Study On The Status Quo, Problems And Policies Of AIDS Control Of Floating People

Background and Significance1.The enormous number of floating people who're in more mobility is still increasingFrom 1990s,under the background that reform and opening up had been in prosperity,thenumber of floating people increased from year to year.And the sum was 2.14 million in last1990,then up to 120 million in 2000,147.4 million in 2005.Meanwhile,the mobility of floatingpeople was enhanced,and the directions were mainly from country to city,from developing todeveloped,from middle-west to east coast.2.The features,environment and high risk behavior of floating people make themsusceptibleYoung and middle-aged compose the most part of floating people.They have a lot ofcommon features,such as high sexual activity,high stress,low educations,lack of necessaryknowledge and high risk occupations.These traits make them hardly prevent the AIDS andshort of necessary medical conditions,and HIV detection rates are low because of wrongattitude.Anyway,the floating people themselves aren't the very risk factors,but their features leadto high susceptibility and HIV incidence.3.The situation of HIV-infected floating people today reveals the needs for study〈REPORT OF UNITED AIDS CONTROLING IN CHINA〉in 2007 revealed,the newinfected individuals emerged mainly from high risk behavior people;and there are more highrisk behavior among floating people.Studies has shown,premarital sex accounted for 62% andmulti-sexual partner accounted for 12% occur more frequently in floating people;〈NarcoticsControl Reports of China in 2006〉reveals,floating people accounts for 81.7% in drug addicts.After clearing the high risk status of floating people's dissemination of AIDS,recent datasupported more stunning situation:HIV-infected individuals of outside provinces accounted for50% at least up to 87% in Beijing,Zhejiang,Shanghai province.More detail here:3204 out of4253 patients came from outside province.The mobility incentives dissemination of AIDS,and it also make the control and management pretty difficult.Now,lots of traits such as unsure work conditions,low-income,nomedical care make them susceptible to HIV and easily infected.4.Studies needed to improve the inefficiency in AIDS control practiceOur government emphasized the AIDS control from 2003,and amount of policies and lawshad been involved,but the results were unsatisfied.Studies has shown,the main defects below:(1) The practices were inappropriate,and coverage was limited;(2) Lack of knowledge offloating process in floating people leaded to no target and low efficiency in works;(3) Lack ofcommon realization on AIDS control and responsibility unclear leaded to confused corporationand shortage of fruit shared;(4) Shortage of gov's finance input leaded to human resourceproblems which include quantity and quality,and that dilemma also reveals conditions thatpower-responsibility confusing;(5) Lack of assessment.Although the policies promised before,there're no details to follow;(6) Contradictions resided in some policies.5.Makeup the blank of home and abroad researches(1) Abroad progressIn medical area,AIDS has been the focus all of the world,which be proved by 3386 plusstudies in MEDLINE.On the other hand,the floating people has been the focus too,which get558 plus.But to merge two into one search,we can get just about 40 around (1980s-4,1990s-16,2000s-20).Epidemiology was the main stream in 1980s,then floating people bounce into researchers'eyes in 1990s,and the most important study introduced KAP and assessed the influence offloating people on society.In sum,abroad studies focused mainly on epidemiology,lack of policy research.(2) Home researchWe got 2600 plus studies by using AIDS or floating people as theme word from 1994 to2007.That told researchers AIDS and floating people had become a hot topic not only formedicine but also for social economy.But as same as abroad,combining the two words tosearch gets less than 80.So we can find that contemporary investigation and health educationhad been developing quickly,but policy researches were not only insufficient in NO,but also inhigh quality.That reminds researchers an emergency front.Materials and MethodsTo know the information of floating people and HIV-infected individuals and the problemsof gov' s AIDS controlling,applying contemporary survey(Guangdong province and Sichuanprovince as inflow,Hunan province and Guangxi province as outflow),expert consulting, multi-department and individual discussion.To know the crucial problems of the AIDS control system,applying literatures inductionand analysis,brainstorming ,System Theory and"Structure-process-outcome"of"AMacro-Model of Health System"to develop the priority of 24 kinds of problems and thenmerge with practice problems.Results1.The work status quo of AIDS control in floating people in ChinaFirstly,the government and relative departments paid attention to AIDS controlwork,and promulgating a