A Study Of HIV/AIDS Intervention Program In Rural Xishangbannan Dai Autonomous District Of Yunnan Province, China

BackgroundFor years, provinces and autonomous regions like Yunan, Xinjiang, Guangxi, and Sichuan, which have reported the Highest cases of HIV infection, are ethnic-minorities-inhabited areas. Currently, Dai people have the highest HIV infection rate among the minorities in China.Xishuangbanna Dai Autonomous District, bordering Mianmar and Thailand, is a prefecture located in the most southern areas of Yunnan Province, China. From 1999 to the end of 2005, there was 501 HIV/AIDS cases reported in the area, including 387 cases transmitted through heterosexual contacts, accounting for 77.2% of all the reported HIV/AIDS cases.Objectives1. To understand the current HIV epidemiology of Xishuangbannan and explore the risk factors.2. Developing an effective, feasible HIV/AIDS intervention model which is adapt to the Dai village of xishangbannan, And provide advices for HIV/AIDS prevention and control of minorities in china.Methods1. Anthropology studies was conducted through researchers living in the Dai people village and observing their live styles. At the same time, in-depth interview(n=20), encountered interview(n=90) and focus group discussion was achieved.2. Baseline survey was used to explore the HIV/AIDS related knowledge, information and resourse of these knowledge and information.425 questionnaires was collected in which 217 from intervention group and 208 from control group.3. Using participatory action research, Researchers cooperated with women team and youth team which is community-based orgization of the village, developed a multi-channel approach of health education and behavioral intervention program, which including 4 channels, namely community educators, singing and dancing shows, VCD and leaflets.4. The multi-channel approach was conducted in 3 villages of MengHai county of Xingshuangbannan district, and another 3 villages was selected as control group which distributing leaflets only. 5. A process evaluation was conducted to evaluate four channel (singing and dancing show, VCD, community communition and leaflets) used in the intervention program to explore process data such as:To what extent does the channel reach the target population? How does the community rate the channel? Is the intended message received clearly and understood by all members of the community?Opinions of the four channels were gathered from two participant perspectives—those of community members recruited as volunteers to implement the trial in their communities(field staff) and those of community members who were recipients of the intervention by interview and focus group discussion.6. Three month later after the intervention finished, Evaluation on the effectiveness and benefit of the intervention program was conducted by qualitative and quantitative study. Effective evaluation was enhance by questionnaire surveys(422 questionnaire was collected), interviews(n=20) and focus groups(n=3) discussion.Results1. Anthrpology study discovered that one of the main reasons causing HIV/AIDS epidemics in Xishuangbanna was related to local traditional customs, such as premarital sex, high divorce rate etc. All of the 15 young men interviewed admitted having premarital sex(100%); And some unmarried young man reported have more than twenty sexual partners. In all of the 110 adults villagers contacted with researchers,13 of them have divorced at least one time; Commercial sex, involving girls from local area as well as those from neighboring countries as Thailand and Mianmar had also played important roles.2. Baseline survey results showed that the TV is the main resourse for the villager to get knowledge and information of HIV/AIDS.71.6% reported to get information from TV. The awareness rates of HIV/AIDS related questions were about 50%; Only 34.1% of villagers could recognize a condom. And 7.5% of village people used condom in the last sex with their fixed partner; The rates of condom use in last causal sex intercourse were 5.9%.3. The results of the research showed that the integration model increased the knowledge levels and skills; After the intervention, The number of respondents who recongnize a condom increased significantly among particepants in the intervention group(34.1% to 65.3%); The condom usage'during the last time' they had sex with fix partner also increased significantly(5.9% to 12.6%).4. Process evaluation shows that VCD attracted large numbers, over 95% of the villagers said they had seen the VCD at least one time; The leaflets have not achieved satisfied effectiveness, only 22.5% of villagers said they had read all the contents of the leaflet. High illiteracy rates and a general lack of reading culture limited the effectiveness.Conclusions1. Health education and intervention program of HIV/AIDS depending women team and youth team achieved approving results. These findings illustrate that the community-based organization in rural of Dai Autonomous district had the capabilities in providing HIV/AIDS prevention service.2. Community participation in the research process can increase community support for an intervention, and can contribute to interventions that are credible and culturally appropriate.