of the stronger effect gained from injecting a smaller amount. Sharing injection equipment is common.27

National policymakers have recently shifted their position and publicly acknowledged the extent and pattern of increasing drug use, which has led to a rapid increase in treatment options for drug users. According to the regulations on the prohibition of narcotics,15 drug users identified by authorities for the first time are fined or sent to a voluntary detoxification centre run by the health system, which might include short-term use of methadone, buprenorphine, or traditional Chinese medicine. Detoxification costs 2000–5000 yuan (about US$250–625) for one phase of treatment.28,29 If, as often happens, the treatment is not successful, relapsing patients identified by authorities are sent to a compulsory rehabilitation centre, administered by the Ministry for Public Security, for 3–6 months. Those with multiple relapses are detained in a re-education-through-labour centre, managed by the Ministry of Justice, for 1–3 years. In reality, internment procedures and durations vary enormously between administrative units. In general, centres focus on detoxification. Although some health education or treatment is provided, the relapse rate is extremely high.30–32

Cooperative actions by politicians, policymakers, government officials, and scientific researchers have resulted in the introduction of new strategies for drug control over the past 6 years. For example, the government is working with neighbouring countries to prevent drug smuggling, and is increasing anti-drug education for the general population and in schools.29 The government has also commissioned research on harm reduction strategies, such as methadone maintenance treatment and needle exchange programmes.

Needle exchange programmes

Needle exchange programmes are not a strategy officially sanctioned by the Ministry for Public Security since such strategies give the appearance of condoning drug use. Thus, when this strategy was first introduced, it was called needle social marketing—increasing the commercial availability and accessibility of needles in combination with health education about safe injecting practices and, in some cases, provision of free needles.27 Since 2001, the State Council has officially advocated needle social marketing as an HIV prevention measure.22 Evidence from research and study tours to countries such as Australia,33 which runs successful needle exchange programmes, prompted the Ministry of Health to support the first such programme in Yunnan province and Guangxi Zhuang Autonomous Region in 1999. In 2000–02, a larger intervention trial of needle exchange programmes was done in four counties of Guangdong province and Guangxi, funded by the World AIDS Foundation.34,35 Cross-sectional data gathered at follow-up indicated that participants in intervention communities were almost three times less likely to have shared needles in the past month than those in control communities (odds ratio 0·36, 95% CI 0·25–0·52). Furthermore, rates of infection with hepatitis C virus were significantly lower in the intervention arm than in the control arm (51·1% vs 83·6%, p=0·001) and HIV rates were lower in the intervention arm; however, this was significant only in Guangdong (p=0·011) and not in Guangxi (p=0·2) nor overall (18·1% vs 23·6%, p=0·391).

The results of the trial were used to develop national policy guidelines in 2002, and needle exchange programmes have been included in the second 5-year action plan.2 The programme was substantially scaled-up in 2006, from 93 sites to 729 by the year's end. Scale-up has been focused in rural areas, and in many places additional services are offered to IDUs, including condom distribution, voluntary counselling and testing, antiretroviral therapy, and educational information about drug use and HIV.36

Methadone maintenance treatment programmes

A large body of international research has shown the efficacy of methadone maintenance treatment programmes for the treatment of drug addiction and subsequent reduction in HIV risk behaviours.37–40 In acknowledgment of this evidence, in 2004 the Chinese government called for the use of such practices to mitigate HIV transmission.41 Immediately, under the governance of the Ministries of Health and Public Security and the State Food and Drug Administration, a pilot study of eight clinics in five provinces was done.42,43 Inclusion in the programme required: (1) several failed attempts to quit the use of heroin, (2) at least two terms in a detoxification centre, (3) age at least 20 years, (4) being a registered local resident of the area in which the clinic is located, and (5) being of good civil character. Those testing HIV positive need only fulfil criteria 4 and 5. To monitor the progress of the clinics, a database was established to gather data on demographics, medical issues, drug use, and other information about the patients. These data were assessed at 3, 6, and 12 months, and indicated reductions in heroin use, drug-related crime, and unemployment in those who received methadone maintenance treatment (figure 3).

Click to enlarge image

Figure 3. Prevalence of participant characteristics in the methadone maintenance treatment pilot project

On the basis of the successes of the pilot, the programme began scale-up in 2004 and plans are in place to open an additional 1500 methadone maintenance treatment clinics for about 300000 heroin users by 2008. A National Training Centre for methadone maintenance treatment has been established in Yunnan to provide clinical and technical support. The services offered at such clinics have been broadened and provide access to other services, including HIV and hepatitis testing, antiretroviral therapy for eligible AIDS patients, group activities, and skills training for employment. The use of methadone maintenance therapy has been incorporated into the AIDS Regulations as a treatment for heroin addiction. Additionally, the requirements for entrance into methadone maintenance treatment programmes have been relaxed to encourage greater access. For example, patients are no longer required to have local residency or a previous history of internment in a detoxification centre. The programme is not without problems, however, and retaining drug users in the programme remains a critical challenge.

Back to top

Sexual transmission

Although most HIV-infected individuals in China are drug users, patients infected through sexual transmission are the fastest growing group, accounting for close to 50% of new infections in 2005.9 Overall, they represent 43·6% of total HIV/AIDS cases, including commercial sex workers or their clients (19·6%), partners of HIV-infected individuals (16·7%), and men who have sex with men (7·3%).9 As with drug use, sexuality is not openly discussed in Chinese society and is therefore neither easily targeted by health promotion campaigns, nor has it traditionally been taught in schools. Even among university students, levels of AIDS knowledge and risk perception are alarmingly low.44,45 On the other hand, attitudes towards sex are becoming increasingly more liberal and, as a result, premarital and extramarital sex are more commonly practised.46,47 Although they are widely available, condoms are rarely used.48

Commercial sex work

Commercial sex work is illegal in China; hence, brothels are illegal and commercial sex workers operate out of places of entertainment (eg, karaoke bars), hotels, hair-dressing salons, or on the street.49 The traditional strategy for controlling HIV transmission through commercial sex workers has been the development of stricter laws to prevent risky behaviours,16 accompanied by raids on suspected sex establishments by public security officials.20,49 Those apprehended are subject to compulsory education on law and morality, testing and treatment for sexually transmitted diseases,49 and forced participation in productive labour.20 Under the Frontier Health and Quarantine Law,12 those knowingly infected with HIV who continue to practise prostitution are subject to more severe penalties and criminal liability for creating a risk of spreading a quarantinable disease.12,49 Detention ranges from 6 months to 2 years. Until recently, health education in this system was uncommon.

In 1996–97, following the success of prevention interventions in neighbouring Thailand,50 the Chinese CDC launched the first intervention projects to promote safer sex behaviours to prevent HIV and other sexually transmitted diseases in commercial sex workers working at entertainment establishments in Yunnan.51,52 These projects showed the feasibility of such programmes, which included condom use to control the spread of HIV and other sexually transmitted diseases in commercial sex workers, and have been officially promoted since 1998.21 Between 1999 and 2001, the World AIDS Foundation supported a five-site trial of a behavioural intervention in commercial sex workers who worked in entertainment establishments.54,55 The intervention included condom promotion, establishment of clinics for sexually transmitted diseases to provide check-ups, and outreach for health education and counselling. HIV-related knowledge improved substantially, and the rate of bacterial sexually transmitted diseases fell. The rate of condom use at last intercourse increased from around 55% to 68%, and fewer commercial sex workers agreed to sex without a condom when requested by a client who offered more money. The prevalence of gonorrhoea fell from about 26% at baseline to 4% after intervention, and the prevalence of chlamydia fell from about 41% to 26%.

The findings from this trial were used to draft national guidelines for interventions among sex workers in China. The provision of condoms at entertainment establishments is now an official requirement under the AIDS Regulations. Condom vending machines are being installed in venues such as university campuses and hotels, and condom promotion and HIV education campaigns that target youth and migrant workers are gradually being scaled up.55,56

Back to top

Influential forces

Changes in government

In 2003, a new administration led by President Hu Jintao, Premier Wen Jiabao, and Vice Premier and Health Minister Wu Yi substantially accelerated the commitment to and implementation of evidence-based HIV policies. Under this administration, a number of initiatives have been introduced: the China Comprehensive AIDS Response (China CARES), which assists 127 high-prevalence counties in providing care and support to people living with HIV/AIDS; the "Four Free and One Care" policy (panel); and the formation of a State Council AIDS Working Committee responsible for the development of a comprehensive policy framework (eg, the Notice on Strengthening HIV/AIDS Prevention and Control).8 New policies, supported by expanded budgets, have been introduced (figure 4), which has permitted a substantial acceleration in programme development, testing, and scale-up.

Panel: Chinese government "Four Free and One Care" policy for AIDS control

•Free antiretroviral drugs to AIDS patients who are rural residents or people without insurance living in urban areas.

•Free voluntary counselling and testing.

•Free drugs to HIV-infected pregnant women to prevent mother-to-child transmission, and HIV testing of newborn babies.

•Free schooling for AIDS orphans.

•Care and economic assistance to the households of people living with HIV/AIDS.

Click to enlarge image

Figure 4. Chinese central government spending on HIV/AIDS by year, 1985–2005

Media

The media have exerted substantial influence over the timing and course of HIV control in China by bringing news of HIV to the attention of the public, administrators, and policymakers. In 1996, the Southern Weekend newspaper ran a front-page story and devoted another two pages to AIDS in China. This coverage was the first time any comprehensive exposure of the HIV/AIDS epidemic in China had been published by the Chinese press. From 1999, the international and subsequently the national media reported on the thousands of infected plasma donors in Henan and neighbouring provinces who did not have access to services. Although the government had acted quickly when the tragedy became apparent in 1995 by shutting down collection stations and, later, introducing new laws and regulations on the collection and management of blood and blood products,6,57,58 provision of HIV testing, prevention, and care for donors in the local areas was slower. Progress was stimulated by the media's attention to the plight of the infected plasma donors. Since these initial reports, the HIV/AIDS situation in China has received much attention from the local and international media.

Severe acute respiratory syndrome

The challenge of managing the severe acute respiratory syndrome (SARS) epidemic in 2003 is often credited with further motivating the government to take aggressive policy action on HIV-related issues. SARS showed not only how infectious diseases could threaten economic and social stability but also the effect of China's policies on international health problems.19 Policymakers announced a change of focus from purely economic goals to increasing the focus on health and social wellbeing and, as a result, increased support for public-health agencies. In controlling SARS, contact between the government and international agencies such as WHO, UN, and the US Centers for Disease Control and Prevention was essential and further stimulated stronger international collaboration for HIV/AIDS prevention and treatment. Intervention strategies necessary for SARS control have been translated into HIV/AIDS prevention—eg, real-time electronic case reporting.

Back to top

Programme scale-up

Case finding

The first step in understanding the extent of an epidemic is to be able to identify cases. National sentinel surveillance has been implemented since 1995, but was initially restricted to high-risk areas and to attendees at sexually transmitted disease clinics, female sex workers, drug users, and long-distance truck drivers. Surveillance has gradually been expanded to 845 national sites and now also includes pregnant women and men who have sex with men.

Around the same time, voluntary testing and counselling was made available in some communities, but, even where available, was rarely used. Reluctance to seek HIV testing was probably due to a number of causes—eg, cost, inaccessibility of services, absence of any treatment, scant publicity or advocacy for testing, low or no perceived risk, and stigma associated with the use of testing services.59–62 In the past 3 years, the government has addressed the environmental barriers. The high cost was addressed in 2003 by making free HIV testing available for the poor,63 and later, under the Four Free and One Care policy, antiretroviral treatment was made freely available for all through the Chinese health system. The number of screening laboratories has been expanded to 5500, and there are now 99 laboratories able to do confirmatory HIV tests. Free HIV testing has been made available, and expanded from 365 counties in 15 provinces in 2002 to over 2300 counties, with 3037 sites, in all provinces in 2006. The AIDS Regulations have introduced penalties for health units that do not provide free testing on request.

The rapid expansion of testing infrastructure has been largely prompted by the introduction of provider-initiated routine testing campaigns to identify infected individuals and put them in contact with treatment services. Client-initiated testing was failing to identify most infected individuals, so campaigns to screen high-risk groups, including drug users, commercial sex workers, prisoners, and former plasma donors, were commissioned to link patients to treatment services.64 The campaigns have resulted in a substantial increase in the number of individuals who know their HIV status, with an additional 60000 people living with HIV/AIDS identified. This increased identification explains, at least in part, the rapid rise in reported HIV cases in the early 21st century (figure 2). However, even with this effort, only about 22% of the estimated 650000 HIV-infected individuals living in China at the end of 2005 have been identified.9 Routine testing in high-risk groups continues.

Educating the public

Testing campaigns were accompanied by community-level social marketing to raise awareness of HIV and to reduce HIV-related stigma. The AIDS Regulations have outlined requirements for local governments at the county level and above, as well as for educational establishments, businesses, health providers, customs and border control, and the media to promote HIV/AIDS education and social marketing. A number of schools now include sex, drug, and HIV education for their pupils, especially in high-risk areas such as Yunnan, Guangxi, and Guangdong.

An important part of HIV education is targeting behaviour to reduce stigma towards people with HIV/AIDS. Stigma is well recognised as a major barrier to HIV control, because it prevents people from seeking services for testing and treatment, and discourages people from practising safer behaviours.59,65,66 To address this issue, senior political figures have been involved in anti-discrimination campaigns, and have publicly shown that HIV cannot be transmitted through casual contact. For example, on World AIDS Day, Dec 1, 2003, Premier Wen Jiabao publicly shook hands with AIDS patients in Beijing Ditan Hospital.67 The day before the 2004 World AIDS Day, President Hu Jintao and other senior government leaders visited patients living with HIV/AIDS and called for the elimination of bias against this group.68 During the Chinese New Year celebrations in 2005, Premier Wen Jiabao visited the homes of HIV-infected villagers in Henan province. These actions had a tremendous effect on the general community, and have now been backed up by policy changes. The AIDS Regulations have made it illegal to discriminate against people living with HIV/AIDS and their families in terms of their rights to schooling, employment, health services, and participation in community activities. Furthermore, the AIDS Regulations and the 2004 revision of the Law on the Prevention and Treatment of Infectious Disease69 include language to protect the identity and disease status of those with an infectious disease, with disciplinary action recommended for those individuals or institutions that violate these laws. Although there had been language in previous regulations to protect the rights of people living with HIV/AIDS, these new laws give such individuals and their families a stronger basis from which to defend their rights.

