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

Questions?