Technical Assistance Consultant’s Report

Project Number: TA-6321 REG December 2014

People’s Republic of China: Fighting HIV/AIDS in Asia and the Pacific (Financed by the Cooperation Fund for fighting HIV and AIDS in Asia and the Pacific)

Prepared by TA Consultant Team

For Longrui Expressway Company

This consultant’s report does not necessarily reflect the views of ADB or the Government concerned, and ADB and the Government cannot be held liable for its contents.

CURRENCY EQUIVALENTS (as of 12 December 2014)

Currency Unit – Yuan (CNY) CNY1.00 = $0.1614 $1.00 = CNY6.1945

ABBREVIATIONS

ADB – Asian Development Bank AIDS – Acquired Immuno-Deficiency Syndrome BHSA – Baolong Healthy and Safe Action Project (ADB TA4142) CDC – Centre for Disease Control and Prevention CYL – Communist Youth League DTL – deputy team leader FIDIC – International Federation of Consulting Engineers (French acronym) HAPAP – HIV/AIDS Prevention and Action Program HIV – Human Immuno-Deficiency Virus IDU – injecting drug user IEC – information, education and communication IQB – Entry-Exit Inspection and Quarantine Bureau ITL – international team leader Longbai – Longlin-Baise (Expressway) Longrui – Longling-Ruili (Expressway) LREC – Longrui Expressway Company MSM – men who have sex with men NPO – national project officer PRC – People’s Republic of China STIs – sexually transmitted infections (also referred to as sexually transmitted diseases – STDs) TA – technical assistance Wukun – Wuding-Kunming (expressway) YPDOT – Yunnan Provincial Department of Transport YIRNDP – Yunnan Integrated Road Network Development Project

NOTE

(i) In this report, "$" refers to US dollars unless otherwise stated. CONTENTS Page

EXECUTIVE SUMMARY I I. INTRODUCTION 1 II. BACKGROUND 2 A. CONTEXT 2 1. HIV/AIDS Situation in PRC 2 2. PRC Response to HIV/AIDS 3 3. HIV/AIDS in the Transport Sector 4 B. IMPACT, OUTCOMES AND OUTPUTS 6 C. PROJECT MANAGEMENT 7 4. Implementation Arrangements 7 5. Constraints and Mitigation Strategies 8 III. PROJECT IMPLEMENTATION 10 A. COMPONENT 1 - TRANSPORT 10 1. Overview 10 2. Preliminary Steps 10 3. Training for Safety Officers and Peer educators 11 4. Site training and testing 12 5. IEC materials and health kits 13 6. Follow-up Work by Transport Companies 14 B. COMMUNITY MOBILIZATION 14 7. Overview 14 8. Community training 15 9. Youth training 16 10. Peer outreach 17 11. Mobile testing in communities 18 12. HIV/AIDS Billboards 18 13. Follow-up 19 C. CROSS-BOUNDARY COLLABORATION ON MOBILITY-RELATED HIV/AIDS ISSUES 19 14. Overview 19 15. Cross-border Assessment 20 16. Migrant training 21 17. Health management education and services for injecting drug users 22 18. Follow-up 22 D. MONITORING AND EVALUATION 23 19. Overview 23 20. Baseline and End line Survey 23

21. Final Workshop 27 22. Evaluation Feedback from Training Participants 28 23. Sustainability and Linkages 28 IV. CONCLUSIONS AND RECOMMENDATIONS 30 1. Lessons Learned 30 2. Concluding Comments 31 3. Recommendations 32

APPENDIXES 1. Design and Monitoring Framework 2. Training and Testing Report 3. TA Assessment Report (Baseline and Endline) 4. Needs Assessment – Construction Sites and Cross-Border Activities 5. Statistics from Training Pre- and Post-Tests

SUPPLEMENTARY APPENDIXES (available on request) A. Report on mid-term workshop (including TOT training) B. Community and youth training report – Nongmulai (3 workshops) C. Community training report – Hannong (2 workshops) D. Community training report – Jinghan (2 workshops) E. Community training report – Guangti (2 workshops) F. Community training report – Nangai (2 workshops) G. Community training report – Neimangguai (2 workshops) H. Community training report – Feihai (2 workshops) I. Community training report – Chudongguai (2 workshops) J. Community training report – Guangti (2 workshops) K. Community training report – Gazhong (2 workshops) L. Community youth training report – Dengxiu M. Community youth training report – Gazhong N. Community youth training report – Huyu O. Community youth training report – Nansan P. Community youth training report – Hannong Q. Community youth training report – Jinghan R. Community youth training report – Guangti S. Migrant Training Report – 1 T. Migrant Training Report – 2 U. Migrant Training Report – 3 V. Migrant Training Report – 4 W. Migrant Training Report – 5

X. Migrant Training Report – 6 Y. Migrant Training Report – 7 Z. Migrant Training Report – 8 AA. Migrant Training Report – 9 BB. Community Youth Peer Educators Training CC. Contents of Health Kits DD. Community Bulletin Boards EE. IEC Materials reproduced by TA FF. TA Training Photos

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EXECUTIVE SUMMARY

1. The HIV/AIDS Prevention and Action Program (HAPAP) associated with the Longling- Ruili Expressway was a component of ADB TA6321-REG: HIV Prevention in the Transport Sector in Yunnan Province and Guangxi Zhuang Autonomous Region (Guangxi). It followed from a previous component of this TA supporting HIV prevention activities along the Baise- Longlin Expressway in Guangxi and the Wuding-Kunming Expressway in Yunnan, 2008-2011. This in turn drew lessons from TA4142 – Baolong Healthy and Safe Action Project (BHSA) – which supported HIV prevention activities on the Baoshan-Longling Expressway (Western Yunnan Road Project), 2005-2008.

2. The intended impact of this TA component was to contribute to mitigating transmission of HIV and STIs in Yunnan Province. The planned outcome was reduced risks and vulnerabilities of HIV/AIDS/STIs among the construction workers and communities along the Longling-Ruili Expressway corridor. This stems from (i) the requirement to avoid or mitigate adverse social impacts associated with ADB financed projects and (ii) a sector approach to address HIV and STI risks caused by the construction of the highway networks in Yunnan and Guangxi.

3. The program had four “outputs”:

(i) Extend existing contractor HIV/AIDS education with value-added activities; (ii) Mobilize communities to reduce threats of HIV/AIDS through people-centered methodologies; (iii) Develop measures to strengthen cross-boundary collaboration on mobility- related HIV/AIDS issues; and (iv) Monitoring and evaluation.

4. The TA commenced in November 2013 and was completed in December 2014. Longrui Expressway Company (LREC) acted as Executing Agency and was responsible for overall facilitation of the TA. As well as implementing its own HIV/AIDS activities, LREC provided strong support to the TA throughout project implementation. The TA was implemented in close collaboration with local government agencies, principally the Dehong Prefecture AIDS Bureau, and the Dehong Prefecture and Ruili City Centers for Disease Control (CDCs). Two TA team members were staff of local NGOs, released for the duration of the TA. This allowed the team to work very closely with the NGOs concerned – AIDS Care China and the Ruili Women and Children’s Development Centre – including in accessing additional expertise for training activities. ii

5. Despite a very tight timeframe and problems with staff recruitment and illness, the TA was able to add considerable value to existing HIV/AIDS prevention initiatives along the Longrui Expressway Project, for both transport companies and communities. For transport companies, the TA team introduced participatory training techniques that can be readily used on construction sites, trained over 60 safety officers and peer educators to use these techniques and sourced and re-produced specially tailored materials and training resources which can continue to be used on this and future expressway construction projects.

6. The team also successfully piloted site-based voluntary HIV testing and counseling, covering all 27 construction sites. The team used a non-obtrusive HIV test and also offered testing for Hepatitis C, blood pressure and blood sugar levels. This added acceptability to the testing and 788 company staff and laborers agreed to take the HIV test, representing 90% of those who received training. Apart from allowing workers to know their status, this process provided rare data on HIV infection rates among transport construction workers. As recognized by the Joint Initiative by Development Agencies for the Infrastructure Sectors to Mitigate the Spread of HIV/AIDS, 1 transport infrastructure projects can increase the risk for HIV/AIDS spread, predominantly through the presence of large numbers of unaccompanied male workers engaging in sex with multiple partners, often through paid sex. Although this behavior is well documented throughout South-East Asia, and despite multiple projects addressing HIV and transport, data on HIV/AIDS rates among mobile transport workers has been extremely limited.

7. This TA demonstrated the feasibility of site-based testing and provides a first step in building the knowledge base in this area in order to ensure appropriate levels of resources are allocated to HIV/AIDS prevention in the future. Notwithstanding concerns about the HIV risks of mobile construction workers, no worker tested positive for HIV, while three tested positive for Hepatitis C. While further testing is needed across different projects, this data, from an area of high HIV prevalence suggests that HIV infection among migrant workers may not be as high as had been feared. As confirmed by the local AIDS Bureau, the testing program filled an important gap in the local HIV response, highlighting that while transport workers remain an important population, the level of risk may be lower than initially thought, and reinforcing the value of incorporating other health issues into HIV/AIDS training. The program also addressed a major gap, identified in previous TAs, in the wider response to HIV in the transport context, not just within China but across the Asian region.

8. The incorporation of wider health issues into the HIV prevention work was also reflected

1 http://siteresources.worldbank.org/INTTSR/Resources/060811JointstatementHIV_final_.pdf

iii in the provision of health kits for construction workers. These kits include HIV/AIDS/STI information and condoms as well as other health supplies relevant to a construction setting, accompanied by a basic first aid manual (see Supplementary Appendix CC for details on kit composition).

9. Testing was also provided for roadside communities, again with strong support from local authorities. 1389 tests were provided in communities, with one case of HIV identified and one case of Hepatitis C. Several requests were received from companies for further testing but there was insufficient time remaining in the TA to access additional test kits.

10. At community level, the baseline study and training pre-tests showed comparatively low levels of HIV/AIDS knowledge despite regular awareness raising programs by government. Previous ADB TAs have found similarly low levels of knowledge among ethnic minorities in particular, highlighting language as a key barrier.2 Although HIV/AIDS has been present in the Longrui expressway area longer than anywhere else in the PRC, the baseline survey also highlighted a marked reluctance among communities to acknowledge and discuss the issue.

11. Twenty one-day training workshops were provided in the 10 target communities, complemented by eight two-day trainings for youth. In all, more than 1,000 people received direct training from the TA team under this component. In partnership with the Communist Youth League, the TA also held a peer educators workshop for suitable participants identified from youth training and supported 12 peer educators in outreach activities.

12. The TA introduced participatory training techniques and engaged trainers with local language skills, allowing participants to discuss the issues in their own language, and using games and other participatory exercises to reinforce key learning points. Post-test results and the end-line survey indicated that these approaches proved highly effective in overcoming the language difficulties for ethnic minorities and in stimulating discussion within and well beyond the workshops. The local government has subsequently engaged a TA team member to demonstrate these techniques on a new UN-funded project. The TA also provided HIV/AIDS billboards in each community to reinforce knowledge and encourage ongoing HIV/AIDS discussion (see Supplementary Appendix DD for photos of these billboards).

13. The fact that the TA was only on one side of the border meant it was not feasible to

2 Marshall, P. and R. Butler, 2008. ‘The Kreung Cry Differently from the Tampuon’, Final project evaluation report, ADB TA6247: HIV/AIDS Vulnerability and Risk Reduction among Ethnic Minority Groups through Communication Strategies.

iv directly support cross-border collaboration, an area that is any case is already being addressed by the respective government authorities. Each year, the Ruili Health Department meets seven times with its counterparts across the border in Muse, and is working to develop a joint system of responding to communicable diseases including a referral system for people with HIV/AIDS. The China side also accesses HIV information materials in Burmese for distribution to migrants. With the TA only working on the Ruili side of the border, the local government requested that the TA focused its activities under the cross-border component on training of migrants, an area of high priority but for which it was under-resourced. In all, 360 migrants were provided with training in the course of which linkages were established with migrant-dominated factories that can be followed up by local health authorities and the National Project Officer’s local NGO, the Ruili Women and Children’s Development Centre. This NGO is currently in the process of seeking accreditation from the Government of Myanmar to establish operations on the other side of the border, which should further facilitate cross-border work.

14. The TA’s research and evaluation component provided rich information on which to develop and assess interventions. The end-line research found that the training activities – despite their largely one-off nature – had significantly improved understanding of the issue and stimulated ongoing discussion of the issue. Pre and post test surveys showed major reductions in misunderstandings about HIV transmission and in negative attitudes, as well as providing almost universally positive feedback on training methods and content.

15. Following the project, expressway companies now report having the skills and materials to apply the approaches learned from the TA team on other roads. Transport authorities from 17 of ADB-financed roads and infrastructure projects executing and implementing agencies from other provinces in PRC attended the final workshop in Mangshi in December 2014. This expanded awareness offers further potential for adaptation and repetition of the approaches and lessons learned to a large number of other projects throughout the country.

16. Based on the experience of the past 12 months, the TA team has a small number of recommendations for transport companies, health authorities and ADB in this area in the future:

a.) Companies should address their responsibilities on HIV/AIDS prevention by implementing programs that include: provision of IEC materials suitable for construction context; induction training for all workers; ensuring access to good quality condoms; and on-site training and testing for all workers. Outside assistance can be sought from local authorities and NGOs as appropriate. b.) As part of their HIV/AIDS prevention work, transport companies, in partnership

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with local health authorities should promote mobile voluntary counseling and testing for HIV, in line with recognized international standards, particularly in regard to confidentiality. c.) All parties involved in HIV/AIDS prevention – transport companies, health authorities and other approved contractors – seek to ensure activities are aligned with construction schedules. d.) Transport companies and health authorities continue efforts to locate HIV/AIDS in a wider health and safety context. e.) Transport companies engage with domestic construction supervision consultants at an early stage of HIV prevention work. f.) Transport authorities consider standardizing monitoring guidelines across different projects to supplement the general HIV/AIDS prevention clause in company contracts and help guide and monitor activity implementation. g.) Local authorities support complementary HIV/AIDS prevention activities by using a small proportion of construction tax revenues. h.) All parties involved in HIV/AIDS prevention activities consider increasing emphasis on qualitative research methods to complement quantitative methods, particularly given doubts over the validity of self-reported behavioral data. i.) All parties involved in training of trainers programs consider this a two-step process, drawing on the TA experience that participants required two TOT training workshops before they felt confident to provide training themselves. j.) ADB consider creating an online repository for materials, perhaps through the AIDS Data Hub that it already supports.