Antiretroviral treatment for people with HIV/AIDS

In 2001 and 2002, the number of patients living with HIV/AIDS being identified through treatment services began to increase. As many as 69000 of these people were the rural poor who had been infected when they sold their blood and plasma in the mid-1990s and who were unable to access or afford much-needed antiretroviral treatment.9 On the basis of the successes of programmes in other nations, such as Brazil,70 a free antiretroviral therapy programme was piloted in late 2002 in Shangcai county, Henan province, one of the most severely affected areas.71 Patients were provided with a combination of zidovudine or didanosine plus lamivudine and nevirapine. On the basis of the improved health status and survival of the initial cohort, the programme was scaled up in early 2003, mainly through the China CARES programme.71

The provision of free antiretroviral therapy to rural residents and the urban poor became policy in 2003 under the Four Free and One Care policy (figure 4).67 The National HIV/AIDS Clinical Taskforce took the lead in establishing the programme, and set up a database to monitor it.71 As of the end of 2006, more than 30640 patients have been treated in 800 counties in all 31 provinces. Research to inform further expansion and improvement of the programme is ongoing. Initial reports indicate that the current treatment regimen has a high drop-out rate (at least 8%), mainly due to side-effects, drug resistance, difficulty with adherence, and progression of disease.71 Therefore, the government is exploring options within the pharmaceutical industry to make additional regimens available,41 which will address both the issues of compliance, by making regimens with fewer side-effects available, and resistance, by making available additional lines of treatment.

Prevention of mother-to-child transmission

After reports of successful intervention in other developing countries,72 a feasibility trial of the prevention of mother-to-child transmission was piloted in late 2002 concurrent with the antiretroviral therapy pilot, with financial and technical support from UNICEF. Mothers who tested HIV positive were offered counselling, the option of abortion or antiretroviral therapy and, where available, caesarean delivery, to reduce the likelihood of mother-to-child transmission. Free formula milk for 12 months was provided for infants.73

On the basis of this pilot programme, national guidelines were developed to guide the prevention of mother-to-child transmission in the country. The provision of such services has been ratified by the AIDS Regulations. Services are being scaled up to cover at least 85% of infected pregnant women by 2007, and to reach at least 90% by 2010.2 Scale-up is being prioritised to the most heavily affected areas first. As of the end of 2005, more than 500000 pregnant women in high-risk groups or in high-prevalence areas had been tested for HIV in 271 counties in 28 provinces. The overall participation rate in HIV testing in these pregnant women was 92%, and the HIV infection rate ranged from 0·3% to 0·7%. Among those who tested positive, 80% received antiretroviral therapy, and more than 90% accepted formula milk for the prevention of mother-to-child transmission.74

Back to top

Planned programmes

Unlike prostitution and drug use, homosexuality has never been banned in China, but it was listed as a psychiatric disorder until 2001, and public acts of homosexual sex are punishable as hooliganism.75 Although increasingly tolerated in the cities, in general, homosexuality is highly stigmatised and men who have sex with men are under considerable pressure to conceal their sexual orientation.76 As a result, most homosexuals are married, or will be in the future, and form a bridge between the high-risk men who have sex with men group to their low-risk wives and other partners.75,77,78 The government has initiated few interventions for men who have sex with men, leaving such programmes to advocacy groups, non-governmental organisations (NGOs), and researchers.79 However, the government recently estimated that there were 5–10 million men who have sex with men living in China, of whom 1·35% are thought to be HIV positive.80 This information, in addition to studies indicating low levels of HIV knowledge, perceived risk, and testing, and high rates of sexually transmitted diseases,61,81,82 has prompted the Ministry of Health to now include men who have sex with men in the high-risk groups and to call for the development of novel interventions to target them.83

Back to top

Challenges ahead

China has made impressive progress in the development and implementation of effective intervention strategies, especially in the past 3 years. The country is currently in a transition stage in its HIV policy development. It is increasingly adopting approaches that are based on scientific evidence and has encouraged the pilot testing of controversial methods of risk reduction (eg, methadone maintenance treatment, needle exchange programmes, and the targeting of men who have sex with men and sex workers).

Failures in scaling-up HIV prevention programmes have not been caused by an absence of policy, but rather, as with other countries, by there being no policy enforcement and timely scale-up. Although China has a strong central government, provincial and lower levels of government enjoy a great deal of autonomy, which has resulted in a mixed response and inconsistent enforcement of HIV/AIDS policy. For example, Yunnan province has shown strong support for implementation and advocacy of harm-reduction strategies that reduce HIV transmission in its many drug users, whereas Henan province had been slower to respond to the needs of former plasma donors in the early stages of the epidemic.84 Moreover, the distribution of HIV in China is not even, and is concentrated in areas with high drug use (eg, Yunnan, Guangxi, Xinjiang, and Sichuan) and in areas where people were infected through unsafe blood or plasma donation (eg, Henan, Anhui, Hebei, Shanxi, and Hubei). The number of cases ranges dramatically between provinces (figure 5), with, for example, just 20 cases reported from Tibet but well over 40000 in neighbouring Yunnan. In provinces with an extremely low prevalence, it can be difficult for officials to see the need for HIV prevention and control.

Click to enlarge image

Figure 5. Reported HIV cases by province, 1985–2005

Conflicts of interest between departments, such as those responsible for health and public security, have also made coordination of services to reach high-risk groups that engage in illegal behaviour difficult.85 The central government has called for greater cooperation between relevant departments—including Public Security, Justice, Edu- cation, Civil Affairs, and Health—but implementation of this policy at the local level varies.

The problem is further exacerbated by inadequate resources and trained personnel. Many rural areas—where most of China's HIV-positive population resides—do not have the capacity to monitor patients' CD4+ cell counts and viral load. In some cases, the physical infrastructure exists, but staff do not have the skills or reagents to use it. Human resource capacity is a major constraint on China's ability to deliver HIV prevention and care. Many health workers and educators have poor knowledge of HIV and hold their own biases and stigmas towards those at risk or infected with HIV.86–88 A substantial proportion of the funds allocated to HIV prevention and control is being spent on establishing training centres and in building the capacity of health workers so that they can deliver better services. But many of those willing to work in rural areas do not have formal medical qualifications to begin with, which limits their abilities to understand the complexities of treating HIV patients.89 Furthermore, health services rely heavily on user fees, which often encourages health workers to do additional, chargeable services that many people living with HIV/AIDS cannot afford.90

With an estimated 650000 people living with HIV/AIDS and an ever greater number of people at risk of infection, the government has embarked upon a formidable task. The provision of accessible testing and treatment services not only requires financial resources, but also, in many cases, reorganisation and supplementary funding of existing local health services infrastructure, especially in rural areas where most of Chinese HIV-positive individuals reside.91 In particular, rural areas do not have adequately trained staff capable of providing effective treatment and prevention services, as well as the laboratory and clinical infrastructure necessary to monitor treatment.71 The problem of inadequate human resources is not restricted to health departments—in rural areas, there are few adequately trained technical and management personnel at all levels and across all sectors. The combination of insufficiently trained staff, inadequate technical resources, and a largely remote, poorly educated, rural population represents a challenge to the implementation of effective programmes.

A major step has been the government's promotion of NGOs,92 which are a new concept in China.93 Many of the larger domestic groups are actually government funded, and those not affiliated with the government are required to go through a complicated registration procedure to be officially endorsed, although there might be a relaxation of these policies in the future.94 The presence of international NGOs is also increasing. The ability of NGOs to work with high-risk groups, especially those that engage in behaviours deemed to be illegal or immoral, and to provide care and outreach where overstretched health services cannot, is recognised.95 The private sector is also being encouraged to undertake prevention and education activities.96

Back to top

Conclusion

What has allowed the mobilisation of multiple sectors within China? First, over a 15-year period there was a long series of educational workshops, conferences, collaborative projects, and networking between members at a number of levels of the government and administrative structural hierarchies. At local, national, and international forums, officials from many sectors were able to meet one another, share a common knowledge base, and debate the appropriateness of different interventions. Personal relationships were formed that facilitated the consideration and examination of previously unrecognised policy options for detection, prevention, and care. In a non-linear process, a consensus slowly evolved, identifying policy options.

Second, political officials, policymakers, administrators, and service providers were increasingly willing to recognise the relevance of a substantial body of scientific research that suggested effective intervention strategies that could change the course of the epidemic. Third, major policy recommendations with regard to behavioural interventions were preceded by small pilot projects that showed feasibility or efficacy in those populations at highest risk. Fourth, once the evidence base was documented, both the policymakers and politicians publicly showed their support for HIV prevention and care, as well as passing legislation to enforce and broadly disseminate health practices (eg, routine HIV testing and access to care).

These processes occurred in a context of ongoing influences from the media and international donor agencies, with some contribution from advocacy groups within China. The SARS epidemic showed the potentially disastrous effect of a fast-moving infectious disease and, simultaneously, allowed the HIV community to acquire new methods to fight the epidemic (eg, real-time data collection of new cases). However, mobilisation of resources, scientific evidence, and administrative drive did not occur until there was enthusiastic political commitment. The pace of implementation of innovative strategies for HIV detection, prevention, and care, accelerated with the commitments made by the government of Hu Jintao, starting in 2003.

After a slow start and reluctance to recognise the existence of risk activities in its population and of the HIV epidemic, China has responded to international influences, media coverage, and scientific evidence to take bold steps to control the epidemic, using scientifically validated strategies. The country now faces the challenge of scaling up these programmes and of convincing all levels of government to implement these innovative strategies and policies. This vigorous response, incorporating research findings into policy formulation, can be informative to other countries that face similar challenges in responding to the HIV/AIDS epidemic.

Back to top

Conflict of interest statement

Z Wu is the Director of the National Centre for AIDS/STD Control and Prevention in the Chinese CDC. Y Wang is the Director of the Chinese CDC. Both have been directly involved in HIV/AIDS research and policy development in China.

Acknowledgments

We thank Wendy Aft for editing the many drafts of this manuscript, and Professor Zuo-Feng Zhang for helpful suggestions. This work was supported by National Institutes of Health grants U19AI51915, D43TW000013, and U2RTW006918.

Back to top

References

1. State Council of the People's Republic of China. Regulations on AIDS prevention and treatment. Decree of the State Council of the People's Republic of China number 457. Beijing, 2006 (in Chinese).

2. State Council of People's Republic of China. China's action plan for reducing and preventing the spread of HIV/AIDS (2006–2010). State Council Document (2006) number 13. Beijing, 2006 (in Chinese).

3. Settle E. AIDS in China: an annotated chronology: 1985–2003. Montreal: China AIDS Survey, 2003:.

4. Ma Y, Li ZZ, Zhang KX. Identification of HIV infection among drug users in China. Zhonghua Liu Xing Bing Xue Za Zhi 1990; 11: 184-185(in Chinese)..

5. Wu Z, Liu Z, Detels R. HIV-1 infection in commercial plasma donors in China. Lancet 1995; 346: 61-62. MEDLINE | CrossRef

6. Wu Z, Rou K, Detels R. Prevalence of HIV infection among former commercial plasma donors in rural eastern China. Health Policy Plan 2001; 16: 41-46. MEDLINE | CrossRef

7. Zhuang K, Gui X, Su B, Tien P, Chen Z, Zhang L. High prevalence of HIV infection among women and their children in Henan Province, China. J Acquir Immune Defic Syndr 2003; 33: 649-650.

8. State Council AIDS Working Committee OfficeUN Theme Group on HIV/AIDS in China. A joint assessment of HIV/AIDS prevention, treatment and care in China. Beijing: China Ministry of Health, 2004:.

9. Ministry of Health of ChinaUNAIDSWHO. 2005 update on the HIV/AIDS epidemic and response in China. Beijing: Ministry of Health, 2006:.

10. Standing Committee of the National People's Congress. Law on the control of the entry and exit of aliens. Order number 31 of the President of the People's Republic of China. Beijing, 1985 (in Chinese).

11. Standing Committee of the National People's Congress. Law on the control of the exit and entry of Chinese citizens. Order number 32 of the President of the People's Republic of China. Beijing, 1985 (in Chinese).

12. Standing Committee of the National People's Congress. Frontier health and quarantine law. Order number 46 of the President of the People's Republic of China. Beijing, 1987 (in Chinese).

13. Ministry of Health of the People's Republic of China. Notice on banning import of blood products such as factor VIII. State Council Document (1985) number 49. Beijing, 1986 (in Chinese).

14. Ministry of Health of the People's Republic of China. Notice on strengthening management of imported blood products. State Council Document (1986) number 2. Beijing, 1987 (in Chinese).

15. Standing Committee of the National People's Congress. Decision on the prohibition of narcotic drugs. Beijing, 1990 (in Chinese).

16. Standing Committee of the National People's Congress. Decision on the strict prohibition against prostitution and whoring. Beijing, 1991 (in Chinese).

17. Wu Z, Rou K, Cui H. The HIV/AIDS epidemic in China: history, current strategies and future challenges. AIDS Educ Prev 2004; 16 (3 suppl A): 7-17. MEDLINE | CrossRef

18. Li D, Xia G, Qiu R, Hamblin J, Yue T. Law, policies and regulations concerning HIV/AIDS prevention and containment: an assessment and recommendations. Beijing: United Nations Development Programme, 2003:.

19. Xue B. HIV/AIDS policy and policy evolution in China. Int J STD AIDS 2005; 16: 459-464. MEDLINE | CrossRef

20. Husain L. Policing AIDS in China: official discourses, change, continuity, and unofficial voices In:  Christiansen F,  Dosch J,  Caroline R,  Hamelman S, eds. Leeds East Asia Papers. Leeds: Department of East Asia Studies, University of Leeds,  2004:.

