The activities in Objective 1, related to creating an enabling social environment, will largely be modeled on activities developed by bilateral, UN, and international NGO projects that have shown effective results in improving the social and policy environment, reducing stigma, and supporting the development of community-government cooperation. Activities already underway in Global Fund Rounds 3 and 4 will also provide a model for both mass media BCC and improvements in local implementation of central government policies.

Examples of possible models to scale up and improve include:
• Zizhong County (Sichuan) and China-UK stigma reduction and prevention activities
• Liangshan County (Sichuan) care and prevention among IDU population
• Marie Stopes School-based Reproductive Health / HIV prevention activities
• Round 3 and 4 process for NGO bidding for project funds. While this process is still being refined, it has produced an increasingly engaged and active civil society sector and greatly increased interest in Global Fund projects from both NGOs and community-based groups.
• UNDP ongoing project to assist central government in drafting new HIV/AIDS regulations and assist local governments in implementing those regulations.

There will also be key links to current central government policies regarding the implementation of the “Four Frees One Care” policy, improving community involvement in HIV/AIDS prevention and control, and rapid scale-up of anti-stigma and discrimination campaigns among all sectors of society.

Activities in Objective 2, reducing high-risk behaviors among sex workers, MSM, and migrants, will mostly be based on existing pilot interventions, NGO initiatives, and international best practice models. This scaling-up has not occurred to date in part due to the high degree of discrimination against MSM and SW in Chinese society, and as a result there has been a rapid spread of HIV among these groups. This proposal will expand the more effective pilot interventions already underway in other provinces, such as the 100% condom use program in Guangxi and Jiangsu provinces, the China CDC-NGO cooperation on rapid-testing of MSM populations in gay bars, and the NGO-led outreach and condom distribution in gay saunas and other venues.

As these activities will be based on existing government and non-government interventions, linkages will exist during both planning and implementation phases. In particular, NGOs that currently run effective projects targeting high-risk groups will be invited to participate, as well as to provide capacity-building services to both government and other NGO partners. Because of the difficulty of reaching the most vulnerable risk populations in China, NGO participation and links to functioning projects will be critical to the success of this plan.

There are few models for reform of STI services in China (Objective 3), so these will largely be new interventions. However, there will by necessity be extensive linkages made both in training, treatment standardization, and service referral with hospitals, STI clinics, and other care providers. NGOs and government bodies providing prevention, outreach and other services will also be used as referral points for STI services.

While there are many existing AIDS prevention projects that aim to build capacity among government and non-government groups, and while much progress has been made in the area of policy drafting, there are still gaps in many areas. Many of the projects underway lack a firm grounding in grass-roots civil society, which reduces their impact among more isolated, vulnerable populations. Therefore the activities proposed in Objective 4 will stress the development of community-based organizations and the participation of target populations. NGOs already working with SW, MSM and migrants will be key partners during implementation and this will connect to and strengthen capacity among government departments, health care institutions, UN and bilateral agencies, and larger NGOs.

The strengthening of the national surveillance system (Objective 5) will build on the efforts of the Chinese CDC and MOH to more effectively collect and utilize information about the epidemic. This will largely be an expansion and improvement of existing efforts, and will rely on technical expertise from a number of international agencies (such as US-CDC and WHO) to expand on the original government plans.

New activities included in this project will be closely coordinated with other projects, including Global Fund Rounds 3 and 4, as well as in other bilateral, international, and domestic interventions. For example: National VCT and counseling materials will be shared between the different projects, and adapted to each target population if necessary. Links between the national HIV surveillance system and prevention efforts will improve the targeting of other prevention and care efforts; and models for increased NGO, PLWHA, and community participation will be replicated within Rounds 3 and 4, as well as among existing programs. In particular, the national treatment program, which is being rapidly scaled up, is facing serious problems of low adherence, drug resistance, and limited outreach to high-risk populations. These barriers will be lowered by the increased participation of PLWHA and other community groups.