China. Key Data Issues and Suggestions

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2 DECEMBER 2011 REFERENCE SOURCES This review of reference sources is categorized into two groups, namely general sources and country sources. The general sources include the regional or global documents, such as the Report on the Global AIDS Epidemic, Towards Universal Access Progress Report, The World Health Report, World Health Statistics, State of World Population, The Human Development Report, and data from the UN Population Division, and The World Bank Database. The country sources are classified into two: 1) surveys 2) others and 3) recent Journal Articles. The others include studies, key presentations and reports. Most reference documents utilized for are available in electronic format and can be accessed through the internet. GENERAL SOURCES All the general sources of data on are available. The socio-economic and demographic information/indicators are drawn from these sources. An overall picture of the HIV epidemic in can be presented with the help of these general sources. COUNTRY SOURCES Surveys UNAIDS, Global Business Coalition, Century JinQin Marketing Research Company Renmin University, Ogilvy Public Relations Worldwide, & CHAMP. (2008). AIDS-Related Knowledge, Attitudes, Behavior, and Practices: A Survey of 6 Chinese Cities. Horizon Market Research, Futures Group Europe (2002 December) Behavioral Surveillance Survey in Yunnan and Sichuan: Sex Worker Report. Other Sources Wu, Z. (2011). HIV Testing and Treatment as Prevention in. Zunyou Wu, Yu Wang, Yurong Mao, et al. (2011). The Integration of Multiple HIV/AIDS Projects into a Coordinated National Programme in. Bull World Health Organ 89, Ministry of Health, UNAIDS, & WHO. (2010) Estimates for the HIV/AIDS Epidemic in. Division of Policy Research and Information, NCAIDS, & CDC. (2010). Gender Analysis of Data on HIV Epidemic and Response in Six Provinces: Guangdong, Guangxi, Yunnan, Henan, Hubei and Chongqing. 2

3 Ministry of Foreign Affairs, & United Nations System in. (2010). s Progress Towards the Millennium Development Goals 2010 Report. Social Development Resource Centre Beijing Academy of Social Sciences, & UNAIDS. (2009). A Literature Review on Spousal Transmission of HIV in. International Development Law Organization, UNAIDS, Labor Law and Social Security Law Institute at Peking University, & Chinese Academy of Social Science (CASS). (2010). Mapping Initiatives to Strengthen The Legal Environment for The Response to HIV in UNAIDS. (2009). AIDS in : Background Information on the Epidemic and the Response. UNAIDS, Marie Stopes International, & Institute of Social Development Research. (2009). The Stigma Index Report. Centers for Disease Control and Prevention (CDC). (2009). HIV Infection--Guangdong Province,, Morbidity and Mortality Weekly Report, 58(15), Asia Catalyst. (2009). I Will Fight to My Last Breath : Barriers to AIDS Treatment for Children in. FHI and IMPACT (2007), Final Report, USAID's Implementing AIDS Prevention and Care (IMPACT) Project. Thompson, D. (2005). Confronts HIV/AIDS, Population Reference Bureau. State Council AIDS Working Committee Office, & UN. (2004). A Joint Assessment of HIV/AIDS Prevention, Treatment and Care in East-West Center, Population and Health Studies (2002 July), HIV/AIDS in : Survey Provides Guidelines for Improving Awareness. The UN Theme Group on HIV/AIDS in (2001), HIV/AIDS: 's Titanic Peril, 2001, Update of the AIDS Situation and Needs Assessment Report. Recent Journal Articles IDU Shen, S.-Y., Zhang, Z.-B., Tucker, J. D., Chang, H., et al. (2011). Peer-Based Behavioral Health Program for Drug Users in : A Pilot Study. BMC Public Health, 11, 693. (open Wang, H., Li, G., Brown, K., Smith, K., et al. (2011). The Characteristics and Risk Factors for HIV Infection among Beijing Drug Users in Different Settings. Drug Alcohol Depend, 113(1), (open Xiao, L., Wu, Z., Luo, W., & Wei, X. (2010). Quality of Life of Outpatients in Methadone Maintenance Treatment Clinics. Journal of Acquired Immune Deficiency Syndrome, 53(S116-S120). (open 3

