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P O P U L A T I O N AND HEALTH STUDIES
) 5 1 ) ` 2 ) + 1 . 1 + Asia–Pacific Population & Policy
&
April 2004
Number 69 POPULATION
POPULATION &
POLICY
POLICY
HIV/AIDS Awareness Is Improving
in China
T
Asia-Pacific Population he AIDS epidemic is one of the condom use between sex workers and
& Policy summarizes clients is low, sexually transmitted in-
most urgent threats to public
research on population
health in China. According to fections (which increase the likelihood
and reproductive health
for policymakers and the Chinese Center for Disease Con- of HIV transmission) are widespread,
others concerned with trol and Prevention, there were an es- and there is continuing risk of infec-
the Asia-Pacific region. timated 840,000 people living with tion through blood transfusions and
HIV/AIDS in 2003, including 80,000 other medical procedures.
This publication was made AIDS patients. Some observers believe One area of concern for the Chinese
possible through support that the number of people living with government has been the low level of
from the David and Lucile
HIV/AIDS already exceeds one million. awareness among the general popula-
Packard Foundation. The
opinions expressed do First observed in coastal and border tion. Lack of knowledge is often accom-
not necessarily reflect the regions, the epidemic is spreading panied by continuing risk behavior,
views of the East-West across the country. Between 2001 and limited adoption of preventative mea-
Center or of its supporters. 2002, the number of reported AIDS cas- sures, and negative attitudes toward
es increased by 44 percent. By 2003, people living with HIV and AIDS. This
Writers: cases had been reported in 31 provinc- issue of Asia-Pacific Population & Pol-
Chen Shengli, Zhang Shikun,
es, autonomous regions, and munici- icy discusses a three-year information,
and Sidney B. Westley
palities. Some have estimated that if education, and communication (IEC)
Series Editor: infection levels continue to increase at project conducted by the National Pop-
Sidney B. Westley the current rate, an estimated 10 mil- ulation and Family Planning Commis-
lion Chinese will be living with HIV/ sion (NPFPC) to improve HIV/AIDS
Editorial Committee: AIDS by 2010. knowledge and attitudes in China.
Tim Brown In addition to expanding geographi-
Minja Kim Choe cally, the epidemic is spreading from
Philip Estermann
high-risk groups to the general popula- ABOUT THE PROJECT
Robert D. Retherford
tion. The main transmission route is
through needle sharing among inject- In October 2000, the NPFPC initiated
ing drug users, but the proportion of a pilot project to test the effectiveness
sexually transmitted infections is ris- of IEC activities in improving HIV/
ISSN 0891-6683
ing—from 6 percent in 1997 to 11 per- AIDS knowledge and attitudes among
cent at the end of 2002. Data from sen- the Chinese population. Support for the
Correspondence address: tinel surveillance indicate that HIV project was provided by the Ford Foun-
East-West Center, Research Program prevalence is increasing among sex dation, the United Nations Children’s
Population and Health Studies workers. Mother-to-child transmission Fund (UNICEF), and the Joint United
1601 East-West Road Nations Program on HIV/AIDS (UN-
of the virus is also rising.
Honolulu, HI 96848-1601, USA
Behavioral surveys suggest substan- AIDS).
Telephone: (808) 944-7482
Fax: (808) 944-7490 tial ongoing risk to support further The project began with a baseline sur-
E-mail: [email protected] spread of the epidemic. Needle sharing vey conducted in December 2000. This
Internet site: www.eastwestcenter.org is common among injecting drug users, was followed by a multifaceted IEC
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Asia–Pacific Population & Policy
program, focusing on five rural and two groups did not turn out to be useful, fection was to practice abstinence or
urban communities with varying lev- however, because many of the project to have only one sex partner (Figure 1).
els of economic development and HIV interventions were also adopted in the Between the two surveys, knowledge
prevalence. control areas. Indeed, with HIV preva- of other ways to avoid infection—us-
The program began with a series of lence levels rising everywhere in the ing condoms, avoiding unsafe blood
training courses on how to conduct IEC country, it would have been unconscio- transfusions, and using disposable or
campaigns for AIDS prevention. Partic- nable to restrict prevention efforts to a sterilized needles—increased several
ipants were family planning staff, pro- few sites. Thus, the analysis compares fold. Yet even in 2003, nearly one in
vincial-level heads of family planning results from seven sites in 2000 with five could not name a single way to
IEC departments, county-level program results from 13 sites in 2003. prevent HIV transmission.
