Multi-sectoral Cooperation in Hubei Province Facilitates HIV/AIDS Prevention and Control

  Hubei Provincial People’s Government AIDS Working Committee Office

Since the work relating to HIV/AIDS Prevention and Control involves many aspects, the relevant sectors should not only perform their own duties, but also make concerted efforts. In Hubei Province, owing to the close cooperation among relevant sectors in the aspects including advocacy and education, care and support, mother-to-infant transmission prevention, high-risk behavior intervention, blood management, medical treatment, legislation and scientific research, the work relating to HIV/AIDS Prevention and Control has brought about obvious effect.
——The Editor

At the working conference of Hubei Provincial Government, the CPC Hubei Provincial Committee and the Hubei Provincial Government have emphasized time after time that the work relating to HIV/AIDS Prevention and Control should be regarded as the embodiment of the guideline of “Adhering to Scientific Development Philosophy and Construct A Harmonized Society” and be carried out properly. For 2 consecutive years (2004 and 2005) the Hubei Provincial Government has listed the work “Allocate special fund, strengthen HIV/AIDS Prevention and Control and offer assistance and support to AIDS patients” as one of the eight practical deeds to be done by the Hubei Provincial Government. In 2004, the Hubei Provincial Government held 8 special meetings for working relating to HIV/AIDS Prevention and Control. On June 13, 2005, the provincial governor presided over the working conference, at which reports about HIV/AIDS prevention and support to AIDS patients in Hubei Province were heard and 10 policies on HIV/AIDS prevention and support to AIDS patients were adopted.

1. Main Methods

(1) Effective working mechanism is the foundation for multi-sectoral cooperation.

In March 2004, the Hubei Provincial Government, on the basis of the original coordination meeting system for prevention and control of AIDS and venereal diseases, established the Provincial AIDS Working Committee for HIV/AIDS prevention and control of which the director is acted by the provincial governor and which is composed of the leading officials of the 24 sectors and the 8 cities/prefectures under the provincial government. Under the Provincial AIDS Working Committee an administrative office responsible for daily coordination was set up. According to the requirements made by the provincial government, the government of each city, prefecture, county or district also set up a Provincial AIDS Working Committee of which the director is acted by the main leader of such government and which is composed of leading officials of relevant sectors. Meanwhile, each Provincial AIDS Working Committee also established a working body to coordinate the work relating to HIV/AIDS Prevention and Control. In addition, monthly reporting system was also formulated for work relating to HIV/AIDS Prevention and Control. The administrative office of the provincial government held scheduling conference for tasks relating to HIV/AIDS Prevention and Control at irregular intervals, at which each department was required to report the progress of work.
 
(2) Defined tasks and strengthened accountability are effective measures for promoting multi-development cooperation.

In April 2004, the Opinion of Hubei Provincial People’s Government on Strengthening Work relating to HIV/AIDS Prevention and Control was promulgated, which set forth 7 principled tasks of HIV/AIDS Prevention and Control in Hubei, including “Expressly formulate working objectives so as to establish the accountability for HIV/AIDS Prevention and Control; strengthen measures for prevention and control so as to check the spread of AIDS; implement policy on assistance and support so as to materialize the care of the whole society to AIDS patients; carry out basic works so as to advance the level of prevention and control; intensify the advocacy so as to popularize the knowledge about HIV/AIDS Prevention and Control; increase investment so as to ensure the smooth progress of the work; strengthen the leadership so as to ensure that the accountability is strictly implemented.” In June 2004, the provincial government gave out the Notice relating to Implementing the Opinion of Hubei Provincial People’s Government on Strengthening Work relating to HIV/AIDS Prevention and Control, whereby the main tasks of HIV/AIDS Prevention and Control were allocated to each area and each department.

(3) Strengthened communication and perfect coordination are important preconditions for multi-sectoral cooperation.

In 2004, with the support from the Chinese Center for Disease Control and Prevention and United Nations Development Programme (UNDP), the Hubei Provincial Government held 3 symposiums on leading ability of HIV/AIDS Prevention and Control and the Hubei Provincial People’s Congress held one symposium on policy relating to HIV/AIDS Prevention and Control. Meanwhile, the Hubei Provincial AIDS Working Committee organized all member units to carry out supervisory inspection at irregular intervals. All these actions helped the leading officials of each department get familiar with the relevant situation, the implementation of policy and the actual needs at grassroots level, understand the impendence, develop the sense of responsibility and the consciousness to actively participate in the work relating to HIV/AIDS Prevention and Control.