4 Bao, Y. P., & Liu, Z. M. (2009). Systematic Review of HIV and HCV Infection among Drug Users in. International Journal of STD & AIDS, 20, (open Jia, Y., Lu, F., Zeng, G., Sun, X., Xiao, Y., Lu, L., et al. (2008). Predictors of HIV Infection and Prevalence for Syphilis Infection among Injection Drug Users in. Harm Reduction Journal, 5(29). (open Liu, W., Chen, J., Rodolph, M., Beauchamp, G., et al. (2006). HIV Prevalence Among Injection Drug Users in Rural Guangxi. Addiction, 101, (limited MSM Li, J., Cai, Y., Yin, Y., Hong, F., et al. (2011). Prevalence of Anorectal Chlamydia trachomatis Infection and Its Genotype Distribution Among Men Who Have Sex With Men in Shenzen,. Journal of Infectious Disease, 64(2), (open Feng, Y., Wu, Z., Detels, R., Qin, G., Liu, L., Wang, X., et al. (2010). HIV/STD Prevalence among MSM in Chengdu, and Associated Risk Factors for HIV Infection. Journal of Acquired Immune Deficiency Syndromes, 53, S74 S80. (open Feng, Y., Wu, Z., & Detels, R. (2010). Evolution of Men Who Have Sex With Men Community and Experienced Stigma Among Men Who Have Sex With Men in Chengdu,. Journal of Acquired Immune Deficiency Syndrome, 53(S98-S103). (limited Ha TH, Liu H, Liu H, Cai Y, & Feng T. (2010). Concurrent Sexual Partnerships among Men who have Sex with Men in Shenzhen,. Sexually Transmtted Diseases, 37(8), (limited Liu, S., Wang, K., Yao, S., Guo, X., Liu, Y., & Wang, B. (2010). Knowledge and Risk Behaviors Related to HIV/AIDS, and their Association with Information Resource among Men who have Sex with Men in Heilongjiang province,. BMC Public Health, 10(250). (open Xiao, Y., Sun, J., Li, C., Lu, F., et al. (2010). Prevalence and Correlates of HIV and Syphilis Infections Among Men Who Have Sex With Men in Seven Provinces in With Historically Low HIV Prevalence. Journal of Acquired Immune Deficiency Syndrome 53(suppl 1), S66-S73. (limited Zhang, H., Wu, Z., Zheng, Y., Wang, J., et al. (2010). A Pilot Intervention to Increase Condom Use and HIV Testing and Counseling Among Men Who Have Sex With Men in Anhui,. Journal of Acquired Immune Deficiency Syndrome, 53, S88-S92. (limited Zou, H., Wu, Z., Yu, J., Li, M., et al. (2010). Sexual Risk Behaviors and HIV Infection Among Men Who Have Sex With Men Who Use the Internet in Beijing and Urumqi,. Journal of Acquired Immune Deficiency Syndrome 53, S81-S87. (open Feng L, Ding X, et al. (2009). High HIV Prevalence Detected in 2006 and 2007 among Men who have Sex with Men in 's Largest Municipality: an Alarming Epidemic in Chongqing,. J Acquir Immune Defic Syndr. Sep 1;52(1): (limited 4

5 Gao L, Zhang L, Jin Q. (2009). Meta-analysis: Prevalence of HIV Infection and Syphilis among MSM in. Sex Transm Infect. Sep;85(5): (limited He Q, Wang Y, et al. (2009). High Prevalence of Risk Behaviour Concurrent with Links to Other High-risk Populations: A Potentially Explosive HIV Epidemic among Men Who Have Sex With Men in Guangzhou,. Sex Transm Infect. Sep;85(5): (limited Lau JT, Wang M, et al. (2009). HIV-related Behaviors among Men Who Have Sex With Men in : AIDS Educ Prev. Aug;21(4): (limited Ruan Y, Luo F, et al. (2009). Risk Factors for Syphilis and Prevalence of HIV, Hepatitis B and C among Men who have Sex with Men in Beijing, : Implications for HIV Prevention. AIDS Behav. Aug;13(4): (open Ruan S, Yang H, et al. (2009). Rising HIV Prevalence among Married and Unmarried among Men who have Sex with Men: Jinan,. AIDS Behav. Aug;13(4): (limited Xing, G., Li-yan, W., Zheng-wei, D., & et al. (2008). Characteristics of Sexual Behavior and HIV Prevalence among MSM in Selected Cities of, Chinese Journal of AIDS & STD. (limited Xu H., Zhang B.,Zeng Y. and Li X. (2006). HIV Epidemic Status and Behavioral Surveillance among MSM in, Paper presented at XVI International AIDS Conference, Toronto. (limited Sex Workers Cai, Y., Shi, R., Shen, T., Pei, B., et al. (2010). A Study of HIV/AIDS Related Knowledge, Attitude and Behaviors among Female Sex Workers in Shanghai. BMC Public Health, 10(377). (open Cai, W.