1. Transport Against HIV/AIDS in China Christopher R. Bennett EASTE 28 November 2007

2. 2 Growth in HIV/AIDS in China

3. 3 China: HIV/AIDS Statistics Population: 1.3 billion Extent (2007):  Adult (15-49) prevalence rate 0.05%  700,000 living with HIV/AIDS  50,000 new HIV/AIDS cases  20,000 AIDS related deaths Primarily in Yunnan, Henan, Guangxi, Xinjiang and Guangdong provinces

4. 4 Change in Sources 2005  Intravenous drug use: 62%  Plasma donation: 9%  Sexual transmission: 8%  Unknown: 19% 2007  Sexual transmission: 41%  Intravenous drug use: 29%

5. 5 China: Need for Education 2003 national survey found  17% of never heard of HIV/AIDS  77% did not know condoms can prevent transmission In 2000 estimated 4 – 6 million commercial sex workers  <30% knew condoms protect  <30% perceived themselves at risk

6. 6 People at high risk (and their families) include  Construction workers away from home  Employees in long-distance transport  People living along transport routes  Commercial sex workers 42% of truck drivers report indulging in commercial sex while traveling; 33% of those who have casual sex don’t use condoms Survey results, Poland and Lithuania border areas (World Bank, 2003) Who is at Risk With Transport?

7. 7 Migrant Workers: China Overview Some 120 million Spend 48+ weeks away from families Working in hard conditions Construction workers stay in same sex dormitories/camp sites Little access to HIV/AIDS prevention information and services Easy targets for drug sellers Have ample opportunities to interact with commercial sex workers

8. 8 Migrant Workers: HIV/AIDS New HIV/AIDS cases disproportionately amongst migrant workers In some cities migrant workers are largest group of HIV cases:  61% in Beijing  61% in Xi’an  66% in Shanghai

9. 9 Addressing HIV/AIDS in Transport Some TTLs included HIV/AIDS as part of environmental management Position strengthened with new Bank SBDs:  HIV/AIDS education as part of ‘Health and Safety’ clauses TTLs now have responsibility to ensure HIV/AIDS education programs are undertaken

10. 10 EAP - Modified SBD Clauses Bank’s HIV clauses adapted in EAP:  Cater for (1) financed as provisional sum and (2) grant projects  Made clarifications and simplified Translated, distributed to contractors and monitored in supervision missions

11. 11 Approach in China Clients do not see the need for HIV/AIDS education “road construction is my business not promoting condoms” Unwilling to put major effort into activities Solution : obtain grant funding as ‘seed’ money  Hire a provider to deliver training  Ensures consistent standard of training throughout project  Minimizes efforts for highway agency (and TTLs)

12. 12 Work to Date 2005 – Shiman Highway Project  Funded by $50,000 Global HIV/AIDS Grant 2006 – Jiangxi III Highway and Inland Waterways V Projects  Funded by $160,000 IDF Grant 2007 – Liaoning Urban Transport Project  Funded by $20,000 UBW HIV/AIDS Grant

13. 13 Shiman Highway Project Typical of expressway projects in China 107 Km Shiyan-Manchuanguan Expressway (SME) in Hubei, China About 11,000 Construction workers  99% males with junior high school education (at best)  Under age of 40  Away from family 300+ days/year Over 140 “recreational places” along SME 500,000 residents in 21 counties and townships

14. 14 Worker HIV/AIDS Knowledge At start of project: 16% of were aware of HIV/AIDS transmission methods 40% thought transmitted by mosquito bites 71% knew how to use condoms 35% never and 26% rarely used condoms 33% knew where to go for HIV/AIDS counseling and blood testing services 44% had stigmatized attitude towards HIV/AIDS carriers

15. 15 Three Phases Develop Program  Co-ordinate with other agencies  Develop materials Deliver Program  Develop effective intervention plan  Train Educators  Set up VCTs for consultation and testing  Conduct field visits Evaluate Results  Semi-Annual monitoring  Establish an HIV/AIDS strategy/operational manual for replication in similar projects

16. 16 HIV/AIDS Intervention Activities Knowledge Transfer  AIDS-related posters, booklet and playing cards, educational board, movies, etc.  Text messages to all cell phone users  Face to face education to construction workers

17. 17 HIV/AIDS Intervention Activities Behavior Change  Set up condom distribution sites & training on proper usage  Activities & trainings at local recreational centers  100% condom use pilot program  Local VCTs & onsite - consultation and testing

18. 18 Covered 100% of the project area Trained  9,034 construction workers and administrative personnel  11,897 village people in 132 villages Set up 7 VCT sites along the expressway Set up 83 condom sites and educational material sites Coverage (end June 2007)

19. 19 Distributed  49,031 copies of handouts  17,286 brochures  2,624 posters  1,682 AIDS playing cards  235 banners and slogan  173 copies of VCDs  31,452 condoms  80,000 text messages to all cell phone users Coverage (continued)

20. 20 Testing Results HIV/AIDSTested6,211 Positive1 STDsTested7,101 Positive1,692

21. 21 Program Outcomes (Census Data) Year: 2004 2005 2006 STD cases: 2344 1901 1172 Decrease(%): 19% 38%

22. 22 Program Outcomes (continued) HIV/AIDS Positive*: 2004: 3 (1 from other region) 2005: 7 (2 from other regions) 2006: 12 (4 from other regions) *(These cases were all past infections, referring to cases infected before 2004)

23. 23 Program Outcomes (continued) Increased general awareness among the workers and local residents –  71.4% in 2005  52.2% in 2005 Condom sales up 10.4% in 2006 over 2005 No significant change in stigmatized attitude

24. 24 Lessons Learned to Date Must include local health department Project must complement existing activities Target both workers and residents Means of intervention do matter – innovations (eg cards, text messaging) Window of opportunity is brief, get the timing and location right

25. 25 Lessons Learned (continued) Focus on behavior change Train ‘peer educators’ among highly mobile workers Get government and contractor’s buy-in early Set practical monitoring indicators – stigmatized attitude will not change overnight

26. 26 2006 – HIV/AIDS Seminar Held in Wuhan Involved 60 domestic and international experts Discussed ways to raise HIV/AIDS awareness amongst transport workers

27. 27 What Next? EAP Transport has adopted a regional HIV/AIDS strategy  Vision: every project have an effective HIV/AIDS campaign  Develop standard approach and education materials  Adapt to each country

28. 28 The End