China’s National Medium-and Long-Term Strategic Plan for HIV/AIDS Prevention and Control (1998-2010)

Printed and Disseminated by the State Council

November 12, 1998
STATE COUNCIL Document
GF (1998) 38

 To: The People’s Governments of all provinces, municipalities, and autonomous regions and to all Ministries and Commissions, and other organization directly under the State Council:

The State Council approves the report entitled “China’s National Medium and Long-Term Strategic Plan for HIV/AIDS Prevention and Control (1998-2010)” jointly drafted by the Ministry of Health, the State Development Planning Commission, the Ministry of Science and Technology, and the Ministry of Finance. The State Council hereby distributes this report to you and asks that you implement its recommendations in a conscientious manner.
Acquired Immune Deficiency Syndrome (AIDS) is a major disease, which is a high priority for disease control in China.  HIV/AIDS is also an important worldwide social and public health issue.  Every region and ever sectors must formulate their own plans and strategies for implementation according to this strategic plan in the context of specific local situations, and to incorporate them into their overall socio-economic development programs. The high priority given to HIV/AIDS prevention and control should be manifested through strong leadership and by implementing various plans and strategies in order to achieve the objectives and tasks of the Plan in time.

November 12, 1998

China’s National Medium-and Long-Term Strategic Plan for HIV/AIDS
Prevention and Control (1998-2010)

Ministry of Health, State Development Planning Commission
Ministry of Sciences and Technology, Ministry of Finance

(October 26, 1998)

Acquired Immune Deficiency Syndrome (AIDS) is an infectious disease with extremely high mortality for which no cure is yet available. The wide spread of AIDS has caused major social and public health problems worldwide. The prevalence of Human Immune Deficiency Virus (HIV) infection, which causes AIDS, has been kept at a relatively low level compared with other countries. However, with the rapid spread of AIDS around the world, China has also seen rapid increases in its own HIV infection rate in recent years. The experience of many countries worldwide with HIV epidemic trends and prevention has been that HIV/AIDS prevention and control is an urgent, complex and difficult long-term task. A comprehensive approach that involves people and agencies from all sectors is essential. China’s National Medium-and Long-Term Strategic Plan for AIDS Prevention and Control (1998-2010) was formulated on the basis of both international and Chinese domestic experience to promote timely efforts for HIV/AIDS prevention and control by governments and sectors at all levels, to ensure that various strategies and measures are implemented, to enhance the capacity of all societies and communities to resist the disease, and to mitigate the impact of HIV/AIDS to the health of China’s people and to China’s social-economic development.

Background 

The first AIDS case in China was found in June 1985. By the end of June 1998, a cumulative number of 10,676 cases of people infected with HIV had been reported by China’s 31 provinces, municipalities and autonomous regions, 301 of whom had developed into full-blown AIDS and 174 had already died. Most of the people infected with HIV were young and middle-aged people and were mainly found in the southwestern and northwestern border regions as well as in the central and eastern coastal areas that are densely populated and have good transportation facilities. The three transmission routes identified through a number of surveys and studies are sexual transmission, blood transmission, and mother-to-child transmission (during pregnancy, delivery, and breastfeeding)--all three transmission routes are present in China. The leading cause of HIV transmission in China is the sharing of needles for the intravenous injection of drugs, which can lead to the transmission of HIV through blood. HIV spreads very rapidly through this route. Cases due to sexual transmission and mother-to-child transmission are also increasing every year. An estimation by some domestic/national experts by using the component modeling method and Delphi method revealed that the number of HIV infections in China had already exceeded 300,000 by the end of 1997. Taking this number as a basis, a calculation made by using the time doubling method estimated that the actual number of HIV infections in China might exceed 1.2 million by the year 2000.  The number of reported cases of Sexually Transmitted Diseases (STDs), one of the important factors involved in the transmission of HIV/AIDS, has increased gradually since the late 1970s. Average annual increases in the STD rate during the years 1989-1992 were in the 11.27% to, 13.79% range, and during 1993 – 1995 in the 20.58% to, 24.75% range. The number of reported cases in 1997 was 460,000, a 15.81% increase over 1996. The incidence of STDs in 1997 was 37/100,000 when STDs ranked third among all the reportable infectious diseases, trailing only dysentery and hepatitis.  Since a large majority of STD patients seek medical care at private clinics and illegal clinics STD cases are seriously under-reported. According to some regional surveys, the actual number of STD patients might exceed the number of reported cases by between five and ten times. National HIV/AIDS surveillance data reveals that the number of HIV infections among sexually promiscuous populations are accelerating