21. Ministry of Health, State Development Planning Commission, Ministry of Science and Technology, Ministry of Finance. Chinese national medium-and long-term strategic plan for HIV/AIDS (1998–2010). State Council Document (1998) number 38. Beijing, 1998 (in Chinese).

22. State Council of the People's Republic of China. China's action plan on HIV/AIDS prevention and containment (2001–2005). State Council Document (2001) number 40. Beijing, 2001 (in Chinese).

23. The UN Theme Group on HIV/AIDS in China. China's titanic peril: 2001 update of the AIDS situation and needs assessment report. Beijing: UNAIDS, 2002:.

24. Kulsudjarit K. Drug problem in southeast and southwest Asia. Ann N Y Acad Sci 2004; 1025: 446-457. MEDLINE | CrossRef

25. UNODC. 2006 World drug report. Geneva: United Nations Office on Drugs and Crime, 2006:.

26. National Drug Abuse Surveillance Center. Annual report on drug surveillance 2001. Beijing: NDSAC in National Institute on Drug Dependence, China, 2001:.

27. Yap L, Wu Z, Liu W, Ming ZQ, Liang S. A rapid assessment and its implications for a needle social marketing intervention among injecting drug users in China. Int J Drug Policy 2002; 13: 57-68.

28. Zhao C, Liu Z, Zhao D, et al. Drug abuse in China. Ann N Y Acad Sci 2004; 1025: 439-445. MEDLINE | CrossRef

29. Qian HZ, Schumacher JE, Chen HT, Ruan YH. Injection drug use and HIV/AIDS in China: review of current situation, prevention and policy implications. Harm Reduct J 2006; 3: 4.

30. Humeniuk R, Ali R. The first methadone clinic in Beijing. Drug Alcohol Rev 2005; 24: 285-287. MEDLINE | CrossRef

31. Liu H, Grusky O, Li X, Ma E. Drug users: a potentially important bridge population in the transmission of sexually transmitted diseases, including AIDS, in China. Sex Transm Dis 2006; 33: 111-117. MEDLINE | CrossRef

32. Zou K. The "Re-education Through Labour" system in China's legal reform. Criminal Law Forum 2002; 12: 459-485.

33. Bowtell W. Australia In:  Yamamoto T,  Itoh S, eds. Fighting a rising tide: the response to AIDS in East Asia. Tokyo: Japan Center for International Exchange,  2006: 19-52.

34. Wu Z, Lin P, Liu W, Ming ZQ, Pang L. Randomized community trial to reduce HIV risk behaviors among injecting drug users using needle social marketing strategies in China. 15th International AIDS Conference; Bangkok, Thailand; July 11–16, 2004.

35. Wu Z. Evaluation of a needle social marketing strategy for control of the HIV epidemic among injecting drug users in China. Final Report to the Word AIDS Foundation. Beijing: Chinese Academy of Preventive Medicine, 2002.

36. Liu B. Needle exchange programmes in China: effectiveness and factors associated with operation in two provinces. MSc thesis, Chinese Center for Disease Control and Prevention, 2006 (in Chinese).

37. Sullivan LE, Metzger DS, Fudala PJ, Fiellin DA. Decreasing international HIV transmission: the role of expanding access to opioid agonist therapies for injection drug users. Addiction 2005; 100: 150-158. MEDLINE | CrossRef

38. Gossop M, Marsden J, Stewart D, Treacy S. Reduced injection risk and sexual risk behaviours after drug misuse treatment: results from the National Treatment Outcome Research Study. AIDS Care 2002; 14: 77-93. MEDLINE | CrossRef

39. Gibson DR, Flynn NM, McCarthy JJ. Effectiveness of methadone treatment in reducing HIV risk behavior and HIV seroconversion among injecting drug users. AIDS 1999; 13: 1807-1818. MEDLINE | CrossRef

40. Marsch LA. The efficacy of methadone maintenance interventions in reducing illicit opiate use, HIV risk behavior and criminality: a meta-analysis. Addiction 1998; 93: 515-532. MEDLINE

41.  In:  Gill B,  Morrison JS,  Thompson D, eds. Defusing China's time bomb: sustaining the momentum of China's HIV/AIDS response. Washington: Center for Strategic and International Studies,  2004:.

42. Wu Z. Landmark government methadone maintenance program in mainland China. 15th International AIDS Conference; Bangkok, Thailand; July 11–16, 2004.

43. Wu Z. Methadone maintenance program in mainland China: from pilot to scale-up. International Conference on the Reduction of Drug Related Harm; Belfast, UK; March 20–24, 2005.

44. Zhang H, Stanton B, Li X, et al. Perceptions and attitudes regarding sex and condom use among Chinese college students: a qualitative study. AIDS Behav 2004; 8 (2): 105-117. MEDLINE | CrossRef

45. Li X, Lin C, Gao Z, et al. HIV/AIDS knowledge and the implications for health promotion programs among Chinese college students: geographic, gender and age differences. Health Promot Int 2004; 19: 345-356. MEDLINE | CrossRef

46. Zhang K, Li D, Li H, Beck EJ. Changing sexual attitudes and behaviour in China: implications for the spread of HIV and other sexually transmitted diseases. AIDS Care 1999; 11: 581-589. MEDLINE | CrossRef

47. Chen XS, Gong XD, Liang GJ, Zhang GC. Epidemiologic trends of sexually transmitted diseases in China. Sex Transm Dis 2000; 27: 138-142. MEDLINE | CrossRef

48. Yang H, Li X, Stanton B, et al. Heterosexual transmission of HIV in China: a systematic review of behavioral studies in the past two decades. Sex Transm Dis 2005; 32: 270-280. MEDLINE | CrossRef

49. Gil VE, Wang MS, Anderson AF, Lin GM, Wu ZO. Prostitutes, prostitution and STD/HIV transmission in mainland China. Soc Sci Med 1996; 42: 141-152.

50. Anon. Thailand condom campaign reduced AIDS infections by fifty percent. AIDS Wkly Plus 1996; 19Aug 12,.

51. Wu Z. Final Report for Intervention on Female Prostitutes in Yunnan. Final Report to the World Bank. Beijing, China: Chinese Academy of Preventive Medicine, 1997:.

52. Wu Z. Promoting condom use among female prostitutes in natural settings in Yunnan, China. 12th International AIDS Conference; Geneva, Switzerland; June 28–July 3, 1998.

54. Wu Z, Rou K, Li F, et al. Sustainability of effective STD/HIV prevention intervention targeting female sex workers and their clients at fice different settings in China. 14th International AIDS Conference; Barcelona, Spain: July 7–12, 2002.

55. Xinhua News Agency. China to improve AIDS awareness among migrant workers. Xinhua News Agency. May 16, 2006: 
http://news.xinhuanet.com/english/2006-05/16/content_45...
(accessed Oct 30, 2006)..

56. Xinhua News Agency. Tianjin makes AIDS prevention education compulsory. Xinhua News Agency. Feb 26, 2006: 
http://news.xinhuanet.com/english/2006-02/26/content_42...
(accessed Oct 30, 2006)..

57. Standing Committee of the National People's Congress. Blood donation law. Order number 93 of the President of the People's Republic of China. Beijing 1998 (in Chinese).

58. State Council of People's Republic of China. Regulations for the management of blood products. State Council Document number 208. Beijing, 1996 (in Chinese).

59. UNAIDS. Stigma and discrimination fact sheet
http://siteresources.worldbank.org/INTEAPREGTOPHIVAIDS/...
(accessed Oct 4, 2006)..

60. Herek GM. AIDS and stigma. Am Behav Sci 1999; 42: 1102-1112. CrossRef

61. Choi KH, Lui H, Guo Y, Han L, Mandel JS. Lack of HIV testing and awareness of HIV infection among men who have sex with men, Beijing, China. AIDS Educ Prev 2006; 18: 33-43. MEDLINE | CrossRef

62. Wu Z, Rou K, Xu C, Lou W, Detels R. Acceptability of HIV/AIDS counseling and testing among premarital couples in China. AIDS Educ Prev 2005; 17: 12-21. MEDLINE | CrossRef

63. Koralage N. China to offer free HIV testing and treatment. BMJ 2004; 328: 975. CrossRef

64. Wu Z, Sun X, Sullivan SG, Detels R. Public health. HIV testing in China. Science 2006; 312: 1475-1476. CrossRef

65. Malcolm A, Aggleton P, Bronfman M, Galvao J, Mane P, Verrall J. HIV-related stigmatization and discrimination: its forms and contexts. Crit Pub Health 1998; 8: 347-370.

66. Yang H, Li X, Stanton B, et al. Willingness to participate in HIV/STD prevention activities among Chinese rural-to-urban migrants. AIDS Educ Prev 2004; 16: 557-570. MEDLINE | CrossRef

67. Watts J. China faces up to HIV/AIDS epidemic. Lancet 2003; 362: 1983. Full Text | Full-Text PDF (78 KB) | CrossRef

68. China Daily. Hu visits AIDS patients in Beijing. China Daily. Nov 30, 2004: 
http://www.chinadaily.com.cn/english/doc/2004-11/30/con...
(accessed Nov 23, 2006)..

69. Standing Committee of the National People's Congress. Infectious disease control act and HIV/AIDS act. Beijing, 2004 (amended) (in Chinese).

70. Teixeira PR, Vitoria MA, Barcarolo J. Antiretroviral treatment in resource-poor settings: the Brazilian experience. AIDS 2004; 18 (suppl 3): S5-S7. CrossRef

71. Zhang FJ, Pan J, Yu L, Wen Y, Zhao Y. Current progress of China's free ART program. Cell Res 2005; 15: 877-882. MEDLINE | CrossRef

72. WHO Technical Consultation. UNFPA/UNICEF/WHO/UNAIDS Inter-Agency Task Team on Mother-to-Child Transmission of HIV. New data on the prevention of mother-to-child transmission of HIV and their policy implications. Geneva: World Health Organization, 2000:.

73. Wu Z, Sullivan SG. China In:  Yamamoto T,  Itoh S, eds. Fighting a rising tide: the response to AIDS in east Asia. Tokyo: Japan Center for International Exchange,  2006: 76-95.

74. Wang LH, Qiu X. Prevention mother to child transmission of HIV In: ,  Wang LD, ed. Epidemics of and responses to HIV/AIDS in China. Beijing: Beijing Press,  2006:(in Chinese)..

75. Liu H, Yang H, Li X, et al. Men who have sex with men and human immunodeficiency virus/sexually transmitted disease control in China. Sex Transm Dis 2006; 33: 68-76. MEDLINE | CrossRef

76. Choi KH, Liu H, Guo Y, Han L, Mandel JS, Rutherford GW. Emerging HIV-1 epidemic in China in men who have sex with men. Lancet 2003; 361: 2125-2126. Abstract | Full Text | Full-Text PDF (60 KB) | CrossRef

77. Qian HZ, Vermund SH, Wang N. Risk of HIV/AIDS in China: subpopulations of special importance. Sex Transm Infect 2005; 81: 442-447. MEDLINE | CrossRef

78. Choi KH, Gibson DR, Han L, Guo Y. High levels of unprotected sex with men and women among men who have sex with men: a potential bridge of HIV transmission in Beijing, China. AIDS Educ Prev 2004; 16: 19-30. MEDLINE | CrossRef

79. Zhang BC, Chu QS. MSM and HIV/AIDS in China. Cell Res 2005; 15: 858-864. MEDLINE | CrossRef

80. China Daily. Chinese gay population announced for the first time. China Daily. April 5, 2006: 
http://www.chinadaily.com.cn/hqylss/2006-04/05/content_...
(accessed Nov 23, 2006)..

81. Jiang J, Cao N, Zhang J, et al. High prevalence of sexually transmitted diseases among men who have sex with men in Jiangsu Province, China. Sex Transm Dis 2006; 33: 118-123. MEDLINE | CrossRef

82. Wong WC, Zhang J, Wu SC, Kong TS, Ling DC. The HIV related risks among men having sex with men in rural Yunnan, China: a qualitative study. Sex Transm Infect 2006; 82: 127-130. MEDLINE | CrossRef

83. Wu Z. Overview of behavioural interventions in China In: ,  Wang LD, ed. Epidemics of and responses to HIV/AIDS in China. Beijing: Beijing Press,  2006:(in Chinese)..

84. Watts J. AIDS in China: new legislation, old doubts. Lancet 2006; 367: 803-804. Full Text | Full-Text PDF (35 KB) | CrossRef

85. Davis S. Restrictions of AIDS activists in China. Human Rights Watch 2004; 17: 1-57.

86. Wu Z, Qi G, Zeng Y, Detels R. Knowledge of HIV/AIDS among health care workers in China. AIDS Educ Prev 1999; 11: 353-363. MEDLINE

87. Hesketh T, Duo L, Li H, Tomkins AM. Attitudes to HIV and HIV testing in high prevalence areas of China: informing the introduction of voluntary counselling and testing programmes. Sex Transm Infect 2005; 81: 108-112. MEDLINE | CrossRef

88. Li L, Lin C, Wu Z, et al. Stigmatization and shame: consequences of caring for HIV/AIDS patients in China. AIDS Care 2006; 10: 463-471. MEDLINE | CrossRef

89. Yip R. Opportunity for effective prevention of AIDS in China In:  Kaufman J,  Kleinman A,  Saich T, eds. AIDS and social policy in China. Cambridge, MA, USA: Harvard University Asia Center,  2006: 177-189.

90. Zhang F, Hsu M, Yu L, Wen Y, Pan J. Initiation of the national free antiretroviral therapy program in rural China In:  Kaufman J,  Kleinman A,  Saich T, eds. AIDS and social policy in China. Cambridge, MA, USA: Harvard University Asia Center,  2006: 96-124.

91. Ministry of Health of China. China's healthcare system and reform. Beijing: Chinese Ministry of Health, 2005:(in Chinese)..

92. Xinhua News Agency. China encourages NGO's participation in fight against AIDS. Xinhua News Agency. Mar 23, 2006: 
http://china.org.cn/english/2006/Mar/162981.htm
(accessed Nov 29, 2006)..