officers, mayors, and district governors As shown in Figure 1, 60 percent of
of the seven project areas. Based on ex- respondents in 2003 knew that using
perience with these training courses, KNOWLEDGE IMPROVING, condoms correctly can prevent HIV
the Commission produced a Training ATTITUDES AMBIVALENT transmission, a dramatic increase from
Manual on IEC for AIDS Prevention, only 14 percent in 2000. By 2003, near-
which was distributed to family plan- AIDS awareness increased significant- ly three-fourths (71 percent) of all re-
ning IEC facilitators at all levels. ly over the 32 months between the two spondents also expressed a willingness
The Commission also produced surveys. By 2003, more than nine out to use condoms. Sixty-three percent
three 20-minute television programs on of 10 respondents had heard of AIDS, knew that condoms are distributed free
AIDS prevention, first aired on World up from eight out of 10 in 2000. by the family planning department, but
AIDS Day, 1 December 2001. In addi- All general measures of AIDS aware- only 26 percent knew that condoms can
tion, print and audiovisual materials ness improved over the project period. be purchased from shops or drugstores.
were distributed free in the seven By 2003, four out of five respondents The surveys asked several questions
project areas. Sample copies of all these knew that HIV is transmitted through about attitudes toward HIV/AIDS and
materials were made available to pro- unsafe sex, and three out of four knew toward people living with the virus. In
vincial family planning commissions that the virus is transmitted through 2003, more than one-third of respon-
throughout China for adaptation and unsafe blood transfusions. dents (36 percent) reported that they
reproduction in every province. In both surveys, the most frequent- were worried that they might become
The baseline survey interviewed ly mentioned way to prevent HIV in- infected, up from 29 percent in 2000.
7,053 men and women age 15–49 in the
seven project areas. In August 2003, the
Commission conducted a follow-up
survey to assess project implementa- Abstain or limit sex to 42
tion and impact and to provide a bench- one partner 74
mark for future work. The follow-up
14
survey included the seven project ar- Use condoms correctly
eas plus six additional sites, covering a 60
total of three urban communities in 2000
Avoid unsafe blood 16
2003
Shanghai Municipality and Hainan transfusions 57
Province and 10 rural communities in
Beijing Municipality and Guangdong, Use disposable or 12
Guangxi, Heilongjiang, and Henan sterilized needles 51
Provinces. The second survey inter-
Don't know any way to 53
viewed 12,998 men and women, also
avoid 18
age 15–49.
The six additional sites were origi- 0 10 20 30 40 50 60 70 80 90 100
nally included in the follow-up survey Percent aware of a way to avoid infection
to provide a comparison with the sev-
en project sites. The classification of Figure 1 Awareness of ways to prevent HIV infection, 2000 and 2003
the 13 sites into project and control Note: Multiple responses were allowed.
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Asia–Pacific Population & Policy
Although most respondents in 2003
33
said that they would feel sympathy or Concerned for them
66
concern toward someone living with
HIV/AIDS, many also reported that 23
Sympathetic with them
they would “avoid contact” or would 59
“detest” or “blame” such a person (Fig- 2000
30
ure 2). Multiple responses were al- Avoid them 2003
32
lowed, and many people expressed
views that were mutually contradicto- 9
Detest them
ry. Ten percent of all respondents in 9
2003 expressed concern and sympathy
4
but at the same time said they would Blame them
6
avoid a person living with HIV/AIDS.
Some people may have negative at- 0 20 40 60 80 100
titudes toward people with HIV because Percent with attitude toward people living with HIV/AIDS
they have a poor understanding of how
the virus is transmitted. Very few re-
Figure 2 Attitude toward people living with HIV and AIDS, 2000 and 2003
spondents in either survey expressed
Note: Multiple responses were allowed.
misinformation about HIV transmis-
sion, however. In 2003, fewer than one
in 10 believed, erroneously, that they AIDS prevention in school. In 2003, 93 among the youngest respondents—age
could become infected by hugging, kiss- percent thought that schools should 15–19 years. In 2003, fewer than one-
ing, or shaking hands with an infected teach about HIV/AIDS prevention, and half (49 percent) of this age group were
person or by touching an infected per- 89 percent thought that schools should aware that correct use of condoms can
son’s belongings. provide sex education. The majority of prevent HIV transmission, compared
Nevertheless, more than one-half respondents felt that AIDS prevention with nearly three-fourths (72 percent)
said that they would not play cards, and sex education should be taught in of respondents age 20–29.
work in the same room, use the same junior middle schools, where pupils are, Knowledge of HIV/AIDS was much
toilet, or swim in the same swimming on average, 13–15 years old. lower in rural than in urban areas. In
pool as a person living with HIV. Four 2003, nearly three-fourths (72 percent)
out of 10 said that they would not shake of rural residents knew that practicing
hands with an infected person. KNOWLEDGE AND ATTITUDES abstinence or limiting sex to one part-
IN SPECIFIC POPULATION ner is one way to avoid HIV infection,
GROUPS but knowledge of the other three most
SOURCES OF INFORMATION important ways to avoid infection was
Knowledge. The demographic charac- much lower. One in five (20 percent)
Most people who knew about AIDS teristic with the largest effect on rural residents could not name a single
learned about the disease from televi- knowledge of HIV/AIDS was education. way to avoid infection, twice the pro-
sion (Figure 3). All sources of informa- Awareness of ways to prevent infection, portion for urban residents.