2. Main Fields for Multi-sectoral Cooperation

(1) Advocacy and Education on AIDS
With respect to advocacy and education on AIDS, the Provincial Health Education Institute, Provincial Bureau of PublicityBureau of Publicicy, Party School, Provincial Education BureauBureau, Provincial Population and Family Planning Commission, Provincial Women’s Federation, Provincial Youth League, Provincial Red Cross and Provincial Labor Union and Provincial Tranportation Bureau, by bringing their own advantages into full play, formulated the measures for unfolding the advocacy and education on HIV/AIDS Prevention and Control respectively and carried out a series of activities. For example, the Provincial Bureau of Publicity, in conjunction wit the Provincial Health Bureau, held the Reporting Conference for Advanced Deeds of Hui Xien and Press Conference for HIV/AIDS Prevention and Control in Hubei at which a group of press units and correspondents who have made great attribution to the advocacy and education on HIV/AIDS Prevention and Control; the Provincial Health Education Institute, in cooperation with the Hubei Provincial TV Station, made a special grogram titled “Care about Women and Fight against AIDS” which has been televised under the column “Sunshine Action” of Hubei Provincial Satellite TV Station; the Provincial Education BureauBureau incorporated the knowledge about prevention of venereal diseases and AIDS into the teaching program of university and high school and listed the knowledge about AIDS, venereal diseases and non-remunerated blood donation as the contents for senior high school admission exam, and carried out supervisory inspection across the province in August 2004; the Provincial Women’s Federation unfolded the one-year activity titled “Face to Face” so as to impart knowledge about HIV/AIDS prevention to all women; the Provincial Youth League and the Provincial Health BureauBureau recruited young volunteers to carry out the activity named “Cherish Life, Keep Away from AIDS, Eliminate Discrimination and Share Health” from June 15, 2004; Doctor Gui Xien with the Zhongnan Hospital under Wuhan University gave speech on knowledge about HIV/AIDS prevention in the Provincial Party School of Hubei.

Through these years’ practices and the concerted efforts made by various sectors, the advocacy and education on HIV/AIDS Prevention and Control in Hubei Province have become routinized, and a working mechanism incorporating routinized advocacy with specially intensified advocacy has been set up basically. The measures taken include: Carrying out extensive advocacy on knowledge about HIV/AIDS prevention and non-remunerated blood donation through various media; carrying out regular education on knowledge about HIV/AIDS prevention in campuses and entertainment places, erecting billboards on which knowledge about HIV/AIDS prevention and non-remunerated blood donation is given in public places, offering free advocacy materials in entertainment places and set up advocacy board in medical institutions; Intensifying the advocacy in areas where AIDS rages through door-to-door advocacy so as to ensure that every household is provided with an HIV/AIDS prevention manual, putting up posters in each sub-district office, community residential committee, university and high school so as to make public the State’s policy on HIV/AIDS prevention; carrying out large-scale activities so as to publicize the World AIDS Day.

(2) Care and Support to AIDS patients and HIV infected peoples
With respect to implementing the policy of “Four Frees and One Care”, the Provincial Health Bureau, Provincial Finance Bureau, Provincial Poverty Alleviation Office, Provincial Education Bureau, Provincial Labor and Social Security Bureau, Provincial Bureau of Civil Affairs  and Provincial Red Cross, by bringing their own advantages into full play, formulated a series of measures which are effective and practical.

-1. Provincial Civil Affair Department: It brought all poverty-struck rural households in which there is HIV infected people under the coverage of the assistance program to extremely poor population in rural areas; it brought all urban households in which there is HIV infected people and of which the per capital income is lower than the minimum living standard under the coverage of the urban subsistence allowance program; it applied 3 methods in resettling AIDS-affected orphans in accordance with the principle “Taking dispersed resettlement as main means and taking centralized resettlement as auxiliary means;” it listed all AIDS-affected lonely old people as objects enjoying the five guarantees (guaranteed food, clothing, medical care, housing and burial expenses). The Provincial Civil Affair Department, by conducting a survey on assistance to and resettlement of AIDS-affected orphans across the province and launching investigation on policy and training on AIDS-affected orphan arrangement, set up a suitable system for assisting and resettling AIDS-affected orphans. In 2005, the Provincial Bureau of Civil Affairs  included the methods for collecting and managing the AIDS patients and HIV infected peoples within floating population into the scope for policy research.

