Study On The Association And Strategy Of Social Capital And AIDS Prevention And Control

BackgroundIn recent years, the theory of social capital had been widely used in the field of healthby foreign researchers. However, fewer studies of social capital and health had beenconducted in our country. Moreover, social capital theory had not been introduced intoAIDS (Acquired Immune Deficiency Syndrome)/HIV (Human ImmunodeficiencyVirus) related issues in China to our knowledge. The epidemic situation of HIV/AIDS inour country is still rigorous, and its prevention and control is an arduous task. Socialcapital, as an intangible resources, could organically combine physical capital, humancapital and other tangible resources. It could reduce the cost and enlarge theeffectiveness of HIV/AIDS prevention and control. So it may be the “Third way” toresolve the public health issues.ObjectivesTo Understand the micro-level (individual level, the paper focused on most-at-riskpopulation, MARP), the meso-level (organizational level) and the macro-level (nationallevel) social capital status; to analyze the impacts of social capital on the HIV/AIDSprevention and control from the above three perspectives; to explore the strategies fordeveloping and utilizing social capital in the field of HIV/AIDS prevention and controlin China.MethodsMicro-level: from September2010to December, study participants identified by meansof convenient sampling method were interviewed by face to face using self-developedquestionnaire in Anhui Province. We input the quantitative data using Epi Data3.0and carried out univariate and multivariate binary non-conditional logistic regressionanalysis using SPSS13.0. We carried out confirmatory factor analysis using AMOS20.0.Meso-level: A total of six provinces were included in the study, two of them beingselected from each of the high, middle, and low prevalence of AIDS epidemic area, i.e.Guangxi Zhuang Autonomous Region, Yunnan province, Shanxi province, Hunanprovicne, Jilin province and Anhui province. From April2012to November, weconducted a questionnaire survey and in-depth interviews with key informants of theprovincial HIV/AIDS Committee Office (PAHCO) and its member organizaions. Wecarried out case study of “Jianghuai Tongxin Working Group”(Working Group) and“Xiao County Sunweizi Community Care Assistance Team”(Assistance Team). Wetranscribed recording data into text data by the Word97software. We carried outexploratory factor analysis and correlation analysis by SPSS13.0.Macro level: We conducted the multivariate linear regression analysis for the statisticdata from the World Values Survey, the World Bank, UNAIDS and the World HealthOrganization official website using SPSS13.0.ResultsMicro-level results:(1)583FSWs (female sex workers),508subjects participatingMMT (methadone maintenance treatment) and369MSM (Men who have sex with Men)were included in this study. The first two MARP were done by another two graduates ofour team. Therefore, this thesis focused only on the findings of the MSM population.(2)The general characteristics of the MSM in our study. More than half (52.85%) ofrespondents aged25years old and below. The majority (69.92%) were not married;Nearly half (46.34%) of the monthly income were in1001to2000. The vast majoritywere from the local (72.90%).(3) Social capital status of study participants of MSM.The four core factors of social capital were respectively membership and involvement,social support, trust and friends network. The proportion of social support factor andtrust factor with high level score were68.56%and50.68%, respectively. Membership and involvement factor: more than half of the respondents did not participate in anyorganization (52.03%), and did not participate in organized activities (55.56%).16.53%of respondents often participate in community activities. Social support factor: whenencountered difficulties,17.61%of respondents can always get economic help less thanthat can always get moral support (31.98%). Trust factor: the proportion of respondentswho trust completely their parents\relatives\friends was the highest (42.28%). Theproportion of respondents who trust completely most people was the lowest (10.57%).Friends network factor: nearly half (48.51%) of the respondents have≥5close friends.72.09%of respondents have close friends with1~2occupational categories.27.10%ofrespondents have≥3kinds of relationship with close friends.(4) The effects ofHIV/AIDS prevention and control for respondents.89.16%of respondents correctlyanswered≥6AIDS-related questions.74.25%of the respondents (46.6%) knew that“Item2: HIV could not be transmitted by mosquito bites”.39.84%of respondents hadcasual partners in the last months.50.95%of respondents used condoms in the lastsexual behavior.(5) The association of social capital and HIV/AIDS prevention andcontrol. Complete trust (OR=8.47, P=0.044) and general trust (OR=5.54, P=0.015) intheir parents\relatives\friends were associated with higher AIDS-related knowledgelevel. Complete trust in CDC staff associated with higher AIDS-related knowledge level(OR=8.48, P=0.039).≥2membership, often participating organization (OR=3.27,P=0.002) and community activity (OR=3.27, P<0.001), and member of MSM voluntaryorganization (OR=3.10, P<0.001) were associated with higher probability of condomuse in the last sexual behavior. More occupational category and relationship type ofclose friends were associated with higher probability of condom use in the last sexualbehavior. Not always completely get the moral support were associated with higherlikely to have casual partners (OR=1.96, P=0.008).(6) The overall descriptives ofeffects of social capital on the HIV/AIDS related issues among MARP. The impact ofthe items of social capital on AIDS prevention and control varied due to different risk-groups.Meso-level findings:(1)79key informants from the PAHCO and its memberorganizations were included in the survey and89participated in-depth interview.