Abstract
In the past two decades, China has witnessed an alarming increase of HIV/AIDS epidemic. Meanwhile, a number of HIV prevention interventions have been conducted. This study reviews existing studies in literature on behavioral interventions on HIV/AIDS in China. Of 25 studies we identified, most have been concentrated in South and South–West China, mainly targeting injection drug users and female sex workers. The most commonly used intervention strategy was individual-oriented HIV-related knowledge education and behavioral skill training. All studies reported positive intervention effects including improved HIV-related knowledge, increased condom use, reduced needle sharing, and reduced STI. Literature also suggests a lack of intervention among other at-risk populations such as MSM, migrant workers, and non-injecting drug users, lack of studies with rigorous evaluation design, inadequate follow-up, limited outcome measurement, and lack of multi-faceted structural interventions. The existing intervention studies document strong evidence of controlling HIV/AIDS epidemic through effective behavioral intervention. More efforts are needed to control the growing HIV/AIDS epidemic in China. Future studies need to employ more rigorous methodology and incorporate environmental or structural factors for different populations at risk of HIV infection in China.
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References
Chen, H. T., Liang, S., Liao, Q., Wang, S., Schumacher, J. E., Greger, T. N., et al. (2007). HIV voluntary counseling and testing among injection drug users in South China: A study in a non-government organization based program. AIDS & Behavior, 11, 778–788.
Cheng, Y., Lou, C. H., Mueller, L. M., Zhao, S. L., Yang, J. H., Tu, X. W., et al. (2008). Effectiveness of a school-based AIDS education program among rural students in HIV high epidemic area of China. Journal of Adolescent Health, 42, 184–191.
China Ministry of Health (CMOH) & World Health Organization (WHO). (2007). A Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China. Beijing: State Council AIDS Committee Office. http://www.chinaids.org.cn/n435777/n443716/appendix/Joint_Assessment_EN.pdf.
CMOH, UNAIDS, & WHO. (2006). Update on the HIV/STD Epidemic and Response in China 2005. Beijing: China Ministry of Health.
Des Jarlais, D. C., Kling, R., Hammett, T. M., Ngu, D., Liu, W., Chen, Y., et al. (2007). Reducing HIV infection among new injecting drug users in the China-Vietnam Cross Border Project. AIDS, 21(Suppl 8), S109–S114.
Detels, R., Vermund, S. H., & Wang, L. (2007). Editorial. AIDS, 21(Suppl 8), S1.
Gao, M. Y., & Wang, S. (2007). Participatory communication and HIV/AIDS prevention in a Chinese marginalized (MSM) population. AIDS Care, 19, 799–810.
Gil, V. E. (1991). An ethnography of HIV/AIDS and sexuality in the People’s Republic of China. Journal of Sex Research, 28, 521–537.
Grusky, O., Liu, H. J., & Johnston, M. (2002). HIV/AIDS in China 1990–2001. AIDS & Behavior, 6, 381–393.
He, N., & Detels, R. (2005). The HIV epidemic in China: History, response and challenge. Cell Research, 15, 825–832.
Holtgrave, D. R. (2005). Causes of the decline in AIDS deaths, United States, 1995–2002: Prevention, treatment or both? International Journal of STD and AIDS, 16, 777–781.
Hong, Y. & Li, X. (2007). Behavioral studies of female sex workers in China: A literature review and recommendation for future research. AIDS & Behavior (epub ahead of print available online).
Khoshnood, K., Wilson, K. S., Filardo, G., Liu, Z., Keung, N. H., & Wu, Z. (2006). Assessing the efficacy of a voluntary HIV counseling and testing intervention for pregnant women and male partners in Urumqi City, China. AIDS & Behavior, 10, 671–681.
Kirby, D., Obasi, A., & Laris, B. A. (2006). The effectiveness of sex education and HIV education intervention in schools in developing countries. In D. Ross, B. Dick & J. Ferguson (Eds.), Preventing HIV/AIDS in young people: A systematic review of the evidence from developing countries (WHO technical report series; no. 938) (pp. 103–150). Geneva, Switzerland: WHO.