-D., Zhao, J., Zhao, J.-K., Raymond, H., et al. (2010). HIV Prevalence and Related Risk Factors Among Male Sex Workers in Shenzhen, : Results from a Time-Location Sampling Survey. Sexually Transmitted Infections 86, (limited Jin, X., Smith, K., Chen, R. Y., Ding, G., Yao, Y., Wang, H., et al. (2010). HIV Prevalence and Risk Behaviors among Male Clients of Female Sex Workers in Yunnan,. Journal of Acquired Immune Deficiency Syndromes, 53(1), (limited Li, Y., Detels, R., Lin, P., Fu, X., Deng, Z., Liu, Y., et al. (2010). Prevalence of HIV and STIs and Associated Risk Factors among Female Sex Workers in Guangdong Province,. Journal of Acquired Immune Deficiency Syndromes, 53(1), S48 S53. (open Tucker, J., Ren, X., & Sapio, F. (2010). Incarcerated Sex Workers and HIV Prevention in : Social Suffering and Social Justice Countermeasures. Social Science & Medicine, 70, (limited Wang, Y., Jiang, Y., Lu, L., Wang, G., et al. (2010). Microbicide Acceptability and Associated Factors Among Female Sex Workers and Male Clients in Kaiyuan County, Yunnan Province,. Journal of Acquired Immune Deficiency Syndrome, 53(Suppl 1). (limited 5

6 Yi, H., Mantell, J. E., Wu, R., Lu, Z., et al. (2010). A Profile of HIV Risk Factors in the Context of Sex Workers Environments among Migrant Female Sex Workers in Beijing,. Psychology, Health & Medicine, 15(2), (open Zhao, J., Cai, W.-D., Chen, L., Gan, Y.-X., et al. (2010). HIV-Related Risk Factors Among Male Sex Workers in Different Settings in Shenzhen,. Retrovirology, 7(suppl 1), 100. (open Lau, J., Wan, S., et al. (2009). Changes in Condom Use Behaviours among Clients of Female Sex Workers in. Sex Transm Infect. Sep;85(5): (limited Lu, F., Jia, Y., Sun, X., Wang, L., Liu, W., Xiao, Y., et al. (2009). Prevalence of HIV Infection and Predictors for Syphilis Infection among Female Sex Workers in Southern. The Southeast Asian Journal of Tropical Medicine and Public Health, 40(2), (limited Wang, H., Chen, R. Y., Ding, G., Ma, Y., Ma, J., Jiao, J. H., et al. (2009). Prevalence and Predictors of HIV Infection among Female Sex Workers in Kaiyuan City, Yunnan Province,. International Journal of Infectious Diseases 13(2), (limited Goodyear, M. D. E. (2008). Incarceration of Female Sex Workers in and STI/HIV. Programmes That Are Not Rights-Based are Doomed to Fail. Sexually Transmitted Infections, 84, 1-2. (limited Kong TS. (2008). Risk Factors Affecting Condom Use among Male Sex Workers who Serve Men in : A Qualitative Study. Sexually Transmitted Infections, 84(6), (limited Lau, J. T., Choi, K. C., Tsui, H. Y., Zhang, L., et al. (2008). Changes in HIV-Related Behaviors Over Time and Associations with Coverage of HIV-Related Services Among Female Sex Workers in Sichuan,. Sexually Transmitted Infections(online pub). (limited Xu, J., Wang, N., Lu, L., Pu, Y., Zhang, G., Wong, M., et al. (2008). HIV and STIs in Clients and Female Sex Workers in Mining Regions of Gejiu City,. Sexually Transmtted Diseases, 35(6), (limited Mi, G., Wu, Z., Zhang, B., & Zhang, H. (2007). Survey on HIV/AIDS-Related High Risk Behaviors Among Male Sex Workers in Two Cities in. AIDS, 21(suppl 8), S67-S72. (limited Pirkle, C., Soundardjee, R., & Stella, A. (2007). Female Sex Workers in : Vectors of Disease? Sexually Transmitted Diseases, 34(9), (limited Rou, K., Wu, Z., Sullivan, S. G., Li, F., et al. (2007). A Five-City Trial of a Behavioural Intervention to Reduce Sexually Transmitted Disease/HIV Risk Among Sex Workers in. AIDS, 21(suppl 8 ), S95-S101. (limited Zhang, D., Lv, F., Wang, L., Sun, L., et al. (2007). Estimating the Population of Female Sex Workers in Two Chinese Cities on the Basis of the HIV/AIDS Behavioural Surveillance Approach Combined with a Multiplier Method. Sexually Transmitted Infections, 83, (open 6

