Government Dominating, Social Supporting and Patie
Government Dominating, Social Supporting and Patients Cooperating
-A New Social Care Model for HIV/AIDS Patients in Suizhou, China
Xiaodong Tan1*, Zhao Peng1, Guan Shan1, Weihua He2, Dongre Liu3, Zhongming Gao3, Changsong Sun3
Abstract: As the world's most populous country, China is performing the national health promotion and controlling of HIV/AIDS campaign. This paper presents a successful social model in China for HIV/AIDS care. Suizhou, a middle city in China, developed a "government dominating, social supporting and patients cooperating" social model, and got a grateful results. This model consisted of 4 nets: supervised management net, health promotion net, community salvation net and "warm homestead" net. In this model, most of organizations, government branches, and some enterprises performed different tasks: leadership or financial support. Meanwhile, all the neighbors took care of the HIV/AIDS patients and help their family. This model has run for more than 4 years and gotten a better social and financial result. It is worthy to introduce for worldwide use.
Key words: AIDS; AIDS/HIV; social care; health promotion; epidemiology
The human immunodeficiency virus type 1 (HIV-1) has spread rapidly in Asia since 1989 [1-3]. Many of these countries have insufficient funds to test all blood and plasma of donors, and several do not inform donors who were found to be HIV-1 antibody-positive that they were infected. HIV infection through plasma donation has been reported in a few developing countries, including China. Thousands of commercial plasma collection centers were established in townships, counties and villages in China between 1990 and 1994, the majority of which are in rural areas. Donating plasma for money was an easy way for rural farmers to augment their income. The majority of paid plasma donors were adults aged 20~50 years.
To date, HIV/AIDS control activities in China have been and continued to be an important task of local and provincial government. Currently accepted frameworks of HIV/AIDS control emphasized the importance of health education, especially the education about HIV/AIDS sexual transmission. The literature has shown that many countries and international organizations are engaged in establishing control models and precaution measures to protect against HIV/AIDS since HIV/AIDS was discovered in 1980's. Some successful control methodologies, which were applied well in European and North American countries, may not be applied in other countries due to the differences in their cultural, economic and social system [4-7]. To find a fitting social care system for HIV/AIDS has become one of most urgent tasks for each society, especially for those third world and developing countries. China, as well as many other Asian countries, also faces the issues of finding suitable social control and care models for different HIV/AIDS infectious areas. In China, there are three kinds of HIV/AIDS transmission pathways each of which has its own mainly infected area: the injection transmission is mostly located in Southwest of China; and sexual transmission is mainly located in South and Southeast of China; while blood and blood-products transmission existed mostly in the poorly developed places of central China, particularly in some mountain areas [8-11]. For China, we need to find different control models for different areas. In the recent years, the government leaders, health staff and other social workers in Suizhou, Hubei province have made full use of their resources to establish an effective model in preventing HIV/AIDS infection through blood transfusion. This model has produced great national and international influence.
Suizhou, a middle-sized city lies in the Yangtze River and Huai River drainage area, located in the Dahong Mountain Range of Hubei province. The city has an area of 9,636 square kilometers with a population of 2,580,000. Last year (2003), the GNP of the city amounted to 120,000,000 Yuan RMB ($14,300,000) approximately, and its financial income is 820,000,000 Yuan RMB ($10,000,000). The annual average governable income of the citizens is 4,333 Yuan RMB ($516) and the annual average net income of the peasants is 2,430 Yuan RMB ($290). Since April 2001, when the first case of AIDS was discovered in Suizhou, 230 citizens have been diagnosed to be HIV positive, and most of them are living in Fujiapeng village, which lies at the foot of a mountain. People living there are always engaged in agricultural work, whose annual average net income of is about 1,150 Yuan RMB ($137). Villagers began to sell their blood in the form of whole blood or blood plasma from 1978. 62 villagers were diagnosed HIV/AIDS positive from 2001 to 2003. In the opinion of epidemiologist, they were all infected through blood transmission because none of they have history of sexual behavior besides marriage or drug injection.
