China has been challenged by the HIV/AIDS pandemic in ways that are both similar to and unique from experiences in other countries. China’s large and ethnically diverse population, its geographic expanse, rapid economic growth, institutional transition from a planned to an open economy and evolution of social norms have shaped its growing HIV/AIDS epidemic. China’s well-organized civil administration, trained professional cadres and far-reaching public health infrastructure have, on the other hand, proved to be a valuable resource in mobilizing a response to HIV/AIDS. As a part of that response, China embarked on an effort between 2001 and 2004 to
evaluate a unique preventive health strategy—the 100% Condom Use Programme (100% CUP)— to determine whether it could be replicated and achieve results in Chinese communities.
The 100% CUP strategy was originally developed in Thailand where it proved to be remarkably effective in assuring condom use in entertainment establishments, and in reducing the prevalence of STI and HIV/AIDS among sex workers and their clients, as well as the general population. 100% CUP is now being implemented in other Asian countries, with similarly positive
results in reducing the threat of STI and HIV/AIDS. In 2001, the Chinese Ministry of Health and the World Health Organization (WHO) worked together to launch the 100% CUP in two locations: Wuhan City in Hubei province, Jingjiang County in Jiangsu province, and one year later in 2002, another two sites in Danzhou City in Hainan province, and Lixian County in Hunan province. In 2003 with the support of the United Nations Population Fund (UNFPA), the China Family Planning Association launched another 100% CUP pilot project in Liuzhou City, Guangxi Zhuang Autonomous Region.
The overall findings of the Chinese pilot projects are that the 100% CUP strategy can be effective in China, that Chinese local governments can organize multisectoral support for the 100% CUP, and that these programmes can achieve notable increases in condom use and a reduction in STI among workers in entertainment establishments.
The four WHO-sponsored pilot sites witnessed dramatic increases in condom use among entertainment establishment workers at each site, ranging from approximately 50% increase over the course of piloting in Hubei province, to a more than 500% increase in the pilot in Hainan province. While the pilots had very low HIV infection rates to start with, even at zero cases in
some provinces (Jingjiang, Huangpi and Danzhou), the pilots did witness decreases in Chlamydia infections ranging from about 34% in the Hubei province pilot, to 88% reduction in rate in the Hainan province pilot.
Essential elements of the 100% CUP strategy were successfully implemented in each of the pilot communities, using a variety of tactics to organize a programme appropriate for local circumstances. Multisectoral “leading groups” which implemented the programmes in each pilot community have included members from various agencies relevant to the local response. The
critical relationship between the bureaus of Public Health and Public Security has been accomplished effectively through a variety of techniques, and methods for monitoring and enforcing condom use among entertainment establishment workers have been adapted to local circumstances. The documented success and utility of the 100% CUP strategy has inspired
district and provincial authorities to scale up and launch new programmes in other communities, including province-wide scale-ups in Hubei and Hunan, which are currently underway.
Important lessons have been learnt through the pilot projects about the challenges of establishing a 100% CUP and the methods for overcoming them. Other communities planning to implement the strategy can benefit greatly by drawing upon the experiences of these pilot projects and the lessons they provide.
The Center for Strategic and International Studies HIV/AID Task Force’s new report examines persistent challenges and gaps in the prevention and control of the epidemic in China. The report notes that a more comprehensive, coordinated, and concerted national and international response to China’s HIV/AIDS challenge is still at a relatively early stage. The report also assesses many “best practices” and innovative strategies that have emerged as China’s response to the epidemic expands and evolves, including methadone replacement therapy, expanding voluntary counseling and testing (VCT) and peer education, condom promotion, comprehensive drug-dependence and rehabilitation services, and access to antiretroviral therapy. Given the HIV/AIDS situation in China, the persistent challenges, and the emergent best practices, the report concludes with four key sets of recommendations: Give primary focus to key marginalized and at-risk populations; work toward a more comprehensive, “full-spectrum”, patient-management approach; intensify engagement with domestic and international nongovernmental players; deepen coordination across government agencies and key actors.