7 Young People Maimaiti, N., Shamsuddin, K., Abdurahim, A., Tohti, N., et al. (2010). Knowledge, Attitude and Practice Regarding HIV/AIDS among University Students in Xinjiang. Global Journal of Health Science 2(2). (open Song, Y., & Ji, C.-Y. (2010). Sexual Intercourse and High-Risk Sexual Behaviours Among a National Sample of Urban Adolescents in. Journal of Public Health, 32(3), (open Xu, T., Wu, Z., Duan, S., Han, W., et al. (2010). The Situation of Children Affected by HIV/AIDS in Southwest : Schooling, Physical Health, and Interpersonal Relationships. Journal of Acquired Immune Deficiency Syndrome, 53, S104-S110. (limited Li S, Huang H, et al. (2009). HIV/AIDS-Related Knowledge, Sources and Perceived Need among Senior High School Students: A Cross-Sectional Study in. Int J STD AIDS. 20(8): (limited Li, S., Huang, H., Cai, Y., Xu, G., Huang, F., & Shen, X. (2009). Characteristics and Determinants of Sexual Behavior among Adolescents of Migrant Workers in Shangai () BMC Public Health, 9(195). (open Other Affected Populations Meng, X., Wang, L., Chan, S., Reilly, K. H., et al. (2011). Estimation and Projection of the HIV Epidemic Trend Among the Migrant Population in. Biomed Environ Sci, 24(4), (open Li, N., Wang, Z., Sun, D., Zhu, Q., et al. (2010). HIV Among Plasma Donors and Other High- Risk Groups in Henan,. Journal of Acquired Immune Deficiency Syndrome, 53, S41- S47. (limited Liao, L., Xing, H., Shang, H., Li, J., et al. (2010). The Prevalence of Transmitted Antiretroviral Drug Resistance in Treatment-Naive HIV-Infected Individuals in. Journal of Acquired Immune Deficiency Syndrome, 53, S10-S14. (limited Wang, L., Liu, W., Wang, L., Wang, Y., et al. (2010). HIV Prevalence Among Pulmonary Tuberculosis Patients in Guangxi,. Journal of Acquired Immune Deficiency Syndrome, 53, S61-S65. (limited Zhang, G., Wong, M., Yi, P., Xu, J., et al. (2010). HIV-1 and STIs Prevalence and Risk Factors of Miners in Mining Districts of Yunnan,. Journal of Acquired Immune Deficiency Syndromes, 53, S54 S60. (limited Zhou, Z., Meyers, K., Li, X., Chen, Q., et al. (2010). Prevention of Mother-to-Child Transmission of HIV-1 Using Highly Active Antiretroviral Therapy in Rural Yunnan,. Journal of Acquired Immune Deficiency Syndrome 53, S15-S22. (limited 7

8 He, N., Zhang, J., Yao, J., Tian, X., Zhao, G., Jiang, Q., et al. (2009). Knowledge, Attitudes, and Practices of Voluntary HIV Counseling and Testing among Rural Migrants in Shanghai,. AIDS Education and Prevention, 21(6). (open Hong H, Qin QR, et al. (2009) Condom Use among Married Women at Risk for Sexually Transmitted Infections and HIV in Rural. Int J Gynaecol Obstet. Sep;106(3): (limited Todrys, K. W., & Amon, J. J. (2009). Within but Without: Human Rights and Access to HIV Prevention and Treatment for Internal Migrants. Globalization and Health, 5(17). (open Qin QR, Ji GP, et al. (2009) Risk of Sexual HIV Transmission among Wives Left Behind and Wives of Nonmigrant Men in Rural Areas of. J Assoc Nurses AIDS Care. Jul- Aug;20(4): (limited Yanhai, W., Ran, H., Ran, G., & Arnade, L. (2009). Discrimination against People with HIV/AIDS in. The Equal Rights Review, 4. (open Qu, B., Guo, H., Sun, G., Zuo, T., et al. (2008). HIV/AIDS Knowledge, Attitudes, and Behaviors of Construction Workers in. International Journal of Biomedical Science, 4(3). (open Wang, B., Xiaoming, L., Stanton, B., Fang, X., et al. (2007). HIV-Related Risk Behaviors and History of Sexually Transmitted Diseases Among Male Migrants Who Patronize Commercial Sex in. Sexually Transmitted Diseases, 34(1), 1-8. (limited National Responses and Other Li, L., Ji, G., Liang, L.