Contributions of international cooperation projects to the HIV/AIDS response in China

Sun, Jiangping; Liu, Hui; Li, Hui; Wang, Liqiu; Guo, Haoyan; Shan, Duo; Bulterys, Marc; Korhonen, Christine; Hao, Yang; Ren, Minghui

Yunnan province has received at least 30 million USD to date through international cooperative efforts. 5 During the implementation of these projects, the Yunnan HIV/AIDS Prevention and Control Program has adapted international experiences to local contexts, integrated their HIV/AIDS prevention and control resources and ensured all projects were compatible with their province framework. International projects have reduced the shortage of financial and technical support in Yunnan. They have achieved remarkable success in advocating for policy change, building capacity, establishing interventions, conducting surveillance, testing MARPs and providing anti-retroviral treatment to those in need. Studies found that the incidence of HIV dropped among the MARPs from 15.4% in 2004 to 9.8% in 2007, even though risk behaviours still remain in the local population. [9] [10] [11] Introducing advanced concepts, strategies, technologies and best practices International cooperation projects not only bring funding to China, but also introduce advanced theories and strategies. These strategies have been employed in several areas, including using surveillance to promote testing and early diagnosis of HIV infection, increasing universal access to AIDS care and treatment and preventing second-generation HIV transmission, among others. These activities have significantly accelerated the improvement of China's HIV/AIDS surveillance strategy from passive surveillance to active case finding combined with case management. In 2000, China initiated a voluntary counselling and testing (VCT) pilot programme with the support of the WHO, the UNFPA and the China-UK programme. Based on the experiences of the pilot programme, VCT became a national strategy in 2004 and was expanded to 7335 sites by December 2009. The surveillance strategy has also changed from sero-surveillance to behavioural surveillance, and later to comprehensive surveillance, which is the combination of the serology and the behavioural surveillance. The development of surveillance system impacts the determination of AIDS policy and the use of HIV/AIDS resource. 12-14 UNAIDS and WHO have recommended a series of intervention measures for high-risk populations including VCT, health education, condom promotion and social marketing, methadone maintenance treatment and needle exchange. In 2001, with the cooperation of WHO, China launched a condom promotion project in Hubei, Jiangsu, Hunan and Hainan provinces. In Yunnan and Sichuan provinces, the China-UK program also began to explore intervention models among commercial sex workers and condom social marketing. These projects proved to be useful in the Chinese context. Several interventions, including condom promotion, STD clinic-based outreach and intervention among low-fee sex workers and clients, have all been developed and are still improving. These methods have been adopted as national guidelines for HIV/AIDS control and were scaled-up throughout the country. Experiences accumulated in these projects have been very helpful to explore appropriate intervention models for high-risk populations in China. These experiences have established a base for the generalization of best practices and have informed strategies at the national level. For example, condom promotion was adopted in the national HIV/AIDS Prevention and Treatment Regulation in 2006.