93. China Daily. NGOs act as bridge between government and people. China Daily Feb 23 2006;.

94. He Z. Helping NGOs develop strength. China Daily May 28 2005;.

95. Chen HT, Liao Q. A pilot study of the NGO-based relational intervention model for HIV prevention among drug users in China. AIDS Educ Prev 2005; 17: 503-514. MEDLINE | CrossRef

96. People's Daily. Chinese government invites private sector to join HIV/AIDS campaign. People's Daily Online. Mar 19, 2005: 
http://english.people.com.cn/200503/19/eng20050319_1774...
(accessed Oct 30, 2006)..

Back to top

Uncited reference

53. Wu Z. Sustainability of effective STD/HIV prevention intervention targeting female prostitutes and their clients at five different setting in China. Final Report to the World AIDS Foundation. Beijing, China: Chinese Academy of Preventive Medicine, 2002:.

Affiliations

a. National Centre for AIDS/STD Control and Prevention, Beijing, China
b. Chinese Centre for Disease Control and Prevention, Beijing, China
c. UCLA School of Public Health, Los Angeles, CA, USA
d. Edith Cowan University, Perth, Western Australia, Australia
e. UCLA Center for HIV Identification, Prevention and Treatment Services (CHIPTS), Los Angeles, CA, USA

Correspondence to: Prof Roger Detels, School of Public Health, University of California, Los Angeles, CA 90095-1772, USA

BANGLADESH: Is the community ready for HIV/AIDS prevention?

A study was conducted to measure the readiness of various community groups in
Bangladesh to adopt HIV prevention activities for young people.

THE ISSUE
Given its relatively conservative religious and cultural norms, Bangladeshi
society is expected to resist the introduction of HIV/AIDS prevention messages
addressing sexual behaviour and the use of condoms. Community groups such as
religious leaders, teachers, health professionals, and union parishads
(development committees) have together created a consensus about prescriptive
norms of sexuality for youth, including that unmarried youth should not be able
to purchase or access condoms and schools should not discuss sexuality.
Consequently, beginning HIV prevention activities for youth will require a
working partnership with these organizations at the community level. Advocacy
with gatekeepers can create an enabling environment for youth to adopt safe
behaviour.

THE RESEARCH
Internationally researchers have been examining the role of communities and
their influence on the prevention of high-risk youth behaviours. Studies have
found that communities can have a profound, positive influence on prevention
outcomes, but only if they are ready. The stages of readiness of a community
organization to act on behalf of HIV prevention include:

1. Awareness/Vulnerability
2. Transmission Knowledge
3. Prevention Knowledge
4. Preplanning
5. Planning
6. Implementation
7. Stabilization

To measure the readiness of various community groups, both members and key
informants of these groups were interviewed and rated for their activities at
each stage. The questions were designed to elicit information about how each
community group was understanding and acting on information about the imminent
HIV epidemic as it affected youth in Bangladesh. Included were questions on
HIV/AIDS awareness and its spread, the HIV pandemic, the country situation,
perception of youth risk- taking behaviour as a problem in the community,
ownership of the problem, awareness of prevention methods, organizational
responses to HIV, and actual community-based activities, such as a prevention
plan, working strategies, action taken, and networks among groups and external
relations. Attitudes towards specific preventive strategies, such as mass media
messages and condom access for youth, were assessed. Finally, with the help of
vignettes and in-depth interviews, youth discussed their own perceptions of
community barriers to preventive strategies. It is anticipated that these
results will form the foundation for more effective community and public health
partnerships and in the end, more effective HIV/AIDS prevention efforts.

A survey of diversified community groups was conducted to assess how ready they
are to facilitate HIV preventive activities, including teachers, businessmen,
religious leaders (imams), drug vendors and union parishad members. Group
discussions, in-depth interviews, key informant interviews, and vignettes were
conducted.

KEY RESULTS
Community readiness amongst the different groups was overall remarkably similar,
with some small variations by type. With the exception of imams, community
groups were quite supportive of mass media HIV/AIDS awareness campaigns. The
groups’ attitudes were much more uniformly intolerant of premarital sexuality
or condom availability. Nearly all groups recognized that condoms could prevent
HIV infection and save lives. Nonetheless, acceptance of condom availability for
unmarried youth was uniformly low: making condoms
available was viewed as encouraging premarital sex. Drug sellers, who have a
pivotal role in HIV prevention, were particularly not ready to accept prevention
messages. None of the organizations interviewed had begun serious preparation
for HIV prevention by taking decisions or identifying resources, and no
activities had been initiated.

KEY MESSAGES
There are high levels of knowledge and agreement on the existence of the problem
but absence of preparation for HIV prevention programming. Although there is
tacit agreement to support these positions, the groups have not yet organized
meetings or formed any kind of coalition or cohesive approach with each other to
openly discuss their knowledge or opinions. Strategies to overcome barriers to
community-wide communication and to prepare for preventive activities are now
needed. Building community cohesion among groups for a mass media strategy could
be the first step. Stronger communication needs to be fostered between these
groups, leadership initiatives need to be encouraged, and input provided for
groups to start planning and participating in HIV prevention activities.

1. Communities are not prepared for meaningful prevention messages.

2. We need to work with communities/groups to better prepare HIV prevention
messages.

3. Promote community readiness, otherwise HIV prevention messages for young
people in Bangladesh will be opposed.

The study was conducted by ICDDR,B as part of a collaborative project between
the National AIDS/STD Programme (Ministry of Health & Family Welfare) and Save
the Children USA, preventing HIV/AIDS in young people in Bangladesh, and funded
by GFATM. We gratefully acknowledge their support.

For further information,

ICDDR,B www.icddrb.org
GFATM Bangladesh www.bdnasp.net/gfatm_project.htm
National AIDS/STD Programme (Bangladesh) www.bdnasp.net


Jo Grzelinska
Communications, ICDDR,B
www.icddrb.org
E-MAIL: <jo_grzelinska@...>

The World Medical Association Statement on HIV/AIDS and the Medical
Profession

Adopted by the WMA General Assembly, Pilanesberg, South Africa, October 2006

Introduction

1. HIV/AIDS is a global pandemic that has created unprecedented
challenges for physicians and health infrastructures. In addition to
representing a staggering public health crisis, HIV/AIDS is also
fundamentally a human rights issue. Many factors drive the spread of the
disease, such as poverty, homelessness, illiteracy, prostitution, human
trafficking, stigma, discrimination and gender-based inequality. Efforts to
tackle the disease are constrained by the lack of human and financial resources
available in health care systems. These social, economic, legal and human rights
factors affect not only the public health dimension of HIV/AIDS but also
individual physicians/health workers and patients, their decisions and
relationships.

Discrimination

Unfair discrimination against HIV/AIDS patients by physicians must
be eliminated completely from the practice of medicine.

1. All persons infected or affected by HIV/AIDS are entitled to
adequate prevention, support, treatment and care with compassion and
respect for human dignity.

2. A physician may not ethically refuse to treat a patient whose
condition is within his or her current realm of competence, solely
because the patient is seropositive.

3. National Medical Associations should work with governments,
patient groups and relevant national and international organizations to ensure
that national health policies clearly and explicitly prohibit discrimination
against people infected with or affected by HIV/AIDS.


Appropriate / Competent Medical Care

1. Patients with HIV/AIDS must be provided with competent and
appropriate medical care at all stages of the disease.

2. A physician who is not able to provide the care and services required by
patients with HIV/AIDS should make an appropriate referral to those physicians
or facilities that are equipped to provide such services. Unless or until the
referral can be accomplished, the physician must care for the patient to the
best of his or her ability.

3. Physicians and other appropriate bodies should ensure that patients have
accurate information regarding means of transmission of HIV/AIDS and strategies
to protect themselves against infection. Proactive measures should be taken to
ensure that all members of the population, and at-risk groups in particular, are
educated to this effect.

4. With reference to those patients who are found to be seropositive, physicians
must be able to effectively counsel them regarding: (a) responsible behaviour to
prevent the spread of the disease; (b) strategies for their own health
protection; and (c) the necessity of alerting sexual and needle-sharing
contacts, past and present, as well as other relevant contacts (such as medical
and dental personnel) regarding their possible infection.

5. Physicians must recognize that many people still believe HIV/AIDS to be an
automatic and immediate death sentence and therefore will not seek testing.
Physicians must ensure that patients have accurate information regarding the
treatment options available to them. Patients should understand the potential of
antiretroviral treatment (ART) to improve not only their medical condition but
also the
quality of their lives. Effective ART can greatly extend the period of
time that patients are able to lead healthy productive lives,
functioning socially and in the workplace and maintaining their
independence. HIV/AIDS is increasingly looked upon as a manageable
chronic condition.

6. While strongly advocating ART as the best course of action for HIV/AIDS
patients, physicians must also ensure that their patients are fully and
accurately informed about all aspects of ART, including potential toxicity and
side effects. Physicians must also counsel patients honestly about the
possibility of failure of first line ART, and the subsequent options should
failure occur. The importance of
adhering to the regimens and thereby reducing the risk of failure should be
emphasized.

7. Physicians should be aware that misinformation regarding the negative aspects
of ART has created resistance toward treatment by patients in some areas. Where
misinformation is being spread about ART, physicians and medical associations
must make it an immediate priority to publicly challenge the source of the
misinformation and to work with the HIV/AIDS community to counteract the
negative effects of the misinformation.

8. Physicians should encourage the involvement of support networks to assist
patients in adhering to ART regimens. With the patient's consent, counselling
and training should be available to family members to assist them in providing
family based care. Physicians must recognize families and other support networks
as crucial partners in adherence strategies and, in many places, the only means
to adequately expand the care system so that patients receive the required
attention.

9. Physicians must be aware of the discriminatory attitudes toward HIV/AIDS that
are prevalent in society and local culture. Because physicians are the first,
and sometimes the only, people who are informed of their patients' HIV status,
physicians should be able to counsel them about their basic social and legal
rights and responsibilities or should refer them to counsellors who specialize
in the rights of persons living with HIV/AIDS.

Testing

1. Mandatory testing for HIV must be required of: donated blood and
blood fractions collected for donation or to be used in the manufacture of blood
products; organs and other tissues intended for
transplantation; and semen or ova collected for assisted reproduction
procedures.

2. Mandatory HIV testing of an individual against his or her will is a violation
of medical ethics and human rights. Exceptions to this rule may be made only in
the most extreme cases and should be
subject to review by an ethics panel or to judicial review.

3. Physicians must clearly explain the purpose of an HIV test, the reasons it is
recommended and the implications of a positive test result. Before a test is
administered, the physician should have an action plan in place in case of a
positive test result. Informed consent must be obtained from the patient prior
to testing.

4. While certain groups are labelled "high risk", anyone who has had unprotected
sex should be considered at some risk. Physicians must become increasingly
proactive about recommending testing to patients, based on a mutual
understanding of the level of risk and the potential to benefit from testing.
Pregnant women should routinely be offered testing.

5. Counselling and voluntary anonymous testing for HIV should be available to
all persons who request it, along with adequate post-testing support mechanisms.

Protection from HIV in the Health Care Environment

Physicians and all health care workers have the right to a safe
work environment. Especially in developing countries, the problem of
occupational exposure to HIV has contributed to high attrition rates of the
health labour force. In some cases, employees become infected with HIV, and in
other cases fear of infection causes health care workers to leave their jobs
voluntarily. Fear of infection among health workers can also lead to refusal to
treat HIV/AIDS patients. Likewise, patients have the right to be protected to
the greatest degree possible from transmission of HIV from health professionals
and in health care institutions.

1. Proper infection control procedures and universal precautions
consistent with the most current national or international standards, as
appropriate, should be implemented in all health care facilities. This  includes
procedures for the use of preventive ART for health
professionals who have been exposed to HIV.

2. If the appropriate safeguards for protecting physicians or
patients against infection are not in place, physicians and National
Medical Associations should take action to correct the situation.

3. Physicians who are infected with HIV should not engage in any
activity that creates a risk of transmission of the disease to others.
In the context of possible exposure to HIV, the activity in which the
physician wishes to engage will be the determining factor. Whether or
not an activity is acceptable should be determined by a panel or
committee of health care workers with specific expertise in infectious
diseases.

4. In the provision of medical care, if a risk of transmission of an
infectious disease from a physician to a patient exists, disclosure of
that risk to patients is not enough; patients are entitled to expect
that their physicians will not increase their exposure to the risk of
contracting an infectious disease.

5. If no risk exists, disclosure of the physician's medical condition
to his or her patients will serve no rational purpose.

Protecting Patient Privacy and Issues Related to Notification

1. Fear of stigma and discrimination is a driving force behind the
spread of HIV/AIDS. The social and economic repercussions of being
identified as infected can be devastating and can include violence,
rejection by family and community members, loss of housing and loss of
employment, to name only a few. Normalizing the presence of HIV/AIDS in society
through public education is the only way to reduce
discriminatory attitudes and practices. Until that can be universally
achieved, or a cure is developed, potentially infected individuals will refuse
testing to avoid these consequences. The result of individuals not knowing their
HIV status is not only disastrous on a personal level in terms of not receiving
treatment, but may also lead to high rates of avoidable transmission of the
disease. Fear of unauthorized disclosure of information also provides a
disincentive to participate in HIV/AIDS research and generally thwarts the
efficacy of prevention programs.

Lack of confidence in protection of personal medical information regarding HIV
status is a threat to public health globally and a core factor in the continued
spread of HIV/AIDS. At the same time, in certain circumstances, the right to
privacy must be balanced with the right of partners (sexual and injection drug)
of persons with HIV/AIDS to be informed of their potential infection. Failure to
inform partners not only violates their rights but also leads to the same health
problems of avoidable transmission and delay in treatment.

2. All standard ethical principles and duties related to confidentiality and
protection of patients' health information, as articulated in the WMA
Declaration of Lisbon on the Rights of the Patient, apply equally in the context
of HIV/AIDS. In addition, National Medical Associations and physicians should
take note of the special circumstances and obligations (outlined below)
associated with the treatment of HIV/AIDS patients.

1. National Medical Associations and physicians must, as a matter of
priority, ensure that HIV/AIDS public education, prevention and
counselling programs contain explicit information related to protection of
patient information as a matter not only of medical ethics but of their human
right to privacy.