17. These recommendations are elaborated in the main report.

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I. INTRODUCTION

1. The HIV/AIDS Prevention and Action Program (HAPAP) associated with the Longling- Ruili Expressway is a component of ADB TA6321-REG: HIV Prevention in the Transport Sector in Yunnan and Guangxi. It follows from a previous component of this TA supporting HIV/AIDS activities along the Baise-Longlin Expressway in Guangxi and the Wuding-Kunming Expressway in Yunnan.

2. This final report of the HAPAP provides a summary of project processes and outcomes from November 2013 to December 2014, as well as an identification of lessons learned and recommendations for future work in the HIV and transport sector. 2

II. BACKGROUND

CONTEXT 1. HIV/AIDS Situation in PRC

3. Latest estimates suggest that around 780,000 people are living with HIV in PRC. 3 Although the HIV epidemic remains one of low prevalence overall (less than 0.1 percent among adults), there are pockets of high infection in certain areas and among specific sub-populations. More than seventy per cent of HIV cases in PRC are to be found within six of the country’s thirty-three provinces; Yunnan, Guangxi, Henan, Sichuan, Xinjiang and Guangdong.4 Yunnan has more cases than any other province and 70% of reported cases are found within six cities and prefectures. These are Dehong (where this TA was located), Honghe, Lincang, Wenshan, Dali and Kunming.5

4. The first case of HIV/AIDS in PRC was detected in Ruili County in 1989 and the area surrounding the Longling-Ruili (Longrui) expressway incorporates a very high number of HIV/AIDS risks, contributing to Yunnan Province having the highest levels of HIV infection in PRC.6 As well as a growing sex trade and the long-standing presence of injecting drug use, the expressway is located in an increasingly active border, requiring cooperation between the authorities of the two countries.7 A significant number of ethnic minority groups straddle this border and are considered at heightened risk.

5. Several TAs jointly undertaken by ADB and UNESCO, including three with components in Yunnan Province, have highlighted the failure of existing HIV initiatives to adequately reach many of these minority groups, due primarily to language issues. 8 Post-TA evaluation respondents in several countries including PRC reported that material was often: (i) presented in the respective national language using terms that they did not understand; or (ii) interpreted

3 UNGASS, 2012. 'China AIDS Response Progress Report' Ministry of Health of the People’s Republic of China. 4 Ibid. p 21. 5 Xu Heping, head of the Yunnan Provincial AIDS Prevention Bureau, www.wantchinatimes.com, 29 November 2011. 6 UNAIDS 2010 – http://www.unaids.org/en/regionscountries/countries/china 7 See du Guerny J; Hsu LN; Hong C, 2003. Population movement and HIV / AIDS: the case of Ruili, Yunnan, China, UNDP, Bangkok. 8 These TAs include: RETA 6083, ICT and Preventive Education in the Cross-border Areas of the Greater Mekong Sub-region and (ii) RETA 6247, Joint Project on HIV/AIDS Vulnerability and Risk Reduction among Ethnic Minority Groups through Communication Strategies in the Greater Mekong Subregion; and RETA 6321-4: Developing Capacity among Ethnic Minority Communities to Combat HIV/AIDS. 3

into local languages by people not comfortable with the subject matter.9

6. The HIV epidemic in Yunnan was initially fuelled by sharing of needles among drug users, but is now driven primarily by sexual transmission which accounts for more than half the cases. During the TA inception meeting, Dehong CDC also noted an increasing number of cases being found among men who have sex with men.

7. Local health authorities also reported during the situational assessment and in subsequent meetings that around 70% of newly diagnosed HIV infections in Dehong are migrants from Myanmar. As early as 2008, one survey in neighboring Baoshan Prefecture found infection rates of 10% among women from Myanmar who have married Chinese men.10 Within Myanmar, HIV prevalence in the adult population was estimated at 0.53% in 2011. The epidemic is concentrated within certain groups. Surveillance data from 2011 showed HIV prevalence at 9.6% in female sex workers, 7.8% in men who have sex with men, and 21.9% in male injecting drug users. All groups have shown a considerable decrease in prevalence over the last years.11

8. The development of the Longrui Expressway is one of a number of developments that will lead to an increase in economic activity in the project area, including increasing contact between different populations, creating the conditions for the potential further spread of HIV/AIDS.

2. PRC Response to HIV/AIDS

9. At national level, The Action Plan of HIV/AIDS Containment, Prevention and Control (2006 - 2010) identified goals, targets and steps for implementing HIV/AIDS prevention and control required that business enterprises carried out HIV workplace education programs and made specific reference to those in the construction, mining and transportation sectors.12 One of the most important national policies on HIV/AIDS is Four Free, One Care, under which the Government is to:

9 Marshall, P. and R. Butler, op cit. 10 Peng Yunlong, Deputy Director of Baoshan AIDS Bureau, presentation to BHSA follow-up workshop, Baoshan, 2 June 2009. 11 Myanmar National AIDS Programme, 2012. 'Global AIDS Response Progress Report: Myanmar 12 This plan was updated in 2012 when the State Council issued “China’s Action Plan for Reducing and Preventing the Spread of HIV/AIDS During the 12th Five Year Period” (the Action Plan), setting out targets for the end of 2015 of reducing new infections by 25% and reducing mortality from AIDS by 30%.

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Four Free a.) Provide free antiretroviral drugs to the people living with HIV/AIDS. b.) Provide free voluntary counseling and testing (VCT) services to people seeking these services. c.) Provide free anti-virus treatment to pregnant women living with HIV/AIDS. d.) Support school-age children who are infected with HIV/AIDS with free education.

One Care a.) Provide welfare to people living with HIV/AIDS.

10. Yunnan Province has a 10-point HIV/AIDS Prevention and Treatment Plan (2008), which incorporates a Migrant Workers Action Plan (MWAP). The MWAP recognizes the growing importance of migrant workers in combating HIV and places quite specific responsibility on the Yunnan Provincial Department of Transport (YPDOT) in terms of incorporating HIV prevention knowledge into trainings for migrant workers and setting clear targets in terms of knowledge and behavior. The Public Security Division of the YPDOT established an HIV/AIDS Prevention Working Committee to coordinate efforts to meet these requirements but this is reportedly no longer functioning. YPDOT staff note, however, that they report frequently on their HIV/AIDS work to the Yunnan AIDS Bureau.

3. HIV/AIDS in the Transport Sector

11. The links between HIV/AIDS and the development of transport infrastructure are well known, stemming back to the improvement of the Mombasa–Kinshasa highway in Africa, which is widely regarded as having helped to open the way for the HIV virus to spread. During road construction, large influxes of unaccompanied workers can greatly increase the number of men who buy sex from women, identified by the Independent Commission on AIDS in Asia as “probably the most important ‘determinant’ of future rates of HIV in Asia.13

12. ADB has long been aware of these issues and has worked with the Peoples Republic of China (PRC) to incorporate HIV prevention programs into infrastructure development projects in the transport sector. This work includes activities targeting migrant construction workers and the local communities they interact with, as well as entertainment sites.

13. ADB and PRC have already worked together on two dedicated technical assistance packages associated with highway construction projects in Yunnan and Guangxi Provinces.

13 Independent Commission on AIDS in Asia, 2008. Redefining Aids in Asia: Crafting an Effective Response, Oxford University Press, New Delhi, pp. 112.

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Technical Assistance package TA4142 – Baolong Healthy and Safe Action Project (BHSA) – supported HIV prevention on the Baoshan-Longling Expressway (Western Yunnan Road Project), 2005-2008. One of the major outputs under TA4142 was More Safety, a Resource Manual for HIV prevention in the infrastructure sector. The Manual, which has a particular focus on implementing HIV prevention activities on construction sites, provided a basis for work to institutionalize HIV prevention approaches in the infrastructure sector. TA4142 also successfully piloted a community ‘peer leaders’ programme, which supported small multi-disciplinary HIV education teams. A key lesson from the project was that managers on construction sites had the highest risk behaviors for HIV, despite having the highest levels of knowledge about the virus and how to prevent it. This related, in particular, to their access to vehicles as well as their higher discretionary income.

14. Following on from the BHSA project, TA6321 Sub-component 7 addressed HIV/AIDS prevention on the Longlin-Baise (Longbai) Expressway in Guangxi Zhuang Autonomous Region (Guangxi) and Wuding-Kunming (Wukun) Expressway in Yunnan Province. A key aspect of this project was that it focused from the outset on pursuing approaches with the potential to be institutionalized into the transport sector. The TA developed a number of additional materials for ongoing use including: (i) a DVD designed for use during the health and safety induction training that is provided to all workers on arrival at site; (ii) a field educators guide, Health and Safety with Me, which contains a series of short participatory training exercises suitable for use in a construction context; and (iii) a case study from Guangxi describing the package of activities implemented by contractors.

15. Since the second phase of TA6321-7 was concluded, the Government of PRC has introduced a requirement for HIV/AIDS prevention activities to be included in the health and safety sections of all road construction contracts nationally. Unlike the recommended FIDIC HIV/AIDS clause used by ADB, however, the PRC clause is not very specific, simply requiring companies to provide basic HIV/AIDS awareness and training to their workers along with other health and safety responsibilities, including drug awareness.

a. Longrui Expressway component

16. This third phase of the TA, known as the HIV/AIDS Prevention and Action Program (HAPAP) was linked to the Yunnan Integrated Road Network Development Project (YIRNDP). YIRNDP consists of four components. The first component, which is the focus of this TA, is the construction of the Longling-Ruili (Longrui) Expressway, consisting of a 134.09 km long access controlled expressway and a new 29.23km of class II highway from Ruili to Nongdao. The other

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components involve improvement of the local road network.

17. At the start of the TA, the Longrui Expressway involved 22 sub-grade contracts and these were the focus of initial activities under the transport component. Midway through the TA, five paving contracts commenced and were incorporated into the HAPAP activities.

IMPACT, OUTCOMES AND OUTPUTS 18. The intended impact of HAPAP was to contribute to mitigating transmission of HIV and STIs in Yunnan Province. The planned outcome was reduced risks and vulnerabilities of HIV/AIDS/STIs among the construction workers and communities along the Longling-Ruili Expressway corridor.14

19. The program had four “outputs”, more accurately defined as objectives or activity clusters:

(i) Extend existing contractor HIV/AIDS education with value-added activities; (ii) Mobilize communities to reduce threats of HIV/AIDS through people-centered methodologies; (iii) Develop measures to strengthen cross-boundary collaboration on mobility- related HIV/AIDS issues; and (iv) Monitoring and evaluation.

20. Following initial scoping work, the TA’s initial Design and Monitoring Framework (DMF) was modified to bring it into line with the realities on the ground, including removal of a planned focus on malaria as health authorities said this was not a significant issue in the TA catchment area. Further, as local authorities were already providing condoms and materials to the transport companies, the planned distribution of condoms was dropped and the TA concentrated material provision on those specifically developed for the transport context, complementing the more general awareness raising materials distributed by government. The TA also provided HIV/AIDS information billboards in the target communities and health kits for transport and migrant workers. Other modifications were made during the TA in response to changing circumstances on the ground, notably when the government was able to identify funds to support work with migrant sex workers, work they had previously requested of the TA. Results against the revised DMF are reported in Appendix 1.

14 See footnote 1.

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PROJECT MANAGEMENT 4. Implementation Arrangements

21. The TA commenced in November 2013 and was completed in December 2014. Longrui Expressway Company (LREC) acted as Implementing Agency and was responsible for overall facilitation of the TA. As well as implementing its own HIV/AIDS activities, LREC provided strong support to the TA throughout project implementation. This support included:

 Introducing the TA team members to domestic supervision consultants;  Working with these consultants to facilitate introductions to each subgrade contractor;  Arranging contractor participation in all TA activities under the transport component;  Participating in, and providing feedback on, TA training activities;  Distributing materials produced by the TA in addition to its own materials;  Facilitating the work of the mobile testing and training team;  Providing in-kind support through the provision of meeting rooms for project training; and  Organizing the inception, mid-term and final workshops and field visit.

22. The TA was implemented in close collaboration with local government agencies, including the Dehong Prefecture AIDS Bureau, and the Dehong and Ruili City Centers for Disease Control (CDCs). Two TA team members were staff of local NGOs, released for the duration of the TA. This allowed the team to work very closely with these NGOs – AIDS Care China and the Ruili Women and Children’s Development Centre – and including in accessing additional expertise for training activities.

23. The Ruili Women and Children’s Development Centre, formed in Ruili in 2000, focuses on “creating a better and healthier life for women and children” with a specific focus on HIV/AIDS prevention, working with communities, sex workers, in-school and out-of-school youth. The Centre works closely with government authorities in Ruili and Mangshi and is thus in a position to support ongoing activities both through advocacy to government as a sub- contractor for government programs. AIDS Care China was established in Kunming in 2002, and now has a field office in Ruili. The organization has a specific focus on people living with HIV/AIDS, including in the provision of voluntary counseling and testing, complementing government initiatives in this area. Several of the transport companies involved in the TA have initiated discussions with AIDS Care China with a view to supporting on-site testing and training.

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5. Constraints and Mitigation Strategies

24. The major constraint for the TA was the very short timeframe. This was exacerbated by a number of factors, in particular difficulties with identifying and recruiting suitably qualified local staff prepared to live in the TA area, and the resignation of the Deputy Team Leader. After two unsuccessful job advertisements, ADB staff and the International Team Leader used personal contacts to identify a Deputy Team Leader (DTL), Mr. Yang Jizhou and National Project Officer, Dr. Chen Guilan, who were contracted in mid-January 2014. The DTL subsequently fell ill and eventually resigned from the TA, leading to further delays in the identification and recruitment of a replacement, Ms. Luo Tingyan.