tion gained in importance during the for example, increased consistently There were also some striking dif-
project period, but the increase was with level of education. The largest ferences between urban and rural resi-
particularly large for lectures and print gain was for respondents who had com- dents in sources of information about
materials provided by family planning pleted primary school compared with HIV/AIDS. Although television and
personnel, demonstrating the impact of those who were illiterate or had only family planning IEC campaigns had
project activities. Use of the Internet attended literacy classes. reached similar proportions in both
and telephone hotlines, although still Knowledge of HIV/AIDS also varied population groups, a much smaller pro-
low, is also increasing. according to the respondents’ age. AIDS portion of the population in rural areas
Nearly all respondents agreed that awareness increased between the two reported learning about HIV/AIDS from
young people should learn about sexu- surveys for all age groups, but knowl- books, newspapers, or radio than in ur-
ality, reproductive health, and HIV/ edge levels were consistently lowest ban areas.
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Asia–Pacific Population & Policy
59
should focus on young people and on
Television
79 population groups that risk being left
behind in China’s general economic and
Family planning 7
lectures, materials 55 social development—the uneducated,
urban migrants, and residents in rela-
30
Books, newspapers tively disadvantaged rural villages.
53
In principle, better information will
15
Radio not only help people avoid infection,
38
but should also improve their attitude
Experts, medical 6 2000
2003 toward people living with HIV. Results
personnel 27
from these surveys suggest, however,
1 that population groups with the best
Internet
6
knowledge of HIV/AIDS do not neces-
1 sarily have the most positive attitude
Telephone hotline
5
toward people living with the virus.
0 10 20 30 40 50 60 70 80 90 100 Better information is likely to im-
Percent who learned about HIV/AIDS from source prove attitudes only if it is coupled with
programs that promote support and
Figure 3 Sources of information about HIV/AIDS, 2000 and 2003 sympathy for affected populations. IEC
Note: Percentages are of respondents who had heard of HIV/AIDS. Multiple responses programs must be particularly careful
were allowed. in talking about intravenous drug use
and sex work not to increase stigmati-
Analysis of results from the nine eas were much more likely to say that zation or inhibit prevention efforts.
rural sites covered in the 2003 survey they would avoid contact with people Survey results on people’s current
highlights the importance of general living with HIV (41 percent) than were and preferred sources of information
economic development for improving respondents in rural areas (28 percent). point consistently to the importance of
AIDS awareness. Knowledge of the Respondents in areas with relative- mass media, particularly television. In
causes of AIDS and how to prevent in- ly high HIV prevalence were particu- addition, family planning lectures and
fection was much higher in villages larly likely to report that they were materials and face-to-face meetings
that had access to a primary school, a worried about becoming infected and with medical personnel and other ex-
hospital or clinic, and/or a bus station to say that they would avoid contact perts gained dramatically in impor-
than in villages without these facilities. with people living with HIV. This sug- tance as sources of HIV/AIDS informa-
Among urban communities, AIDS gests that worry and negative attitudes tion over the three-year project period.
awareness was lower in communities are likely to increase as the epidemic A comparison of respondents’ actual
with large migrant populations than in spreads across the country. and preferred sources of information
communities with relatively few mi- suggests that many people in China
grants. AIDS awareness was particular- would like to receive more information
ly high in urban communities that have THE WAY AHEAD on HIV/AIDS from family planning and
family planning IEC facilitators, sug- medical personnel. In addition, 13 per-
gesting that IEC facilitators can play A comparison of results from the 2000 cent of respondents under 20 men-
an important role in increasing the pub- and 2003 surveys shows that AIDS tioned that they would like to receive
lic’s knowledge of HIV/AIDS. awareness has improved a great deal in information on the Internet.
China. Yet even in 2003, more than one The materials developed and expe-
Attitudes. Respondents with high lev- in 10 (13 percent) of men and women rience gained from this project should
els of education were more likely than age 15–49 could not name a single mode help family planning workers conduct
other respondents to express sympathy of AIDS transmission, and nearly two successful IEC campaigns for HIV/AIDS
or concern for people with HIV/AIDS, in 10 (18 percent) could not name a sin- prevention in other parts of China. Fu-
but they were also more likely to re- gle way to protect themselves against ture programs should place special em-
port that they would avoid contact with infection. Survey results suggest that phasis on improving attitudes as well
such people. Respondents in urban ar- future AIDS-awareness activities as increasing HIV/AIDS awareness.