2. Special safeguards are required when HIV/AIDS care involves a
physically dispersed care team that includes home-based service
providers, family members, counsellors, case workers or others who
require medical information to provide comprehensive care and assist in
adherence to treatment regimens. In addition to implementing protection
mechanisms regarding transfer of information, ethics training regarding patient
privacy should be given to all team members.

3. Physicians must make all efforts to convince HIV/AIDS patients to
take action to notify all partners (sexual and/or injection drug) about their
exposure and potential infection. Physicians must be competent to counsel
patients about the options for notifying partners.

These options should include:

1. notification of the partner(s) by the patient. In this case, the
patient should receive counselling regarding the information that must
be provided to the partner and strategies for delivering it with
sensitivity and in a manner that is easily understood. A timetable for
notification should be established and the physician should follow-up
with the patient to ensure that notification has occurred.

2. notification of the partner(s) by a third party. In this case, the third
party must make every effort to protect the identity of the patient.

3. When all strategies to convince the patient to take such action
have been exhausted, and if the physician knows the identity of the
patient's partner(s), the physician is compelled, either by law or by
moral obligation, to take action to notify the partner(s) of their
potential infection. Depending on the system in place, the physician
will either notify directly the person at risk or report the information to a
designated authority responsible for notification. In cases where a physician
must disclose the information regarding exposure, the physician must:

1. inform the patient of his or her intentions,
2. to the extent possible, ensure that the identity of the patient is protected,
3. take the appropriate measures to protect the safety of the patient,
especially in the case of a female patient vulnerable to domestic
violence.
4. Regardless of whether it is the patient, the physician or a third
party who undertakes notification, the person learning of his or her
potential infection should be offered support and assistance in order to access
testing and treatment.
5. National Medical Associations should develop guidelines to assist
physicians in decision-making related to notification. These guidelines should
help physicians understand the legal requirements and consequences of
notification decisions as well as the medical,
psychological, social and ethical considerations.
6. National Medical Associations should work with governments to
ensure that physicians who carry out their ethical obligation to notify
individuals at risk, and who take precautions to protect the identity of their
patient, are afforded adequate legal protection.

Medical Education

1. National Medical Associations should assist in ensuring that there
is training and education of physicians in the most current prevention
strategies and medical treatments available for all stages of HIV/AIDS,
including prevention and support.

2. National Medical Associations should insist upon, and assist with when
possible, the education of physicians in the relevant sychological, legal,
cultural and social
dimensions of HIV/AIDS.

3. National Medical Associations should fully support the efforts of physicians
wishing to concentrate their expertise in HIV/AIDS care, even where HIV/AIDS is
not recognized as an official specialty or sub-specialty within the medical
education system.

4. The WMA encourages its National Medical Associations to promote the
inclusion of designated, comprehensive courses on HIV/AIDS in
undergraduate and postgraduate medical education programs, as well as
continuing medical education.

14.10.2006

http://www.wma.net/e/policy/a25.htm

Dear All,

There will be two events in Iran in coming days related to media and
HIV/AIDS.

1- First Festival for Movies, TV and Script on AIDS which is being held  Feb
20-22, closing ceremony will be on Thursday Feb 22,14:00-18:00.

This is organized by Women's Studies & Research Institute with collaboration of
many governmental and nongovernmental organizations. UNICEF Iran GWA was a
member of jury for selecting the award winners. website: www.aidsfilm.org

2- First National Conference on Mass Media & HIV/AIDS to be held March 6-8,
closing ceremony will be on Thursday March 8, 16:00-18:00.

This is organized by AIDS Research Center and some GO and NGOs.  They will cover
TV,cinema, radio, websites and press. website: http://ircha.tums.ac.ir

Both events have technical support from UNICEF Iran and Mr Christian Salazar
Volkmann (UNICEF Representative and head of UN HIV/AIDS Thematic Group in Iran)
will address the closing ceremonies. Also Ms Mahtab Keramati (Iranian actress
and our GWA) will do so.

Sincerely

Omid Zamani MD, MPH
Program Communication Officer
UNICEF Iran
(Founder of eCommunity of HIV/AIDS activists in Iran
http://groups.yahoo.com/group/iranhivaids)
e-mail: <omid.ir@...>

Dear All,

We, the Mamata network of Positive women (MNPW), a collective of Women living
and affected by HIV/AIDS in addition with the Durbar Mahila Samannwaya
Committee,a forum of sexworkers will organize a rally on 19th February 2007 at 4
pm from College Square to
Esplanade in Kolkata, West Bengal, India, against "Anti People Patenting
Policies of Novartis". The rally is intended to end with burning of an effigy of
Dr. Daniel Vassella,  chairperson and CEO of Novertis AG. We request everybody
to support us and be a part of
this protest rally against Novartis.

Perhaps you are aware that if Novartis succeeds in patenting trivial
formulations across the board, then the price of the antiretroviral drugs like
many other drugs will be hiked enormously and we the members of the positives'
network will suffer to a great extent.

It is in this context on behalf of MNPW, I request all the Health care
professionals to boycott Novartis all over India and other affected countries.

We also appeal to all Pharmacist's and Chemist's associations to boycott all the
products of Novartis and be a
part of this movement.

In solidarity,

Ms. Mangala Pradhan
Conveynor
Mamata Network of Positive Women (MNPW)
12/5 Nilmoni Miotra Street
Kolkata 700006
Ph. 033 25306619 / 3148
Fax : 033 25437777
Email: mnpw@...
URL: www.durbar.org

The Australia-India Council (AIC)to help make cheaper version of
vital HIV test

Cavidi Exavir Load technology to cost Rs 900 compared to existing Rs
7000 version

Ravik Bhattacharya

Kolkata, February 19: A simple, cost-effective alternative technology
for testing viral load (number of virus of per ml blood) for people
living with HIV/AIDS, expected to initiate a marked change in the
treatment scenario in India, is in the offing, courtesy the Australia-
India Council (AIC).

The method, based on "Cavidi Exavir Load technology", already tested
in Australia, will be developed in the government sector in Hyderabad
in a joint venture between CII, NACO and AIC.

The initiative is aimed at providing cheap and easy viral load
testing compared to prevalent Polymerised Chain Reaction (PCR)-based
tests, which are very costly and currently available only at the
National AIDS Research Institute, Pune.

The new technology will cost around Rs 900 per patient per test,
compared to the PCR-based tests which cost around Rs 3,000 to 7,000
per patient.

The viral load testing is necessary to know if the condition of the
patient is worsening so anti-retroviral medicines can be prescribed.
Currently, the prescription is made according to the physical
condition of the patient. But that leaves room for error and is
liable to make the patient ART resistant.Such HIV positives then have
to go for second line drugs which are costly and toxic.

The project is among the initiatives by the Indo-Australian joint
venture in combating HIV/AIDS in India. The AIC is interested in
introducing the system in West Bengal.

"Viral load testing facilities are not available for common people
here. The only technology -- PCR based -- is available at a very high
cost and that too is rare in the government sector. We have been
working with NACO and are introducing Cavidi Exavir load testing
technology, which is five times cheaper than other tests and apt for
resource-constraint settings," said Professor Suzanne Crowe, board
member, AIC, and head of AIDS Pathogenesis and Clinical Research
Programme, Macfarlane Burnet Institute for Medical Research and
Public Health, Australia.

"Andhra Pradesh has shown interest and soon we will set up a
laboratory facility in Hyderabad. We are eager to introduce the
system in West Bengal," said Crowe who was present at an interactive
session in the CII's eastern region headquarters in Kolkata.

"We are training doctors and laboratory technicians in the country in
proper diagnosis methods and procedures for giving ART medicines to
HIV positive patients," she said.

The Centre has begun free distribution of the medicines to seven
states, but lack of infrastructural facilities are hampering the
programmes. Alleging that the Indian government was initially slow in
responding to the AIDS menace, she said currently there is a
turnaround in prevention and care in the country.

"The situation in India will be worse by 2010, if the government
fails to take action," she added.

http://cities.expressindia.com/fullstory.php?newsid=223207

AIDS ASIA e FORUM subscriber survey: Questionnaire (02/07)
http://health.groups.yahoo.com/group/AIDS_ASIA/

With more than 7, 500 subscribers AIDS ASIA e FORUM is one of the
largest e FORUM for information and communication on HIV and AIDS in
ASIA Pacific region

Few days ago you must have received an announcement about this survey
on the AIDS-ASIA e FOURUM. This survey is an evaluation of the
effectiveness of a peer to peer, HIV/AIDS related electronic
discussion group. We are interested in finding out how to make this
FOURM more useful to you and your work. We would appreciate, greatly
if you could help us by taking a few minutes to answer this short
survey. Your valuable feedback will assist us to meet your needs
better and to improve this service in support of AIDS prevention and
care initiatives in Asia Pacific region.

This is a voluntary survey, and confidentiality of your identity will
be respected. The results of this study will be posted on the FORUM.

There are twenty one questions in this questionnaire. Please answer
to all questions and reply by e-mail before March 30th, 2007 to
joe_thomas123@...

Please contact me if you have any further questions about this survey.

Thank you for your attention

Joe Thomas
Editor, AIDS ASIA e FORUM
http://health.groups.yahoo.com/group/AIDS_ASIA/
______________________________________

INSTRUCTIONS

First hit "Reply" to this email message. Then simply type an 'X'
where appropriate. When you have answered all the questions,
press "send" to send the email message.


Q. 1 what is your profession? (Type an X between the brackets
preceding your choice. Select only one choice)

      [  ] Student
      [  ] Government/ Civil Service
      [  ] Researcher/ Academic
      [  ] Social Worker/ Counsellor
      [  ] Staff of AIDS Service agency
      [  ] PLWHA/ PLWHA activist
      [  ] Other (please explain) [               ]



Q. 2 Affiliation/Institution: (Type an X between the brackets
preceding your choice. Select only one choice)

      [  ] AIDS service agency (International)
      [  ] AIDS service agency (National)
      [  ] University/ research institution
      [  ] PLWHA organization
      [  ] Bilateral agency (Eg. AusAID, Dfid, USAID)
      [  ] Multi lateral agency (UN/ World Bank)
      [  ] Hospital/ clinic (Health care worker)
      [  ] Government employee
      [  ] Human rights/ Development agency
      [  ] Funding/ Donor agency
      [  ] Other (Please specify) [                     ]

Q. 3 (Type your answer between the brackets.  Don't worry about extra
spaces at the end of your response).

      1) Country           [        ]
      2) State                [        ]
      2) District (City)  [        ]
      3) PIN/ZIP/POST CODE [        ]

Q. 4 Gender (Type an X between the brackets of your choice. Select
only one choice)

      [  ] Female
      [  ] Male
      [  ] Transgender

Q. 5 what age bracket do you belong to? (Type an X between the
brackets of your choice. Select only one choice.)

      [  ] Less than 20
      [  ] 20- 29
      [  ] 30- 39
      [  ] 40- 49
      [  ] 50- 59
      [  ] 60 +


Q. 6 How would you rate the overall value of AIDS ASIA e FORUM as a
regular source of AIDS related information?  (Type an X between the
brackets of your choice. Select only one choice.)

      [  ] Excellent
      [  ] Good
      [  ] Adequate
      [  ] Poor


Q. 7 How many of the AIDS ASIA e forum messages do you read
weekly?.     (Type an X between the brackets of your choice. Select
only one choice).

      [  ] All or almost all (75-100%)
      [  ] Many (50-75%)
      [  ]  Some (25-50%)
      [  ] A few (10-25%)
      [  ] Very little (less than 10%)


Q. 8 How frequently do you participate in discussion on AIDS ASIA e
FORUM? (Type an X between the brackets of your choice. Select only
one choice.)

      [   ]   Weekly
      [   ] Fortnightly
      [   ] Once a month
      [   ] Once in three months
      [   ] Once in six months
      [   ] Never


Q. 9 What are your reasons for not participating in discussions on
the FORUM?  (Type an X between the brackets of your choice you wish
to select.  Choose All that is Applicable).

      [  ] Too much information
      [  ] Prohibitive cost and expenses of the internet
      [  ] My agency prohibits posting messages on the e FORUMS
      [  ] Do not have regular access to internet connection
      [  ] No time/too busy
      [  ] Am happy just to read the discussions
      [  ] Not confident in English
      [  ] Don't know how to submit messages
      [  ] Reluctant to give opinions in public
      [  ] Other, specify [                                   ]


Q. 10 what type of messages do you find most useful? (Type an X
between the brackets of your choice you wish to select. Choose all
that is Applicable).

      [  ] Discussion of specific topics by other subscribers
      [  ] Announcements of conferences, scholarships,  web sites, job
vacancies, etc.
      [  ] Journal articles, book references
      [  ] Conference coverage
      [  ] Project reports, lessons learned, best practices
      [  ] Links to resources on the Internet
      [  ] Cross postings from other lists
      [  ] Requests for information (RFI)
      [  ] Other, please specify [                        ]


Q. 11  In which ways do you use the information from the AIDS ASIA  e
FORUM in your work? (Type an X between the brackets preceding each
choice you wish to select. Choose All That Apply).

      [  ] To increase current knowledge and awareness about HIV/AIDS
      [  ] Program development/ Policy development
      [  ] Clinical management
      [  ] Teaching, research
      [  ] Share information with my colleagues
      [  ] Networking
      [  ] Print messages and keep these in the resource centre
      [  ] Other, specify [              ]


Q. 12 Can you give an example of how the AIDS ASIA e FORUM has been
helpful to you in your work?    (Please type your answer between the
brackets, using as much space as necessary.  Do not worry about extra
spaces at the end of your response.)

      [                                                ]


Q. 13  In the last one month have you done any of the following after
having seen/read on the AIDS ASIA  e FORUM. (Type an X between the
brackets of your choice you wish to select. Choose all that is
Applicable).