(2)Social capital status of PAHCO and its member organizations: in this study, wemeasured organizational social capital from five factors of the network and participation,norms, trust, common language and shared vision. The proportion of high level trustwas the highest (69.62%) among the five factors. The high level of norms was thelowest (37.97%). The factor of network and participation: the proportion of respondentswho meet regularly the co-coordinators of the other member organizations for the workof HIV/AIDS prevention and control was the lowest (20.25%). The factor of norms:effective system of rewards and penalties has not been established; The factor of trust:the proportion of respondents trusting the ability of PAHCO was the highest (88.61%).The factor of common language: the proportion of respondents who mostly knew theresponsibility of the other member organizations was the lowest (44.30%). The factor ofshared vision: the proportion of respondents who recognized the national and provincialpolicy or activities was the higest (81.01%).(3) Self-assessment HIV/AIDS preventionand control work of PAHCO and its member organizations. The vast majority of surveydepartments (81.01%) expressed satisfaction with their capacity and effectiveness ofHIV/AIDS prevention and control. More than half (59.49%) of the survey departmentswere dissatisfied with their funds of HIV/AIDS prevention and control.(4) The impactsof social capital on the self-assessment of HIV/AIDS prevention and control. Trustcorrelated with self-rate satisfaction of the ability, effect and funds of HIV/AIDSprevention and control (r=0.303,0.317and0.341).(5) The outcome of qualitativeinterviews. Network and participation: Most of the respondents said that effectivecoordination mechanism and cooperation platform had not been established.Communication with coordinators of the other member organizations was insufficient.Part of the non-government organizations focused on the informal contractual relationship and activated tangible resources. Norms factor: an effective reward andpunish system had not yet been established and most respondents expressed the need toestablish the system to regulate member organization work. Trust factor: most of theinterviewees expressed the belief that the PAHCO had the ability to coordinateHIV/AIDS prevention and control. Fewer respondents from low AIDS epidemic did notrecognize PAHCO work. Common language: most of the respondents from the lowHIV/AIDS epidemic area reported they basically mastered the general knowledge, hadthe ability of HIV/AIDS prevention and control and did not need training. While part ofthe respondents from the middle and high HIV/AIDS epidemic area expressed that theyneed further training. Most of the respondents said that they did not know theresponsibility of the other member organization in the HIV/AIDS prevention andcontrol. Shared vision: most of the respondents said they recognized the objectives ofHIV/AIDS prevention and control at the national and provincial level. Less conflictexisted in the member organizations.(6) The results of case analysis of grass-rootsorganizations. For Working Group and Assistance Team, the low level “norms” is themost prominent problem of their social capital, mainly because there is no soundorganizational system and clear regulations. The biggest advantage is that members ofthe organization have the higher volunteerism and strong active sense of participation.Grass-roots organizations operate flexibly, efficiently and low-cost and playirreplaceable role of formal organizations.Macro-level findings:(1) The World Values Survey (2005to2009) indicated the levelof organization participation in China located in50of53countries and trust level in12.(2)"The level of organization participation" was significantly associated with HIVprevalence (15-49years), and anti-viral treatment coverage.Conclusions and policy implicationsThe main conclusions:(1) The impact of social capital on the effect of HIV/AIDSprevention and control differed in different MARP and we did not yet find the negative impact.(2) HIV/AIDS prevention and control personnel were generally lack ofawareness of cultivation and use of "social capital".(3) The trust factor can improve thesatisfaction of the funds for HIV/AIDS prevention and control of member organizations.(4) Grassroots organizations are an important source of social capital. However, lowlevel norms became the barriers for them to be involved in HIV/AIDS prevention andcontrol.(5) More studies are needed to determine the association of social capital andHIV/AIDS prevention and control at the national level.This study proposed the following strategies for developing and utilizing social capital:(1) The micro level: To actively cultivate the individual-level trust-based social capitaland consolidate the effect of the education for MARP. To develop fully relatives-basedsocial capital and make up for the limited resources of HIV/AIDS prevention andcontrol. To consciously cultivate and utilize structured social capital and enhance thelong-term effects for HIV/AIDS prevention and control for AMRP.(2) The meso level:To cultivate the inter-organizational trust-based social capital and reduce the cost ofHIV/AIDS prevention and control from the breakthrough of system construction andinterpersonal communication. To cultivate common-language-based social capital andenhance the ability of HIV/AIDS prevention and control of multisectors from thebreakthrough of classification guidance and training. To build the norms-based socialcapital and ensure the implementation of multi-sectoral cooperation mechanism fromthe breakthrough of building the legal system. To develop the network and participationbased social capital and innovate the means of HIV/AIDS prevention and control fromthe breakthrough of construction of modern information platform. To cultivatecitizen-based social capital and innovate the model of HIV/AIDS prevention and controlfrom the breakthrough of enforcement of social organization.(3) The macro level: Toestablish awareness of social capital and include the development of social capital in thetop-level design. To value the combined effect of social capital and other social factorsin HIV/AIDS prevention and control.