25. In parallel with these issues, strong political pressure on the LREC and the transport companies to speed up construction meant that they were extremely reluctant to engage with the TA in the early stages, which fell right in the middle of peak construction season. LREC leaders expressed support for the TA but requested that the bulk of the TA activities under the construction component took place from June. Therefore, the TA team planned to commence with a TOT in early June, but at this point the DTL was suffering from ill-health. The TOT did take place in July 2014 but the replacement DTL was not on board until mid-October. Faced with only limited time, the TA recruited a mobile testing and training team to support the work of the new DTL. The team, consisting of six persons in addition to the DTL, was recruited under the DTL’s contract and was in the field within three working days of contract issuance. It was able to provide training and testing on all 27 construction sites within one month. As such the TA was able to provide major value-added even within a greatly compressed timeframe.

26. Community activities were also delayed and implementation accelerated significantly in the second half of the project.

27. The TA included a component on strengthening cross-boundary collaboration on mobility-related HIV/AIDS issues without making any provision to work on the other side of the Myanmar border. The TA did consider the feasibility of a cross-border workshop but an assessment of the existing situation that there was had been an agreement in place between the local governments on each side of the border for several years and it was not clear how the TA could add value. Instead, the TA focused on activities for migrants from Myanmar, strongly encouraged to do so by local authorities.

28. A number of activities were already being implemented by government, LREC and the transport companies. In a longer project, this would have been a major asset. With less than a

9 year for implementation, it meant the TA could not follow a traditional response template to secure “easy wins” in areas such as condom distribution. Faced with this constraint, the TA team made a conscious decision not to pursue activities that would crowd out existing initiatives and threaten long-term sustainability. Instead, in close and regular consultation with project partners, the team sought to add value to existing initiatives and fill gaps as appropriate.

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III. PROJECT IMPLEMENTATION

COMPONENT 1 – TRANSPORT 1. Overview

29. For the first time in four expressway projects in Yunnan and Guangxi, the transport contractors were engaged in a significant program of HIV/AIDS prevention prior to, and independently of, the TA. Therefore, the TA focused on adding value, which it did in three main ways: (i) complementing existing information materials with those specifically tailored to the transport context; (ii) introducing the companies to participatory training techniques aimed at moving beyond awareness raising and suitable to the construction site environment; and (iii) providing on-site testing for HIV/AIDS and other diseases, accompanied by training for managers and construction workers.

2. Preliminary Steps

30. At the suggestion of LREC, activities under the transport component commenced with a small workshop for the four domestic supervision consultants. The consultants were already promoting HIV/AIDS work on sites and were able to provide an overview of existing activities. They made a number of suggestions taken up by the TA, including for the team to introduce more participatory training approaches and to provide materials adapted to the worksite. Together with LREC, the supervision consultants proved instrumental in facilitating on-site training to all 22 contractors.

31. As noted in the previous section, all contractors expressed their support for the TA but unanimously requested that activities demanding worker time did not commence until early June. In the meantime, the independent researcher for the TA conducted an assessment of existing responses, knowledge and risks on six selected sites. This assessment, presented in full in Appendix 4, highlighted the following points, which helped to inform TA activities:

 Based on interviews from a cross-section of sites and supplementary information from LREC, there were few people from the communities employed on construction sites and limited interaction between these two groups.  Informants suggested the risk behavior among construction workers was quite limited, with no obvious clusters of high-risk behavior. Survey respondents highlighted that most work teams came from the same geographic areas and that this had a regulatory effect on behavior, likely reinforced by government crackdowns on the sex trade which served to focus increased attention on the unacceptability of buying sex. This was supported by sex worker interviews (different from other projects where sex workers reported road workers as major 11

clients despite denials by the latter).,It was subsequently reinforced by the results of the HIV testing, which found no HIV/AIDS cases among almost 800 tested workers  LREC, with advice from CDC, had disseminated pamphlets, cartoons, posters, playing-cards. However, many of the materials were considered by workers to be too wordy and in the case of posters not sufficiently robust for site settings. LREC also distributed condoms to the safety officers from each contractor. Some put small boxes at sites while others simply distributed these to team leaders.  No HIV testing was available. CDC did not have budget for migrant construction workers.  Only one contractor could demonstrate adequate written records of activities.

3. Training for Safety Officers and Peer educators

32. The TA supported three training of trainer (TOT) workshops. The first, in July 2014, was developed for safety officers. Although initially planned for one worker per company, several companies sent multiple representatives, with the result that there were 47 participants, covering 26 of the 27 companies (including five paving contractors that had mobilized recently) and all four domestic supervision consultants. All present highlighted that the workshop had been extremely successful both in conveying HIV knowledge and introducing participatory training methods, which they saw as being suitable for sites. A full report is annexed to the mid- term workshop report (Supplementary Appendix A).

33. At this point, plans for work on transport sites were reviewed in consultation with participants. It was agreed that the TA should focus its remaining attention on: site training and testing; provision of health kits for workers; training of company leaders;15 and training for peer educators. Two TOT workshops for site peer educators were subsequently held in Mangshi, covering a total of 62 participants. The workshops were similar in format to that for the safety officers although with less focus on in-depth HIV knowledge and more on training and communication techniques. As part of the workshop, participants developed a shared plan for follow-up. Feedback on these workshops has been very positive. Several people had also participated in the safety officer workshop and noted that the first workshop had exposed them to participatory methods but, as these were so new, it was only after the second workshop they felt confident in implementing these techniques themselves.

15 Training of leaders was subsequently combined with training of management staff on site.

12

4. Site training and testing

34. Under this output, the TA provided on-site training and testing to all 27 construction sites. This process comprised the following steps:

 30-minute training for management level staff covering: basic HIV transmission and prevention knowledge: condom demonstration; importance of testing; confidentiality requirements; and relevance of the work to the company;  Distribution of project materials;  Informal training to workers during breaks (often away from main site) covering: basic HIV transmission and prevention knowledge: condom demonstration; importance of testing, pre-test counseling;  Voluntary testing for HIV/AIDS, Hepatitis C, blood sugar and blood pressure; and  Post-test counseling.

35. HIV/AIDS testing was done using an oral swab. Workers were informed that should there be a need for a follow-up test,16 they would be contacted by the testing team. Feedback from the mobile team is that the inclusion of testing for other diseases was very well received by workers, most of whom appeared more concerned about their blood sugar levels than possible HIV infection. Combined with the unobtrusive nature of the HIV test, this supported very high rates of testing – 90% of those receiving training opted to take a test.

36. In all, the team undertook 788 tests with construction workers (639 male, 149 female). To the knowledge of the team, this is the first significant source of data on HIV infection from any transport project in Asia supported by an external agency. Although not a fully random sample, the opportunistic nature of the training – based on worker accessibility – suggests that the data can be taken as strongly indicative. Among the 788 tests, there were no cases of HIV and three of Hepatitis C. While further testing is needed across different projects this data, from an area with one of the highest HIV levels in PRC, provisionally suggests that levels of HIV infection among migrant workers may not be has high as feared. While transport workers remain an important population, the level of risk may be lower than initially thought.

37. In the absence of clearly identified risk behaviors among any specific worker clusters, and with limited time for in-depth engagement that might possibly reveal hidden patterns, encouraging all workers to take the HIV test through easy access to voluntary testing and counseling services accompanied by education – thus knowing their HIV status – represented

16 If the oral test is positive, there is a need for a confirmation test.

13 the key behavioral aspect of this component. As well as allowing access to treatment for those with HIV and contributing to increased data collection, testing is a key part of prevention. The likelihood of transmitting HIV during sex is largely related to viral load (amount of active virus in the blood). Treatment can reduce this load to undetectable levels and hugely reduce risk of transmission.

38. The onsite training and testing activity was strongly supported by the transport companies, several of whom requested a follow-up visit to capture workers who had not been covered in the first round. Unfortunately, the success of the program on construction sites and in communities meant that the team had used all the available testing kits and there was insufficient time to acquire new kits and implement further testing and training. There remains the possibility for companies to fund additional work by the mobile team members, who are based in Ruili and have developed a strong rapport with many of the safety officers. Now that the program has been established and successfully piloted, it could be run exclusively by the local training and testing team. The cost for this team to cover all transport sites, test kits included was around $10,000 or $370 per company. These costs could be further reduced if the companies were able to provide transport and meals to the team. Several companies were already in discussion with the local training team about providing further services, for which local health authorities do not currently have a budget.

5. IEC materials and health kits

39. The project reproduced IEC materials developed on the Wukun Expressway TA – a 30- minute training DVD designed for use at induction, a field educator’s guide with interactive training exercises adapted to construction settings, including a second DVD, and posters specifically targeted to migrant workers (see Supplementary Appendix DD). As requested by counterparts, these posters complement the more generic materials supplied by LREC and the local health authorities, which focus on providing basic information. One poster draws a connection between safety on site (hard hat) and safety off site (condom), while the other seeks to remind workers of their responsibility to family back home, previously identified as a key motivating factor for safe behavior. The materials have been produced with the Yunnan Highway Development and Investment Co. logo so that will remain usable on other projects in Yunnan.

40. The other area in which TA support was requested by LREC and companies was in the provision of health kits for workers. These include condoms and IEC materials but also wider health materials in line with the focus on incorporating HIV/AIDS into a wider health agenda.

14

Payment difficulties delayed this component but 3900 kits (at a cost of $4 per kit) were provided before the completion of the TA for distribution by LREC. The health kit has been designed to be used by both Chinese and Myanmar nationals – materials are in both languages and culturally-specific medicines have been removed. The TA team planned to allocate the unused health kits to migrant workers – that will now done by LREC.

6. Follow-up Work by Transport Companies

41. Feedback during the final workshop (see paragraph 81 highlighted the following points with regard to follow-up work by project partners after the completion of the TA:

 LREC and the transport companies recognize the importance of ongoing work in this area and pledged to continue their efforts, in line with the contractual responsibilities;  Company representatives indicated that, following participation in project TOT activities they are now confident in running educational activities for workers using the resources provided;  Companies now recognize not just the importance of testing but also how readily this can be done on site and combined with other health tests;  Transport authorities from 17 of ADB-financed roads and infrastructure projects executing and implementing agencies in the PRC have now been introduced to effective, affordable strategies for HIV prevention in the transport context; and  Linkages have been established between transport companies and authorities and local NGOs working on HIV/AIDS. Local team members have already been approached about possible engagement with follow-up activities.

COMMUNITY MOBILIZATION 7. Overview

42. In consultation with LREC and local HIV/AIDS officials, the TA team identified 10 possible target communities along the expressway, and these were subsequently revised as two were found to be too far from the road. The communities eventually selected were spread across as many contractor sections as possible and were all identified as priority communities by local authorities, due to their size and proximity to the road. They were: Feihai, Nangai, Neimangguai, Chudonggua, Gazhong, Guangti, Jinghan, Nangsan, Hangnong, and Nongmuluai. These villages included seven Dai villages, two De’Ang villages, and one mixed (Dai, Han, De’Ang).

43. The primary activity in this component was a series of participatory workshops aimed at increasing HIV knowledge, changing discriminatory attitudes and encouraging communities to

15 discuss HIV/AIDS more openly. Twenty one-day training workshops were provided in 10 communities, complemented by eight two-day trainings for youth. In all, more than 1,000 people received direct training from the TA team under this component. In partnership with the Communist Youth League, the TA also held a peer educators workshop for youth and supported 12 peer educators in outreach activities. This was complemented by the provision of testing services and the establishment of community billboards to reinforce HIV knowledge and encourage ongoing discussion.

8. Community training

44. The TA team implemented two community training workshops in each of the ten communities, covering 695 people (300 men, 395 women). These workshops were generally held on successive days in each community and proved so popular that participants often requested to be able to attend the second workshop, even knowing that it was the same as the first. Pre-test surveys confirmed information from the baseline survey that HIV knowledge levels were low for an area in which there was a long history of HIV and where there have been many government information campaigns. Across the ten communities, for example, only 50% of participants were able to state correctly that you could not tell whether a person was HIV positive from their appearance (This rose to 83% in the post-test, one of the highest changes across all questions – refer to Table 2).

45. Emphasis in the training included addressing gaps that still remain in knowledge and stimulating discussion on the issue within communities, with a particular focus on discriminatory attitudes. Space was also given for communities to discuss other issues of concern, principally the risks faced by young people, including the growing use of ephedrine, which was as priority concern for many parents. In all workshops, a support trainer with competence in the relevant ethnic language was engaged, and most group discussion took place in the participants’ own language. This aimed to promote more open discussion among community members in both the workshop and the longer-term, and also reduce possible resistance to the youth peer educators component, which involved young people talking openly about sensitive issues. The workshops also made heavy use of visual aids. Specific attention was paid to the interplay between gender and other factors such as culture – in some communities, men and women were trained separately by request.

46. The workshops were well extremely received by the communities. Indicative comments were:

16

“There has been a lot of propaganda about HIV in the village. But most of the previous ones just taught us lessons. You are different; your attitude is great and makes us feel at home.” “Nobody has ever explained HIV to us in such detail as you are doing today.” “It is the first time I knew how to use a condom after 20 years’ marriage.” (Many similar comments). “I thought a mosquito bite could transmit the HIV virus, I know now that it cannot.” “The game we played makes me realize the tremendous pressure faced by people with HIV/AIDS, so we must not despise them.”

47. Pre- and post-test information is provided in Table 2.

9. Youth training

48. In addition to the community trainings, the TA team ran eight training workshops for youth in partnership with the Communist Youth League (some workshops involved youth from more than one community). In total, 412 youth were trained (229 male, 183 female17). The workshops were of two days duration and the content differed from the community trainings in that there was less specific focus on HIV/AIDS/STI information and more on life skills, in particular decision-making skills.