-2. Provincial Poverty Alleviation Office: In 2004, the Provincial Poverty Alleviation Office brought 14 AIDS-affected poor villages under the poverty alleviation program. By allocating a fund of RMB100 thousand to each village and dispatching a special team to carry out on-site survey, the Provincial Poverty Alleviation Office formulated poverty-alleviating plan and measures for each village and helped them to implement such plans. In 2005, the Provincial Poverty Alleviation Office appropriated RMB1.4 million Yuan for poverty alleviation in 15 AIDS-affected poor villages.

-3. Provincial Education Bureau: The Provincial Education Bureau, in conjunction with the Provincial Health Bureau, specified the scope of assistance program for AIDS-affected poor class attendees in Hubei Province, the conditions for class attendees to be assisted, the standard of assistance, the assistance methods, the resources of fund and the requirements on assistance work. According to this program, all AIDS-affected orphans who are at the stage of nine-year compulsory education are exempted from incidental expenses and teaching material expenses; all AIDS-affected orphans who meet the admission conditions of university, technical secondary school or ordinary high school are filed unitedly and exempted from incidental expenses, teaching material expenses and accommodation expenses. Meanwhile, the Provincial Education Bureau required that the education administrative sectors at various levels should offer care and aid to class attendees who are children of HIV infected peoples or are HIV infected themselves so as to avoid unnecessary panic and eliminate social discrimination.

-4. Provincial Labor and Social Security Bureau: The Provincial Labor and Social Security Bureau required that: None of its branches may not take discriminatory attitude towards HIV infected peoples who have participated in medical insurance; all of its branches should offer medical treatment to AIDS patients in time, file and follow up all HIV infected peoples who have participated in the basic medical insurance for urban worker, provide them with convenient conditions and policy support in the course of medical treatment, and offer employment service for all HIV infected peoples who are suitable for working and willing to get a job.

-5. One-to-one Assistance to AIDS patients: Method that sectors, enterprises and institutions which have relatively strong economic strength carry out one-to-one assistance for HIV infected people and AIDS affected households has been adopted in areas including Shuizhou and Daye, and has brought about the effects such as stabilizing the mood of People living with HIV/AIDS, lightening the burden on the government and alleviating the appealing pressure from AIDS patients who get infected owing to blood transmission.

-6. Assistance to HIV infected peoples in Hubei Province: In 2004, a total of 933 rural households in which there is HIV infected people were brought under the coverage of the assistance program to extremely poor population in rural areas and exempted from agricultural tax; a total of 558 class attendees who are either children of AIDS patients or AIDS-affected orphans were exempted from incidental expenses and teaching material expenses at the stage of nine-year compulsory education; a total of 202 AIDS-affected persons (including orphans and lonely old persons) were adopted or fostered by their relatives or the society. On the eve of the Spring Festival of 2005, the Provincial Bureau of Civil Affairs granted a subsidy of RMB1000 to each of 166 AIDS-affected orphans. In addition, the government at various levels supported People living with HIV/AIDS who have working ability to take up production by providing them with necessary productive materials. In areas where AIDS rages, 26 AIDS mutual help groups were established with the help from the government so as to help and assist AIDS patients and their families.
 
(3) Prevention of Mother-to-infant Transmission
In May 2004, the Provincial Health Bureau, the Provincial Population and Family Planning Commission and the Provincial Finance Bureau, by issuing the Notice relating to Distribution of Detailed Rules (Draft) for Administration on Free Prevention of Mother-to-infant AIDS Transmission in Hubei Province, jointly set forth provisions for organization, execution and management for work relating to free prevention of mother-to-infant AIDS transmission in Hubei Province and allocate the tasks relating to prevention of mother-to-infant AIDS transmission among various sectors. The health administrative sectors at various levels are responsible for organize and manage the work relating to free prevention of mother-to-infant AIDS transmission; the population and family planning sectors at various levels are responsible for procuring family planning service stations to provide information about early pregnant women to local maternal and children’s health care institutions in time, carrying out advocacy on knowledge about mother-to-infant transmission prevention in key areas and assisting health administrative sectors in mobilizing all HIV infected pregnant women to accept preventive measures at hospitals designated by the local health administrative sectors; the free HIV antibody detection agents and apparatuses for pregnant women, the free preventive drugs for mother-to-infant transmission and the baby detection agents are covered by provincial finance, part of the working costs is also covered by the provincial finance with the rest to be covered by local finance; the disease prevention and control bodies at various levels are responsible for carrying out primary screening test for HIV antibody and collecting samples, distributing testing agents, sampling equipment and free preventive drugs for mother-to-infant AIDS transmission, setting up and managing files of HIV-positive pregnant and postpartum women, presenting copies of such files to local maternal and children’s health care institutions and following up HIV-positive pregnant and postpartum women; maternal and children’s health care institutions are responsible for termination of pregnancy, drug-based prevention, safe delivery, instruction on baby feeding and regular following-up; the hospitals designated to carry out safe delivery for HIV-positive pregnant women should formulate preventive measures for iatrogenic infection and possess the ability to carry out HIV treating ability; the medical institutions are responsible for collecting and testing samples in the course of early pregnancy inspection and then submitting such samples to the testing institutions designated by local health administrative department for HIV antibody detection.