-J., Ding, Y., Tian, J., & Xiao, Y. (2011). A Multilevel Intervention for HIV-Affected Families in : Together for Empowerment Activities (TEA). Social Science & Medicine, In Press, Corrected Proof. (limited Wong, K.-H., & Chan, K. C.-W. (2011). HAART for HIV in Much Achieved, More to be Done. Lancet Infectious Diseases, 11(7), (limited Gao, L., Zhou, F., Li, X., et al. (2010). HIV/TB Co-Infection in Mainland : A Meta- Analysis. PLoS ONE, 5(5), e (open Han, X., Dai, D., Zhao, B., Liu, J., et al. (2010). Genetic and Epidemiologic Characterization of HIV-1 Infection In Liaoning Province,. Journal of Acquired Immune Deficiency Syndrome, 53(S27-S33). (limited Jia, M., Luo, H., Ma, Y., Wang, N., et al. (2010). The HIV Epidemic in Yunnan Province,, Journal of Acquired Immune Deficiency Syndrome, 53, S34-S40. (limited Li, J., Ha, T. H., Zhang, C., & Liu, H. (2010). The Chinese Government s Response to Drug Use and HIV/AIDS: A Review of Policies and Programs. Harm Reduction Journal, 7(4). (open 8

9 Li, L., Liang, L. J., Lin, C., Wu, Z., et al. (2010). HIV Prevention Intervention to Reduce HIV- Related Stigma: Evidence from. AIDS, 24(1), (open Wu, Z., & Wang, Y. (2010). Meets New AIDS Challenges. Journal of Acquired Immune Deficiency Syndromes, 53(1), S1-S125. (open Zhao, Y., Sun, X., He, Y., Tang, Z., et al. (2010). Progress of the National Pediatric Free Antiretroviral Therapy Program in. AIDS Care, 22(10), (limited Liu H, Liu H, et al. (2009). Money Boys, HIV Risks, and the Associations Between Norms and Safer Sex: a Respondent-Driven Sampling Study in Shenzhen,. AIDS Behav. Aug;13(4): (limited Wang, L., Wang, N., Wang, L., Li, D., Jia, M., Gao, X., et al. (2009). The 2007 Estimates for People at Risk for and Living with HIV in : Progress and Challenges. Journal of Acquired Immune Deficiency Syndromes, 50, (open Lu, L., Jia, M., Ma, Y., Yang, L., et al. (2008). The Changing Face of HIV in. Nature(455), (limited Lu, F., Wang, N., Wu, Z., Sun, X., Rehnstrom, J., Poundstone, K., et al. (2008). Estimating the Number of People at Risk for and Living with HIV in in 2005: Methods and Results. STI Online. (open Futures Group (2004, May), AIDS Crisis Impending-Research on Knowledge, Attitudes and Behaviors Related to HIV/AIDS in, Volume 1, Main Findings. (limited INDICATORS HIV prevalence and epidemiological status: HIV surveillance system was initiated in 1986 and it has evolved in three stages of i) Passive surveillance ( ) ii) HIV sentinel surveillance with co-existing active and passive surveillance ( ), and iii) comprehensive surveillance (1999 onwards). 1 Comprehensive surveillance includes internet-based real time case reporting system, HIV sentinel surveillance, HIV behavior surveillance, and Special Epidemiological Surveys. National HIV sentinel surveillance system was established in 1995 and since then sex workers, IDUs, long-distance truck drivers, and STD clinic attendees have been included in the sentinel populations. 42 sentinel sites were established in 23 of 31 provinces in 1995 and by 2009 there was a total of 1,318 sentinel sites were operational in 31 provinces. ANC clinic attendees have been included since 1997 and plasma donors were included in the sentinel populations from 1998 to MSM population has been included as a sentinel population since By 2009, sentinel groups comprised of sex workers, men who have sex with men, IDUs, ANC attendees, STD clinic attendees, long-distance truck drivers, TB patients, young students, and migrants. Though surveillance system is in place since 1995, prevalence data by sentinel sites and provinces are not available. Most of the information is not available in the public domain apart from the data cited in UNGASS country progress reports. Data on HIV estimates are available for 2001 and 2009 from the reports on Global AIDS Epidemic. On a related note, HIV and AIDS estimation exercise was conducted in 2003 to assess and estimate the national level of HIV epidemic and 3 more rounds of HIV estimation exercises were conducted in 2005, 2007, and The data from these estimation 1 Jia, Y., Lu, F., Sun, X., et al. (2007). Sources of Data for Improved Surveillance of HIV/AIDS in. Southeast Asian J Trop Med Public Health, 38(6),