The Central Committee of the Chinese Communist Party and the State Council have always attached great importance to the prevention and control of AIDS and STDs. A coordinating meeting mechanism has been set up directly under the State Council. A number of advisory organizations and associations such as the Expert Committee for HIV/AIDS and STDs Prevention and Control, the Association for STDs and HIV/AIDS Prevention and Control have been established. Under the leadership of the Party and governments at all levels and support from the sectors and social organizations concerned, a force for prevention composed mainly of public health and epidemic prevention institutions at all levels has been formed. These institutions and organizations have implemented HIV/AIDS surveillance and a preliminary understanding of the prevalence and distribution of HIV infection in the China has been achieved. Certain appropriate strategies and measures, and relevant legislation and regulations have been worked out, and a large amount of activities have been organized in relation to professional training, health education, scientific research and international cooperation.

However, China’s capacity for HIV/AIDS prevention and control remains under-developed. Moreover the awareness among leaders of governments and the sectors concerned on the potential risk of wide spread of HIV/AIDS and the harm that it causes is inadequate. Furthermore, wide-ranging cooperation that involves multi-sector coordination and community participation in prevention activities is yet to be created. The public lacks an understanding of how to prevent HIV/AIDS. Investment in HIV/AIDS prevention and control in research is inadequate. Medical and health services are limited. The surveillance and management of blood collection and supply as well as measures to prevent infections resulting from medical care are weak. Trained personnel are in short supply and lack both experience and effective ways and means to prevent AIDS and STDs.  Health professionals in most medical institutions are not able to provide standard quality services for the diagnosis and treatment of HIV/AIDS and STDs. We now face an increasingly serious spread of HIV/AIDS in certain neighboring countries and a big floating population within China itself that is difficult to manage. Drug abuse and prostitution are unlikely to be completely eliminated within the foreseeable future. Therefore China confronts a situation in which the spread of HIV/AIDS within the country is accelerating rapidly and there is an urgent need to strengthen work for the prevention and control of HIV/AIDS.

Guiding Principles:

1. This document was developed for the implementation of “The Resolution of the Central Committee of Chinese Communist Party on Strengthening the Effort to Set Up the Socialistic Spiritual Civilization”, and also follows the essence of strengthening the prevention and control for severe diseases that is articulated in the “Ninth Five-year Plan for National Socio-economic Development and the Outline for the Scenario up to the Year of 2010 of the People’s Republic of China” and the “The Resolution of the Central Committee of Chinese Committee of Chinese Communist party and the State Council on the Health Reform and Development”. The document aims to slow down the HIV/AIDS epidemic through the substantiated prevention and control efforts and will help to achieve the goal of national socio-economic development.

2. Implement the strategies and measures stipulated in the “Recommendations on Strengthening HIV/AIDS Prevention and Control” approved by the State Council and issued by the Ministry of Health. Strengthen leadership, enhance coordination among sectors and mobilize all the entire society. Implement a comprehensive approach, which combines health education, policy development, law enforcement, surveillance, medical care and counseling. Scientific researches in the area of HIV/AIDS prevention and control will be scaled up and international cooperation will be actively encouraged.

3. Strengthen health education and work for behavioral change in certain population so as to bring under control the spread of HIV/AIDS through sexual contact and injecting drug use. Standardize STD management and implement STD surveillance, prevention and treatment. Implement strict measures to prevent the transmission of HIV through blood/blood products and as a result of iatrogenic transmission. Create a supportive social environment which will be built up for the HIV/AIDS prevention and control so as to mitigate the impact of HIV/AIDS on infected individuals and their families, communities affected and the whole society.

4.   All the prevention and control work must take the local situation and realities into consideration. The best international practices and experiences will be adapted and put into practice. Prevention and control should be pragmatic, tackling not only the epidemic itself but also its determinants and constraints on anti-epidemic work. It should also be contextualized and make full use of local existing resources. The principle of categorizing guidance and supervision, decentralizing administration and management, classifying responsibilities will be followed. Among all the strategies and measures, the top priority should be given to prevention, and health education is the most important prevention strategy. Prevention and control should be implemented routinely without any interruption. Applied research is the top priority for HIV/AIDS related research.
  