series of policiesFrom 1997 to now,the government promulgated a series of policies to improve the workof AIDS control among floating people,such as〈Fight against AIDS-the status quo anddemands report in China〉in1997,〈Policy on AIDS control〉in 2006 and so on.According to national law,every province had their particular plans:Ministry of Railways,Ministry of Justice,All-China Women's Federation made〈Prevention plan of fighting againstAIDS〉;Agriculture department initiated a program to bring re ribbon into every residents in thecountries;In addition,CDCs also launched a series of activities to prevent AIDS.From above,we could see the gov's determination.Secondly,most of departments made the work plan on AIDS control especially aboveprovince levelThe government and social organizations had made their own work plans and strategies,up to 2005,31 provinces and 88% of local government set up AIDS control and coordinationagencies,Ministries of Health,Finance,Justice,Public Security,Railways,All-China Women'sFederation made sense of coordination system.From the very survey,most of individualspicked AIDS prevention work as the department's responsibility.All-China Women'sFederation and Ministry of Justice even plugged the AIDS control into the department'simportant agenda and daily assessment.Thirdly,cooperation of several departments has been budding,including educationprevention,monitoring and management of patients' files,international cooperation,healthcare related18 departments and organizations related in the interview areas has launched 5 kinds ofwork,including education prevention,monitoring and management of patients' files,international cooperation,healthcare related.Fourthly,compared with launched policies,prevention responsibility needed to be clarifiedAccording to the rules of every department's responsibility,102 out of 122 responsibilitieshas been done,but implementation rate declined to 71.3% after eliminating unfinished ones.Among the 28 main responsibilities,only 13 had been done,while 15 done partially.Fromabove,although so many work plans or laws were launched,the implementation rates were faraway from initial target,and that might be paid more attention to.Fifthly,implementation rate among departments or areas was differentAccording to the rules of every department's responsibility,different departments or areashad diverse performance.Health,Women's Federation,Justice departments carried outfundamental work related.In contrary,culture department had insufficient performance.Cooperation of multiple-department differentiated among areas too.For example,Tradeand Industry Department developed a series of advertisements on AIDS prevention theme bybroadcasting through media in Guangdong province,yet there're no work plans for AIDSprevention in Sichuan province.Sixthly,temporary labors,constructers,factory workers and entertainers out offloating people has the highest risk in HIV-infected factors,in addition,the number andeconomic,social features of floating people also make them susceptible.(1)Young and middle-aged mainstream,high risk rate evilAverage age of the survey was 30.9,67.7% in 20-40 groups.Constructers andhome-servers were mainly in 30-50 groups,and factory workers and self-employed persons in20-40 groups.Most of floating people were high sexually active,in addition to their economic conditions,work environment and no partner,then high risk behaviors occurs unsurprisingly.The surveyshowed 15.8% males involved had commercial sex activities,and entertainers and temporarylabors accounted for most,more than 20%.And the rate of partner-isolated ones who hadcommercial sex activities are more than company-besides.At last,the rate of usage of condomwas low among these people,just about 59.3%.(2)Lack of AIDS-related knowledge among floating people,and slight awareness ofsearching for health careThe education level of floating people was low from the survey results,of which 57.1%was primary school level,and 20.2% below the elementary school.Because the shortage of thesecond education,they had few chance to get the training outside their occupations.That factresulted in the condition that lack of AIDS-related knowledge among floating people. Floating people didn't have city identities,and most of them were temporary workers.Thefact kicked them out of the medical care system.In addition,the low income also impededreceiving health serves.The survey had shown,regarding to demands,half answered no.Justabout 1.6% received VCT serves,in which the ones having commercial activities accounted for3.6%.