1. Transport Against HIV/AIDS in China
Christopher R. Bennett
EASTE
29 March 2007

2. Growth in HIV/AIDS in China
1985
1995
1989
1998

3. China: HIV/AIDS Statistics
Population: 1.3 billion
Official prevalence rate: 650,000 or 0.05% (excluding those who had died)
AIDS-related deaths: 25,000
Sources:
IDUs: 62%
Plasma donation: 9%
Sexual transmission: 8%
Unknown: 19%

4. China: Need for Education
2003 national survey found
17% of never heard of HIV/AIDS
77% did not know condoms can prevent transmission
In 2000 estimated 4 – 6 million commercial sex workers
<30% knew condoms protect
<30% perceived themselves at risk

5. Who is at Risk With Transport?
People at high risk (and their families) include
Construction workers away from home
Employees in long-distance transport
People living along transport routes
Commercial sex workers
42% of truck drivers report indulging in commercial sex while traveling; 33% of those who have casual sex don’t use condoms Survey results, Poland and Lithuania border areas (World Bank, 2003)

6. Migrant Workers: China Overview
120 million
Spend 48+ weeks away from families
Working in hard conditions
Staying in same sex dormitories/ camp sites
Little access to HIV/AIDS prevention information and services
Easy targets for drug sellers
Have ample opportunities to interact with commercial sex workers

7. Migrant Workers: HIV/AIDS
Migrant workers have high HIV/AIDS rate
61% of HIV cases in Beijing (2000)
61% in Xi’an
66% in Shanghai
New HIV/AIDS cases disproportionately amongst migrant workers

8. China: Bank Transport Portfolio
Since projects $US 5.6 b in loans
7 projects $US 1.2 b under preparation
Sub-Sector
Projects
Upcoming
Highways
17/$3.6 b
2/$0.4 b
Urban Transport
7/$1.1b
3/$0.4 b
Rail + Container
4/$0.5b
1/$0.3 b
Inland Waterways
4/$0.4b
1/$0.1 b

9. Addressing HIV/AIDS in Transport
Some TTLs included HIV/AIDS as part of environmental management
Position strengthened with new Bank SBDs:
HIV/AIDS education as part of ‘Health and Safety’ clauses
TTLs now have responsibility to ensure HIV/AIDS education programs are undertaken

10. EAP - Modified SBD Clauses
Bank’s HIV clauses adapted in EAP:
Cater for (1) financed as provisional sum and (2) grant projects
Made clarifications and simplified
Translated, distributed to contractors and monitored in supervision missions

11. Approach in China Clients do not see the need for HIV/AIDS education
“road construction is my business not promoting condoms”
Unwilling to put major effort into activities
Solution : obtain grant funding as ‘seed’ money
Hire a provider to deliver training
Ensures consistent standard of training throughout project
Minimizes efforts for highway agency (and TTLs)

12. Work to Date 2005 – Shiman Highway Project
Funded by $50,000 Global HIV/AIDS Grant
2006 – Jiangxi III Highway and Inland Waterways V Projects
Funded by $160,000 IDF Grant
2007 – Liaoning Urban Transport Project
Funded by $20,000 UBW HIV/AIDS Grant

13. Shiman Highway Project
Typical of expressway projects in China
107 Km Shiyan-Manchuanguan Expressway (SME) in Hubei, China
About 11,000 Construction workers
99% males with junior high school education (at best)
Under age of 40
Away from family 300+ days/year
More than 140 recreational places along SME
500,000 residents in 21 counties and townships

14. Worker HIV/AIDS Knowledge
At start of project:
16% of were aware of HIV/AIDS transmission methods
40% thought transmitted by mosquito bites
71% knew how to use condoms
35% never and 26% rarely used condoms
33% knew where to go for HIV/AIDS counseling and blood testing services
> 44% had stigmatized attitude towards HIV/AIDS carriers

15. Three Phases Develop Program Deliver Program Evaluate Results
Co-ordinate with other agencies
Develop materials
Deliver Program
Develop effective intervention plan
Train Educators
Set up VCTs for consultation and testing
Conduct field visits
Evaluate Results
Semi-Annual monitoring
Establish an HIV/AIDS strategy/operational manual for replication in similar projects

16. HIV/AIDS Intervention Activities
Knowledge Transfer
AIDS-related posters, booklet and playing cards, educational board, movies, etc.
Text messages to all cell phone users
Face to face education to construction workers
Diverse Media to initiate public education. Use “Health Education Wall Paper” as carrier, matched with broadcast, TV and newspapers, etc., to undertake a HIV/AIDS/STD educational campaign.

17. HIV/AIDS Intervention Activities
Behavior Change
Set up condom distribution sites & training on proper usage
Activities & trainings at local recreational centers
100% condom use pilot program
Local VCTs & onsite - consultation and testing
Diverse Media to initiate public education. Use “Health Education Wall Paper” as carrier, matched with broadcast, TV and newspapers, etc., to undertake a HIV/AIDS/STD educational campaign.

18. Coverage (end 2006) Covered 100% of the project area Trained
4,214 construction workers and administrative personnel
4,860 village people in 47/57 villages
Set up 7 VCT sites along the expressway, tested 2,084 persons for HIV and STDs
Set up 83 condom sites and educational material sites

19. Coverage (continued) Distributed
45,061 copies of handouts
17,286 brochures
2,624 posters
1,237 AIDS playing cards
366 banners and slogan
173 copies of VCDs
25,452 condoms
new! 80,000 text messages to all cell phone users (July-Dec 2006)

20. Program Outcomes Year: 2004 2005 2006 STD cases: 2344 1901 1172
Decease(%) : % 38%

21. Program Outcomes (cont’)
HIV/AIDS Positive*:
2004: 3 (1 from other region)
2005: (2 from other regions)
2006: 12 (4 from other regions)
*(These cases were all past infections, referring to cases infected before 2004)

22. Program Outcomes (cont’)
Increased general awareness among the workers and local residents – by 71.4% in 2005 and 52.2% in 2005
Condom sales up 10.4% in 2006 over 2005
No significant change in stigmatized attitude

23. Lessons Learned to Date
Must include local health department
Project must complement existing activities
Target both workers and residents
Means of intervention do matter – innovations (eg cards, text messaging)
Window of opportunity is brief, get the timing and location right

24. Lessons Learned (cont’)
Focus on behavior change
Train ‘peer educators’ among highly mobile workers
Get government and contractor’s buy-in early
Set practical monitoring indicators – stigmatized attitude will not change overnight

25. 2006 – HIV/AIDS Seminar Held in Wuhan
Involved 60 domestic and international experts
Discussed ways to raise HIV/AIDS awareness amongst transport workers

26. What Next? EAP Transport has adopted a regional HIV/AIDS strategy
Vision: every project have an effective HIV/AIDS campaign
Develop standard approach and education materials
Adapt to each country

27. Challenge
Client Funded
Grant Funded
Organization ?
Delivery
Focusing on
Organizational issues
Delivery issues
Need to ensure long-term commitment by governments to maintain and expand programs
Biggest problem: no funding to implement strategy!

28. The End