49. Youth generally had more knowledge of HIV than older community members – for example, in the pre-test 97% of youth were able to state that HIV can spread through shared syringes, compared to 72% of community members. Thus, the main barriers to safe behavior center on assessment of risk and the nature of decision-making. A focus on this area sought not only to address the main barriers to safe behavior with regard to HIVAIDS, but also to better equip young people to minimize other risks they face, including drug use and human trafficking, which is significant from the TA area.18

50. As with the community workshops, the youth workshops were well received by participants:

“I will tell the other friends in the village about what I have learned here.” “I was fed up with my parents’ words, now I understand them better.”

17 There are a lot fewer young women in the communities than young men. 18 See: http://www.curiousanimal.com/dreadful-lie-young-women-trafficked-burma-become-brides-china/ and http://www.washingtonpost.com/wp-dyn/content/article/2009/12/25/AR2009122501841.html

17

“I have learned how to reject some bad suggestions from the peers (peer pressure).” “I know now how to use condom and the importance of using condom. It will be useful all through my life.” “I thought I knew about HIV/AIDS. After the training, I came to realize that I did not know much in detail.”

51. Pre- and post-test information is provided in Table 2.

10. Peer outreach

52. The peer education component sought to build a cadre of young people, able to talk to their peers on their own terms, and potentially to other community members. The skills developed by the peer educators, through both training and practice, will remain with them beyond the TA period and be applicable to other issues as well as HIV/AIDS. Peers were jointly selected from the community youth based trainings by the TA team and the Communist Youth League (CYL) based on their interest and assessed suitability. At the request of the Youth League, the peer educators’ workshop was expanded from 30 participants to 42. One teacher and three health experts also attended to observe the participatory methods. The peer training focused on understanding the reasons underlying different behaviors and how to identify and address these with peers.

53. While many participants expressed an interest in being peer educators, the timing of the peer education outreach clashed with tobacco planting season and, combined with uncertainty of funding, reduced potential numbers. Twelve participants were selected for outreach of whom 11 attended the final review meeting, three females and eight males. In the short time available these educators were able to engage in in-depth discussions and follow-up with 123 people, 91 male, 32 female, as well as distributing 3000 condoms to young people. At their own initiative, the educators added road safety as a key subject, noting that many young people ride motorcycles very quickly and without adequate protection.

54. At the review workshop, the educators expressed strong support for peer education methods, as they considered that young people were much more responsive to suggestions from peers, particularly as they were able to use peer pressure in a positive manner. In addition, the interactive nature of peer education had provided the team with additional insights into HIV/AIDS risks including: early marriage and repeated divorce, leading to multiple sexual partners categorized as spouses; a process of “trial purchase” of wives from Myanmar, with similar implications; and a lack of access to sexual and reproductive health information for

18

people with disabilities. The educators noted that the small information booklet provided as part of their training had been extremely useful in reinforcing and augmenting their training.

55. The Communist Youth League expressed strong support for the initiative, which representatives highlighted as providing new insights into “what young people have on their minds”. In terms of follow-up, the CYL is working with the National Project Officer to pursue the following:

 Use of peer educators and other CYL youth networks to distribute condoms to youth. Currently, youth must buy condoms at high prices or approach the head of the women’s association, which they do not want to do for reasons of shyness and shame (they consider the whole community is likely to find out they are engaging in sex). The TA team has shared the model developed on BHSA in which peer educators sold condoms for a small profit as an incentive to continue their work.  Joint approach by CYL and National Project Officer to local authorities to support more training for peer educators, as well as life-skills education tailored for wives from Myanmar, identified as a priority for many youth.  Establish of a Wi-chat19 discussion group for the peer educator team.

56. A report on the peer education workshop is available as Supplementary Appendix BB.

11. Mobile testing in communities

57. The mobile testing team also visited the 10 target communities as well as other communities along the roadside. Although the initial intention for this work was primarily to provide services for people not covered by annual government testing programs (external and internal migrants and mobile populations), the team found a surprisingly high take-up by other community members. A total of 1389 people were tested, one of whom found to be HIV positive and referred to local health authorities for treatment. One case of Hepatitis C was also found in this population. More details are included as Appendix 2.

12. HIV/AIDS Billboards

58. HIV/AIDS information billboards were established in all ten communities near the end of the TA, with a view to reinforcing the knowledge provided at the workshops and encouraging

19 Chinese version of WhatsApp.

19 ongoing discussion of the issues within the communities. Under the heading “Action against AIDS: Getting to Zero”, the billboards cluster information under seven key messages:

(i) Let’s talk about HIV/AIDS (ii) Let’s learn about HIV/AIDS (iii) Zero new infections: lets prevent the spread of HIV/AIDS (iv) Let’s learn our HIV status (v) Zero deaths from HIV/AIDS: Lets learn about treatment (vi) Zero discrimination: Lets help people with HIV/AIDS (vii) Let’s fight HIV/AIDS together as a community

59. The billboards also include a phone number for further information. The Dai language used in seven of the communities has a written script and there was discussion among the team about the possibility of making the billboards dual language but it was unclear whether this would require special permission and it was reluctantly agreed to drop this idea given the time available.

13. Follow-up

60. Although in the time available implementation in communities amounted to just 2-3 training workshops, feedback from the end-line research (see Section D.2) highlights that these activities have been very successful in stimulating conversation in the community about HIV/AIDS, where previously there had been a marked silence. Community members attributed this to the use of participatory training methods, which not only created the opportunity to analyze and discuss the issues but also allowed participants to do so in their own language. These methods included: games to demonstrate how HIV is spread and the effects of HIV on the immune system, participatory exercises to assess and discuss the riskiness of different behaviors and group discussion on a range of sensitive topics (see photos in Supplementary Appendix FF). As noted above, the billboards will assist in keeping the issue present in communities while a cadre of peer educators has been created. The TA’s cooperation with the Communist Youth League offers the potential for this work to be continued. Finally, the National Project Officer will return to her local NGO and, along with the assistant trainers, remain a resource for the community.

CROSS-BOUNDARY COLLABORATION ON MOBILITY-RELATED HIV/AIDS ISSUES 14. Overview

61. The identification of useful cross-border activities that can be run solely from the

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Chinese side required ongoing discussion with government authorities, as well as the modification of planned activities in response to changing local priorities and resource availability. For example, the TA developed a detailed component for working with an increasing number of migrant sex workers at the request of the local authorities. The government was subsequently able to identify funding to undertake this work itself and therefore requested the project to redirect its efforts towards other migrant workers that they found it more difficult to access.

62. Following the assessment of cross-border initiatives and intensive discussions with local officials and NGOs, the project identified four areas in which (1) migrant populations are underserved; and (2) the project could make a meaningful contribution in the remaining project period, without creating potential problems relating to sustainability. These were: training for migrant workers; health management education and services for injecting drug users; training and outreach for migrant sex workers (subsequently dropped as noted above); and increasing access to testing for migrants. Consideration was also given to working with Chinese truck drivers but the TA team felt that it could not develop a viable program in the available timeframe following the completion of the cross-border assessment.

15. Cross-border Assessment

63. TA researcher, Huang Jiansheng undertook an assessment of cross-border initiatives and identified the following points:

 In the past three years, 60-80% of newly diagnosed HIV/AIDS were from Myanmar. This is despite the fact that not all migrants are covered by testing.  Since 2007, the Ruili Health Department has endeavored to establish a joint control system with Muse (adjacent to Ruili). An annual coordination meeting, two bilateral meetings, and four epidemic briefings, are held each year. However, many migrant workers are from further afield. Working with the relevant authorities in Myanmar beyond the border region requires cooperation at a national level, and a working framework for this is currently not in place.  The Entry-Exit Inspection and Quarantine Bureau (IQB) has temperature scanners at the national gates to test for fever and will transfer any infected person to hospital. They test all drivers for HIV twice a year.  IQB has also set up a “Home of Drivers” and employs two Chinese Burmese to take care of it. Home of Drivers is located in a huge square where all the Burmese trucks are parked. It provides a space where drivers can come to chat, drink, watch TV, play games. There are weekly HIV activities but there is nothing

21

similar for Chinese drivers, who currently appear underserved.  Most Burmese migrants do not appear to have access to HIV education or to testing.

64. The assessment also found that the local authorities had produced significant HIV/AIDS materials in Burmese language, an area in which the TA team had previously thought there might be an opportunity to contribute.

16. Migrant training

65. Local authorities were extremely keen that the TA team provide training for migrant workers from Myanmar. As noted in paragraph 7, migrants from Myanmar account for the large majority of new HIV infections. Although this issue is not directly related to expressway construction, the expressway is likely to accelerate already rapid development in the border area, generating an ever increasing demand for migrant labor. All new migrants from Myanmar are required to take an HIV test on arrival and the government provides IEC materials in Burmese but currently lacks resources for training. Local authorities asked the team to initiate a training program that could potentially be adopted by the government in future.

66. The team began this work by providing two workshops at the migrant service center where migrants must register on arrival in PRC. The registration takes several hours so the team sought to take advantage of this ‘captive audience’. Unfortunately, this was not workable as the requirements of the registration process meant that participants had to come and go. Thus, in consultation with CDC, the team changed its focus to cover the main migrant- dominated factories. Overcoming initial resistance by owners by providing training in the evenings the team was able to provide nine training workshops covering 360 people (187 male, 173 female).

67. Indicative comments from participants of the migrant training were:

“HIV/AIDS is not that horrible. I think I will not be scared when I find somebody has been infected with it.” “I am very happy to know that we (Burmese) can also get medical treatment in Ruili if we are infected with HIV/AIDS.” “I thought only those who had extra-marital sexual activities can be infected with HIV. After the training, I know it is not true.” “Through this training, I come to know that HIV/AIDS can be transmitted not just through sexual behaviors; it can be transmitted through other means.”

22

“Through the training, I come to know different ways of birth control. It is really very useful.”

68. Pre- and post-test information on migrant trainings is provided in Table 2.

17. Health management education and services for injecting drug users

69. Although the primary form of HIV transmission in the TA area has moved from injecting drug use to sex, the potential remains for high HIV rates among injecting drug users (IDUs) to provide a “pool” of infection, creating the potential for rapid spread along the expressway. Not only does HIV spread much more easily through shared syringe use than through sexual transmission, but injecting drug users are often less likely to adhere to treatment protocols which lessen the amount of HIV in their blood.

70. This issue has a strong cross-border element and services for injecting drug users are currently limited. With this in mind, the TA worked to support an existing treatment and education program through the drop-in center and clinic of local NGO, AIDS Care China. The program targets 500 IDU from both sides of the border and has a strong focus on promoting better health management among IDUs, including knowing their HIV status, adhering to treatment protocols and seeking treatment for TB and other communicable diseases, particularly affecting those who are HIV positive. To complement the treatment and counseling undertaken by AIDS Care China, the TA provided 500 specially designed health kits.

71. The TA also initially intended to further expand its work to provide medicine currently not available from government and model a practice of closer engagement for IDUs, which could potentially be extended cross-border. This, however, was could not be undertaken.

18. Follow-up

72. The TA has been successful in initiating HIV/AIDS training in factories with high concentration of migrant workers, against initial reluctance from factory owners. This has further established a relationship between the companies and the NGO of the National Project Officer. Unfortunately, despite attempts by the TA team, it was not possible to develop this relationship prior to TA conclusion to the point where the owners might have been encouraged to implement their own HIV/AIDS in the workplace program. This area remains a priority for local government but as yet without funding. Having demonstrated that the owners will accept HIV/AIDS training, the NPO will continue advocacy efforts with local government to find a budget for this work, at least until such time as owners can be persuaded to take more responsibility for this issue themselves.

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MONITORING AND EVALUATION 19. Overview

73. Baseline and end line surveys, using both quantitative and qualitative methods, were conducted by an independent researcher to monitor the impact of the TA activities. Findings from the baseline helped to guide TA activities, including through a focus on reducing the silence around this issue in roadside communities. These surveys were complemented by pre- and post-test questionnaires for all training activities and activity observation by the independent researcher.

20. Baseline and End line Survey

a. Baseline Survey

74. The project researcher undertook a baseline survey of 12 communities – the 10 communities selected for the TA and two other control communities. The assessment consisted of two parts – a quantitative survey administered by a small team of research assistants and in- depth group interviews undertaken by the lead researcher. A total of 514 questionnaires were completed, 308 people participated in group discussions and 42 people were interviewed individually. The researcher also visited 6 construction sites, interviewing 43 people. He further interviewed 80 migrant workers from Myanmar (including factory workers, sex workers, IDUs and truck drivers) plus 15 officials and organizational representatives associated with migrants. The key finding results of the in-depth interviews for all the above groups are reported under the respective output headings.

75. In terms of the quantitative survey, the research found that most of the villagers had some knowledge of HIV/AIDS through government propaganda, TV and many other media. These levels were, however, low, given that HIV/AIDS has been a significant issue in the project area for more than a decade, and generally below government targets dating back to 2010. These targets were for 75% of people to give the correct answer for each of the individual eight government questions.20 Knowledge levels ranged from 73% in one village across all questions to 51%, and was generally clustered around 60%. Responses on sentiment, that is, how people felt about HIV, ranged from 73% to 47% and attitude, that is, how people thought about others with HIV, from 69% to 49%.

20 Yunnan HIV/AIDS Prevention and Treatment Plan, 2008.

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b. Endline Survey

76. The end-line survey was undertaken in six communities, randomly chosen among the ten baseline communities. Although it had initially been intended to survey the control communities, these communities were reluctant to participate in another survey during peak work season given they had not received any assistance from the TA. The researcher and TA team determined that it would not be possible to generate sufficient responses in these communities to make a quantitative comparison. Instead, the qualitative data in the end-line was used to help determine attribution.

77. In terms of the quantitative data that was collected, the assessment looked at changes community-wide, not just among those who participated in one of the trainings. Table 1 below shows the comparison between the baseline and end-line results in the six surveyed communities, classified by knowledge, sentiments (personal feelings) and attitudes. As can be seen, there are significant changes across all categories. More detailed information can be found in the full assessment report is included as Appendix 3.

