高危人群性病艾滋病干预 工作的开展与挑战 the Work and Challenges of STD/AIDS Prevention and Control in high risk population

Most at risk groups FSW MSM Clients STD clinic attendants Drug users (In particular those drug users also sell sex in order to have more $ for buying drugs) Transgender group?

FSW的干预工作 Intervention for FSW Strategies Condom promotion； IEC for HIV and STIs at the EE venues Counseling and testing STI diagnosis and treatment, reproductive health services Applied Research Vaginal microbicides gel Female condoms Prep ARV treatment

干预模式和方法 Models and Methods of intervention 100%安全套推广使用 condom promotion 依托性病门诊开展的外展服务 outreach services based on STD clinics 以社区卫生服务中心为依托开展综合干预 comprehensive services based on community health service center 同伴宣传教育 Peer education 路边店、站街低档暗娼干预 intervention for low-level sex workers, such as street based sex workers 定期对娱乐场所服务人员体检 regular physical examination for entertainment venues personal 宾馆、旅馆、招待所、娱乐场所等安全套摆放 put condoms in hotel、entertainment venues

FSW人群干预的实施 the implementation of intervention for FSW 疾控中心（高干队）CDC 性病门诊医务人员 Health care workers from STD clinics 非政府组织 NGOs 社区卫生服务中心 Community health service center

MSM人群干预的开展 the implementation of intervention for MSM Community survey and evaluation Capacity building Mobilize primary beneficiaries to engage in HIV and STIs prevention and control Health education and promote safe sex behavior Safe sex behavior Peer education Hotline counseling VCT services STI services IEC development and community readings Experiences scale up

预防干预措施 strategies for prevention and intervention IEC (Internet, venues) Peer education Outreach services Promote condom use STI diagnosis and treatment Testing and counseling Medical follow up and treatment for people living with HIV and AIDS 以MSM民间组织和志愿者为主，CDC提供技术支持 Implemented by MSM-CBOs and volunteers with technical support by CDC 以医疗卫生机构为主，MSM民间组织协助和支持 Implemented by medical organizations, and assisted and supported by MSM-CBOs

MSM干预的模式 models of intervention for MSM MSM-CBOs CDC led community based intervention Cooperation between CDC and CBOs Cooperation between STD clinics and CBOs CBOs organized by CDC NGOs led intervention

MSM干预内容 content of MSM intervention 目前广泛实施的措施 strategies widely implemented currently IEC Condom promotion STIs treatment HIV treatment Reduce sexual partners Safe sex Applied research: Rectal microbicides gel Preventive medicine and post exposure medicine

MSM干预的实施 the implementation of MSM intervention CDC Health care workers from STD clinics CBOs NGOs

高危人群干预工作存在问题 issues of most at risk groups’ intervention Insufficient intervention coverage Low intervention quality, and low effectiveness The intervention coverage difficult to reach low level sex workers Insufficient capacity for personal including CDC, social organizations and NGOs Lack of effective cooperation and communication mechanism； Insufficient health service for STIs and reproductive health (targeting FSWs) ； No good indicators for evaluating the working quality.

Low coverage覆盖率低 19% 5.4% 1% 8% 获得干预服务的静脉吸毒者比例 通过常规性的安全套推广使用所保护到的危险性行为比例 干预项目覆盖到的男性同性恋人群比例 1% 8% Source: WHO (2004). Coverage of Selected Services for HIV/AIDS Prevention, Care and Support in Low and Middle Income Countries in 2003

目标人群的需求调查 survey on the demands of FSWs Reproductive health services 62.6% Condoms 76.9% STIs knowledge 56.4% HIV issues 12.2% Skills 10.5% Counseling (health seeking) 13.3%

我国不同人群梅毒血清阳性率 positive rate of syphilis serum in different groups in China MSM group：10.6%-18.7%， Median: 14.56% FSWs group：4.95%-17.8%，Median: 2.49% Mid level FSWs ： 4.0% - 8.8% Low level FSWs： 32.2% - 33.1% IDUs： 5.01% - 11.17%， Median: 6.81% Clients： 2.99% - 5.79%， Median: 3.04% Pre-marriage:0.31% - 1.43%， Median: 0.66% Pregnant women: 0.29% - 0.6%，Median: 45%

性病对生殖健康的影响 the effects of STD on reproductive health Complications among women: Pelvic inflammatory diseases, infertility, ectopic pregnancy, genital tract tumors Pregnancy adverse consequences： Fetal abortion, Dead fetus in uterus, Premature labor, low birth weight, Congenital infection, Newborn babies infection

Effective Prevention: Targeting beneficiaries Adopting proper measures Achieving sufficient coverage

高危人群干预工作的挑战 challenges of most at risk groups’ intervention Expand intervention coverage and testing coverage targeting most at risk groups (FSWs, MSM, IDUs) ； Strengthen intervention quality and effective evaluation; Strengthen low level sex workers, and elderly clients’ intervention services; Further strengthen integrated intervention package for HIV, STI and Hepatitis C； Strengthen the collaboration with medical services, to further improve the referral and standardized STIs diagnosis and treatment for MARPs ； Community based STIs/HIV/AIDS prevention and control

STIs services for most at risk groups STIs preventive knowledge (increase knowledge and awareness rate) Provision of STIs/HIV counseling services HIV and syphilis screening Timely identify suspected STIs cases Provide referral services (standardized clinics)

以社区为基础开展艾滋病防治优势 advantages of HIV/AIDS prevention and control based on Community Practical multi-sectoral working platform Accessibility for the beneficiaries Convenience for the beneficiaries Improve the intervention coverage for the beneficiaries HIV prevention integrated with the community functions which are well accepted by the beneficiaries Experiences for the chronic diseases control model to be learned from Integrated prevention for group and individuals Cleared division of labor for HIV/STIs work for different agencies/platform

谢谢！