 General Goals:

Establish a government-led system of HIV/AIDS and STDs prevention and control in which many sectors work together and the entire society participates. And disseminate relevant knowledge to the whole society for the prevention and control of HIV/AIDS and STDs. By the year of 2002, the HIV transmission through blood collection and supply will be eliminated, the rapid spread of HIV among drug users will be contained, and the annual increase of STD incidence will be kept under 15%. By the year of 2010, the annual increase of STD incidence will have stopped or perhaps even begun to decline and the number of HIV infections will have been kept to within 1.5 million.

 Objectives
1. Establishment and improvement of leadership and managerial mechanism:

(1) People’s Governments at provincial, municipal and autonomous region level should incorporate the prevention and control of HIV/AIDS into the local programs for the socio-economic development and the development of socialistic spiritual civilization. They should establish a leading group or cooperation meeting mechanism for the coordination of AIDS prevention and control under the leadership of the local governments and with the participation of the sectors concerned.

(2) In areas hard-hit by the HIV epidemic, local governments and departments concerned should formulate each year an annual plan for the prevention and control of HIV/AIDS. They should build upon existing organizations to set up the necessary institutional structures and designate professional staff, full-time or part-time for the management of AIDS prevention and control.

2. Universal dissemination of knowledge relating to the prevention and control of HIV/AIDS and STDs, and reduction of risky behavior of target population groups (drug users, prostitutes and their clients):

(1) By the year of 2002, over 70% of the urban population, 40% of the rural population and 80% of high-risk populations should have basic knowledge about HIV/AIDS and STDs prevention and control.

(2) By the year of 2002, the “health education prescription” should reach all the freshmen at universities, colleges and vocational training schools. HIV/AIDS prevention and control knowledge should be incorporated into health education curriculum at junior high schools. All junior high schools at the level of municipalities, provincial capitals and cities with separate economic planning should have HIV/AIDS information in their curriculum. For schools at the county level and above this should reach over 85%. For schools at the township level and above, 70% should reach to have HIV/AIDS information as part of the curriculum.

(3) Information and health education on HIV/AIDS prevention and control should appear in the major public media such as news agencies, radio stations and television stations at the central level and below. By the year 2002, HIV/AIDS prevention and control should be covered in different forms and by different channels on regular basis.

(4) By 2002, health education on preventing HIV/AIDS and STDs should be carried out at all detoxification centers and re-education centers as well as in 80% of jails, and reeducation through labor centers. Relevant health education materials must be available at all of entertainment establishments, service centers, and work units where migrant workers congregate and working places or institutions that organize labor export.

(5) By the year 2002, at least one model community in the prevention and control of HIV/AIDS and STDs is to be set up in each province, municipality and autonomous region.

3. Establish and Improve the surveillance system for HIV/AIDS and STDs, strive to achieve more accurate and timely analysis, and  predict epidemiological trends. Establishment of a HIV/AIDS and STD prevention and control system.

 (1) By the year of 2002, build up a fully functioning national reference center for HIV/AIDS. A standardized confirmatory laboratory for HIV/AIDS diagnosis at provincial, municipal, and autonomous region level, and at least one medical or health institution that can provide HIV screening test should be established. An efficient national surveillance system for HIV/AIDS is to be established by the year of 2005.

(2) By the year 2002, all blood collection and supply working units and centers for the production of blood products shall meet the requirements for standardized HIV antibody screening. An efficient system for quality assurance and monitoring mechanism will be established.

(3) By the year 2002, in all large and medium sized cities and in areas hard-hit by HIV/AIDS epidemic, one hospital will be strengthened to provide standardized treatment and care, counseling and prevention for HIV infected individuals and people living with AIDS. All health professionals should be trained in HIV/AIDS prevention and control.

(4) By the year 2002, at least 85% of all health professionals are expected to have received short term training on STDs, 85% of the medical institutions at county or prefectural level and above will be capable of providing standardized diagnosis, treatment, and counseling. STD prevention and control, surveillance, and health education shall be incorporated into community health care service network by the year of 2005.