Latkin, C. A., & Knowlton, A. R. (2005). Micro-social structural approaches to HIV prevention: A social ecological perspective. AIDS Care, 17, S102–S113.
Lau, J. T., Wang, R., Chen, H., Gu, J., Zhang, J., Cheng, F., et al. (2007). Evaluation of the overall program effectiveness of HIV-related intervention programs in a community in Sichuan, China. Sexually Transmitted Diseases, 34, 653–662.
Lau, J. T., Zhang, L., Zhang, Y., Wang, N., Lau, M., Tsui, H. Y., et al. (2008). Changes in the prevalence of HIV-related behaviors and perceptions among 1983 injecting drug users in Sichuan, China. Sexually Transmitted Diseases, 84, 212–216.
Li, X., Stanton, B., Wang, B., Mao, R., Zhang, H., Qu, M., et al. (2008). Cultural adaptation of the focus on kids program for college students in China. AIDS Education and Prevention, 20, 1–14.
Li, X., Wang, B., Fang, X., Zhao, R., Stanton, B., Hong, Y., et al. (2006). Short-term effect of a cultural adaptation of voluntary counseling and testing among female sex workers in China: A quasi-experimental trial. AIDS Education and Prevention, 18, 406–419.
Liao, S. S., He, Q. Y., Choi, K. H., Hudes, E. S., Liao, J. F., Wang, X. C., et al. (2006). Working to prevent HIV/STIs among women in the sex industry in a rural town of Hainan, China. AIDS & Behavior, 10(Suppl 4), S35–S45.
Lin, P., Fan, Z. F., Yang, F., Wu, Z. Y., Wang, Y., Liu, Y. Y., et al. (2004). Evaluation of a pilot study on needle and syringe exchange program among injecting drug users in a community in Guangdong, China, Zhonghua Yu Fang Yi Xue Za Zhi. Chinese Journal of Preventive Medicine, 38, 305–308.
Liu, Z., Lian, Z., & Zhao, C. (2006). Drug use and HIV/AIDS in China. Drug & Alcohol Review, 25, 173–175.
Liu, B., Sullivan, S. G., & Wu, Z. (2007). An evaluation of needle exchange programs in China. AID, 21(8), S123–S128.
Ma, S., Dukers, N. H., van den Hoek, A., Yuliang, F., Zhiheng, C., Jiangting, F., et al. (2002). Decreasing STD incidence and increasing condom use among Chinese sex workers following a short term intervention: A prospective cohort study. Sexually Transmitted Infection, 78, 110–114.
Maticka-Tyndale, E., & Brouillard-Coyle, C. (2006). The effectiveness of community interventions targeting HIV and AIDS prevention at young people in developing countries. In D. Ross, B. Dick & J. Ferguson (Eds.), Preventing HIV/AIDS in young people: A systematic review of the evidence from developing countries (WHO technical report series; no. 938) (pp. 243–287). Geneva, Switzerland: WHO.
Pang, L., Hao, Y., Mi, G., Wang, C., Luo, W., Rou, K., et al. (2007). Effectiveness of first eight methadone maintenance treatment clinics in China. AIDS, 21(Suppl 8), S103–S107.
Qian, X., Smith, H., Huang, W., Zhang, J., Huang, Y., & Garner, P. (2007). Promoting contraceptive use among unmarried female migrants in one factory in Shanghai: A pilot workplace intervention. BMC Health Services Research, 7, 77.
Rou, K., Wu, Z., Sullivan, S. G., Li, F., Guan, J., Xu, C., et al. (2007). A five-city trial of a behavioural intervention to reduce sexually transmitted disease/HIV risk among sex workers in China. AIDS, 21(Suppl 8), S95–S101.
Stanton, B., Kim, N., Galbraith, J., & Parrott, M. (1996). Design issues addressed in published evaluations of adolescent HIV-risk reduction interventions: A review. Journal of Adolescent Health, 18, 387–396.