[  ] Not Applicable
[  ] Visited a website of a project
[  ] Down loaded a publication or online resource
[  ] Requested for more information
[  ] Registered for an event (training, workshop, meeting)
[  ] Contacted other people/organization whom I have never contacted
before
[  ] Responded to an advocacy call for action
[  ] Other (Please specify)


Q. 14 How many other HIV/AIDS related discussion groups do you
subscribe to? (Type an X between the brackets of your choice. Select
only one choice).

    [  ] Member of only this FORUM
    [  ] 1-5 Forums
    [  ] 6-10 Forums
    [  ] More than 11 FORUMS

Q. 15. What is the most important benefit you had by being on this
FORUM? (Type an X between the brackets of your choice you wish to
select. Choose all that is Applicable)

[  ] Got my current job
[  ] Attended a conference
[  ] Received a scholarship
[  ] Beneficial information about grants/funds
[  ] More aware of the HIV/AIDS policies
[  ] Extended my friendship/contact net work
[  ] Other benefits (please list)


Q. 16 where do you usually access your e-mails from? (Type an X
between the brackets preceding your choice. Select only one choice.)

      [  ] From my office/ Work Place
      [  ] From my home
      [  ] Internet Café
      [  ] From my home and office


Q. 17. How frequently do you check your e-mails? (Type an X between
the brackets of your choice. Select only one choice).

      [  ] Daily
      [  ] 2-3 times in a week
      [  ]  Once in a week
      [  ] Few times in a month


Q. 18. How would you assess the quantity/Number of the messages
posted on the FORUM? (Type an X between the brackets preceding your
choice. Select only one choice.)

      [  ] Too many messages are posted daily
      [  ] 4 - 5 messages posted daily is fine with me
      [  ] Post more the 5 messages in a day
      [  ]  Reduce the postings to 2-3 messages


Q. 19. What type of network access do you have?  (Type an X between
the brackets of your choice. Select only one choice).

    [  ] Direct dial up net work (Slow connection)
    [  ] Direct broad band connection (ADSL, Cable, ISDN) (Faster
connection)
    [  ] Part of a LAN. (My computer is linked to an office computer
network)
    [  ] Don't know


Q. 20 please share your suggestions to improve the contents of AIDS
ASIA e FORUM. (Type your answer between the brackets, using as much
space as necessary.  Don't worry about extra spaces at the end of
your response.)

      [                            ]

Q. 21 Any other comments about the Forum?

      [                            ]

Thank you for your feedback.

Please e-mail the filled questionnaire to <joe_thomas123@...>

Indonesia's AIDS epidemic among the fastest growing in Asia

JAKARTA (AP): Indonesia's AIDS epidemic is among the fastest growing
in Asia, especially among intravenous drug users and commercial sex
workers, and half of new infections have been found in the
easternmost Papua province, the World Health Organization said.

"Indonesia is facing a huge threat," Bjorn Melgaard, WHO's senior
health consultant, said Saturday after an independent review team
spent nearly two weeks surveying efforts to fight theAIDS virus in
several provinces across the sprawling archipelago.

The team found that the government has put in place good strategies
and intervention programs to handle the epidemic, but more needs to
be done on a local level to secure long-term funding to fight the
spread of HIV, the virus that causes AIDS, and to improve access to
condoms, testing and counseling.

Surveillance of sexually transmitted disease also needs to be stepped
up, the team found.

There were 2,873 new AIDS cases in Indonesia in 2006, a 140 percent
increase from 1,195 in 2004, with most cases found in intravenous
drug users and commercial sex workers, the team said.

Papua, the country's most remote province geographically and
politically, had by far the largest population of people living with
the AIDS virus, accounting for 20 times the national average- around
50 percent of the country's total number of cases.

"More than 2 percent of the population in Papua were infected with
HIV/AIDS," the report said, adding that health centers in the
province must work especially hard to strengthen programs to prevent
mothers from spreading the virus to their children.

WHO warned late last year that Indonesia showed a trend that its AIDS
epidemic was still not under control, compared to neighboring
Thailand and Cambodia, where rates of infection appear to stabilizing.

"Its HIV/AIDS epidemic is among the fastest growing in Asia,"
Melgaard said.

HIV has infected an estimated 169,000 to 216,000 in the nation of 220
million. (***)

http://www.thejakartapost.com/detailtoplatest.asp?
fileid=20070218150244&irec=0

UNSAFE FIENNES DUBBED 'AIDS HYPOCRITE'

RALPH FIENNES has been dubbed a hypocrite by the air hostess he had
unprotected sex with, hours before giving a lecture in India about the
dangers of HIV and Aids.

The actor and UNICEF ambassador didn't wear a condom when he romped
with Qantas cabin crew member LISA ROBERTSON during a flight from
Darwin, Australia to Mumbai - ahead of a trip to AIDS-ravaged villages
in rural India.

Robertson says, "He didn't' wear a condom. Looking back it was
dangerous behaviour - and pretty hypocritical given that he was going
to India to talk about Aids. "But at the time I didn't care. As we were
going at it he joked, 'Are you promiscuous.'"

http://www.contactmusic.com/news.nsf/article/unsafe%20fiennes%20dubbed%
20aids%20hypocrite_1022477

New HIV/AIDS cases in Japan reach record high

The number of people newly diagnosed with HIV and those who developed
AIDS in Japan in 2006 reached record highs of 914 and 390,
respectively, according to preliminary data released Wednesday by the
Japanese AIDS Surveillance Committee, the Kyodo/Yahoo! Asia News
reports (Kyodo/Yahoo! Asia News, 2/7).

According to the committee's report, the most significant increase in
new HIV cases occurred among men who have sex with men, and 15 times
more men than women reported a new HIV-positive diagnosis in 2006
(AFP/Nation, 2/8).

In addition, an increasing number of people ages 30 and older became
HIV-positive in 2006 compared with 2005, the report found.

It also shows a nearly 10% increase in new HIV cases from 2005 to
2006 and a 6.3% increase for those who developed AIDS during the same
time period, the AP/Forbes reports (AP/Forbes, 2/7).

Revised data from 2005 indicate that 832 new HIV cases and 385 AIDS
cases were reported that year (Kyodo/ Yahoo! Asia News, 2/7).

In addition, the report found that the number of people in Japan
receiving no-cost HIV tests increased by 16.2% in 2006, suggesting
that HIV/AIDS awareness in the country is increasing, according to
AFP/Nation (AFP/Nation, 2/8).

"While the number of people getting checks is growing, we believe
infections themselves are on the increase," Aikichi Iwamoto,
committee chair and a professor at the University of Tokyo's
Institute of Medical Science, said, adding, "Given most were infected
through sexual contacts, we hope people will understand that HIV is
increasingly common, take preventive measures and get examined early
if they are worried about anything."

This was the third consecutive year that HIV/AIDS cases in Japan
totaled more than 1,000 and reached record highs, the Kyodo/Yahoo!
Asia News reports (Kyodo/Yahoo! Asia News, 2/7).

http://www.news-medical.net/?id=21868

HIV Spreading Rapidly in Malaysia

HIV infections in Malaysia could surge to 300,000 by 2015, senior
health official says

KUALA LUMPUR, Malaysia, Feb. 11, 2007

(AP) The number of HIV infections in Malaysia could surge by more
than fourfold to 300,000 by 2015 as the virus spreads rapidly from
high-risk groups to the general public, a senior health official
warned Sunday.

Other than drug addicts, official statistics indicate the HIV virus
that causes AIDS is spreading quickly to women, fishermen, lorry
drivers and factory workers, said Ramlee Rahmat, deputy director-
general of public health.

Some 73,000 Malaysians have been infected with HIV, of which 75
percent are intravenous drug users and 7 percent are women, he said.

"Based on the trend that we are seeing, HIV infections can escalate
to 300,000 cases by 2015 if we do not do anything," Ramlee said.

The government has taken aggressive steps to fight HIV transmission
under a five-year national strategic plan launched in 2006, he said.

This include drug substitution therapy and needle exchange programs
for drug addicts, and providing free antiretroviral drugs at
government clinics especially for women and children.

"We have put up intervention measures. We are taking this very
seriously. If we carry out our plans effectively and the public
cooperates with us, we will be successful in curbing the spread of
the disease," he added.

UNAIDS has last year said Malaysia was among several Asia-Pacific
countries that risked an HIV epidemic among drug users unless the
government took the problem more seriously.

Three people die from AIDS-related illness every day in Malaysia, the
Health Ministry has said. It warned last year that the spread of AIDS
could wipe out Malaysia's development made over the last 50 years and
devastate the economy.

http://www.cbsnews.com/stories/2007/02/11/ap/health/mainD8N7BCEO3.shtm
l

Announcement

Universal access to HIV prevention, treatment care and support for
Women and Children. A National consultation.
(March 7th and 8th 2007: New Delhi)

`India, along with other Member States adopted the Declaration of
Commitment on HIV/AIDS, in the United Nations General Assembly
Special Session (UNGASS) on HIV/AIDS in June 2006. The Declaration of
Commitment reflects global consensus on a comprehensive framework to
achieve the Millennium Development Goal of halting and beginning to
reverse the HIV/AIDS epidemic by 2015'.

The call for scaling up efforts to provide universal access to
prevention, treatment and care has gathered momentum ever since.
However, there is a need for greater focus on scaling up of efforts
to provide universal access to prevention, treatment, and care for
Women and Children.

It is essential to initiate an urgent national dialogue among key
stake holders on universal access to HIV prevention, treatment care
and support and particularly on setting up targets for ARV coverage
for women and children, 1st and 2nd line, between now and 2010. And
universal means 85-100% coverage.

In response to this need, MAITRI along with several other key
stakeholders are proposing to hold a national consultation on the
International Women's Day to bring focused attention to this issue.
The objectives of the consultation are;

• To review the progress of scaling up universal access to HIV
prevention, treatment and care for Women and Children.

• To identify the barriers of scaling up universal access to
HIV prevention, treatment and care for Women and Children.

• To develop a national advocacy strategy to enhance scaling up
universal access to HIV prevention, treatment and care for Women and
Children.

• To set targets for scaling up universal access to HIV
prevention, treatment and care for Women and Children

Some of the specific Issues to be addressed are;

1. Scaling up universal access is slow
2. Enhancing Community-based initiatives for universal access
3. Gaining Political support for universal access.
4. Financial support and deployment.
5. Addressing Technical problems.
6. Addressing Logistics support needs.
7. Legal, economic and social issues remain significant barriers.
8. Equity considerations
9. Prevention of Mother to Child Transmission (PMCT)
10. Post Exposure Prophylaxis (PEP)
11. Universal access to women and families of Uniformed Services
12. Universal access to Children infected and affected by HIV
and AIDS

MAITRI is an NGO, which endeavours to address the causes and
consequences of HIV and AIDS, with a particular focus on uniformed
personnel, women and children, ex-servicemen and aspirants to the
uniformed services, and has a geographical focus on the Northeast
region.

Several key stake holders have already expressed their support and
intention to participate in this crucial consultation.

A detailed list of partners, collaborators and sponsors will be
announced soon.

Representing some of the key stake holders, a preliminary working
committee has been established to develop a broad based coalition to
host this consultation.

We would like to invite Expressions of Interest to collaborate,
attend, present papers during the course of the 2-day conference.

Please do reach us in case of any questions / clarifications that you
require.

Thanking you,

With Best Regards.

Sonal Singh Wadhwa
For the Organizing committee
e-mail: < universal.access2007@...>

Geneva – The Board of the Global Fund has chosen Michel Kazatchkine,
a physician and global health expert, as the next Executive Director
of the Global Fund. He replaces Sir Richard Feachem, the founding
Executive Director, who steps down at the end of his five-year term
on March 31.

Professor Kazatchkine is a physician who has treated people with AIDS
for more than 20 years and led the world's second-largest AIDS
research agency.  He currently serves as France's Ambassador for
HIV/AIDS and Communicable Diseases. Professor Kazatchkine is a former
Vice Chair of the Global Fund Board and first Chair of the Global
Fund's Technical Review Panel, which assesses the quality of grant
proposals.

"The Vice Chair of the Board, Dr Lieve Fransen , and I are very
pleased to welcome Professor Kazatchkine, an accomplished Global
Health specialist, as the new Executive Director-designate of the
Global Fund," said Dr Carol Jacobs Chair of the Board of the Global
Fund. "This is a new period in the life of the Global Fund and we are
indeed fortunate to have Professor Kazatchkine lead the Secretariat
at the start of the Fund's second five year cycle.  He has a right
blend of skills and experience needed to manage this unique financial
institution".

"I am delighted by the choice of Michel Kazatchkine as my successor,"
said Professor Richard Feachem.  "I look forward to handing over a
strong institution that is positively impacting tens of millions of
lives in 136 countries.  Under Dr Kazatchkine's leadership the Global
Fund is in excellent hands and its life saving work will continue to
expand."

In just five years, the Global Fund has become a leading force in the
fight against the three diseases.  It provides two-thirds of
international funding for the fight against malaria and TB, and 20
percent of the global funding to fight AIDS.  With 450 programs in
136 countries Professor Kazatchkine will lead the largest
international financier of TB and malaria programs and one of the
three largest funders of HIV/AIDS programs in the world.

The Global Fund has approved grants for 450 programs in 136 countries
with a total commitment of US$ 7 billion. As of December 2006,
770,000 people have begun antiretroviral (ARV) treatment through
Global Fund-supported programs and nearly 18 million insecticide-
treated bed nets have been distributed to prevent malaria. In
addition, tuberculosis programs have detected and treated 2 million
TB cases under DOTS, the internationally-approved TB control strategy.

Further information, please contact:

Jon Lidén – Head of Communications (The Global Fund)
Office: +41 22 791 17 23
Mobile: + 41 79 244 60 06
jon.liden@...

Information on the work of the Global Fund is available at:
www.theglobalfund.org and on www.jointheglobalfund.org

First national AIDS policy draft approved

ISLAMABAD: The Health Ministry approved on Friday the first ever
National HIV/AIDS Policy draft to provide and maintain prevention and
care services in the country.

The draft, prepared by the National AIDS Control Programme (NACP)
with support from the World Health Organisation (WHO), will soon be
sent to the cabinet for final approval. The draft was approved after
comprehensive discussions in a meeting held here today under the
chairmanship of Health Secretary Syed Anwar Mahmood.

