Evaluation Of Interventions During Aids Prevention Work In Xinjiang Uyghur Autonomous Region

Objective:To investigate the implementation of aids intervention work of Government Agencies(GA),Centers of Disease Control(CDC),and Non-Governmental Organizations(NGO)in Urumqi,Yili Kazakh Autonomous County,Kashgar,Khumul during the period of 2008-2010.To evaluate the attitude,knowledge,and behavior of different communities towards aids,effect of aids prevention program in four counties.We also gathered experience of success and pointed out areas of further improvement,trying to provide scientific basis for future improvement of aids prevention,education,and public health work of related GAs.Method:We looked through records,conducted questionnaire investigation,deep interviews,and on-the-spot investigations among university and college students,ordinary citizens,intravenous(IV)drug users,and sex workers in areas of high(Urumqi,Yili),moderate(Kashgar),and low prevalence(Khumul).We also conducted investigation and gathered data at the aids department of local CDSs,and interviewed GA officials at city government,CDC,education bureau,public security,drug control,labor union.Interviewed individuals in 6 NGOs include red-cross,aids association,women's association,mosques,aids carrier association.Result:(1)Aids prevention service among CDCs:CDCs in 4 regions of Xinjiang implemented 37 programs including 19 dissemination programs,10 service programs,4 planning and audit programs,and 4 behavior intervention programs.All programs are implemented in Urumqi and Yili,followed by Khumul and Kashgar.In terms of aids intervention service among different communities,Urumqi and Yili implemented most services,followed by Khumul and Kashgar.(2)Aids prevention service among NGOs:Most aids intervention work among 14 NGOs surveyed in Xinjiang during 2008-2010 were public health knowledge and training.71.43%of NGOs believe lack of funding is the main obstacle in their work;other important factors are volunteer mobility and discrimination.57.14%of NGOs are have cooperated or currently cooperating with other NGOs.78.57%of NGOs believe that they gained most by sharing information with other NGOs.Among 25 mosques,95.83%of them used gatherings in big religious events,annual Ramadan,5 times of daily pray,wedding ceremony for aids propaganda.Their main means of distribution are lecturing,distribution of leaflets,and notice boards.(3)Effects of aids intervention among different communities in Xinjiang:Aids knowledge among 4 communities about the route of transmission are statistically different according to community,ethnicity,and living areas(P<0.05).Awareness of aids transmission:84.99%among female sex workers,83.27%among IV drug users,and 76.23%among ordinary citizens.Routes of non-transmission awareness are 82.71%among female sex workers,73.60%among students,72.93%among ordinary citizens and 52.64%among IV drug users.Awareness of aids prevention knowledge among ordinary citizens,students,IV drug users and female sex workers are 51.64%,54.90%,60.80%,and 61.35%respectively.(4)Different communities in Xinjiang mainly receive aids knowledge through public media such as television,radio,magazines,and books.Awareness through television and radio reached 81.17%among ordinary citizens,while it is 70.59%,20.38%and 22.50%among students,IV drug users and female prostitutes.(5)Aids intervention among different communities in Xinjiang:79.14%of IV drug users participated in aids health education,while 64.37%of female sex workers,52.54%of students,and 48.22%of ordinary citizens participated.(6)Sexual behavior among ordinary communities:63.23%of ordinary citizens had pre-marital sex,30.89%among them did not use contraception,and 6.13%had history of sexually transmitted diseases(STD).64.31%of IV drug users had had pre-marital sex,28.56%among them did not use contraception,and 58.27%had history of STD.Statistically significant differences are observed among different ethnic groups in terms of pre-marital sex and contraception usage(p<0.05).28.01%of female sex workers admitted having multiple sex partners,74.05%of them used condom during last transaction,63.93%used condom with a client every time for the last 3 months,and 13.04%never used condom.Condom usage among Han Chinese female sex workers is significantly higher than Uyghurs(p<0.05).(7)Rate of satisfaction for aids prevention services:90.57%,89.67%,76.43%,and 75.06%among ordinary citizens,IV drug users,students,and female sex workers respectively.Conclusion:(1)Aids intervention work achieved gained some achievements in Xinjiang:Quick rise of aids epidemic in Xinjiang has been the main focus of regional government and party committee.CDCs in 4 regions used multiple methods and gradually increased the scope of intervention after Health 9 Program,and improved knowledge,belief and behavior awareness among high-risk groups.NGOs in Xinjiang have strong willingness to participate in aids programs and awareness of the importance of aids prevention.(2)Problems in aids intervention program in Xinjiang:survey revealed that aids prevention work is still guided by government health agencies;there are no cooperation of multiple agencies and participation of whole society.There is daily increasing aids epidemic and huge task of prevention,but shortage of personals,professional knowledge,and funding are the main problems.Main work is concentrated on aids prevention propaganda,and lack of design,evaluation,coordination and full coverage hardly make profound difference in the community.(3)Recommendation for further improvement of aids intervention in Xinjiang:Aids prevention and treatment is a comprehensive and systematic project,it needs cooperation among multiple agencies,not just health agencies.Governments in central and local level should strengthen the financial support for aids/STD prevention.At the same time,role of NGOs in aids prevention should be emphasized.Different intervention technique is recommended for different communities,and mass audio-visual media coverage in minority languages such as television and radio should be increased.Later work should be focused on existing problems,areas that need improvement,larger scale of propaganda and intervention,and establishing a multi-agency cooperation framework in preventing aids.