4.  Accelerate the development of HIV testing reagents, medicines, vaccines and related epidemiological, social, behavioral and health economic research that support for HIV/AIDS prevention and control policy and strategy development. Strive to raise the level of some research projects to the advanced international standard. Make efforts to apply the research findings to the prevention and control.
(1) By 2002, domestic production for the laboratory kits of HIV antibody confirmatory test should be achieved. The quality of laboratory kits used for HIV antibody screening should meet international standards. By the year 2010, laboratory kits for HIV antigen detection, immunological and clinical diagnostic kits with the similar quality to comparable products on the international market should be produced domestically.

(2) By 2002, a center for clinical trials of medicines for HIV infection and AIDS will be established. New breakthroughs will be made for the anti-virus drugs and immunoboosters by 2010. Vaccines against major HIV subtypes circulating in China will be developed and the clinical trials will be finished.

(3) By 2002, studies on models for the projection and prediction of HIV/AIDS epidemic will have been completed. A set of indicators suitable for China’s conditions to evaluate behavioral interventions, including assessments to measure advances in knowledge and behavioral changes, among different populations will be developed.

5.  To develop and improve the HIV/AIDS related legislation
 
(1) By the year of 2002, relevant laws, stipulations and regulations for the prevention and control of HIV/AIDS and STDs will be developed and refined. They will clarify the responsibilities of governmental departments and segments of society in HIV/AIDS prevention and control, as well as the rights and obligations of HIV infected individuals and people living with AIDS.
 
(2) A supervisory and monitoring mechanism will be developed for the enforcement of relevant laws, stipulations and regulations. Illegal blood collection and supply and illegal STD services will be eliminated according to the relevant laws and stipulations.
 
Strategies and Measures
1. Strengthen leadership for the implementation of comprehensive control measures:
Governments at different levels are expected to strengthen their leadership for HIV/AIDS and STDs prevention and control, to implement the measures and the requirements set forth in the Plan conscientiously. They should stay current with the most recent information on local HIV/AIDS and STD epidemiological trends and those in neighboring regions. They should develop the plan and implementation protocol for HIV/AIDS prevention suitable for their locality and incorporated them into the local socio-economic development programme. The plan should be implemented and evaluated seriously. A pragmatic approach is to be adopted to analyze and solve the difficulties and problems encountered. Relevant departments and organizations such as health, propaganda, education, civil affairs, public security and justice should work out and coordinate their specific plans for HIV/AIDS prevention and control. They should fulfill their own commitments and work closely with other relevant parties to achieve a comprehensive prevention and control effort. Most resources for HIV/AIDS prevention and control should come from government at various levels and supplement by other funds raised through various channels in order to ensure the smooth implementation of the HIV/AIDS prevention and control plan. Governments at different levels are responsible for fund raising and allocation of needed funds. However, governments should also actively seek support from all sectors of society and international assistance in order to broaden the investment channels. All social bodies, voluntary organizations and the community should be mobilized and actively involved in HIV/AIDS prevention and control and they should be encouraged and supported to provide home-based care and psychological counseling service for people living with AIDS, and health education among high-risk populations.  Insofar as possible, these organization should be assisted in offering support to help HIV infected individuals and people living with AIDS so as to mitigate the prejudice against HIV infected individuals, people living with AIDS and their families.

2.  Meet the Plan Targets and Offer Guidance According to Specific Conditions

The short-term tasks for the implementation of the Plan are carrying out health education for HIV/AIDS and STD prevention and control through the mass media and wide spread health education network, improving the capacity of health system for STDs and HIV/AIDS prevention and care and strengthening efforts to control the blood collection and supply more strictly. Young people, women and high-risk populations who are more vulnerable to HIV infection should be the core populations for HIV prevention and control. Based upon local survey work analysis of the HIV/AIDS and STD epidemic both locally and in neighboring areas along with the determinants that drive the epidemic (such as increasing sexual promiscuity, injecting drug use and floating/mobile population,) as well as local prevention, control, supervision and surveillance capability, the priority and key population and regions for preventive measures should be identified.  Prevention and control should be guided by local context and situation, namely, in the areas with no HIV infection, low STD incidence, and few high risk populations, the main approach in these areas will be setting up and improving the surveillance system, training professionals especially for HIV/AIDS and STD prevention and control, and disseminating the knowledge for HIV/AIDS and STD prevention. In other areas where HIV infected individuals and people living with AIDS are common, STD incidence is high or increasing sharply, and high risk populations are common or increasing rapidly, a comprehensive prevention should be mounted, and all the strategies and measures stated in the Plan should be implemented. A highly efficient leadership coordination and supervision mechanism should be set up. The surveillance system and the network for providing medical and care services should be developed.  Changing the risk behaviors of the target populations should be a priority and HIV/AIDS and STD prevention and control knowledge should be disseminated widely and without delay.