According to the draft, the national response to HIV will be guided
and coordinated by a single, multi-sectoral coordinating body called
the National HIV and AIDS Council. The council will be made up of
representatives from national and provincial governments, people
suffering from HIV, civil society and religious groups and the
private sector. This will ensure that international assistance for
HIV/AIDS is coordinated and in line with Pakistan's priorities, and
that reporting methods are efficient and streamlined. The existing
Technical Advisory Committee on AIDS (TACA) will provide technical
support for the body while the provincial governments will be
encouraged to establish similar mechanisms at a provincial level.
Media will be encouraged to play a constructive role by distributing
accurate information and decreasing HIV-related stigma and
discrimination.

The draft will amend anti-discrimination laws and make it illegal to
discriminate against people with HIV/AIDS. Similarly, existing laws
and policies will be reviewed to assure they do not increase HIV
vulnerability and risk. The promotion and sale of unproven HIV/AIDS
cures will also be punishable by law. The draft will ensure that
HIV/AIDS affected people have the same access to health services as
other citizens of the country.

Public and private blood supplies will also be secured to prevent
transmission of HIV and other blood-borne diseases. The primary focus
of the HIV prevention efforts will be on reducing HIV infections
among the most vulnerable, including drug users, migrant workers,
sexual partners, individuals who engage in risky sexual behavior,
long distance truck drivers and the spouses and children of these
people.

National AIDS Control Programme Manager Dr Asma Bokhari presented the
salient features of the policy in the meeting, which was attended by
Health Director General Maj Gen (r) Shahida Malik, Finance and
Development Senior Joint Secretary Saira Karim and representatives
from various ministries. app

http://www.dailytimes.com.pk/default.asp?page=2007%5C02%5C03%
5Cstory_3-2-2007_pg11_3

Bangladesh: Young clients of sex workers

A study was conducted among young clients who visited hotels in Dhaka city to
buy sex from female sex workers (FSWs), to generate knowledge on risk behaviour
and practices.

THE ISSUE
Adolescents and youth (aged 15-24 years) constitute one-third of the total
population of Bangladesh (43/129.2 million), and many are sexually active and at
risk of contracting STIs and HIV/AIDS. Studies have shown prevalence of sexual
risk behaviours, and premarital and extramarital sex is common. There is limited
data however on the youth who are involved in risky sexual behaviour:
information on sexual risk behaviour and practices, condom use, STI symptoms and
the STI disease burden are essential for designing successful HIV intervention
programmes.

THE RESEARCH
A total of 1013 youth (aged 15 to 24 years) visiting hotels to buy sex were
enrolled in the study between September 2005 and February 2006. The study was
conducted in 9 hotels (6 hotels with HIV intervention programmes and 3 hotels
without such a programme) in Dhaka, Bangladesh, using both qualitative and
quantitative methods. Eighty per cent of the sample was from intervention hotels
and twenty percent from non-intervention hotels. A sub-sample of 53 young
clients was purposively selected for in-depth interviews and 5 young clients and
hotel staff were selected for key informant interviews.

THE RESULTS
Sexual risk behaviour and practices:
Among the enrolled youth around two thirds were aged 21 years or more, one sixth
were married and around two thirds had high school or college education (12
years of completed school). Approximately half of them had their first sexual
exposure before the age of 18. Qualitative data shows that some of the clients
started sexual relations as early as 11-14 years of age. FSWs were the single
most common sex partners in such exposures. More than 80% of the respondents
reported that their first sexual exposure was influenced by peers/friends and
peers/friends accompanied them in such exposures. Approximately one third
reported buying oral sex along with vaginal sex and 10% reported buying anal sex
along with vaginal sex. More than one third of the respondents reported having
had group sex with FSWs.

Condom use:
Around 18% of the young people reported that they had never used a condom and
15% reported that they always used condoms. Condom use was around 60% in the
prior 5 sexual episodes with FSWs. Ninety percent of the young people in
intervention hotels reported having received condoms from the hotels (compared
to around 80% in non-intervention hotels). Around 20% of the young people in the
survey and in-depth interviews reported having a non-commercial female sex
partner, and almost all survey respondents reported having sex with
non-commercial partners during the last year. Both qualitative and quantitative
data shows that ‘last-time condom use’ with a non-commercial sex partner was
only 20%. More than half of the youth thought that it gives less satisfaction.
In-depth interviews explored factors linked to the likelihood of condom use,
like the trust of a sex partner, cleanliness, status, and negotiation skills.

HIV/AIDS knowledge:
The most common mode of transmission of HIV/AIDS cited by the respondents was
‘sex without a condom’ (52.2%) but only 1.5% could name ‘unprotected sex
with HIV-infected person’ as another mode of transmission. One quarter of the
youth couldn’t name any route of HIV/AIDS transmission and had no HIV
prevention knowledge. Using condoms during sex was the most cited way (59.6%) of
preventing HIV/AIDS infection. Both the survey and in-depth interview data
showed prevalent misconceptions amongst young clients:
• more than one-third believed HIV can be spread by coughing or sneezing,
• 72% believed HIV can be spread through sharing food or water, and
• 79% believed washing his/her genitals after sex could prevent HIV
transmission.

More than half of the respondents had not heard about STIs and only one-third
could name the most common, syphilis. Sex without condoms was the most
frequently cited mode of STI transmission (40.5%), however around 35% of
respondents could not name any mode. Condom use was the most cited way to
prevent STIs (48.7%). More than one-third of youth clients did not know any
means of STI prevention and 80% had no knowledge about male STI symptoms.

STI disease burden:
Twenty percent of the youth reported symptoms suggestive of STI in the last year
and of these, more than half did not seek any health care. Of those who did seek
care, only 15.3% had visited a doctor and 3.7% had visited a hospital/clinic.
Laboratory testing found more than 10% of surveyed youth had at least one STI.

Risk perception:
Around 60% and 65% of the respondents reported that they perceived risk for STI
and HIV infection respectively. However, the basis for such risk assessment was
not due to irregular condom use but perceived risk of visiting sex workers.

Pornography:
Almost all youth reported exposure to pornography, with more than 98% reporting
such exposure in the last six months. In-depth interviews revealed that after
watching pornographic films many respondents were heavily influenced to visit
sex workers. Friends were the main source of pornographic materials, and more
than 85% of respondents reported that they had learned about oral and anal sex
through pornography. Qualitative data showed that types of sex act and sexual
preferences were often linked with respondents’ perceived beliefs about mode
of transmission of sexual infections.

Visiting hotel sex workers:
Qualitative data highlighted some reasons for visiting FSWs. Some youth believed
that wet dreams and masturbation were harmful to health and were influenced by
peers to have regular sex to control them. Others reported that they had first
visited FSWs to prove their masculinity, but then became habituated. Married
respondents mentioned that they visited FSWs as a result of living apart from
their wives, marital disharmony, or dissatisfaction in their sexual
relationship.

THE KEY MESSAGES
Clients have been identified as bridging population for the HIV/AIDS epidemic
Bangladesh. Around half of them visit FSWs at least once in a month. They have
high rates of STI and low STI care-seeking behaviour. Although they have
knowledge about HIV/AIDS, their condom use is low. Youth friendly health
services need to be strengthened to offer STI management and STI/HIV counselling
services targeted to youth. Appropriate strategies for intervention among young
clients of sex workers need to be implemented. Different strategies targeting
both female sex workers and clients need to be tested. For these types of
combined strategies, the involvement of gatekeepers (particularly hotel
management) is essential.

The study was conducted by ICDDR,B as part of a collaborative project between
the National AIDS/STD Programme (Ministry of Health & Family Welfare) and Save
the Children USA, preventing HIV/AIDS in young people in Bangladesh, and funded
by GFATM. We gratefully acknowledge their support.

For further information,

ICDDR,B www.icddrb.org
GFATM Bangladesh www.bdnasp.net/gfatm_project.htm
National AIDS/STD Programme (Bangladesh) www.bdnasp.net


Jo Grzelinska
Communications, ICDDR,B
www.icddrb.org
e-mail: <jo_grzelinska@...>

Letter to Dr. Chan at WHO on Thai Compulsory Licenses


We would like to get as many sign-ons to this letter as soon as
possible so we can get it to WHO by the end of the week at the
latest.

Please email gregg.gonsalves@... or ocouzin@... with
your endorsement (please provide name, organization, country) by
WEDNESDAY, 7 FEBRUARY.


Margaret Chan
Director General, World Health Organization

Dear Dr. Chan, 5 February 2007

We represent people living with HIV/AIDS and their advocates around
the world who are fighting for access to affordable treatment for
HIV. We are extremely disappointed by your recent comments to the
Royal Thai Government, regarding compulsory licensing, that you
feel "we have to find a right balance for compulsory licensing. We
can't be naive about this. There is no perfect solution for accessing
drugs in both quality and quantity" (Bangkok Post, 2 February
2007, "WHO raps compulsory licensing plan Govt urged to seek talks
with drug firms").

We are writing to request that you reconsider your comments regarding
the Thai government's decision to issue a compulsory license for the
production or importation of three drugs, two for treating HIV/AIDS.
You have been entrusted, in your position as director general of WHO,
to work for "the attainment by all peoples of the highest possible
level of health." We believe that your comments last week do not
reflect this mission, and in fact work against it.

We expected that you would have congratulated Thailand for its
efforts, completely legal under WTO rules, to increase public health
and access to medicines for its people.

As you know, TRIPS grants the right to countries to act in the
interests of public health and override the monopoly power that a
patent grants a company. As reaffirmed in the Declaration on the
TRIPS Agreement and Public Health, each WTO member "has the right to
grant compulsory licences and the freedom to determine the grounds
upon which such licences are granted" (Article 5(b)). Also, according
to the TRIPS agreement Article 31(b), as well as Thai law, a
compulsory license for government use does not require prior
negotiation with the patent-holder.

You mention finding a "balance" issuing compulsory licenses. While
this may sound reasonable on the surface, surely you are aware that
the pharmaceutical companies have time and again shown that they are
only committed to maximizing their own profits. In the case of
Kaletra, one of the three drugs for which Thai authorities issued a
compulsory license, Abbott (which produces Kaletra) pursues a deeply
cynical and profiteering marketing strategy within the US that was
recently revealed by internal company memos (see Wall Street Journal,
3 January 2007, "Inside Abbott's tactics to protect AIDS drug"). In
July 2006, Abbott announced a new "discounted" price for Kaletra in
developing countries such as Thailand , but the price (US$2200/year/
person) still includes more than 300% profit margin and would create
undue financial burdens on the Thai government's universal treatment
program, making this program financially unsustainable.

Your predecessor at the WHO, Dr Lee Jong-wook, led a bold and
courageous campaign to treat 3 million people with HIV/AIDS by 2005.
Though the campaign failed to reach this goal, it proved to the world
that effective AIDS treatment can be provided in the developing
world, and helped create the momentum to produce affordable generic
medicines to carry out that treatment. These generic medicines are
today keeping millions of people alive, and providing hope to
millions more. We need you, as a world leader in public health, to
take the lead and keep the spirit of Dr Lee's initiative alive by
supporting all possible efforts to provide more affordable and
effective treatment to people living with HIV/AIDS in developing
countries, especially the promotion of generic competition, which has
proven over and over to be the most important factor in decreasing
the cost of medicines. The Thai government's actions are keeping Dr.
Lee's initiative alive. We urge you to use your position to support
the health of all people living with HIV/AIDS by publicly endorsing
the Thai compulsory licenses rather than criticizing the legal
actions of a sovereign nation.

Best Regards,

The International Treatment Preparedness Coalition and its members:

Cc:
Country Representatives, WHO National Offices
Peter Piot, UNAIDS
Kevin DeCock, WHO HIV/AIDS Director

AIDS ASIA eFORUM Subscriber Survey (2007) Alert

Dear FORUM Subscribers,

This posting is to alert you to the forthcoming, subscriber survey of
AIDS ASIA eFORUM.

AIDS ASIA e FORUM has emerged as an effective knowledge management,
peer to peer information, communication and networking tool among key
HIV/AIDS stake holders, reducing the digital divide and contributing
to the much needed social capital for HIV response in Asia Pacific
region.

This eFORUM is being run on a voluntary basis for the last four
years.  Currently we have more than 7,500 subscribers.

As part of our efforts to maintain this FORUM relevant to the
information and communication needs of the participants, we are
carrying out a subscriber experience survey during the month of Feb-
March 2007.

The AIDS ASIA eFORUM Subscribers survey is being carried out to make
sure that we are providing you with useful information each day and
to learn form your experience in using this FORUM. You will receive a
survey questionnaire and the instructions on how to answer the
questions by next week and we will send a reminder a week after. We
will not contact you further on this survey.

The survey may take about 15 minutes to complete and it is voluntary.
Confidentiality of your response will be respected. When you receive
the questionnaire please take a few moments to share your thoughts on
how well the AIDS ASIA e FORUM meets your information needs, and how
we can improve on coverage of news, information, and events related
to HIV and AIDS  related issues in Asia Pacific region.

The summary results of the survey will be posted on the FORUM. If you
need further information please feel free to contact me by e-mail:

Thank you for being with AIDS ASIA eFORUM

Joe Thomas

Editor
AIDS ASIA eFORUM
http://health.groups.yahoo.com/group/AIDS_ASIA/
e-mail: joe_thomas123@...

HIV/AIDS Situation  in Bangladesh

Having 140 million populations, the reported cases of HIV/AIDS in Bangladesh is
very low in comparison to other neighboring countries.

But many risk factors like, high prevalence of HIV in the neighboring countries,
increased population movement both internal and external, lack of awareness of
HIV infection, existence of commercial sex and MSM with multiple clients, high
prevalence of STIs amongst the commercial sex workers, spread of HIV through
bridging population (transport workers, drug users),the trend of rise of HIV
among (lDUs) injecting drug users (7% in central Bangladesh- BSS-7), low condom
use and lack of voluntary blood donation make Bangladesh vulnerable to HIV
infection. At the same time factors like religious and cultural values, family
bondage which help Bangladesh to remain a low prevalent country for HIV. A
cumulative total of 874 cases of HIV/AIDS have been confirmed and reported as of
1st December 2006.

