AS the fight against AIDS has reached a critical stage in China, disease control and prevention workers are focusing their efforts on building awareness among the general public and high-risk groups.

A recent motorcade parade organized by the China Family Planning Association is among the events that have already taken place.

A team of AIDS education workers from Beijing recently traveled to south China's Guangzhou to cooperate with local task forces in 31 large and medium-size cities over a 20-day period.

The various promotion activities proved fruitful. Yet discussions with local AIDS workers also indicate the killer virus was time-bomb and could spread at any time from high-risk groups to the general public - especially when fueled by the interaction between prostitutes and migrant laborers.

Condom use remains the most effective way to prevent transmission. However, investigations reveal condom use is still uncommon among sex workers, who are illegal in the Chinese mainland and conduct their business underground.

Therefore, AIDS prevention workers have turned their attention on this group.

Anti-AIDS frontiers

He Xiaotao, in his early 30s, is a health worker with the Qingyang District Center for Disease Control (CDC) in Chengdu, the capital city of southwest China's Sichuan Province.

Last November, his centre joined the China-UK HIV-AIDS Prevention and Care Project.

The initiative is aiming to develop repeatable models of HIV prevention, treatment and care in two pilot provinces, Sichuan and Yunnan, among high-risk and vulnerable groups in order to reform and develop a national policy framework.

In 1999, He had his first contact with an AIDS patient, a 40-year-old man.

"It was a great shock for me," said He, after he talked with the patient and his family.

"I could clearly feel his feelings of despair. I wished that I could give a helping hand to him, but I was at a loss what to do," recalled He.

That unforgettable experience made him realize an AIDS patient needs more than medical treatment. They need mental care too. He has since contacted more and more AIDS patients. He has concluded the long incubation period of the virus means many patients never receive tests or take necessary protection.

"If we allow the situation to continue, the AIDS epidemic will affect the general population," he said.

It was the above experiences that lead to He submitting his bid for the project without any hesitation when he was informed that a China-UK pilot project would be conducted in Sichuan Province.

In 2003, 2,902 cases of sexually transmitted diseases (STDs) were reported in the Qingyang District of Chengdu. Between January and June of this year, three cases of HIV or AIDS have been reported. He and his colleagues focus their work on those massage centers in the district some of which offer sex services secretly.

In order to know exactly which massage centers provide sex services, He and his colleagues pretended to be the clients. "After we spoke to the girls pretending to be punters, and got information, we made to leave and feared we may not be allowed. That is the bad situation and we had to escape cleverly," He said.

He said there was a potential danger involved when secretly taking photos..

After months of research along every street in the district, they compiled a report detailing the active sex market.

About 500 prostitutes, who charge the lowest rate to clients, have been found in communities and most hail from Fujian, Hunan, Jiangxi and Sichuan provinces. According to He, condom use rate was less than 30 percent.

"Compared with the high-price prostitutes in the hotels, these women in massage centers have little choice of customers. Also, the competition between different massage centers on the same street makes it difficult to refuse some customers who demand no condom use," He explained.

Through the neighborhood committee, He organized a series of meetings of employers of massage centers providing sex services. AIDS and STDs experts were invited to educate them about the diseases.

"We try to persuade them to cooperate and give them free condoms," He said.

Peer education

Peer education has been one of the most outstanding features of the project.

Some female sex workers have been selected to be peer educators. They have a better educational background, more self-confidence and better communication skills.

Twice per month, they come to the center and learn about AIDS prevention, including tactics of persuading customers to use condoms, and encourage their peers to do likewise.

"To make information easier to understand, we have introduced role-playing in our training," He said.

So far, 58 peer educators have received training. However, He admitted only three of them had performed their duties well.

"Generally, the peer educators have undertaken the role of being the bridge between us and prostitutes. Through their introduction, our education work will be much easier," said He.

He found that an appropriate way of talking with prostitutes, such as not patronizing them, is key for successful intervention.

Peer education has proved to be one of the most effective intervention strategies.

In the AIDS prevention project funded by the World Bank in Houma, Shanxi Province, education workers have tried peer education since 2002.

"At first, we are quite suspicious of its effect, because prostitutes are always on the move and we could not keep in contact with them continuously," said Wang Xiuzhen, head of the rescue department of Shanxi Red Cross Society.

However, she often received phone calls from those who had received peer education and moved to other regions.

"They told me that they have become the teachers of new peers," said Wang.

She believed people's health awareness was improving and everyone was afraid of catching STDs. "When prostitutes told their clients about AIDS transmission, most would not refuse condom use," she said.

Providing care

STD patients are most likely to acquire or transmit HIV, with the risk increased 3 to 5 times as high as normal patients, experts note.

However, at present, STD treatment has been a big problem in China and many people prefer to seek help from illegal clinics to protect their privacy.

In Chengdu many clinics and even hospitals do not provide effective treatment. Worse, in some large hospitals medical workers commonly look down upon patients with STDs.

He's project office has selected two hospitals located in areas where prostitution workers are rife, and STD patients can receive comparatively cheap, convenient and standard treatment.

"Doctors there received special training from STD experts and said they would observe the treatment guideline issued by World Health Organization," He said.

The project office has also set up AIDS voluntary consultant service (VCT) offices in Qingyang CDC. According to He, it has already been proved to be effective worldwide and can help better identify HIV carriers or AIDS patients among the general population.

From July, Qingyang CDC started to provide free AIDS test service for citizens. However, the exemption of 100 yuan (US$12) of test fee did not attract more people, according to Zhou Zhongwei, a laboratory worker in Qingyang CDC.

"Most still lack awareness of how AIDS is spread and believe they cannot be infected even though they have engaged in high-risk sexual behaviours," said He. "Some do not know how to face the cruel reality once they are tested positive. So they are afraid to come."

He just finished a VCT training course and a significant part of the classes involved psychology.

"Psychological consultation is absolutely necessary. The moment we tell a patient their positive test result, which means they have been affected, they may be angry, depressed, or sad. They do need mental therapy at first," He said.

In the future, He and his colleagues will focus on the promotion of public VCT services.

"In the process of consultation, we are not just relieving their concerns, but also providing them with knowledge of AIDS prevention," He said.

(China Daily November 10, 2004)