Formative Assessment Research On HIV/AIDS Behavior Change Communication Strategies For Rural-to-Urban Migrant Workers At Workplace

Research Background:The epidemic of AIDS has become a global crisis,and also is a prominent social problem in China.Its spread has been some new trends of rapid dissemination,from rural to urban and from HIV/AIDS high-risk group to the general population.Rural-to-urban migrant workers(called 'nongmingong' in China),as a bridge group of HIV/AIDS spread,will be at high risk of HIV infection.The "China's AIDS prevention and control joint assessment report(2007)" pointed out that,for migrant workers,the HIV/AIDS publicity and education activities was still insufficient,and not strong,also the target population is not clear,which caused the lack of effectiveness of publicity and education.Under this background,this study, based on the China Workplace HIV/AIDS Education Programme,and taking the theory of behavior change communication as foundation,carried out formative assessment to provide a basis for developing a better strategy for AIDS education of migrant workers.Objective:To understand the real situation of migrant workers at workplace,to develop effectively information,themes and channels for AIDS-related behavior change communication,to provide a basis for carrying out Workplace HIV/AIDS education project,and to promote AIDS prevention work for migrant workers. Methods:A combination of quantitative and qualitative research.In quantitative research,to obtain the survey respondents through multi-stage stratified cluster random sampling,using two forms of questionnaires(computer and paper-based) to collect data,using SPSS 13.0 to set up database and carry out general descriptive analysis,χ2 test,Correlation analysis and Logistic regression analysis,etc.;In qualitative research,to select interviewee with purposive sampling,using key informant interview,in-depth interview and focus group discussion and other methods to collect qualitative data,after using Excel software to carry out open-end coding,, classified into a variety of different themes according to the logical similarity,and collated and analyzed by the theme analysis and analytical comparison.Results:A total of 2771 managers and ordinary employees accepted the questionnaire survey at 13 enterprises in Yunnan,Guangdong and Anhui province,thereinto,1013 urban workers(comparative group) and 1758 migrant workers.And a total of 131 migrant workers,business management or health personnel accepted qualitative interviews within five pilot sectors.Results of Quantitative Analysis:1) Knowledge level on AIDS:Among the respondents of migrant workers,being not fully aware of three transmission of AIDS(account for 42.15%);to identify fully non-transmission of AIDS(only 6.48%);to know fully knowledge on AIDS prevention(only 12.29%);and 31.34%of migrant workers did not know HIV/AIDS could be transmitted by sex,70.48%thought they might infect HIV by sneezing or coughing,62.68%considered sharing utensils could make the spread of AIDS.All indicators for measuring the knowledge level on AIDS were lower than the comparative group.The knowledge level had a positive correlation with Age, educational level,working year and income level.Gender,educational level and mobility of the population will be the focus of consideration to improve the level of AIDS knowledge.Mining industry,construction and garment manufacturing sector were with lower level of AIDS knowledge.2) Attitude towards AIDS:13.71 percent of the respondents among migrant workers, who did not accept fully AIDS or people living with HIV/AIDS(PLWHA).Among them,76.17 percent was unwilling to accept services provided by PLWHA,and they did not want to live together with PLWHA,which accounted for 73.55%,nearly 60% was unwilling to work with PLWHA,and the extent of discrimination was higher than the comparative group.AIDS-related discrimination had a negative correlation with educational level.In addition,gender and job category were also important factors. Mining and construction industry were with a higher degree of discrimination.3) High-risk behaviors:Among respondents of migrant workers with having sex during the last 3 months,23.19 percent had high-risk behaviors,and half of them did not use condoms,significantly higher than the comparative group.Among them,the male was higher than the female,and workers with the lower level of education or jobless being in the labor market,who was in a higher proportion of high-risk behavior.Results of Qualitative analysis -- The basic situation of migrant workers was varied for the characteristics of different industries,while the common findings are following:·Improving the living conditions,enhancing economic security and getting good job opportunities were often as the reasons of working outside their hometown;being not aware of planning for the future;to express similar concerns about the stability of income,happiness,health and safety,etc.;·Compared to formal workers at workplace,migrant workers were very difficult to enjoy the full range of medical insurance.·Getting information mainly by television,newspapers and computer.The major social network was "hometown fellowship"(companions).The communication channels in enterprises,which were their own training programs and facilities,the occupational security meeting,trade unions and a variety of sports activities.·Being Lack of AIDS/STD knowledge among migrant workers,and underlying causes of AIDS-related stigma and discrimination,which may be related to social negative evaluation on sexual and drug abuse behaviors.·Surrounding the workplace,there were some entertainment places,at where the phenomenon of commercial sex trade happened among migrant workers;both young male and female migrant workers had a tolerant attitude on pre-marital sex behaviors; the main obstacles of condom usage for male migrant workers were,which they felt they did not purchase real services after using condom,and the impact of friends / colleagues and condom accessibility.·At the enterprise level,they did not develop AIDS-related policies,and provided fewer AIDS-related information and services,while being gaps on treatment and testing information related to AIDS/STD.·Enterprise management shows a support attitude to HIV/AIDS education;at the community level,there are some potential organizations with the same goal; HIV/AIDS related code,regulations and policies respectively at international,national and provincial level can give a support for developing workplace HIV/AIDS policy.Conclusions and Suggestions:Among migrant workers,they were lack knowledge on HIV/AIDS,and AIDS-related stigma and discrimination was widespread,and more high-risk behaviors happened.The AIDS risk varied from different social-demographic characteristics,such as gender,age,educational level,job category,ethnicity,marital status and income level.Considering the target group's values,ideals,social network and living habits,as well as the local AIDS epidemic and policy,industry characteristics,the workplace / community activities and surrounding environment,and the availability of health services,to identify the highest risk target groups of migrant workers,and to determine the opportunities and resources of behavior change communication intervention,at last,to develop a better AIDS behavior change communication strategy for migrant workers.