Although overall HIV prevalence in China remains relatively low, there are clusters of extremely high prevalence among certain groups and in particular geographic areas. HIV/AIDS in China was initially concentrated among commercial blood donors in several central provinces and injecting drug users in the southern and southwestern parts of the country. Today it has spread across China, and there is a high risk of continued transmission, in particular among SW, MSM, IDU and migrants. Case reports indicate that the epidemic has reached the exponential phase of growth and is spreading into the general population, with the proportion of sexually transmitted HIV infections, and of female HIV cases, both continue to grow.

In response, the Chinese central government has made a strong commitment to fighting HIV/AIDS. The “Four Frees and One Care” policy provides free treatment and care to rural and poor populations, and free VCT sites are being expanded nationally. A recently announced “Task Force for High-Risk Behavior Interventions” will draft new policies for strengthened prevention efforts among populations with high-risk behaviors. Domestic public sector funding for HIV/AIDS efforts has more than doubled in a year, from $47 million in 2003 to $98 million in 2004. Funding from Rounds 3 and 4 of the Global Fund has helped to speed up and scale up a number of government-led initiatives, including free ARV and OI treatment, harm reduction activities, and prevention efforts in the provinces most affected by HIV/AIDS.

Despite these efforts, there remain large program and funding gaps. Overall HIV prevention efforts in China have had relatively limited coverage and low impact. The capacity of local governments and NGOs to plan and implement interventions is weak, and the lack of good behavioral and epidemiological data makes planning and implementing effective prevention activities difficult. As a result, prevention efforts are not well directed, coordinated, or sustained. Discrimination, stigma and a lack of effective government-civil society partnerships also hinder access to those most at risk, reducing the impact of the funding available for these interventions. Due to social stigma and lack of experience, there have been very few interventions aimed at the MSM community, despite a significant HIV infection rate and high risk behavior indicated by several surveys.

As an integrated component of the national strategy, this proposal addresses each of these gaps in 18 municipalities in seven provinces where there is a high risk that the spread of HIV will increase rapidly: Chongqing, Liaoning, Heilongjiang, Jilin, Inner Mongolia, Ningxia, and Gansu. Rapid expansion of proven prevention activities (such as stigma reduction campaigns, aggressive peer outreach, IEC/BCC, and promotion of condom/lubricant use), as well as introduction of new activities (such as outreach to MSM communities and linkages between STI and HIV services) will strengthen China’s overall HIV/AIDS strategy by moving to prevent new infections and reduce the risk of a new wave of HIV transmission in areas that have seen limited prevention interventions to date.


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