In order to control HIV/AIDS effectively, under the support of the Hubei Public Health Bureau and Hubei Centers of Diseases Control and Prevention (CDC), the Suizhou municipal government quickly established a precaution and control model of "government leading, social aiding and mutual helping among patients". They insisted on the principle that the patients' lives are the most important. Focusing their work on precaution, control and aid, they set up effective HIV/AIDS precaution and control system, which worked well enough to attract the citizens to be aware of the HIV/AIDS around that area. The construction of the precaution system was shown in fig.1. The municipal controlling system consisted of 4 nets: managing net, health promotion net, community salvation net, and "warm homestead" net by the sufferer helping mutually, their own functions were briefly described in Fig. 1.
MAIN JOBS OF THE CONTROLLING SYSTEM AND RESULTS
During the past two years, the system of HIV/AIDS precaution and control worked well as it obtained obvious social effects in diffusing AIDS knowledge, fostering a good social atmosphere and providing social aid to the patients. The model of Suizhou social care for AIDS patients brought new breakthrough to the Chinese and the world's AIDS precaution and control.
1. Government lead
The municipality has successfully set up a series of organizations and specialized precaution network to prevent AIDS (as shown in Fig. 1).
1.1 The municipality established a committee specializing in preventing AIDS
The mayor was appointed to the director of the committee and the principals of 29 departments become committee members. Every district of the city also established a relevant committee. A strict responsibility and supervision system was set up to define the duties, leader candidates and personnel candidates of each relevant department.
1.2 The municipality set up 15 AIDS precaution institutes, specializing in personnel training, technological instruction, education, custody and management of those HIV positive patients.
1.3 The HIV/AIDS precaution and control system also helped resolving some other questions actively.
1.3.1 The municipal finance gave an allowance of 4,000 Yuan per AIDS patient family and arranged the reconstruction of the 48 patient homes which were under threat of collapsing. The village government was responsible for the implement of this plan.
1.3.2 Every year, the municipal finance gave an allowance of 100,000 Yuan to strengthen the basic establishment of "warm homestead" both in the city and in the township.
1.3.3 Every year, the municipal finance gave an allowance of 1,000 Yuan to each of the 25 families without direct descendants until the patient's death.
1.3.4 AIDS patients or infected families were exempted.
1.3.5 Work groups from 7 departments of the municipality were sent out to those villages with the most AIDS patients, focusing their aids on those areas. Each group was required to produce at least one program to promote the economic development for those areas.
1.3.6 According to national prescription, the municipality government brought free medical aid into effect, carrying out medical care against virus and infection, and convincing AIDS patients to continue the treatment.
2. Social aid and action
2.1 Establishing a good network to diffuse health-promotion intervention
Through news media, setting up large public advertisement, and interpersonal propagation model, social workers strongly propagandized the knowledge of AIDS precaution in the prosperous districts of the city. They carried out precaution education as part of the students' health education and popular adolescent education, especially to those who were most likely to suffer from AIDS. They offered specialized training to officials and teachers in areas with the most AIDS patients. During the past 3 years, they have sent out 800,000,000 leaflets, held about 30 specialized lectures and organized 11 large-scale consulting activities. The point that AIDS could be prevented but couldn't be cured has been shaped among the mass.
Fig. 2 and table 1 showed the results, which came from one of the performed health promotion villages. Fig.2 showed clearly that the awareness rate of HIV/AIDS increased notably after health promotion compared with that in the previous period among the different persons around the villages (Rate of awareness represented the percentage of people who could correctly recognize the major transmitting pathways of HIV and knew that ordinary contact can't spread AIDS and the disease can be effectively prevented through usage of condoms). The persons' attitude towards AIDS patients also had a distinct alteration: after health promotion intervention, the villagers were more willing to deal with the HIV/AIDS patients as normal persons without any prejudice and discrimination.
Fig.2 Awareness rate of AIDS among people before and after health intervention
2.2 Establishing "warm homestead" foundation
Under the guidance of the Provincial Sanitation Department and Provincial CDC, they set up a "warm homestead" foundation with complete facility, integrative function, and normative management. The foundation primarily took charge of medical aid, supervision of AIDS patients, health education and health promotion. It also provided volunteer consulting test, performing behavioral intervention, living assistance, HIV determination and caring for death. Medical staff in "warm homestead" foundation gave examinations to AIDS patients each month and sent out antiviral medicines to the patients every ten days. They have provided patients and their families with 10,000 pieces of health education materials, sent out 15,000 condoms, and carried out volunteer consulting for 4,300 persons. It was essential for each "warm homestead" station to have consulting room, medical care room, activity room and health education room. It was also necessary to post propagandistic bulletin, install consulting telephone, store education materials and condoms, and equip with video facility and medical diagnosing apparatus.