Table 1: Changes in Knowledge, Sentiments and Attitudes between Baseline and Endline (N = 240)

Village Knowledge Sentiments Attitude

Nansan Pre-survey 71% 63% 55% Post-survey 84% 66% 61% Jinghan Pre-survey 71% 54% 52% Post-survey 87% 70% 75% Hangnong Pre-survey 69% 58% 48% Post-survey 84% 71% 59% Feih ai Pre-survey 83% 56% 55% Post-survey 89% 84% 81% Nangai Pre-survey 67% 52% 47% Post-survey 89% 79% 78% Neimangguai Pre-survey 65% 48% 48% Post-survey 86% 66% 72% c. Pre and post test findings

78. Pre- and post-test surveys were undertaken for all community and migrant trainings. Initially the team was slightly over-ambitious in collecting data. The pre- and post-test forms were subsequently streamlined to focus on the eight core government questions on HIV/AIDS (see questions 1-8 in Table 2). This is in line with recognized good practice of “ensuring that the

25

output-level M&E indicators developed inform, and are informed by, national M&E framework.”21 The team wished to collect additional data on questions relating to attitudes. In order to do so, four more questions were added (questions 9-12 in Table 2).

79. The team set a target of reducing incorrect or negative answers by 70% across all categories. This was an extremely ambitious target. For example, if 60% of answers were correct in the pre-test, a post-test result of 88% was required to meet this standard. Across all community, migrant and youth workshops, this target was achieved 51% of the time. A reduction of 50% in wrong answers was achieved 74% of the time. There was no significant difference between the responses of men and women. Table 2 provides a summary of pre- and post-test results under the three major training categories: community: youth; and migrants. The information is broken down by workshop in Appendix 5.

Table 2: Training Pre- and Post-test Results Summarized by Category

Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12

?

osquito osquito

Village Male Total

Name Female

child

bite?

PLHIV

isolated

relatives

condom?

appearance

sharingfood?

againstPLHIV

PLHIV PLHIV beshoud

Transmission byTransmission byTransmission banSchoolscan

sharingneedles?

Cantell a whether

childrenHIV+ with

person HIV by has

Preventionby using

Okayto discriminate

Infected by m Infectedby from food buy Would

Transmission mother to motherTransmission to

Only bad people get Onlybad HIV people Transmission byTransmissionblood? Pre and Post Test results - communities 266 72% 69% 53% 46% 46% 46% 58% 32% 43% 42% 36% 60% TOTAL 627 361 86% 87% 77% 78% 84% 82% 86% 52% 81% 81% 74% 83% Increase in correct 20% 27% 46% 69% 82% 78% 49% 61% 86% 93% 104% 39% answers Reduction in incorrect 51% 59% 52% 59% 70% 66% 67% 29% 66% 67% 60% 58% answers Pre and Post Test results - Community youth trainings 171 98% 97% 72% 70% 60% 66% 78% 62% 70% 62% 55% 80% TOTAL 332 161 99% 98% 85% 84% 90% 82% 95% 79% 92% 89% 80% 88% Increase in correct 1% 1% 18% 19% 48% 25% 22% 29% 31% 44% 45% 10% answers Reduction in incorrect 54% 30% 47% 46% 74% 47% 80% 47% 74% 71% 55% 41% answers Pre and Post Test results - migrants 187 74% 81% 63% 66% 51% 61% 64% 56% 66% 48% 42% 65% TOTAL 360 173 98% 100% 90% 91% 90% 93% 97% 85% 92% 84% 84% 89% Increase in correct 32% 23% 44% 39% 77% 51% 51% 52% 40% 74% 101% 37% answers

21 ADB. 2010. Practice Guidelines for Harmonizing HIV Prevention Initiatives in the Infrastructure Sector–Greater Mekong Subregion. Manila, p.16.

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Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12

?

osquito osquito

Village Male Total

Name Female

child

bite?

PLHIV

isolated

relatives

condom?

appearance

sharingfood?

againstPLHIV

PLHIV PLHIV beshoud

Transmission byTransmission byTransmission banSchoolscan

sharingneedles?

Cantell a whether

childrenHIV+ with

person HIV by has

Preventionby using

Okayto discriminate

Infected by m Infectedby from food buy Would

Transmission mother to motherTransmission to

Only bad people get Onlybad HIV people Transmission byTransmissionblood? Reduction in incorrect 92% 100% 74% 74% 80% 81% 91% 66% 77% 69% 73% 69% answers d. Overall findings

80. The findings of the end line survey, supported by pre and post-test data, suggest clear improvements in knowledge and indicate that the training activities have successfully stimulated discussion among the wider community. The training complements government fundraising efforts. The end-line also confirmed that construction workers and migrant factory workers had found the testing very beneficial. The main findings, as documented by the TA independent researcher, were:

 The training and testing were very complementary to the existing Chinese system of HIV/AIDS prevention.  Safety officers from construction sites were trained in TOT so that they not only learn about HIV/AIDS knowledge, but also know how to train their workers properly. This makes a significant difference. In the past, they just warned the workers against HIV/AIDS at meetings, delivered pamphlets and playing cards, and never paid too much attention to the effect although their obligation is written in the contract. Now they know HIV/AIDS prevention activities can be more effective by delivering the message in an interesting and more productive manner.  This TA also reproduced tailored materials from previous TAs, providing more alternatives in disseminating HIV/AIDS knowledge in the future.  The training with games, performances and various activities plays a vital role in encouraging the participants to discuss HIV/AIDS more openly and to learn more details about HIV/AIDS.  The youth workshops are particularly significant in the sense that teenagers are regarded as the most risky group in local social life. The baseline research found that young people in this area are facing several challenges. The training under this TA tries not only to help the young people know about HIV/AIDS, but also helps them know about life skills, particularly decision-making.

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 The findings of the end-line suggest clear improvements in knowledge and indicate that the training activities have successfully stimulated discussion among the wider community.  By providing training to the Burmese migrant workers in various factories and governmental service centers in Ruili, this TA helps to initiate the cooperation between local CDC and factories, the service center in the future HIV/AIDS prevention activities, and hence strengthen cross-border prevention.

21. Final Workshop

81. The final workshop to review the success of the TA implementation and lessons learned was held in Mangshi on 9 and 10 December 2014. The workshop was attended by government agencies involved in implementation of the Yunnan Integrated Road Network Development Project – Yunnan Provincial Financial Bureau (YPFB), Yunnan Highway Administration Bureau (YHAB) and Longrui Expressway Company (LREC) – 26 representatives from expressway project contractors, one domestic supervision consultant, the Dehong Prefecture AIDS Bureau, and Dehong CDC. The workshop was also attended by 17 of ADB-financed roads and infrastructure projects executing and implementing agencies in the PRC, three representatives from ADB and the TA team.

82. The workshop elicited strong praise for the work of the TA, particularly the testing component, the participatory training methods used in both transport companies and communities, and the way in which the TA had complemented the existing activities of both the government and the companies. Health authorities highlighted how the TA had supported work that was crucial for the government but for which they did not currently have a budget. They further praised the TAs engagement of “social organizations who have an active way of engaging communities, which seems more suitable and acceptable to the local people.” Subsequent to the workshop, the government has invited the National Project Officer to demonstrate the TA training methods to a new UN-funded HIV project in Dehong.

83. The final workshop was also used to launch the Chinese version of the case study on HIV prevention from the previous TA in Guangxi titled “Implementing HIV Prevention in the Road Construction: A Case Study from Guangxi in China”. The publication was very well received and about 135 copies were distributed to various agencies who attended the workshop. A post-workshop training session using the Case Study was held specifically for delegates from other provinces. On 10 December, these delegates travelled to a nearby community and had the opportunity to discuss TA activities with local community members, as

28 well as seeing the newly installed HIV/AIDS informational bulletin board. Participants then visited a construction site to view site training and testing activities.

22. Evaluation Feedback from Training Participants

84. As well as the pre and post test survey, evaluation feedback was sought from all training participants. Comments from these evaluations were almost invariably positive and have been reflected in comments in the training section. For the training and testing visits to construction sites, companies were asked to sign a form confirming that all activities had taken place and rate the work of the team on a three-point scale: highly satisfactory; satisfactory; unsatisfactory. Twenty-six of the 27 companies rated the activities as highly satisfactory and just one as satisfactory. Activity observation by the external researcher confirmed the feedback received from participants on the high level of engagement and demonstrated learning in training activities.

23. Sustainability and Linkages

85. The following results achieved by the project will continue beyond the life of the TA:

 Knowledge/Understanding: The TA has successfully piloted a model of mobile training and testing which is highly acceptable to both government and transport companies.  Knowledge/Understanding: Both transport sector actors and health authorities report an increased understanding of the importance of participatory training methods.  Information: The government now has access to data on HIV rates among transport workers, as well as increased data on HIV rates in the community.  Skills: The TA has developed a cadre of peer educators for transport companies who can continue to apply their skills on this and other expressways, as well as a group of youth educators with potential to continue their work in association with the Communist Youth League.  Materials: Materials identified and re-produced by the TA – training manual and DVDs – can be used ongoingly on this and other expressways.  Relationships: Linkages have been established between transport companies and local NGOs, and strengthened between these NGOs and local government. Several of the companies have already contacted local team members about providing additional training and testing.

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 Relationships: Links have also been developed with owners of major factories largely staffed by workers from Myanmar, which can be further developed by both governments and NGOs. TA experience demonstrated that workers are willing to attend trainings after hours if the trainings are sufficiently enjoyable and come with a meal.  Knowledge/Behavior: HIV/AIDS knowledge has increased significantly in all target communities and communities are now discussing the issues more openly which will help influence their behavior.  Materials: The ten community billboards will remain in place and, as part of the contract the company will maintain them in good condition for 12 months.  Knowledge of HIV status: More than 2000 people now know their HIV status. One person with HIV will now have access to treatment, not only benefitting his own health but reducing the possibility of passing HIV to others. Four people are aware of their Hepatitis C status and can access treatment as appropriate.

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IV. CONCLUSIONS AND RECOMMENDATIONS

1. Lessons Learned

86. The principal lesson learned on the current TA was that the provision of HIV testing services for management and laborers on construction sites is not only feasible and cost effective but also highly acceptable to both the companies and workers, particularly when combined with testing for other diseases that are of greater immediate concern to the workers. Combined with basic HIV training, the testing has three major benefits:

(i) It allows people diagnosed as HIV positive to seek treatment. (ii) It has an important prevention impact as effective treatment greatly reduces the amount of HIV in the blood and therefore the possibility of transmission. Further, a negative diagnosis can encourage people to maintain or adopt safer behaviors to maintain this status. (iii) It allows the collection of data on HIV rates among migrant transport workers, identified in the previous TA as a major gap in the response.

87. Comments from those who participated in more than one trainer of trainer workshops suggest that it was the second workshop that was the tipping point in terms of their confidence to run training activities themselves. One participant noted that the first workshop served to introduce participatory methods but because the concepts were so new, the progression from learning about them to using them was too big to be done in one step. Report from youth peer educators indicated similar sentiments. Feedback from government officials at the final workshop also suggested that their own understanding of the value of participatory training methods has also been enhanced.

88. Much previous work on HIV/AIDS in the transport sector has relied heavily on quantitative data to measure change. However, while this can be effective in assessing changes in knowledge and to some extent attitudes, there are strong questions on the reliability of self- reported behavioral data, particularly where the reported behavior – for example, going to sex workers – is frowned upon or expressly prohibited.22 On other projects, for example, large discrepancies have been found between the use of sex workers by construction workers, as reported by the two different groups. With this in mind, and given the very short project timeframe, the project opted for a mixed methods approach to assessing change. This resulted in: 1) a much richer baseline, which guided the development of TA activities; and 2) insights into

22 http://www.sciencebrainwaves.com/uncategorized/the-dangers-of-self-report/ 31 changes brought about by the program that would not have been identified through a uniquely quantitative focus.

89. Finally, while this and the previous TA have highlighted how much HIV/AIDS prevention work can be undertaken by the companies themselves, work within communities required considerable outside resources. This is a similar experience to the BHSA project, while attempts to develop replicable low-cost models on the previous TA, in particular along the LongBai expressway, were largely unsuccessful.

90. In projects where there is a significant local workforce engaged by the companies, it may be possible to use locally-recruited workers as community educators but, as identified in previous TAs, it appears that support for HIV/AIDS work in communities is best outsourced This requires the identification of a budget source, perhaps the use by local governments to use some of the construction tax revenues that they receive from the road construction process for HIV prevention, in line with their responsibilities under the National Plan. In discussions with ADB staff, it appears that a small proportion, 1-2% of those revenues should be sufficient to cover related health risks.

2. Concluding Comments

91. Overall, despite a very tight timeframe and problems with staff recruitment and illness, the TA was able to add considerable value to existing HIV/AIDS prevention initiatives along the Longrui Expressway, for both transport companies and communities. For transport companies, the TA team introduced participatory training techniques that can be readily used on construction sites, trained safety officers and peer educators to use these techniques and provided specially tailored training resources. The team also successfully piloted site-based HIV testing, combining this with other health testing.

92. The testing filled an important data gap both in the local HIV response – as confirmed by the local AIDS Bureau – and in the wider response to HIV in the transport context. The TA team was also able to fill gaps in testing of mobile populations and initiate a training programme for migrants, a government priority for which it has yet to obtain funding. Participatory training techniques were introduced to communities where they helped to overcome language difficulties for ethnic minorities and to stimulate discussion within and well beyond the workshops. The presence of bulletin boards will help to reinforce the importance of HIV/AIDS discussion.

93. The research component provided rich information on which interventions could be developed and assessed. The research indicated low levels of HIV/AIDS knowledge in an area

32 where the issue has been present for many years but also how training activities – despite their largely one-off nature had significantly improved understanding of the issue.

94. Finally, transport companies now have the skills and materials to apply TA approaches on other roads. The attendance of transport authorities from 17 of ADB-financed roads and infrastructure projects executing and implementing agencies from other provinces in PRC offers further potential for adaptation of the approaches and lessons learned to a large number of other projects throughout the PRC.