(3)Lots of factors of floating people,such as low income,hard life conditions andgloomy lifestyles led to mobility,resulting in being susceptible to high risk behavior.The fundamental power of economic-style floating people was economic factors.Theincome of inflow was higher than outflow but below local average.The survey had shown,61.8% of individuals' income was below 1000 yuan per month,and the situation differentiatedamong areas.Although the floating people worked in cities,they cruised between cities and countriesfrequently.Due to the imbalance of economy in China,the mobility occurred among provincelevel,and the direction from east to west was much more familiar,for example Chengdu as thebig hometown.Searching for more income resulted in unstable work conditions and made floating peopleuneasy to establish social relationship and lack of support from society.(4)The support from society was weak,lack of training and health promotingMost of floating people went out to work spontaneously,and that disordered conditions letinsufficient 6 million input from Ministry of Agriculture lose the last resort to train.In addition,the contact between floating people and departments was little,and there're some daily workrelated such as getting health certification from Ministry of Health.Only 8.9% had got freecondoms and 26.5% had received education material about AIDS which revealed practiceperformance far away from gov's demands.(5)Morality and attitude towards AIDS among floating people twistedThe survey on attitude towards HIV-infected partner had shown,75.4% of floating peopledidn't like to work with HIV-infected ones.Among different people,temporary workers werethe most reluctant group,up to 84.6%.2.Problems definition in the area of AIDS control of floating peopleSummarizing the problems in the area of AIDS control of floating people by analyzing 285literatures from 1994 to 2008 is the first step,and then squeezing 65 kinds of problems into 24by the Macro-Model of Health System.Finally,nailing down the priority by emergingimportance and severity,which shown below. Considering the solution of problems and practice,we nailed down the common problemswhich both theorists and practitioners focused:(1)Lack of cooperation and coordination among departments and organizations.The workon AIDS control of floating people often had single style,low work rate and no-cooperation. (2)The broadcasting,training and coverage rate of AIDS control of foating people waslow.(3)The funds of AIDS control of floating people were insufficient.(4)The management of floating people,especially the HIV-infected,was inefficient.(5)Lack of HR in the area of AIDS control of floating people and insufficient quality ofHR.3.The policy study on AIDS control of floating people in ChinaReferring to the common problems,on basis of the interaction surveys,the study made thepolicies on AIDS control of floating people in China below.First of all,more input more out come.The key point is to establish the eligible inputsystem to ensure the development of every department.Secondly,strengthening the coordination ability of AIDS control committee through fiveaspects endeavor is crucial.Developing net work as an incentive spurs the spontaneousactivities,making the full use of low level organizations.Thirdly,improve the KAP of floating people is the root of the problems.In details,government should launch more health education or trainings to promote the health of floatingpeople.Fourthly,one-stop management is a useful resort to regulate HIV-infected.Making therelationship between inflows and outflows,collection the files of patients,clarifying thecondition of the medication are worthy ways.Fifthly,the construction of HR on AIDS control.First of all,definition of responsibilitiesmust be clarified,and the performance assessment should be done efficiently.Sixthly,the study realized it'll be successful if social cooperation,so we define theresponsibilities of 14 departments for suggestion.4.The innovation and weakness in the study(1)The innovation of resultsTo know the information of floating people and HIV-infected individuals and the problemsof gov' s AIDS controlling,applying contemporary survey(Guangdong province and Sichuanprovince as inflow,Hunan province and Guangxi province as outflow),expert consulting,multi-department and individual discussion.As a result,we got the common problems whichboth theorists and practitioners focused at the first in China,paving the road for policymakers' decisions. The survey including Guangdong and Sichuan as inflows while Hunan and Guangxi asoutflows clarified the status quo of AIDS control.And the individual interviews offered thefloating people's conditions,which is the basis of the work on AIDS control.(2)The innovation of method and usageTo know the crucial problems of the AIDS control system,applying literatures inductionand analysis,brainstorming,System Theory and"Structure-process-outcome"of"AMacro-Model of Health System"to develop the priority of 24 kinds of problems and thenmerge with practice problems.Generating a lot of methods into searching a series of ways defines the problems in thearea of AIDS control of floating people in China.(3)WeaknessDue to time limited,there haven't done pilot to testify the feasibility.If there's time left,the study will add this part to the research,and that's my next target too.