2.3 Mobilizing industrial and social strength into charitable donations to relax economic stress
In order to solve the problems of patients and their families, especially education and economic burden of AIDS patients' orphans, 7 large-scaled companies in Suizhou were responsible for a standard allowance of 300 Yuan RMB every month for each of the 21 orphans until they are 18 years old or until they have finished their education. Children of AIDS patients were exempted of various costs of their education. Social strength was also focused on providing economic aid to the areas with the most AIDS patients.
2.4. Setting up the AIDS patients groups and village AIDS unions
While offering social care to AIDS patients, social workers were also actively exploring a new way for mutual help among patients. That was to establish AIDS patient groups and village AIDS unions in villages for mutual help. Village officials and villagers constituted the village AIDS union which was responsible for publicizing precautions within the village, affording life assistance, education for the patients' children, and taking detailed measures encouraging AIDS test for those highly endangered people and pregnant women into effect. Because the members of the union were local people, they were familiar with each other and had a good affinity. Patient mutual help groups were all consisted of AIDS patients. They carried out regular activity, such as medical care management and mutual assistance in daily lives, etc. Through those activities, AIDS patients could learn corresponding skills and survival abilities, and thus contribute to social stability. Take Fujiapeng village of Junchuan town, which had 19 AIDS patients, for example. The village government provided a 40 square meters room equipped with TV, video and other health education materials to AIDS patients specifically for activity of mutual help. Every month, they held several activities for its members. Also, they organized their members to make cool pillows, which would be purchased and sold by the village government. The members acquired a skill for social survival and improved their economic status. With the improvement of survival quality, the compliableness of medical cure also increased.
Although HIV/AIDS is regarded as a health problem generally, the world has come to realize it is also a social problem that impact on human's welfare, economic development, social productivity and cohesion, and even national security. HIV/AIDS affects every member of society, including parents and children, elder and youth, rich and poor. Preventing and controlling AIDS is a long-term and arduous task [12, 13]. The American and the European government-dominated systems have definitely inspired our country, but those systems do not fit the developing and third world countries well. The "government lead, social support, and mutual cooperation among patient" social care model of Suizhou sufficiently applied the principle of focusing on the usage of human resources. Through combining precaution, surveillance with support, it has displayed considerable results and is worthy of recommendation. One must also take note that the model was designed to control AIDS transmitted through blood transfusion alone, and if was applied in a relatively compassionate society, it would be more likely to succeed. An effective method to control AIDS transmitted through illegal drug usage still need to be discovered. Despite the fact that the Suizhou model can only control limited AIDS transmission methods, it still possesses great reference value.
1. Zunyou Wu, Keming Rou, Detels R. Prevalence of HIV infection among former commercial plasma donors in rural eastern China. Health policy and planning. 2001, 16(1): 41-46.
2. Wu Z, Liu Z, Detels R. HIV-1 infection in commercial plasma donors in China. Lancet. 1995, 364: 61-62.
3. Ye DQ, Hu ZP, Song HP, et al. Serological epidemiology of blood donors in Hefei, Anhui Province, Chinese. Journal of Public Health. 1998, 17: 367-368. (to be continued to Page 58)
* Corresponding to Xiaodong Tan, PhD, professor of School of Public Health, Wuhan University; Address: Donghu Road 185, Wuhan, Postcode: 430071; Tel / Fax: 027-87331398; E-mail: email@example.com
1 School of Public Health, Wuhan University, Donghu Road, Wuhan, P.R of China, Postcode: 430071
2 Suizhou Municipal Center of Diseases Control and Prevention, Suizhou, Hubei, P.R China
3 Division of Diseases Control, Hubei Public Health Bureau, Wuhan, Hubei, P.R China