3. Recommendations

95. Based on the experience of the past 12 months, the TA team has some recommendations for Transport Departments and Health department to consider in this area in the future.

a.) Companies should address their responsibilities on HIV/AIDS prevention by implementing programs that include: provision of IEC materials suitable for construction context; induction training for all workers; ensuring access to good quality condoms; and on-site training and testing for all workers. Outside assistance can be sought from local authorities and NGOs as appropriate.

96. In these efforts, companies can draw on the ADB document, Implementing HIV prevention in the context of road construction: A case study from Guangxi Zhuang Autonomous Region in the People’s Republic of China, distributed at the final project workshop.23

b.) As part of their HIV/AIDS prevention work, transport companies, in partnership with local health authorities should promote mobile voluntary counseling testing for HIV, in line with recognized international standards, particularly in regard to confidentiality..

97. As noted several times throughout this report, the testing program was extremely

23 Implementing HIV prevention in the context of road construction: A case study from Guangxi Zhuang Autonomous Region in the People’s Republic of China. Mandaluyong City, Philippines: Asian Development Bank, 2014.

33 successful in helping workers know their status and providing previously missing data. Some caution is needed, however, as the TA was operating in an environment of a strong local response and supportive companies. As no company worker was found to be HIV positive, the TA did not have to address the implications of this, and no company was in a situation of being singled out. It is important that future programs ensure appropriate safeguards, in line with the World Health Organization’s 5 Cs of Consent, Confidentiality, Counselling, Correct Test Results and Connection/linkage to prevention, care and treatment. 24 It is further attempt to ensure companies are supported for encouraging testing rather than punished for the results.

c.) All parties involved in HIV/AIDS prevention – transport companies, health authorities and other approved contractors – should seek to ensure activities are aligned with construction schedules.

98. HIV/AIDS activities should commence prior to the arrival of the first contractors. This period can be used to engage with senior managers on the importance of HIV/AIDS prevention, source condoms and IEC materials and identify possible outside expertise to assist with training of company trainers and testing services. Once activities commence, discussion of all parties is needed to balance the needs of activities to cover as many workers as possible with the reality that the time when the most workers are employed is also peak construction. Special activities can be scheduled prior to major events such as Spring Festival when workers may be more likely to engage in risk behaviours.

d.) Transport companies and health authorities continue efforts to locate HIV/AIDS in a wider health and safety context.

99. This strategy was mooted by ADB staff at the start of the previous TA and partially implemented on the Wukun Expressway. It was taken forward on the LongRui Expressway, notably through the addition of tests for other diseases to the HIV testing process. Incorporating HIV/AIDS work in a wider health and safety process has a number of advantages. As demonstrated on the previous TA, linking HIV/AIDS with safety offers opportunities to build activities and monitoring into established processes. Including a focus on other health issues not only allows progress on these issues but also demonstrably contributes to making the program more acceptable. In particular, the TA testing team considers that the possibility for workers to be tested for other infections at the same time as HIV serves to de-stigmatize HIV

24 http://www.who.int/hiv/topics/vct/about/en/

34 and greatly increases test take-up.

e.) Transport companies engage with domestic construction supervision consultants at an early stage of HIV prevention work.

100. Domestic supervision consultants play a crucial role in bringing HIV/AIDS contract clauses to life by ensuring they are adequately monitored. In the absence of detail in these clauses, monitoring guidelines can also provide guidance to companies on the types of activities they should implement. At the suggestion of LREC, the supervision consultants were engaged during the first month of activities and provided strong support throughout, first by providing the team with an overview of activities, then by facilitating meetings with all companies and finally by active participation in TA activities. Had more time been available, the TA would have pursued further work on the monitoring guidelines and this is something that could be done on future projects (see next recommendation).

f.) Transport authorities consider standardizing monitoring guidelines across different projects to supplement the general HIV/AIDS prevention clause in company contracts and help guide and monitor activity implementation.

101. As noted in para 16 , the PRC government has introduced a standard HIV/AIDS prevention clause in all transport construction contracts. The clause is, however, quite general. Rather than seek to modify this clause at a national level, the clause could be given more specificity by the development and use of monitoring guidelines, outlining in more detail the components of an effective HIV/AIDS prevention program. An example is provided in the Guangxi Case Study. 25

g.) Local authorities support complementary HIV/AIDS prevention activities by using a small proportion of construction tax revenues.

102. The issue of how to support effective HIV activities in communities associated with road development remains unresolved. Experience across four expressways suggests that this cannot be effectively built into the work of the transport companies, and that this work generally needs sufficient resources for the engagement of specialist expertise. With a view to long-term sustainability, consideration may be given to allocating some of the construction tax revenues

25 Asian Development Bank, 2014, op cit. p16.

35 that local authorities receive from the road construction process for HIV prevention, in line with their responsibilities under the National Plan. A small proportion, 1-2% of those revenues should be sufficient to cover HIV/AIDS and other health risks.

h.) All parties involved in HIV/AIDS prevention activities consider increasing emphasis on qualitative research methods to complement quantitative methods, particularly given doubts over the validity of self-reported behavioral data.

i.) All parties involved in training of trainers programs consider this a two- step process, drawing on the TA experience that participants required two TOT training workshops before they felt confident to provide training themselves.

103. The term ‘training of trainers’ tends to be used loosely in the development sector. As a key strategy in many of ADB’s projects, it would be useful to circulate the lesson learned on this TA about the benefits of a two-step TOT process. Ideally, this would be complemented by additional support for the TOT course graduates in implementing their first trainings on-site.

j.) ADB consider creating an online repository for materials, perhaps through the AIDS Data Hub.

104. The current TA was able to reproduce specifically tailored materials developed on previous TAs, including a field educators guide, an induction training DVD, posters and a case study from Guangxi, setting out an 12-step approach to HIV prevention in the transport context. The first two materials were identified due to common staff members across different TAs and may not necessarily have been used by other personnel. To ensure the wheel is not re-invented in future it may be worthwhile creating an online repository for such materials, perhaps through the AIDS Data Hub. The produced materials are available in English as well as Mandarin so could be adapted for use elsewhere, as has already happened in Mongolia.26

105. With materials available in soft copy, modifications could be made as appropriate. On the current TA, for example, the testing team created a clever variant on the Wildfire game contained in the field educators guide, making the exercise both more interesting and more educational.

26 http://www.adb.org/sites/default/files/project-document/81924/42027-012-tacr-01.pdf

Appendixes

RETA 6321: Fighting HIV/AIDS in Asia and the Pacific Subproject 7 – PRC: HIV/AIDS Prevention and Transport Sector in Yunnan and Guangxi Longling-Ruili Expressway

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APPENDIX 1: DESIGN AND MONITORING FRAMEWORK RETA 6321: Fighting HIV/AIDS in Asia and the Pacific Subproject 7: PRC HIV/AIDS Prevention and Road Transport Projects Design and Monitoring Framework

Design Performance Data Achievements Summary Targets/Indicators1 Sources/Reporting Mechanisms Impact No new cases of HIV identified Contractors’ registers No cases of HIV among 788 Halt and begin to among construction workers and Provincial health survey expressway construction reverse the spread communities along the Longling- workers tested of HIV/AIDS by 2015 Ruili Expressway corridor. in Yunnan Province Outcome Increase in knowledge of Surveys of construction Pre and post test results Reduced risk of HIV/AIDS and prevention workers and repeatedly showing transmission of HIV practices among construction communities along the reduction of incorrect among the workers and communities along Longling-Ruili responses by at least 50% construction workers the Longling-Ruili Expressway Expressway corridor on and knowledge levels above and communities corridor as measured against the knowledge of HIV/AIDS 80%. including cross- governments core eight M&E and prevention practices border migrants questions – 80% (M/F) for (communities). Pre and along the Longling- communities and workers, and post-test training surveys Ruili Expressway reduction in incorrect responses (workers) corridor by 70%.2 Reports, unlinked test Achieved 2177 HIV tests in Increase in access to, and results 2 months, as well as testing uptake of voluntary testing and for Hepatitis C and blood counseling – 1000 test per pressure month of program Baseline and end-line Pre- and post-test results Increase in positive community surveys show strong increases in attitudes to people living with community attitudes (by at HIV/AIDS, (70% fall from least 50% across baseline in negative responses categories). Results from on attitudes to people living with end-line study less HIV/AIDS). Project records. conclusive. Government response at Youth peer education network final workshop developed with government Seven youth workshops held commitment to ongoing support and youth peer network - no. of active per educators piloted with 11 educators at end of project active at end of project. Several follow-up activities planned by Communist Youth League with ongoing support from ex-TA staff Outputs 1.1 Gap analysis conducted for Project progress and Gap analysis (Appendix 3)

1 Data to be disaggregated wherever possible by target group, sex and ethnicity. 2 Percentages to be finalized after baseline survey completed and with reference to the Yunnan Province Monitoring and Evaluation Framework and core indicators. 2

Design Performance Data Achievements Summary Targets/Indicators1 Sources/Reporting Mechanisms 1. Extended existing 18 contract packages and monitoring reports completed and results contractor HIV/AIDS measures developed and reflected in programming. education with value- implemented for 18 packages; added activities 1.2 HIV/AIDS material gaps for Two sets of posters contract workers identified and reproduced and two DVDs - context-specific materials one for induction and one for developed and distributed to fill field trainers. Folder these gaps; produced for trainers to keep up to date info. 3900 health kits provided to LREC for distribution.

1.3 80% contract workers Coverage estimated at 40- covered by awareness training; 50% will increase as companies continue training based on TOT. Lower than target due to major delays in in recruitment of Deputy Team Leader

1.4 No of sites for which testing Onsite testing provided on services are available through all construction sites. (1) referral and/or (2) onsite testing;

1.5 100% of domestic All 4 domestic supervision supervision consultants covered consultants attended at least by training two trainings

1.6 60% of management staff of Training provided to companies provided training; management staff of all companies on site.

1.7 100% of safety officers 47 participants in TOT, with trained as trainers; 26 of the 27 contractors represented (96%) as well as all four domestic supervision consultants. Two follow-up trainings held. Safety officers report attendance at second TOT was the tipping point in terms of confidence to train 2. Mobilized Communities communities to 2.1 Vulnerable communities Project progress and Assessment completed and reduce threats of along the project identified and monitoring reports 10 communities selected. HIV/AIDS through vulnerability related needs

3

Design Performance Data Achievements Summary Targets/Indicators1 Sources/Reporting Mechanisms people-centered assessed (No of communities methodologies covered);

2.2 HIV/AIDS material gaps Assessment identified that identified and context-specific local communities had materials developed and access to much information distributed to fill these gaps; but all in Han and very dry. Billboards provided in ten communities with clear messages and pictures in local languages

2.3 No. of community members 27 workshops: provided awareness and - 20 community prevention training; workshops with 695 participants (300 male, 395 female) - 7 youth workshops with 412 participants (229 male, 183 female) 2.4 No of health kits distributed 3900 kits to LREC for onward distribution

Community Youth

2.5 No of youth peer-educators 42 educators trained trained;

2.6 Number of youth actively 12 active educators (others participating in peer education willing but restricted by network; seasonal work obligations)

2.7 Number of peer outreach 123 youth reached through activities; peer outreach (91 male, 32 female) Coordination 2.8 Coordinate with other Coordination is ongoing and ongoing programs supporting led to several activity prevention efforts for target modifications as communities and share key documented in final report information; (para 61).

3. Develop measures 3.1 Desk review conducted and This was changed to a field to strengthen cross- issues identified; report, which has been boundary completed and informed TA collaboration on activities Appendix 4) mobility-related HIV issues 3.2 No. of sites identified and Eight sites covered for

4

Design Performance Data Achievements Summary Targets/Indicators1 Sources/Reporting Mechanisms covered for cross-border training migrants awareness and prevention training;

3.3 HIV/AIDS material gaps Health kits designed for both identified and context-specific Chinese and Burmese target materials developed and groups. distributed to fill these gaps;

3.4 No of migrants and mobile Nine migrant worker populations provided training trainings completed covering and condoms, and access to 370 persons (187 male, 173 voluntary HIV counseling and female), two in the testing;3 immigration service center and seven in factories

3.5 No of peer educators Not done due to lack of developed among migrant and agreement by factory mobile populations; owners.

3.6 Cross border workshop to Not done. There are existing strengthen cross border initiative mechanisms for this. to deal with HIV spread.4 Instead, final workshop expanded to focus on lessons learned across the 3 TAs. Activities with Milestones Progress

1.1. Needs assessment of the 18 contractors to identify the contractors who need Complete – Main report added support for HIV/AIDS education; April 2014 Section III.A 1.2. Conduct desktop study to gather all relevant HIV/AIDS, STI and malaria literature Changed to field analysis, for gap-analysis of project-specific information needs; complete – Appendix 4 1.3. Translate and redevelop tools that have proven to be effective in other parts of Complete – Main report China and the GMS; Section III.A 1.4. Ensure availability of cost-effective peer education and training of the trainers Complete - Appendix 4 techniques and tools in induction courses at construction sites/camps for the workforce; 1.5. Report on the risks and vulnerabilities faced by construction workers; Complete – Appendix 3

2.1. Conduct a sex-disaggregated baseline survey of knowledge of HIV/AIDS and Complete – Main report prevention among local communities Section III.B 2.2. Actively engage communities to enhance their HIV prevention characteristics to Complete – main report para change the norms, attitudes, and risk behavior practices; 42 2.3 Conduct desktop study to gather all relevant HIV/AIDS, STI and malaria literature Changed to field analysis for gap-analysis of project-specific information needs; and complete 2.4 Translate and redevelop tools that have proven to be effective in other parts of Bulletin boards developed to

3 This potentially includes long-distance truck drivers. 4 Subject to confirmation that this is a gap.

5

Design Performance Data Achievements Summary Targets/Indicators1 Sources/Reporting Mechanisms China and the GMS; complement existing materials 2.5. Implement activities for affected communities to understand, anticipate and Complete – main report adjust to development factors that contribute to HIV vulnerability resulting from section III.B mobility; 2.6. Report on the risks and vulnerabilities faced by local communities and other Complete – Appendix 3 affected groups;

3.1. Develop program performance and management system applied throughout the Complete – main report program duration (baseline, and outcome evaluation) that is aligned with Yunnan section III.D Province Monitoring and Evaluation Framework; 3.2. Implement baseline, mid-term and end-term surveys and provide raw data and Baseline and end-line analysis in reports; surveys completed, no mid- term due to short TA time period.– main report section 3.3. Document and report on dissemination activities with construction workers and III.D communities; Complete – main report 3.4. Conduct mid-term and end-term workshops among key stakeholders to discuss section III results, lessons learned and deviations and improvements for achieving the Complete. Final workshop, objectives of the program. included 17 provincial transport departments attending the final workshop.