In June 2004, Hubei Province launched the training course on technology for mother-to-infant AIDS transmission prevention. Subsequently, all cities, prefectures and counties held similar training courses respectively. In July 2004, the systematic work relating to prevention of mother-to-infant AIDS transmission was carried out across the province in accordance with the Detailed Rules. By December 2004, a total of 103 thousand pregnant women were tested, and all the 15 HIV-positive pregnant women found accepted the free preventive measures.

(4) Prevention of Blood Transmission
In order to prevent the blood transmission, the public security sectors, in conjunction with the Health Bureau, launched a special campaign to crack down on illegal blood collection and supply in 2004. In this campaign, a total of 1613 inspection personnel were dispatched, 6 cases were investigated and 18 organizations were ordered to make correction. At present, blood collected through non-remunerated donation accounts for 86% of all clinically-used blood in Hubei Province, and the problem that AIDS spreads through blood-related route has been checked basically.

Currently, more than 90% of medical institutions in the province use disposable syringe and transfusion apparatuses.
 
(5) Intervention in High-risk Population
The Hubei Judiciary Department has developed advocacy and education in the whole province for criminals in prison and in rehabilitation through labors. All prisons and Rehabilitation stations have listed HIV/AIDS prevention into the instruction content of “Three Lessons”. The HIV antibody inspection rate of high-risk population in imprisoned criminals has reached 100%. A concentrated imprisoning place has been set up in Qianjiang in 2004, and 3 new concentrated imprisoning places have been set up in the province in 2005. In addition to strengthening the striking of prostitution, drug using and trafficing, the Hubei Provincial Public Security Bureau has cooperated with health sectors to conduct intervention for high-risk population, e.g. provide the name-lists of entertainment venues for 100% condom project; cooperate with health sectors to develop the hygienic needles exchanging and methadone maintenance therapy. Moreover, the Hubei Provincial Family Planning Committee, Hubei Provincial Technical Supervision Bureau, Hubei Provincial Medicine Supervision Bureau, Hubei Provincial Industrial and Commercial Bureau, Hubei Provincial Tourism Bureau have actively cooperated with the Hubei Provincial Health sectors to conduct 100% condoms generalization in entertainment venues. In 2005, the scope of 100% condoms generalization has been extended to the whole province from 48 counties in 2004.

The communication department has actively cooperated with the inspection for drivers of long-distance truck and provided the names of drivers for the health sectors. The Hubei Tianmen disease control center associated with the public security department and stated that the drivers with B license shall go through HIV antibody examination at the AIDS section of the disease control center when they transact annual driver license attestation.

From the first ten days of Nov. in 2004 to Feb. 2005, a complete investigation has been organized on the distributing of paid flood supplier, AIDS infection situation and the development situation of AIDS for infected patients. The responsibility system for leaders at different levels has been established. From the province to the village, special investigation teams have been set up according to the requirements of working scheme, and the powerful organization system has provided guarantee for the investigation work. The investigation teams and the supervision teams conducted advocacy and investigation at the same time. According to statistics, 180,000 executive leaders, party leaders and medical personnel have participated in the investigation, 12,000,000 advocacy materials have been distributed and almost 30,000,000 residents have been covered.  

（6）Multi-sectoral Cooperation of Global Fund Project

In Sep. 2004, the Hubei Provincial Global Fund HIV/AIDS prevention Project has been formally launched. According to the instruction of National Project Office, 35% of the fund will be applied to multi-sectoral cooperation. (20% to governmental multi-sectoral cooperation and 15% to multi-sectoral cooperation)  On Nov. 29, 2004, the Hubei Provincial Project Office organized and held a multi-sectoral cooperation seminar. More sectors and personnel were activated to focus on HIV/AIDS prevention project and the multi-sectoral cooperation project has been responded actively. Up to June 23, 2005, more than 60 recommendation letters on multi-sectoral cooperation from 23 sectors, organizations and institutions have been received. According to the appraisements of relevant experts, The Hubei Project Office approved the execution of 24 projects which involved in anti-discrimination, occupational exposure training, policeman instruction, construction workers instruction, AIDS peer education for high-school students, peer education for entertainment venues, instruction for men who have sex with man, instruction for administrative cadres of education-through-labor, training for teachers, web-based education for university students, technical manuals of antiviral treatment, training for grassroots medical personnel, construction of care system for AIDS-affected orphans, mental research on AIDS infected patients and their family members.