10 exercises is available from published online journal articles. Concerning reported cases, total number of reported cases up to 2010 is available from some of the key presentations from UNAIDS website. Vulnerability and HIV knowledge: There are several journal articles available regarding the HIV knowledge among different sub-populations (key affected populations, migrants, young people, clients of sex workers, etc.) in different cities/provinces. In fact, comprehensive surveillance systems also collect knowledge related data but limited data is available through UNGASS country progress reports and Universal Access reports. National data on comprehensive HIV knowledge among young people is cited in the UNGASS report as the data from Population based indicator survey, but the full report is not available. One of a few publications related to HIV knowledge is AIDS-Related Knowledge, Attitudes, Behavior, and Practices: A Survey of 6 Chinese Cities in Other population based and household surveys such as DHS and MICS have not been conducted in. Risk behaviours: Similar to knowledge data, the data on risk behaviour among different subpopulations in different cities/provinces are widely available through journal articles. However, the data from the behaviour surveillance system is not available apart from the reported national data in the UNGASS and the Universal Access reports. Nationally representative data on risk behaviour among general population and young people is also lacking. Socio-economic impact of the epidemic: Data on domestic and international expenditure and financing sources are available for 2008 and However, expenditure breakdown by spending categories are not available. National response: Concerning key affected populations, data on HIV testing and prevention coverage are available from reported data in the UNGASS reports and Universal Access reports. ART and PPTCT coverage are also available through the same source. Data on HIV testing among general population is quite limited. Data related to prevention of transmission through injecting drug use such as number of syringes/needles distributed per injecting drug use per year by NSP is available for 2009 from the Universal Access report. OVERALL IMPRESSION AFTER THE DATA REVIEW Strengths A comprehensive surveillance system has been in place since 1999 and also introduced unified data collection techniques and systems since The process of unification and standardization of data and indicator is to avoid geographic and programmatic overlap in data collection and also to overcome inconsistency in data collection, measurement and reliability. 2 Remark: Though surveillance and a good national monitoring system is in place, the accessibility of data is very limited. 2 Zunyou Wu, Yu Wang, Yurong Mao, et al. (2011). The Integration of Multiple HIV/AIDS Projects into a Coordinated National Programme in. Bull World Health Organ 89,

11 Weaknesses The reports of annual HSS as well as National Comprehensive Surveillance are not accessible. Several journal articles on HIV prevalence, knowledge, and risk behavior among FSW, MSM, IDU, and clients of sex workers are available and these surveys are conducted in different provinces, regions, or cities across the country. However, due to heterogeneity of sample size and sampling methods, there is a limitation to compare the data across the regions or to compare overtime to capture the changes or trends. Data on standard indicators for knowledge, risk behavior, and national response is limited. 11