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APPENDIX 2: TRAINING AND TESTING REPORT Date Venue No. of People Receiving HIV No. of People Receiving HIV Other Education Counseling and testing Male Female Total Male Female Total Oct. 14 Contract Section 21 27 3 30 25 2 27 Oct. 14 Contract Section 22 14 4 18 4 1 5 Oct. 15 Contract Section 20 15 15 8 8 Oct. 15 Contract Section 18 25 2 27 23 1 24 Oct. 16 Contract Section 21 20 10 30 16 10 26 Oct. 17 Contract Section 17 46 1 47 39 1 40 Oct. 20 Contract Section 14 18 7 25 16 6 22 Oct. 20 Contract Section 15 26 26 26 26 1 HCV (Paving) Oct. 21 Supervision Office of 17 6 23 16 5 21 Section 3 Oct. 21 Contract Section 17 51 1 52 51 1 52 Oct. 21 Contract Section 16 46 15 61 45 15 60 1 HCV Oct. 22 Contract Section 15 28 2 30 24 2 26 Oct. 23 Contract Section 12 17 8 25 16 7 23 Oct. 24 Contract Section 13 34 6 40 33 5 38 Oct. 24 Contract Section 8 16 2 18 15 2 17 Oct. 27 Contract Section 11 15 15 15 15 Oct. 27 Admin. Office of 13 4 17 12 4 16 Contract Section 4 Oct. 28 Contract Section 2 16 4 20 9 4 13 1 HCV (Paving) Oct. 28 Contract Section 8 17 3 20 16 2 18 Oct. 29 Contract Section 10 11 4 15 10 4 14 Oct. 29 Contract Section 10 21 9 30 20 9 29 Oct. 30 Contract Section 6 22 8 30 22 8 30 Oct. 30 Contract Section 7 15 5 20 12 4 16 Nov. 4 Contract Section 4 13 2 15 10 1 11 Nov. 4 Contract Section 6 12 1 13 1 1 2 (Greening) Nov. 5 Contract Section 5 9 4 13 8 4 12 Nov. 5 Contract Section 3 11 9 20 7 9 16 Nov. 5 Contract Section 2 18 7 25 16 6 22 Nov. 6 Contract Section 1 43 22 65 42 22 64 Nov. 7 Admin. Office of 8 2 10 8 2 10 Contract Section 1 Nov. 7 Supervision Office of 12 8 20 12 7 19 Contract Section 1 Nov. 10 Supervision Office of 12 3 15 10 2 12 Contract Section 4 Dec.10 Contract Section 8 33 4 37 31 1 32 Dec. 10 Contract Section 22 1 23 21 1 22 2(Paving) Sub- All construction 723 167 890 639 149 788 0 3 HCV total sites Oct. 22 Hua’e Village 8 9 17 Oct.23 Mengga Village 7 15 22 7

Date Venue No. of People Receiving HIV No. of People Receiving HIV Other Education Counseling and testing Male Female Total Male Female Total Nov. 10 Hunban Village 12 28 40 Nov.11 Weather Station 6 12 18 Nov.11 Manxiang Village 7 19 26 Nov. 12 No. 3 Division of the 8 37 45 Farm Nov.12 No. 3 Division of the 7 21 28 Farm Nov. 13 Huihuan Village 7 24 31 1 Nov. 13 Bangyang Village 7 25 32 Nov. 14 Mengga Village 11 21 32 Nov. 14 Bandong Village 3 26 29 Nov. 17 No. 2 Division of the 16 35 51 Farm Nov.17 No. 6 Division of the 6 21 27 Farm Nov. 18 No. 7 Division of the 17 46 63 1 HCV Farm Nov. 19 Hua’e Village 13 14 27 Nov. 19 Huahai Village 8 19 27 Nov. 20 Lixin Village 10 15 25 Nov. 20 YunHai Village 5 19 24 Nov. 21 No. 4 Division of the 18 43 61 Farm Nov. 24 Fapo Village 6 54 60 Nov. 25 Nonghong Village 5 18 23 Nov. 25 Nongyang Village 7 17 24 Nov. 26 Banlai Village 9 16 25 Nov. 26 Nongxuan 7 17 24 Nov. 27 YunHa Village 12 51 63 Nov. 28 Mengbingdong 10 15 25 Village Nov. 28 Leiwu Village 5 18 23 Dec. 1 Hayulai Village 6 15 21 Dec. 1 Mengbinglai Village 7 19 26 Dec.2 Eluo Village 22 39 61 Dec. 3 Yinmen Village 4 19 23 Dec.3 Yinwen Viaalge 7 17 24 Dec.4 Nanmen Village 7 19 26 Dec.4 Xindong Village 6 22 28 Dec. 5 Xinping Village 12 49 61 Dec.8 Padong Village 6 22 28 Dec. 8 Xingna Village 9 19 28 Dec.9 Pase Village 8 18 26 Dec. 9 Denghan Village 9 16 25 Dec.11 Dadenghan Village 12 19 31 Dec.11 Mengwen Village 6 22 28 Dec.12 Dongyang Village 10 22 32 Dec. 12 Mangna Village 7 22 29

8

Date Venue No. of People Receiving HIV No. of People Receiving HIV Other Education Counseling and testing Male Female Total Male Female Total Sub- All communities 375 1014 1389 1 I HCV total TOTAL 723 167 890 1014 1163 2177 1 4 HCV

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APPENDIX 3: ASSESSMENT REPORT (Baseline and Endline Surveys)

Qualitative Research Report

December 2014

This consultant’s report does not necessarily reflect the views of ADB or the Government concerned, and ADB and the Government cannot be held liable for its contents. 10

Contents ABBREVIATIONS 11 INTRODUCTION 12 1. THE IMPLEMENTATION OF THE TA 17 1.1 Baseline Survey 17 1.1.1 Baseline Surveys in the 12 Villages 17 1.1.2 Baseline Surveys among Construction Workers 19 1.1.3 Baseline Surveys among Burmese Migrant Workers 21 1.2 The Implementation of the TA 22 2. THE IMPACT ASSESSMENT 26 2.1 End-line Survey 26 2.2 Comparison on Pre & Post Surveys 27 2.3 General Assessment 30 2.4 The Proposed quality assurance approach for HIV/AIDS interventions on the road project 33 APPENDICES 34 1. Baseline survey questions 34 1.1 Semi-Structure Interview 34 1.2 Questionnaire in baseline survey 35 2. Name List of the Persons who Participate in the Group Discussion or Who are Interviewed in Baseline Survey 38 3. The Fundamental Questions for Qualitative Research in baseline survey 43 3.1 To leaders of Contractors 2, 3, 9, 14, 21, 22 in baseline survey 43 3.2 To the construction workers from Contractors 2, 3, 9, 14, 21, 22 in baseline survey 44 3.3 To leaders/persons from local AIDS Bureau/CDC in Ruili 45 3.4 To leaders/persons from NGOs in baseline survey 46 3.5 To Burmese migrant workers in baseline survey 47 4. Name List of the Persons Interviewed in baseline survey 48 4.1 From Contractors and Construction Site 48 4.2 Persons Interviewed for Cross-border HIV/AIDS Prevention in baseline survey 50 5. End-line Survey Questions 52 5.1 Questions for semi-structured interviews 52 5.2 Questionnaire for quantitative survey 53 6. Name list of the Persons interviewed in end-line survey 55

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ABBREVIATIONS CDC Center for Disease Control GMS Greater Mekong Subregion HAPAP HIV/AIDS Prevention and Action Programs LREC Longling-Ruili Expressway Company MSM men who have sex with men NGO non-governmental organization PITC provider-initiated HIV testing and Counseling PRC People’s Republic of China STD sexually transmitted diseases STI sexually transmitted infections TA technical assistance VCT voluntary counseling & testing 12

INTRODUCTION

1. RETA-6321: Fighting HIV/AIDS in Asia and the Pacific, Subproject 7 – PRC HIV/AIDS Prevention and Transport Sector in Yunnan and Guangxi has been implemented through HIV/AIDS Prevention and Action Programs (HAPAP) in Guangxi and Yunnan provinces of the PRC to develop measures and tools to address HIV/AIDS issues through the various stages of road transport projects.

2. This TA, as a component of RETA-6321, is aimed at: 1) preventing the spread of HIV/Aids and sexual transmitted infections (STIs); 2) consolidating and scaling-up evidence- based good practices gained from previous investments in Yunnan, Guangxi Provinces and the GMS-region; 3) incorporating and complementing current Government activities with the construction workers and local communities.

3. This qualitative research is to assess and evaluate the value-added activities and cross- boundary collaborations on HIV/AIDs prevention implemented by the TA (RETA 6321) among the construction workers and the communities along the 157.876-kilometer Longling-Ruili Expressway. The research consists of three main tasks:

(i) To assess the existing intervention activities implemented by government offices, public institutions and NGOs to identify the possible improvements which can be integrated into this TA’s value-added activities; (ii) To conduct a qualitative after-TA sample survey among the building site construction workers and local communities for a comparative studies; and (iii) To develop and pilot a feasible quality assurance approach for HIV/AIDS interventions on the road project.

4. Both quantitative (with questionnaires) and qualitative (interviewing people on group or individual basis) & observing the implementation of training and testing) methods are employed in community baseline and end-line surveys, while among construction workers and Burmese migrant workers qualitative survey is the main method employed owing to the fact that the population in these two sections are in flow.

A. The Communities and Construction Sites along the Longling-Ruili Expressway

5. The 157.876-kilometer Longling-Ruili Expressway is going from Longshanka (Longling County) through Mangshi and Ruili Municipalities to Nongdao, a town on Sino-Myanmar border. The construction work is undertaken by 22 contractors for baseline works and 12 contractors for landscaping and other facility works.

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6. The local government statistics shows that a total number of 157 villages in Mangshi and Ruili is impacted by the Longling-Ruili Expressway. From Longshanka to Neimanguai village (about 35 kilometers), the expressway is mostly in mountains, thus the impact on the villages in Longling County is quite limited in terms of HIV/AIDS infection. The majority of the population in the 157 villages is the Dai and Han, with the exception of a few villages of the De’ang and A’Chang. Owing to various reasons, few local community people work on Longrui Expressway construction sites and the construction workers have hardly any contact with the local communities.

7. Burmese migrant workers in Dehong Prefecture are mostly living and working in Ruili. There is no precise number of Burmese migrant workers in Ruili due to the easy-pass of the national border, but the official estimations reach 50,000—60,000 each year. Most of the contractors on Longrui Expressway do not have Burmese workers, except Contractor 21 who employs less than 50 Burmese workers. Burmese migrant workers in Ruili are mostly working in processing or service sectors. To regulate the management of Burmese migrant workers, Ruili Municipal Government set up a “Service Center for International Migrant Workers” where regular tests and various services are provided.

B. HIV/AIDS Infection and Prevention in Dehong Prefecture

8. In June 1985, the first AIDS patient, a foreign tourist, was reported in Beijing. In the next few years a couple of AIDS patients were found, and most of them were either foreigners or overseas Chinese. In August 1989, blood tests were conducted among 50 narcotic addicts in Ruili Drug Addiction Treatment Center, and 26 of them were identified positive. Soon after this, a total number of 146 were found HIV positive allover Yunnan Province, which marked the real spreading of HIV in the PRC.

9. On November 27, 2013, Heping Xu, deputy director of Yunnan Provincial Department of Health, head of Yunnan Provincial AIDS Prevention Bureau, told media that the newly reported HIV/AIDS cases were 9091 in Yunnan Province from January to October 2013. Of them, 6,540 were HIV infected and 2,551 were AIDS patients. It was the first time that the number had decreased by 6.0% (585 cases) compared with the same period last year. Injecting drug use (12.5%), sexual transmission (86.1%), MSM (4.3%), and maternal-neonatal (1.1%) are the main AIDS transmission channels. Of them, men accounts for 64.3% of the newly reported cases. 1 10. According to Xu, while the newly HIV infected persons, AIDS patients and the number of death are decreasing, the infection among elderly people (the age of 60 and above) and foreigners is increasing dramatically. Of the reported 6,970 infected foreigners, Burmese account for the highest percentage (86%) and most of them are working or living in Dehong

1 Yunnan Information (http://news.yninfo.com/yn/zhxw/201311/t20131127_2187006.html), November 27, 2013.

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Prefecture. The other infected foreigners are Vietnamese (4%), Laos (0.1%) and the unidentified (9.9%).

11. In November 2014, Xu announced to the mass media that 9,601 newly HIV-infected and patients are discovered between January and October 2014. 89.5% are sexually transmitted. The infection is increasing among students, the aged, MSM and migrant workers in Zhaotong Prefecture, Xishuangbanna Prefecture and other bordering areas. Dehong Prefecture is not clearly indicated as the most serious infection place as it was in 2013 in Xu’s announcement.

C. Legal Framework and current HIV/AIDs Prevention activities in the Region

12. On December 26, 1987, the State Council of PRC ratified and issued Some Provisions of the Monitoring and Control of AIDS. In January 2006, an updated version of the previous Provisions: Regulations on AIDS Prevention and Treatment was adopted at the 122nd Executive Meeting of the State Council, and took into effect since March 1, 2006. The Regulations outline the general principles, publicity & education, prevention & control, treatment & help, safeguard measures, and legal liabilities in AIDS prevention and treatment in China.