(7) Medical Units Dispatched Experts Team 

On March 2004, the Hubei Provincial Department of Health dispatched 10 expert teams of HIV/AIDS prevention from 11 departmental and provincial affiliated medical units to 21 districts with severe AIDS situation. They would take charge of the HIV/AIDS prevention and treatment in related counties and cities. Each expert team was supposed to complete the itinerant medical treatment in one county or city and then go to another. They would conduct complete physical examination for local AIDS Infected patients, instruct and supervise the development of prevention, diagnosis and antivirus treatment of AIDS, go deep into the towns and villages with severe AIDS situation to give treatment, and participate in and instruct the treatment and prevention of AIDS for local people. Meanwhile, the expert teams would develop technical training widely, deliver special reports for party and administrative cadres at villages and town’s level or above, and give special speech to students in middle school level or above.
 

(8) Strengthen the legal system and adhere to legal prevention and treatment

In order to accelerate the construction of legal system of HIV/AIDS prevention in Hubei Province, the provincial government, after seriously summarize the HIV/AIDS prevention experience, constituted and enacted the No. 269 provincial government order: Temporary Measures on HIV/AIDS prevention in Hubei Province. This order is formally put into effect on Dec. 12, 2004. By fixing up previous effective prevention measures in the form of governmental regulation, the basic system of HIV/AIDS prevention in Hubei province has been set up.

(9) Funds and Finance Management

In 2004, the Hubei Provincial Bureau of Finance increased the amount of special funds from 6,500, 000 Yuan in 2003 to 13,400,000 Yuan; and it kept a level of 13,400,000 Yuan in 2005. At the province governor office meeting on June 13, 2005, 30,000,000 Yuan of special funds for AIDS assistance was determined to set up. In addition of the lump sum of 5,000,000 financed by the provincial department of finance, the funds are mainly acquired from social contribution; and the deficiency will be made up from the income of welfare lottery.  

In 2004, the Hubei provincial department of Health and Finance jointly issued documents to enact the following detailed rules in sequence: Detailed Rule for the Implementation of Regulation of the Free Voluntary Counseling and testing (For trial implementation), Detailed Rule for the Implementation of the Regulation of Free or Expense-deduction Medication on AIDS or Familiar Opportunistic Infection (For trial implementation), Administrative Measures for Reimbursement of Expense of Medicine for AIDS-related Disease (For trial implementation), Implementation Scheme for Regulation of Funds for HIV/AIDS prevention Project, Detailed Rule for the Implementation of Free Blockade of Mother-To-Infant Transmission of AIDS (For trial implementation).

(10) Strengthen the Scientific Research on HIV/AIDS prevention

The Hubei Provincial Department of Science & Technology placed the HIV/AIDS prevention into important scientific Research items. Special expenditure has been financed to develop the research on prevention and treatment.

By attaching importance to develop the technical advantage of provincial medical universities, Hubei province supports the AIDS Center of Wuhan University, Wuhan Virology Institute of China Science Academe, Mid-South Hospital of Wuhan University to do research on basis theory and application of examination, treatment and mother-to-infant transmission blockade.

3. Existing Problems and Deficiency

Currently, there are four main problems existed in the HIV/AIDS prevention and treatment in Hubei Province: 1. As some of the local governments didn’t fully realize the importance of HIV/AIDS prevention, they are not able to sufficiently estimate the severity and harm of the large-scale spread of AIDS, and they can not completely understand the difficult and hardship of the prevention and treatment. Meanwhile, they make enough search on effective prevention and treatment mechanism; 2. The funds of prevention and treatment haven’t been fulfilled. The provincial government has ordained that the funds of prevention and treatment should be arranged according to the local population at a standard of 0.2 Yuan per person. Only 40% of the local governments have financed to this standard up to now; 3. In spite of the national government has enacted the assistance policies for AIDS patients and infected patients, related sectors didn’t set forth general corresponding measures. As the grassroots units have no specific guidelines to comply with while implementing these policies, the implementation rate of these assistance policies has been influenced greatly; 4. The policies for AIDS people infected by blood transfusion are to be researched and implemented.

                                  (Liu Dongru，Xia Qinghua，Ke xianzhou)