The national health system, as it relates to HIV/AIDS, faces heavy constraints at the provincial and local levels. Local governments bear heavy public health expenditures that are not covered by central funding, and weak financial controls further impact the flow of funds and their intended use. In addition, free-market reforms have effectively transformed public health hospitals and clinics into profit-making enterprises that must create enough revenue to support their own costs, a strong disincentive for health providers to provide the centrally-mandated free HIV/AIDS treatment and care.

Other important challenges facing the health system in providing HIV/AIDS care and treatment include stigma and discrimination against PLWHA by medical staff, the need to upgrade the effectiveness and availability of STI services, and the need to improve access for high risk groups, SW, IDUs, MSM, and migrants.

There are pronounced differences in access to HIV/AIDS treatment and prevention services between urban and rural areas. In general, reduced quality and limited access of health services in poor and remote areas are the result of insufficient funding and a lack of regulation and coordination of healthcare providers. Migrant populations also present special concerns and have lower access to services than resident populations. Women and children, particularly in rural areas and within migrant communities, remain most vulnerable.


b) Describe comprehensively the current disease-control strategies and programs aimed at the target disease, including all relevant goals and objectives with regard to addressing the disease. (Include both existing Global Fund-financed programs and other programs currently implemented or planned by all stakeholders and existing and planned commitments to major international initiatives and partnerships).

China’s national AIDS control plan has made great strides in recent years. There has been political commitment from the highest political levels to fighting stigma and preventing further spread of HIV and a large increase in international cooperation and technical assistance, has helped facilitate long-term strategic planning. Coordination of the overall response has been greatly strengthened. The central government has adopted a National Medium and Long Term Plan for HIV/AIDS Prevention and Control (1998-2010) and a Plan of Action (2001-2005). At a central level, the State Council has created a multi-sectoral working group on HIV/AIDS, and this group has taken the lead in directing and coordinating national efforts curbing the epidemic. International partners will support the preparation and implementation of a national five-year plan for 2006-2010.

In 2004, China introduced the “Four Frees and One Care” policy (free treatment, free schooling for AIDS orphans, free VCT testing, free PMTCT, and care and economic assistance to the households of PLWHA). Free anti-retroviral therapy launched for rural and poor urban patients and the China Comprehensive AIDS Response (China CARES) Program continues to be expanded. Several provinces have also already developed their own “action plans” to respond to the local situation. Under rounds 3 and 4 of the Global Fund, China is providing care, treatment, and prevention services to PLWHA and vulnerable populations in 14 provinces. DFID has recently increased its support for HIV/AIDS projects, especially technical and strategic support to China’s Global Fund offices and the State Council Working Group on HIV/AIDS. Other donors are also increasing their activities.

However, major efforts to date have largely concentrated on treatment and care for those already infected with HIV. There is still not a coherent, effective national prevention strategy to prevent the continued increase in HIV infections, a critical element to prevent the epidemic from moving from relatively isolated populations (mainly IDU, MSM and SW) into the general population. It is recognized that the means of transmission for this spread into the general population will be sexual transmission. In April 2005, the Ministry of Health announced the formation of a high-risk behavioral intervention team to address high-risk behavior among a number of different populations. This project will build on this commitment and focus on sexual transmission in targeted provinces where there are indications that the epidemic is spreading, or will soon spread if immediate action is not taken. There are large vulnerable populations with high-risk behavior, insufficient access to STI services, and limited access to information about HIV and HIV prevention.

c) Describe the role of AIDS-, tuberculosis- and/or malaria-control efforts in broader developmental frameworks such as Poverty Reduction Strategies, the Highly-Indebted Poor Country (HIPC) Initiative, the Millennium Development Goals or sector-wide approaches. Outline any links to international initiatives such as the WHO/UNAIDS ‘3-by-5 Initiative’ or the Global Plan to Stop TB or the Roll Back Malaria Initiative.

China’s economy is one of the fastest growing in the world, with an average 9.4% annual GDP growth over the past two decades. By 2003, China had reached an annual per capita income of US $1100. According to national statistics, China has already achieved the Millennium Development Goal (MDG) of halving income poverty and made considerable progress in other indicators such as life expectancy, child mortality and illiteracy. However, many goals are still to be reached. There are also sharp regional variances in the levels of development, with increased economic imbalances and inequalities between urban and rural areas, and between the coastal provinces and the interior of the country.

Unless effective measures are taken to slow the spread of HIV in China, it is estimated that there will be 10 million people living with HIV/AIDS by 2010. This will in turn threaten China’s development and economic progress, particularly for the poor, rural, and more vulnerable populations. Inequalities in areas such as access to education, health, and social services add to the vulnerability of rural migrants and SW.

If the epidemic continues to grow at the present rate, China’s progress in MDGs such as poverty relief, primary education, and gender equality could be impacted. The loss of productive capacity among families affected by HIV/AIDS has a negative impact on economic growth, and threatens to push millions of Chinese into poverty, as each infection affects the whole family. In rural areas, family incomes are affected, and students are often forced to drop out of school, in particular girls. Many girls are kept at home to care for sick or dying family members, depriving them of an education and exacerbating gender inequalities.

China has endorsed the WHO’s 3x5 plan, and is increasing its treatment targets to approach the 3x5 treatment goals. The “Four Frees and One Care” policy includes the provision of free ARV therapy to poor and rural HIV/AIDS patients. China has set its own goal of treating 120,000 PLWHA nationally, all at no cost to the patient. However, there are major barriers to the expansion of the treatment program: The lack of community and non-government participation has limited access to vulnerable populations; The lack of effective peer counseling, as called for in national treatment guidelines, has caused low adherence and potential treatment failure in some areas; the lack of broadly accessible, high-quality VCT services has seriously limited the number of people on treatment; and the lack of effective prevention activities means that the number of people infected with HIV continues to grow, making the government’s treatment and care plans increasingly difficult to realize.

This project will address each of these gaps. It will strengthen the growth of civil society and promote partnerships between NGOs and government, and will provide training to PLWHA and NGOs. It will strengthen VCT services and access to VCT services by vulnerable populations. This will in turn have a positive impact on the rapid scale up of the treatment plan and efforts to meet the 3x5 treatment targets.