HIV/AIDS Prevention in Transport Sector in Guangxi and Yunnan, People’s Republic of China

ADB TA6321 Sub-project 7
Presented by SCOTT FERGUSON, EARD 26 May 2010

Background to ADB HIV Actions in the PRC Transport Sector
• The PRC is different from the Mekong Region because ADB has been constructing expressways to relieve congestion on existing highways, so remote areas were not being opened up for the first time. • Our focus has been on large construction workforces. • Early projects focused on HIV awareness by giving information to workers and local communities. • In 2004, the ADB financed Baolong Expressway project had a separate TA for HIV prevention implemented with the local health bureau.

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Background for the TA
• ADB has been financing highway projects in Yunnan and Guangxi provinces for the 10 years. • Yunnan and Guangxi rank first and third in number of HIV cases in the PRC. • New TA to work with the provincial transport departments to mainstream HIV Prevention for highway construction projects. • Two new expressways - one in Yunnan is just starting; and one in Guangxi (LongBai) started in 2008 - the main focus of this presentation.

Background for the TA

• Builds on TA4142 - Baolong Healthy and Safe Action (BHSA) project in Yunnan. • BHSA very successful project and local peer education model is now adopted, expanded and paid for by local government. • But level of resources too high to replicate. Also, limited buy-in from transport sector.

Pre- TA Situation in Guangxi
• HIV transmission has shifted from needle sharing by drug users to sexual transmission. • Road construction brings mobile men with money and demand for paid and casual sex. • HIV found among sex workers who have construction workers as clients = clear risk. • Communities further from main centers have relatively lower understanding of HIV and also less willing to use condoms.

Pre-TA Situation in Transport Sector
• Limited HIV/AIDS activities on earlier projects. • Limited understanding of importance of HIV prevention within the Transport Department. • Resistance to activities that may interfere with expressway construction. • HIV was included in ICB clauses of road contractors but there was no formal monitoring system. So contractors did not carry out their obligations seriously.

Objectives for Mainstreaming
• Reduce risk of transmission of HIV and sexually transmitted infections (STIs) among construction workers, sex workers and local communities. Standard objective. • Strengthen institutional capacity for HIV prevention in the transport sector. Find approaches which could be adopted more widely (i.e. with local expertise & lower budget). • Develop an effective monitoring and evaluation system. Need accurate yet affordable information on behavior change among target groups.

Phase I of Guangxi Results
• Pilot activities in 5 of 13 construction sections. • Training for HIV prevention teams (HPT) and peer educators in each section. • Ongoing training to workers by HPT and peer educators, using monthly safety talks and induction trainings • Provision of condoms, information materials (playing cards, brochures, posters) • Initial prevention activities in selected communities (through health agencies) and entertainment venues (existing programs).

HIV Education in a Work Break

Phase II of Guangxi Results
• HIV prevention was included into the safety monitoring system, ensuring activities are monitored regularly and with financial penalties for non-compliance. • Expanded activities to remaining 8 construction sections. • This included 3 sections not covered by ADB funding (i.e. clauses were added to national contracts). • One company has indicated it will expand HIV activities into all its projects. • New training materials: HIV field educators guide; site monitoring guidelines; checklist of HIV responsibilities on sites; and guidelines for transport sector.

Condom Training in Downtime

Lessons Learned
• Good communication with the Expressway Headquarters office is crucial, including to ensure activities take place at right times. • Take advantage of pre-construction phase to do initial training when contractors are not so busy. • Use of peer educators model can be problematic due to high turnover of construction teams. • Place more focus on STIs as these facilitate HIV spread and act as an early warning of risk behavior. • If people need to seek treatment, ensure good health services are accessible.

Conclusions
• This approach can have wider adaptation in the transport sector. • Much can be done by the transport sector but involvement of health expertise at key points is still necessary. • A monitoring system was developed but how to evaluate impact affordably • Need to decide who pays for what (although the costs can be internalized)*

Next Steps
• Disseminating lessons to ministries of Transport and Health, as well as the State HIV/AIDS Office. • Clarification of the roles of the transport agencies and the various health agencies. • Implementing a slightly different Yunnan model on two new expressway projects, including involvement of an NGO in place of the TA consultant.

THANK YOU

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