Jiele village is where China’s first HIV cases were reported in 1989. Located in Dehong prefecture in Yunnan province, Jiele experienced a devastating AIDS epidemic, burying almost 200 people, who died from AIDS-related causes. However, a quarter of a century later, the village is now brimming with hope and renewed energy and the fear inspired by HIV no longer rattles residents.
“In the past, everyone was so scared of HIV, but now we are getting great health services and we are living normal healthy lives. We are not afraid of HIV anymore,” said a resident of Jiele village.
The more than 100 people currently living with HIV in the village are receiving regular check-ups and almost all are on HIV treatment. The village’s success is echoed across Dehong prefecture, which was at the heart of China’s early AIDS epidemic.
In 2009, Dehong prefecture started to decentralize antiretroviral (ART) management down to the community level for people living with HIV, who had been accessing treatment for more than a year. Ruili ART hospital provides assistance and technical support to the community level ART sites, which in 2014 were providing treatment to more than 600 people living with HIV.
“The Ruili ART hospital is a model of how one-stop shop HIV services save lives and money,” said Mr Sidibé. “It’s remarkable how the hospital is spreading its know-how down to the community level and ensuring quality health is available in even the most remote corners of China.”
Dehong prefecture attracts migrants from Myanmar and Ruili City is a major trading post. The numbers are expected to grow with the planned implementation of massive China-Myanmar transportation projects. Migration can place people in situations of heightened vulnerability to HIV and has been identified as a risk factor for HIV. Over the past decade an increasing number of new HIV infections in Dehong are migrants from Myanmar.
“The fourth round of the People’s War Against AIDS has just been launched in Yunnan,” said Gao Feng, Vice Governor of Yunnan Province, “ Weare confident we will achieve the’90-90-90’Fast-Track commitment by 2020 in Yunnan! ”
China and other countries have committed to implementing a bold agenda to end the AIDS epidemic by 2030 during the United Nations General Assembly High-Level Meeting on Ending AIDS in New York in June 2016. The agenda includes a set of specific, time-bound targets and actions that must be achieved by 2020 if the world is to get on the Fast-Track and end the AIDS epidemic.
Dehong’s HIV response has evolved to meet the new challenge of providing quality health care to cross-border migrants. While in most parts of China access to key HIV services such as treatment and methadone require a Chinese identification card, in Dehong HIV treatment is available to non-Chinese, who can present residence and employment permits as well as health certificates.
Mr Sidibé visited Jiegao, which is a district of Ruili where around 50 000 Burmese people are estimated to live. The Needle Exchange and Methadone Maintenance Treatment Extension (MMT) sites provide services to mainly migrants who inject drugs.Truck drivers crossing the China and Myanmar borders are provided comprehensive services at a government funded truck driver action spot The services include health education, HIV counselling and testing, condom distribution, and referral To HIV treatment.
“I am so impressed by the HIV prevention programme for truck drivers on the China and Myanmar border. It is so inclusive and well designed!” said Mr.Sidibé.
The local government in Dehong has a strong partnership with community-based organizations, which have played a key role in reaching migrants, who use drugs, engage in sex work or are living with HIV.
Due to these effective strategies, Dehong is the only prefecture in Yunnan province to receive public recognition for having reversed its AIDS epidemic. Health authorities report that HIV treatment coverage is around 60% of all people living with HIV, while the prevention of mother to child transmission programme coverage is 100%. In Ruili, among people living with HIV eligible for ART, the mortality rate has decreased by 95% to 1.4% in 2014, compared to 2005. There have been zero new HIV infections reported among people who use drugs attending MMT clinics from 2008-2014 and no babies born to pregnant women living with HIV have been reported to be HIV positive since 2008. Dehong’s success is all the more remarkable as neighbouring prefectures in Yunnan province continue to experience expanding epidemics.
“Dehong has found the magic bullet to turn around the HIV epidemic,” said Mr Sidibé. “I am sure it’s political leadership, engagement with communities and programmes based on scientific evidence can inspire other communities in China to end the AIDS epidemic.”
During a week-long mission to China, UNAIDS Executive Director Michel Sidibé witnessed the achievements of Dehong prefecture. He met with officials and community groups and visited a range of sites, including the Ruili ART hospital on 7 September. He saw how the city hospital provides one-stop shop HIV prevention and treatment services including health education, HIV testing, methadone for people who inject drugs and prevention of mother to child HIV transmission. Located near the opium producing areas of the “Golden Triangle” and the major drug trafficking routes, Dehong’s initial HIV cases were among people who inject drugs, as well as sex workers and their clients. In the past 15 years the prefecture has worked with community organizations, the central government and international organizations and implemented a wide range of innovative measures leading to a remarkable turnaround in the AIDS epidemic.