3. Scale up health education to improve HIV/AIDS prevention awareness among the people

All media and education and propaganda units have a duty to teach the people about HIV/AIDS and STDs. With their wide coverage and enthusiastic audiences, radio and television stations, newspapers and other media should disseminate free of charge information related to the prevention of HIV/AIDS and STDs.  Both routine and emergent intervention approaches should be adopted for health education among the general population, key groups and high-risk populations. All government sectors and social organizations should commit themselves to health education for HIV/AIDS and STD prevention and control conscientiously by making full use of their special capabilities. This work should be integrated into their education work plans and carried out in a systematic way to educate the staff within their systems and other populations concerned about HIV/AIDS and STD prevention educational activities.  Knowledge on HIV/AIDS and STD prevention should be introduced to university, college and vocational school students as a key element incorporated in the health education, or population and adolescent education. The health education prescription on HIV/AIDS and STD prevention should be distributed to the freshmen of university, college and vocational schools during their enrollment medical check-up.  Medical/health centers, centers for blood collection and supply, health education institutes and family planning institutions at different levels should not only provide health education and counseling service, but also provide educational materials and technical assistance for other relevant sectors and organizations. All these efforts are aimed at building a health education network. For all the educational initiatives, the fundamental principle is to provide correct advice and guidance. Health education should provide basic knowledge on HIV/AIDS and STD prevention, promote norms for healthy and positive love and marriage and family value, and stress sexual morality and healthy sex. Preventive measures and methods should be introduced to the general population to make them aware of how they can protect themselves and prevent disease. Education of high-risk groups such as prostitutes and drug abusers about relevant laws and regulations against these activities should aim at behavioral changes in these groups. Condoms should be promoted vigorously and the risk of infection for those sharing needles and syringes for drug injection should be publicized among high-risk populations.

4. Manage according to the law, and strengthen  efforts for supervision and surveillance

Relevant laws and stipulations such as the “Law of the People’s Republic of China on the Prevention and Control of Infectious Diseases”, and the “Law of the People’s Republic of China on Blood Donation” should be strictly adhered to in order to achieve 100 percent voluntary blood donation. Institutions involved in blood collection and supply or the manufacture of blood products should be reorganized and consolidated. Illegal blood collection and supply should be suppressed more vigorously. Screening and surveillance for HIV infection and other blood borne diseases should be implemented among blood or plasma donors, and for blood and blood products. Monitoring and supervision needs to be carried out at health system to prevent HIV infection resulting from medical care. Any case of HIV transmission through blood collection and supply, transfusion, or as a result of medical care should be viewed as a crime and those responsible for such a crime must be punished seriously by the relevant laws and stipulations.  HIV and STD surveillance will be enforced by the relevant laws and the surveillance system should be managed in a standardized way. Quality control measures should be installed to make sure that the surveillance reflects epidemiological dynamics in a timely and precise way. Health care and counseling services needs to be improved. Commercial STD clinical service providers must be thoroughly reformed in order to improve service quality.  Measures have to be taken to ensure confidentiality to STD clinic patients and to alleviate their burdens. Effective prevention and treatment will be described and promptly spread. Current technical criteria and managerial protocols will be revised as necessary. All these initiatives hopefully will contribute to the reduction of STDs and their spread.

The enactment and revision of laws and regulations relevant to HIV/AIDS and STD prevention and control will be accelerated. Laws and regulations should be enacted or revised at different levels according to the local situations and contexts.  The legal framework for HIV/AIDS and STD prevention and control needs to be gradually improved.

