Assessing HIV/AIDS Initiatives in China - Center for Strategic and ...

24 Assessing HIV/AIDS Initiatives in China
spokesperson Pu Cunxin, highly visible in public health clinics and even in the departure
halls of the Beijing airport.
HIV testing is offered at many hospitals and clinics as well as CDC sites, but the
quality, availability, and affordability of testing is inconsistent from place to place.
Despite a policy of free testing, many venues still charge fees, and others only provide
free testing during promotional campaigns. Health care workers are often unaware of the
need for confidentiality in counseling, while most lack the training to effectively convey
important knowledge to at-risk persons. Local clinics tend to be passive about testing,
waiting for people to come in for testing on their own accord, rather than proactively
conducting outreach to at-risk persons. This is partly due to the lack of political or
financial incentives for clinics to expand free services. Finalizing fund allocation and
reimbursement policies for clinics will improve the application of VCT and allow for the
expansion of services to a larger segment of the population. As the capacity to expand
testing occurs, however, identifying and reaching out to those in need of testing will
require the greater involvement of the community, including peer- and NGO-driven
outreach. But the willingness of all government authorities to allow a greater role for
NGOs and other peer groups varies widely across different parts of the country.
The health bureaus in many provinces with concentrated HIV/AIDS epidemics have
actively encouraged people with HIV/AIDS to form mutual support groups. Under the
close supervision of health authorities, these groups are generally provided with meeting
space, which is used for training and sharing information and other social activities.
Some clinics have made use of peer educators to reach out and identify IDUs and
distribute clean needles. Unfortunately, although these programs are very useful, they
remain relatively small scale—estimates vary, but there may be as many as a million or
more IDUs sharing needles in China today—and will not make a significant impact on
the national scale of the spread of HIV unless such programs are dramatically expanded.
Needle exchange is often not supported by communities or the police, and peer educators
carrying needles and narcotics have reportedly been arrested in some areas. Health
authorities, however, have more strongly encouraged peer outreach activities that serve
less controversial purposes.
The Ministry of Health and the CDC are demonstrating their support for the peerdriven
delivery of a variety of services. Government-controlled funds are being made
available to NGO groups as part of each Global Fund grant. The Round 5 grant is to train
540 peer educators and 1,440 health counselors per year, over five years, in VCT services
in order to reach 777,000 CSWs and economic migrants. Other funds have been made
available to peer groups seeking to reach MSM and IDU populations.
This stance reflects the government’s growing awareness that they cannot find these
marginalized groups and must rely on grassroots organizations to conduct outreach and
provide prevention education and counseling. Some peer groups have demonstrated
innovative outreach and VCT activities, such as one MSM group that hosts tea parties for
MSM in the community to disseminate prevention information, condoms, and lubricants
and to collect blood samples that are numbered and sent to CDC labs for HIV testing.
The CDC provides the test results back to the peer group, which then contacts the
individuals to inform them of the results. This process creates a welcoming and sensitive
environment and helps ensure confidentiality for the tested person.