4.4.1.2 Describe how these goals and objectives are linked to the key
problems and gaps arising from the description of the national context. Demonstrate
clearly how the proposed goals fit within the overall (national) strategy
and how the proposed objectives and service delivery areas relate to the
goals and to each other.
This project is designed to help reduce the systemic barriers and gaps
China is facing in its fight to control the spread of HIV/AIDS. Central government
policies have moved much more quickly than local political will, financial
ability, or capacity to implement such policies. The high degree of social
stigma surrounding HIV/AIDS has further slowed the implementation of effective
prevention, treatment and care interventions. The lack of accessible VCT
and STI services has limited the scale-up of the national treatment and care
program and weakened the linkages between prevention and care services. Despite
high-level government officials expressing the need and desire to work with
civil society, the limited number of NGOs and PHA groups has prevented this
from becoming a reality. This project will address all of these issues, and
its implementation will significantly improve the effectiveness of national
HIV control and prevention policies.
Objective 1 will address these issues by working to build an enabling
social environment, strengthen civil society and PLWHA participation, and
advocate for the local implementation of policies and regulations regarding
PLWHA and HIV/AIDS. Advocacy and anti-stigma campaigns will target the
general public, policymakers and other government officials who come into
contact with PLWHA. Mass-media and other public information campaigns will
supplement government-run activities with more aggressive, accessible,
and relevant information to break down social stigma and fear of HIV and
AIDS.
While all of these service delivery areas outlined in Objective
2 (behavioral interventions to reduce risk behavior) are part of Chinese
government initiatives and policies, their implementation has mostly been
at a small scale, pilot level. Government information campaigns usually
do not target the most vulnerable populations, instead concentrating on
the general public. 100% condom use campaigns have had considerable success,
but have only been held among sex workers, and only in certain areas. This
project will scale-up those pilot efforts and increase populations covered
by 100% condom use promotion activities, as well as using international
and national best practice methods such as peer education for MSM and SW,
community outreach, counseling, and VCT for high-risk populations.
Objective three addresses gaps within and access to STI treatment
services. The rapid increase of sexually transmitted infections in China
highlights the risk of a similar HIV transmission from high-risk groups
into the general population. For example, the incidence of reported STDs
in 2002 was nine times greater than in 1986 and almost two times higher
than in 1996. The incidence of syphilis and gonorrhea from 1990 to 1998
increased approximately twenty times and 2.6 times respectively. There
were 860,000 new STD cases reported in 2000 but the actual number of new
STD cases is thought to be five or ten times higher. Because sexually transmitted
infections correlate strongly with the occurrence of HIV infection, they
present a major vulnerability for the spread of HIV in China. The effective
detection, treatment, and management of sexually transmitted infections,
targeted for specific populations, is an essential component of this proposed
HIV prevention program.
Objective four addresses the lack of a mature civil society and
experienced CBO/NGO partners to help implement and expand community outreach
and other prevention activities, and the lack of effective mechanisms to
create government-community-NGO partnerships in HIV/AIDS prevention. The
lack of a well-developed non-government sector has severely limited community
involvement in HIV/AIDS prevention and care programs despite a clear recognition
from central government leadership that such involvement is essential.
The key service delivery areas in this objective will both support the
growth of community-based groups (including NGOs and PLWHA groups) with
basic operating expenses and support them with technical and programmatic
training. These activities align with China’s National AIDS Strategy, in
which there is a call for increasing the role of NGOs, and for involving
“all of society” in HIV/AIDS prevention activities.
Objective five addresses a major barrier to effective scaling
up of prevention efforts, the weaknesses in the epidemiological and behavioral
surveillance data regarding HIV/AIDS. The activities under this objective
include technical assistance for a province-wide early warning system,
improving links between surveillance and prevention and control activities,
compiling existing demographic and epidemiological information, conducting
behavioral surveys among target groups, and adding additional survey and
sentinel sites in project areas. The use of both national and provincial
sentinel surveillance sites, as well as the incorporation of other agencies
and organizations (such as academic researchers, NGOs, CBOs, and peer groups)
will broaden the scope and increase the amount of information collected.
Collaboration with hospitals, and blood collection departments will improve
and synthesize the utilization of HIV prevalence information currently
being collected but not utilized, (such as screening of blood donations and pre-operative HIV screening in hospitals), and will strengthen the overall
surveillance system.
See Annex 4.4.1.2 for a more detailed reply to this question
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