Sullivan, S. G., & Wu, Z. (2007). Rapid scale up of harm reduction in China. International Journal of Drug Policy, 18, 118–128.
Tian, L., Tang, S., Cao, W., Zhang, K., Li, V., & Detels, R. (2007). Evaluation of a web-based intervention for improving HIV/AIDS knowledge in rural Yunnan, China. AIDS, 21(Suppl 8), S137–S142.
UNAIDS. (2007). HIV/AIDS epidemic update. Geneva, Switzerland: UNAIDS.
Wang, L. (2007). Overview of the HIV/AIDS epidemic, scientific research and government response in China. AIDS, 21(Suppl 8), S3–S7.
Wang, B., Hertog, S., Meier, A., Lou, C., & Gao, E. (2005). The potential of comprehensive sex education in China: Findings from suburban Shanghai. International Family Planning Perspective, 31, 63–72.
Wingood, G. M., & DiClemente, R. J. (2008). The ADAPT-ITT model: A novel method of adapting evidence-based HIV interventions. Journal of AIDS, 7(Suppl 1), s40–s46.
Wu, Z., Detels, R., Ji, G., Xu, C., Rou, K., Ding, H., et al. (2002a). Diffusion of HIV/AIDS knowledge, positive attitudes, and behaviors through training of health professionals in China. AIDS Education and Prevention, 14, 379–390.
Wu, Z., Detels, R., Zhang, J., Li, V., & Li, J. (2002b). Community-based trial to prevent drug use among youths in Yunnan, China. American Journal of Public Health, 92, 1952–1957.
Wu, Z., Luo, W., Sullivan, S. G., Rou, K., Lin, P., Liu, W., et al. (2007a). Evaluation of a needle social marketing strategy to control HIV among injecting drug users in China. AIDS, 21(Suppl 8), S115–S122.
Wu, Z., Rou, K., & Cui, H. (2004). The HIV/AIDS epidemic in China: History, current strategies and future challenges. AID Education & Prevention, 16, A7–A17.
Wu, Z., Rou, K., Jia, M., Duan, S., & Sullivan, S. G. (2007b). The first community-based sexually transmitted disease/HIV intervention trial for female sex workers in China. AIDS, 21(Suppl 8), S89–S94.
Wu, Z., Sullivan, S. G., Wang, Y., Rotheram-Borus, M. J., & Detels, R. (2007c). Evolution of China’s response to HIV/AIDS. Lancet, 369, 679–690.
Yang, H. T., Du, Y. P., Ding, J. P., Qian, W. J., Li, L., Zhou, Z. L., et al. (2005). Evaluation of the “Jiangsu/WHO 100% condom use programme in China” Zhonghua Liu Xing Bing Xue Za Zhi. Chinese Journal of Epidemiology, 26, 317–320.
Yang, F., Wu, Z., Xu, C. (2001). Acceptability and feasibility of promoting condom use among families with human immunodeficiency virus infection in rural area of China, Zhonghua Liu Xing Bing Xue Za Zhi. Chinese Journal of Epidemiology, 22, 330–333.
Zhao, M., Wang, Q. Y., Lu, G. H., Xu, P., Xu, H., & McCoy, C. B. (2005). Risk behaviors and HIV/AIDS prevention education among IDUs in drug treatment in Shanghai. Journal of Urban Health, 82(3 Suppl 4), 84–91.
Zhongdan, C., Schilling, R. F., Shanbo, W., Caiyan, C., Wang, Z., & Jianguo, S. (2008). The 100% Condom Use Program: A demonstration in Wuhan, China. Evaluation and Program Planning, 31, 10–21.
Acknowledgment
This study was supported in part by NIH Research Grants R01MH76488 and R01NR10498 by the National Institute of Mental Health and the National Institute of Nursing Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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Hong, Y., Li, X. HIV/AIDS Behavioral Interventions in China: A Literature Review and Recommendation for Future Research. AIDS Behav 13, 603–613 (2009). https://doi.org/10.1007/s10461-008-9483-0
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DOI: https://doi.org/10.1007/s10461-008-9483-0