Since the first detection of HIV in Bangladesh in  1989, the rate of infection
has not been increased in comparison to our neighbors. A total of 240 AIDS cases
were detected so far of which 109 have already died. However the estimate of
HIV/AIDS remains at 7500 as of 2004.

Although Bangladesh is still a low prevalence country for overall HIV rates
(less than 1%) but it is clear that this situation may not continue if the risky
behavior that increases vulnerability is not reduced among the high-risk group,
vulnerable group and also among general population. Needle sharing among drug
users occurs at alarmingly high rates (77%) in Central region.  HIV infection
rate among IDUs poses serious risk as this group is categorized as bridging
group and may expand the epidemic rapidly to general population. Several
vulnerable factors like unfavorable social, economic and geographical
conditions, open borders, vulnerable groups like Female Commercial Sex Workers
(CSWs), their clients and men having sex with men (MSMs) are widely engaged in
unsafe sexual behavior. Data from the last round of the National Serological and
Behavioral Surveillance in 2004/05 show the prevalence in most sentinel
populations to be less than 1%, they also point to a rise to
  4.9% among IDUs in Central Bangladesh, up from 1.4% in 2000, 1.7% in 2001 and
4% in 2002/03.

Indeed, there is a host of factors that render the country highly vulnerable to
a surge in the epidemic.  These include the overall poverty levels, the
documented risk behaviors including injecting drug use, growing sex work,
considerable population movements in and out of the country, persisting gender
disparities and inequities, not to mention low levels of general awareness and
knowledge about HIV/AIDS among the population in general and, critically, among
those who are most vulnerable and/ or engaging in risk behaviors. There is also
a relative lack of availability and access to relevant services (sexual and
reproductive health, HIV counseling and testing).  There is also
HIV/AIDS-related stigma and discrimination prevalent in the society.

Now under the HAPP 98 safe blood transfusion centers are screening the blood for
HIV and 5 other diseases. The screening kits for HIV, viral hepatitis B, C,
Malaria and syphilis have procured and distributed to 98 centers through HAPP.
The service will be expanded as the unscreened transfusion risking the
recipients/patients.

Pregnant mothers are the most vulnerable groups to be affected due to huge
consumption of blood during childbirth threatening the future generation. 
Victims of road traffic accidents are also at risk.

Bangladesh is therefore geographically vulnerable to HIV and AIDS, and at risk
due to the prevalence of high-risk behaviors like injecting drug use, commercial
unprotected sex with an overlap between more vulnerable and bridging
populations, and high rates of sexually transmitted infections (STIs). There are
also low levels of HIV and AIDS awareness; migration and trafficking; poverty
gaps; low nutritional status; gender inequalities that place women and young
girls at risk; and gaps in the healthcare delivery system.


Rehan Raju
e-mail: <rehanraju@...>

'AIDS activists spread HIV/AIDS myths', says former world health
organisation and expert

UNAIDS and AIDS activists are circulating misconceptions about the
AIDS pandemic according to a former WHO AIDS epidemiologist.

A myth-shattering book by the WHO's former Chief AIDS epidemiologist
published today exposes the extent that AIDS programmes developed by
international agencies and faith-based organizations are politically
correct but epidemiologically inaccurate.

The AIDS Pandemic: the collision of epidemiology with political
correctness by James Chin is the first book to provide an objective
assessment of the AIDS pandemic. The clear and rational conclusions
subvert the prevailing position of UNAIDS and most AIDS activists.

During the past couple of decades, a case has been made by UNAIDS and
many public health authorities and organizations that AIDS must be
seen as a risk for whole populations globally. Chin disputes this.

The AIDS Pandemic argues that: (1) AIDS has a different pattern in
different countries based on behaviours and for some countries it is
better to target high risk groups than dilute resources in
interventions aimed at the general population; (2) rates of disease
projected by public health agencies are often higher than the
epidemiology would support and (3) social determinants are less
relevant for AIDS transmission than patterns of sexual behaviour and
opportunities for parenteral exposure.

Chin contends that HIV prevalence is low in most populations
throughout the world and can be expected to remain low, not because
of effective HIV prevention programmes, but simply because HIV
infection rates can rise only to the level permitted by the
prevailing patterns and prevalence of HIV risk behaviours. This
epidemiologically sound conclusion explains past and current HIV
patterns and prevalence, but has been minimised and ignored by UNAIDS
and AIDS activists. UNAIDS' more politically and socially acceptable
message is that HIV risk behaviours are present in all populations
and therefore all populations are at high risk of HIV epidemics.

Yet no such spread into any general population outside of sub-Saharan
Africa has occurred! In well over 100 IDU (injecting drug users)
and/or MSM (men who have sex with men) epidemics documented
worldwide, no significant spread to the general population has
occurred except to the regular sex partners of infected IDUs or
bisexual MSM.

The book argues that that scarce public health resources in low HIV
prevalence countries are being wasted on prevention programmes
directed to the general public and all youth when they should be
targeted primarily to those at the highest risk of contracting HIV.

In its review and evaluation of the unique natural history of HIV and
its basic epidemiology, Chin's book will lead to a reappraisal of the
validity of the prevailing view of HIV/AIDS, and a better
understanding of the most probable past, present and future of the
pandemic.

About the author: James (Jim) Chin was the State Epidemiologist
responsible for communicable disease control when the first AIDS
cases were recognised and reported in southern California. He then
worked from 1987 until 1992 as the WHO's Chief of the Surveillance,
Forecasting and Impact Assessment (SFI) Unit of the Global Programme
on AIDS (GPA) and developed their methods and guidelines for
surveillance of the AIDS pandemic. He is currently a Clinical
Professor of Epidemiology, School of Public Health, University of
California at Berkeley. He is available for interview.

UNAIDS is the Joint United Nations Progamme on HIV/AIDS.

The AIDS Pandemic: the collision of epidemiology with political
correctness is published by Radcliffe Publishing at £27.50 (ISBN
97681846191183). For orders, please call 01235 528820 or email:
orders@....

For all media enquiries to Radcliffe Publishing please contact
Felicity Howlett on 01235 528820 or email fhowlett@....
Bound proof copies are now available.

LAOS: Keeping the lid on HIV

[This report does not necessarily reflect the views of the United Nations]

VIENTIANE, 1 February (PLUSNEWS) - Being sexually active couldn't be more
natural for Wath Jommanevong, 27, who hopes to marry one day when he has enough
money. "I like sex. Sex is good," he said with a grin, standing beside his
three-wheeled taxi or 'samlor' on the streets of the Laotian capital, Vientiane.
"Sometimes the sex is free. Sometimes you pay."

Such candour was not always possible. Since the collapse of the former Soviet
Union in 1991, when commercial sex, and to a certain degree pre-marital or
non-marital sex, was suppressed by the threat of arrest or fines, Laos has
experienced a barrage of change.

The country is opening up economically and socially, altering the lifestyles of
its six million inhabitants and, increasingly, their attitudes to and
perceptions of sex.

How the government addresses those challenges will have a direct effect on the
spread of HIV.

LOW PREVALENCE

Laos is surrounded by countries with higher infection rates, but the nation
enjoys low prevalence, estimated by the government's Centre for HIV/AIDS/STIs
(CHAS) at less than 0.1 percent of the adult population.

Between the first reported case of HIV in 1990 and the end of 2005, 1,827 cases
of HIV infection were officially recorded, with 1,190 people still living with
the virus.

Almost 95 percent of infections occurred through heterosexual sexual
transmission, 3.9 percent from mother to child, 0.7 percent in men who have sex
with men (MSM), 0.3 percent from blood products and 0.2 percent by unsterilised
needles.

While the number of cases among the general population remains low - although
unofficial estimates assume a much higher figure - the same studies indicate
that there is little room for complacency. In 2004, prevalence rates among
commercial sex workers in the country rose to 2.02 percent, compared to 0.9
percent in 2001.

"This has increased because the knowledge of HIV among certain high-risk groups
remains low," Dr Phouthone Southalack, deputy director of CHAS, told
IRIN/PlusNews. "Moreover, we have a much more mobile population than before,
making the risk of spreading the virus higher."

According to CHAS, the main propellant of HIV in Laos is the so called mobile
populations, comprising sex workers, their clients, and migrant labourers, many
of whom travel outside the country or make regular trips between rural and urban
areas.

"Our government is fully aware of this and is committed to containing the
problem at this level," Southalack said. But that may be easier said than done:
low levels of awareness, limited access to prevention and protection, including
condoms, increase the likelihood of infection rates rising in the impoverished,
landlocked nation.

KEY CHALLENGES

Laos, a largely Buddhist country, was isolated until fairly recently, but there
are now more than 180,000 Lao nationals living as registered migrants in
neighbouring Thailand, where prevalence rates among the general population stand
at 1.4 percent.

Many mobile men are potential clients of sex workers, but fail to consider
themselves as being at risk of HIV/AIDS and sexually transmitted infections
(STIs). According to UNAIDS, other factors, such as the low socioeconomic status
of women, high levels of poverty and a widening generation gap, are contributing
to the spread of HIV.

There is also a growing use of recreational drugs, particularly amphetamines. An
alarming number of sex workers are also thought to be injecting drugs, which
could substantially deepen the HIV problem. Alcohol plays a significant role in
the spread of the virus, particularly in relation to commercial sex and condom
use, while behaviour patterns among young people are changing.

"More young people in Laos are having pre-marital sex at a younger age," said
Sythong Nouansengsy, executive director of Population Services International,
which has been advocating for safer sex and condom use since 1998. "This puts
the country's prevalence rates in danger."

"Urban society is loosening up," Tony Bennett of Family Health International
(FHI) agreed.

Such changing perceptions can be seen at popular meeting places and restaurants
along the banks of the Mekong River, where young patrons may pair off for more
romantic interludes afterwards - a sign of more liberal attitudes towards sex in
this otherwise conservative society.

MSM

Xay Boulommavong, peer education supervisor at the Peuan Mai or New Friend
Centre, the only facility of its kind dedicated to supporting members of the MSM
community, warned that young people, including gay men, were not only having
more sex, but more partners as well.

"There is a lot more freedom in terms of sexual behaviour in Laos than before,"
Boulommavong said. "Nowadays, everyone has a mobile phone and motorbike, meaning
everyone seems to have a network of people they can tap into, any time, any
place, for sex."

MSM is a particularly high-risk group in need of further awareness, with condom
usage perhaps even lower than among the general population. "Some MSM have
limited understanding of HIV, and feel that if they are having sex with a man
they aren't at risk of becoming infected. That's problematic, and that's why we
are here," said the activist.

Paramount to any successful intervention effort, however, is how to do deal with
the growing number of sex workers - an estimated 8,000 women - much to the
chagrin of the authorities. Although they work hard to keep the sex industry
under wraps, a short stroll down Setthathirat Road, in the heart of Vientiane,
reveals that this is proving all but impossible.

"I work here every night," Ning, 22, giggled in broken English. Most of her
clients are Thai businessmen who come across the Mekong River for the weekend.
She occasionally has run-ins with the law, but she and her friends are generally
back on the street next day.

One reason cited for the increase in sex work is the upsurge in large-scale
infrastructure projects being undertaken by the government, which is eager to
open the country up for further development.

Hundreds of men, separated from their wives and families, now work for extended
periods on a variety of bridge and road projects in areas like Champasak, in the
far south, and Vientiane, in the northwest near the border with Thailand,
resulting in innumerable informal brothels sprouting up to cater to the demand.

Sex work in Laos generally takes a more subtle approach than in neighbouring
Thailand and Cambodia. It is often conducted behind the closed doors of massage
parlours or guesthouses catering for Laotian men with money, and makes access
for outreach programmes particularly difficult.

Clients in these establishments, many of whom are married, might share a drink
and food with one of the working women before retiring upstairs for sex, which
can set patrons back anywhere from US$25 to $30, a price largely out of reach to
the average man.

"If the price of sex - which is currently quite high - gets down to a level
below $5 per act, then you'll have a situation where client volume will probably
increase and you'll have the ingredients for an HIV outbreak," Bennett said.
"The lower the price, the higher the number of partners."

Once you start having more than two partners a night, and you have a less than
50 percent condom usage, you have a serious problem, and it is "time to ring the
alarm bell", he commented.

At one such popular venue in Vientiane, upwards of 30 girls could be working on
any night. But, unlike their Thai counterparts across the river, they appeared
to have more control over who they went with, providing a greater capacity to
negotiate safer sex: if they did not like the customer, they were free to get up
and leave.

"I always insist on the man wearing a condom and if he refuses, I don't go with
him," said one demure 20-year-old, who dreams of one day opening up her own
beauty parlor with the money she earns. "Sometimes I find a customer. Sometimes
I don't." She hesitated when asked how many customers she might have in a night.

Many of the women are finding a growing number of customers. The latest round of
surveillance, undertaken in the country in 2004, showed an accelerated
transmission of HIV among sex workers in Bokeo Province in the north, bordering
Thailand, and the central, highly populated province of Savanakhet.

Bokeo has reached an HIV prevalence of 3.9 percent, while rates in Savanakhet
had risen to 3.3 percent, compared to 1 percent in 2001. Data collected in six
provinces revealed an overall increase of HIV among sex workers from 0.9 percent
in 2001 to 2.02 percent in 2004.

Equally worrying was the number of STIs reported among sex workers - ranging
from 19.9 percent to 46 percent for chlamydia and/or gonorrhoea - suggesting
that consistent condom usage remained a key challenge.

A WAY FORWARD

Pushing for consistent condom usage will require sustained interventions,
according to CHAS director Southalack. "The government is committed at the
highest level to these efforts and - given similar campaigns now taking place in
neighbouring countries - properly assisted by the international community, we
can do it."

This article is part of a web special on HIV/AIDS in Asia. Please see:
http://www.irinnews.org/webspecials/Asia-HIVAIDS/default.asp
_________________
Cross posted from IRINnews.org
IRIN-SA
Tel: +27 11 895-1900
Fax: +27 11 784-6759
Email: IRIN-SA@...