5, Strengthen institutions and develop trained personnel

Make full Use of the capacities of existing health institutions such as academies for preventive medicine, anti-epidemic stations, quarantine services, institutions for STD prevention and control, centers for blood collection and supply, and other medical or health services. The National Center for HIV/AIDS Prevention and Control will be established immediately. Every area shall develop and strengthen expertise, technical capacity, facilities, and improve working conditions for HIV/AIDS prevention and control within the existing health, anti-epidemic system and other institutions so that they will be capable of assuming HIV surveillance, education, technical training, technical guidance and other tasks.  More laboratories for HIV screening will be set up within the medical and health system, and the system for blood collection and supply on all three levels -- the provincial, prefectural (city) and county (city) levels. The number of sentinel sites for HIV surveillance will be increased progressively in a scientific way. The systems for STD prevention and control, medical services, maternal and child health and family planning will gradually assume an appropriate degree of responsibility for HIV/AIDS surveillance, prevention and control.

Training activities will be planned and implemented using different modalities and approaches for the personnel working at different levels on HIV/AIDS and STD prevention and control. People trained will include relevant scientific researchers, health educators as well as managerial staff.  This training will improve their ability to diagnose and treat HIV/AIDS and STDs, to carry out surveillance, health education and counseling, and to manage projects. This endeavor is aimed at gradually establishing a professional work force. In order to maintain the stability of this professional force, relevant policies will be developed to encourage the full commitment of the professionals to HIV/AIDS prevention and control, and certain measures will be taken to improve their working and living conditions.

6.  Strengthen scientific research and actively develop international collaboration

An effective HIV/AIDS prevention and control programme depends upon the strengthening of scientific research, and upon scientific advances and developments. The HIV/AIDS related researches will continue to be included in the national plan for tackling key problems in the scientific domain and will be set a priority in “China’s Agenda for the Twenty-First Century”. All relevant scientific research should mesh with the implementation of this Plan and scientific findings and results should benefit HIV/AIDS prevention and control. Full advantage should be taken of the strengths of Chinese traditional medicine and the combination of Chinese traditional medicine and western medicine. The role of the Expert Committee for HIV/AIDS and STD Prevention and Control in providing consultation and advice will be emphasized so as to identify and address key technical problems. Scientists in different disciplines should work together and their joint efforts should focus on the prioritized areas and key technical problems. Where conditions permit, the scientific management department should include applied research on HIV/AIDS in the local science and technology plan and be given financial support.
 
Successful foreign science, technology and experience should be assimilated, learnt and disseminated if they are justifiable and suitable for China. International exchange, cooperation and assistance in the areas such as information, technology and resources should be actively sought.  Partnerships should be established with neighboring countries on HIV/AIDS prevention and control. China should participate in and contribute to the implementation of the global strategy for HIV/AIDS control.

Assessment and Evaluation:

A mechanism for assessment and evaluation will be established to assure the smooth progress and implementation of this Plan for HIV/AIDS prevention and control. The outcome and impact of this Plan will be evaluated comprehensively through self-assessment, selective evaluation, mid-term evaluation and final evaluation. The assessment and evaluation will be an ongoing process in order to monitor and guide the implementation of strategies and initiatives leading to the realization of the objectives in the Plan. Objectives, strategies and initiatives will be re-adjusted according to evaluation results and the constantly changing situation. Self-assessments will be made at different levels and the progress reports will be made annually. The protocol for self-assessment will be developed locally by each province, autonomous region and municipality.  The annual project progress report should be sent to the local government responsible for HIV/AIDS prevention and control and to the in-line department at the next higher level. The central government will carry out selective investigations and evaluations on the programme implementation on an irregular basis in different geographic regions and in different departments. Mid-term evaluations are planned for 2002 and 2005 and the final evaluation will be at 2010. The working objectives and targets will be re-adjusted according to the results of mid-term evaluation. The protocol for mid-term and final evaluation will be worked out jointly by the relevant ministries and agencies under the State Council.

Note: This Programme does not apply to the Hong Kong Special Administrative Region, Taiwan or Macao.
Key words: plan, program, health, diseases, and notification

Copy to:

All departments under the Central Committee of the Chinese Communist Party; General Office, General Departments, Armed services, and Military Area Commands under the Central Military Commission.

General Office of the National People’s Congress, General Office of the National Committee of the Chinese People’s Political Consultative Conference, the Supreme People’s Court, the Supreme People’s Procuratorate. All central committees of democratic parties.

Secretariat of the General Office of the State Council
Printed and disseminated on November 19, 1998