13. General Principles: Government of above-county level should take the leading role and main responsibilities in prevention and treatment, meanwhile the participation of various social organizations/individuals are encouraged and supported; any discrimination on the HIV-infected, AIDS patients and their families is prohibited; research on AIDS prevention and treatment is encouraged; both Chinese traditional medicine and western medicine are supported in AIDS prevention and treatment; international cooperation and exchange are encouraged.

14. Publicity and Education: Local government of different levels should take the responsibility to publicize HIV/AIDS knowledge in public (e.g. stations, airport, parks etc.) through various means. Health department at county level and above, in cooperation with hospitals and other medical organizations, should provide technical support/services in AIDS prevention and treatment. Education department should integrate AIDS knowledge into curriculum schools at different levels. The entry-exit inspection and quarantine institutions should take the responsibility to disseminate knowledge and provide consultation and supervision to persons who frequently cross the national borders. Mass media, enterprises, companies and various social organizations should all participate in dissemination of AIDS knowledge.

15. Prevention and Control: The national health authorities, together with health authorities of different levels, CDC and entry-exit inspection and quarantine institutions, establish a monitoring network so as to grasp the changes and trends in the AIDS epidemic; HIV test should be conducted on the basis of voluntary counseling & testing (VCT) system; The county-

15 government should make specific plan, encourage and support village (urban community) committees and other social organizations/individuals, to promote interventions to change the behavior of the HIV-infected; the government and other social organizations should provide treatment to the infected and drug-addicting persons, and to provide free condoms; Blood transfusion and blood products should be under strict control; personal information of the infected should be kept confidential except that some relevant persons have to be informed so as to prevent further infection.

16. Treatment and Help: The infected persons have the right to be informed and treated. The medical institutions should give some in-time VCT, advice and supervision to pregnant women; the county government should give necessary care, free treatment and relief measures to those infected persons in poverty.

17. Safeguard Measures: The county government should include AIDS prevention in their plan for national economic and social development and strengthen their network of AIDS prevention, monitoring, control, treatment and various services; the county government should include AIDS prevention expenses in their annual budget and the central government will give special financial support according to the empirical programs of publicity, training, monitoring, testing, epidemiological investigation, medical treatment, emergency disposal, supervision and inspection.

18. Legal Liabilities: The government of different levels should take their due obligations, according to this regulation, to organize, lead and safeguard AIDS prevention activities, those who fail to fulfill their obligations should be criticized by higher authorities or legally punished; The medical institutions/individuals who do not follow the rules of blood transfusion, organ transplant so that HIV infection is caused should be legally or financially punished.

19. “Adhere to the crackdown, strengthen the control of drug use” is taken as an indispensable part of HIV/AIDS prevention in Dehong Prefecture. This includes mainly reducing the poppy cultivation area on Burmese land and cracking down the cross-border drug smuggling, reducing the number of drug-addicting persons by strengthening village norms and regulations, no-drug community building, compulsory abandonment of drug habits, regular training in the villages and responsibility system of the leading cadres of various levels.

20. Since 2004, a national campaign named “people’s war against drugs and AIDS” which metaphorically means to mobilize all the people to fight against drugs and HIV/AIDS. Yunnan Provincial Health Bureau, through policy, financial, technical support and project management, extends its scope of HIV/AIDS monitoring, particularly among the risky groups such as people working at places of entertainment, IDU, MSM etc.

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21. Medical institutions of different levels provide provider-initiated HIV testing and counseling (PITC) to 11 types of patient (such as patient before operation, pregnant women, those who are having pre-marital medical check-up, those who come to STD clinics etc). Institutions for women and children also provide HIV testing for those who come for pre-marital medical check-up, pregnant women, and CDC provides HIV voluntary counseling testing (VCT). The blood centers and Entry-Exit Inspection and Quarantine institutions provide VCT service to the blood donators and those exit/enter the national borders.

22. The local-government-leading AIDS prevention measures include: 1) dispatching working-team to villages; 2) face-to-face dissemination of HIV/AIDS and drug knowledge in the villages; 3) dissemination through special columns in local media; 4) publicity of anti-drug and AIDS prevention knowledge in village Culture Rooms; 5) organizing various performances or sending mobile phone messages to publicize the knowledge and information on drug and AIDS; 6) organizing volunteers (mainly college students) of anti-drug and AIDS prevention; 7) anti-drug education in rural areas; 8) building exhibition rooms of anti-drug and AIDS prevention in each county/municipality; 9) training government employees and village-level cadres on anti-drug and AIDS prevention knowledge through the Party School at prefectural level; 10) integrating anti- drug and AIDS prevention into school curriculum; 11) dispensing condoms in entertainment places.

23. The HIV/AIDS monitoring network in Yunnan has now covered all the 16 prectures. 2,226 HIV testing laboratories and 387 voluntary counseling stations have been established. 1,871 medical institutions provide PITC. 146 working teams (1,388 members) on HIV/AIDS intervention among the risky groups have been organized.

24. The HIV infection rate of mother-baby has dropped from 11.36% (2007) to 4.19% (2013). The infection rate among IDU has dropped from 5.19% (2005) to 1.92% (2014). Among the sex workers, the rate has dropped from 0.99% (2005) to 0.19% (2014). The infection rate between HIV-positive mothers to their babies has dropped from 11.36% (2005) to 4.19% (2014). The death rate of HIV/AIDS patients has dropped from 24.16% (2005) to 5.15% (2014).2

2 Figures are from Ms. Xu Heping, the deputy director of Yunnan Provincial Health Department and director of Yunnan Provincial AIDS Bureau, statement on November 2014.

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1. THE IMPLEMENTATION OF THE TA

1.1 Baseline Survey 25. Before starting the quantitative and qualitative research for this TA, the consultant conducted a series of documentary researches on: 1) the general situation of HIV/AIDS infection in Yunnan Province and Dehong Prefecture. 2) What is the legal framework in China, particularly in Yunnan and Dehong Prefecture in terms of HIV/AIDS prevention? 3) What has the government, at both provincial level and prefectural level, done in preventing HIV/AIDS.

26. After consulting LREC, Dehong Prefectural AIDS Bureau and Dehong CDC, the consultant tentatively chooses, among the 157 impacted villages, 10 communities (5 in Ruili and 5 in Mangshi), 2 controlled communities (1 in Ruili and 1 in Mangshi) and 6 construction sites as the focused case studies. Later, with suggestions from ADB specialist and TA team leader, the assessment is extended to Burmese migrant workers.

27. After the first training of persons from Domestic Supervision Offices in Longling-Ruili Expressway (LRE) construction, the consultant drives to the 10 chosen villages along the alignment on January 19--23. The purpose is: 1) to find out the precise locations of the villages; 2) to get the preliminary information to judge whether these villages are proper for the follow-up activities; 3) to find out the related information in order to make the proper arrangement for base-line survey. This preliminary visit finds that some of the chosen villages are less impacted by the expressway owing to the fact that they are located on the tops of mountains while the expressway is far at the foot of the mountains. The consultant re-adjusts and finalizes the list of case-study communities.

1.1.1 Baseline Surveys in the 12 Villages

28. In February 2014, the consultant conducted the baseline survey in the 12 targeted villages with the help of 3 research assistants. 514 copies of questionnaire have been collected in the 12 villages, covering about 30% of the households in each village. 42 individuals have been interviewed, which include local doctors, community leaders, men, women and young people. 308 persons participate in the group discussions or questionnaire survey (See the name list in Appendices 2). Group discussions include: 1) village leaders; 2) married men; 3) married women; 4) young boys (age 11—25); 5) young girls (age 11—25). The empirical discussion, however, is different from village to village. In some villages, village leaders and married men are put into one group, in some villages, married men and women discuss together, and still in others young boys and young girls are discussing together, depending on the availability of people and the villagers’ suggestions. Individual interview is done mostly through random choice of the people at spot on the basis of individual willingness.

29. The main findings in the baseline surveys in the villages include:  Among the 12 villages, 2 belong to De’ang people, 1 Han village (resettled here 18

51 years ago) and the other 9 are Dai villages.  Few people from the 12 villages work on expressway construction sites mainly because people do not know how to find a job at the construction site and also because most people think the payment is not good enough.  The construction workers have hardly any contact with the village people, neither do the construction workers come to the villages.  Most of the villagers claim that they have the basic knowledge of HIV/AIDS (50% or more) through government propaganda, TV and many other media  The local government agency have regular free blood test for all the village people (once or twice a year) in the village but some villagers do not want to have the test either because they think it unnecessary or they worry that they are discriminated if they are found positive in the test.  A system of medical care has been established. Each village has a fixed local doctor who is monitoring not only HIV infection but also other infectious diseases.  “Anti-drug and HIV/AIDS Prevention Working teams” from different governmental departments have fixed responsibilities on supervising and monitoring specific villages.  Most of the villagers have greater concern on teenagers in terms of drug abuse and HIV/AIDs. The survey also shows that the people under the age of 20 often have lower percentage in correct answers though most of them claim that they have got some education in schools. The main reason is that these younger people think HIV/AIDS has nothing to do with them. Parent-Children conflict owing to the lack of communication and mutual understanding often leads children to drug abusing, idling and may finally leads to HIV infection through sharing needles. Quite a number of parents say that they hope to get some help for “managing children properly” so as to reduce the chances of getting to drugs or HIV-infection.  Married women worry about their husbands in terms of drug abuse and HIV/AIDs, too. In some villages, people have lost their land through land acquisition. On the one hand, the compensation makes village people feel rich (most of them have built modern houses), on the other hand, people do not have much to do.  Most of the village people admit that they have had different training in the village. If more training is coming, they hope to extend the training to other health issues (not just HIV/AIDS). They hope to have the training in both Chinese and Dai language so that everybody can understand. They also hope that the way of training can be more interesting rather than “lecturing”.

30. The following table shows clearly that the correct answers to the questionnaires are just around 50% although people claim that they know the basic knowledge about HIV/AIDS after governmental propaganda.

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Table 1

Village Name QuestionnaireKnowledge Sentiment Attitude Chudonggua 22 56% 73% 49% HVillageangnong 40 55% 50% 51% VillageNansan 34 62% 65% 57% NongmulaiVillage 59 52% 50% 57% GVillageazhong 61 50% 50% 53% VillageNangai 49 57% 51% 55% GVillageuangti 55 51% 52% 52% VillageFeihai 32 73% 53% 63% JVillageinghan 36 56% 60% 57% Neimangguai 43 51% 51% 51% XVillageinping 50 59% 47% 59% Village Manglai 32 60% 67% 69%

1.1.2 Baseline Surveys among Construction Workers

31. In April and May 2014, the consultant conducted another survey among construction workers and Burmese migrant workers with the purpose of: 1) assessment of cross-border issues and cooperation on HIV/AIDS; 2) assessment of existing HIV/AIDS prevention activities on selected Longrui Expressway construction sites; 3) the observation of TA community training.

32. After consulting Xiao, Tianxiang, the director of Administration Office of Longling-Ruili Expressway Company (LREC), Contractors 2, 3, 9, 14, 21, 22 are selected as the 6 case-study construction sites for qualitative assessment. The justification for such a choice is that Longling, Mangshi, Zhefang and Ruili are the only bigger cities or towns on the alignment of Longrui Expressway. The construction sites closer to these places are estimated to be the places which may have higher risks to construction workers in terms of HIV/AIDS and other infectious diseases owing to the fact that the construction worker may have more chances to access to cities/towns or sex workers and more contact with people (either from different parts of China or from Myanmar side). Contractors 2 & 3 are closer to Longling City, Contractor 9 to Mangshi, Contractor 14 to Zhefang, and Contractor 21 to Ruili. Contractor 22 is adjacent to Sino- Myanmar border so that many cross-border issues may involve (see the location in Map 1).

Map 1

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33. On the 6 construction sites, a total number of 43 persons (one woman) have been interviewed either individually or in group. Most of these people are team leaders or construction workers. Through extensive interviews, the consultant has the following main findings:

 LREC, under the supervision of AIDS Bureau and CDC, distributes posters, pamphlets, cartoons, playing cards to each contractor, who in turn distributes them to safety assurance leaders, then to team leaders, and finally to construction workers. All the six contractors have followed the instructions.  The awareness of HIV/AIDS among leaders and construction workers is high. Almost all the leaders, construction workers interviewed know what HIV/AIDS is, and how they are transmitted.  People from the local communities are seldom employed on construction sites, and the construction workers hardly have any contact with the community people. Though some construction workers may visit sex workers in cities, the chance and number are quite limited and small.  Not one case of HIV/AIDS infection has been identified among the construction workers so far;  The local AIDS Bureau and CDC do not have any direct contact with contractors, rather they entrust LREC to disseminate or distribute all the relevant materials.  The construction workers all say that they are busy with their work, and feel exhausted after work. The posters or pamphlets are not very useful because they never want to read.  The construction workers do not have any blood test in terms of HIV/AIDS prevention. This is largely because, on the one hand, the construction workers are not included in the budget of the local CDC so that extra budget is needed if the local CDC wants to give free blood test to the construction workers, and on the other hand, the construction workers move frequently. Each team comes for a specific part of the work. In a few months, they finish it and move on to another project. This makes HIV/AIDS prevention/intervention difficult.  There is no special staff member who is responsible for health issue (particularly

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HIV/AIDS and other infectious diseases) in each contractor. Normally, it is the section of Safety Assurance or Administration Office that is taking the responsibility for health issues.  There is no specific measure or indicator for supervising or monitoring of HIV/AIDS infection on construction sites. When asked, all the contractor leaders or team leaders say they have done some work on HIV/AIDS prevention. But it is difficult to evaluate the real effect.  There is no training on HIV/AIDS prevention among the construction workers. Section leaders, team leaders are all told about HIV/AIDS prevention at different meetings. Usually the Party secretary, Trade Union leader warn the safety assurance leaders, team leaders and construction workers against HIV/AIDS or other infectious diseases.

1.1.3 Baseline Surveys among Burmese Migrant Workers

34. In Ruili, 95 persons are interviewed individually or participate in group discussion. Some of them are local officials or persons from different institutions related to cross-border HIV/AIDS prevention or Burmese migrant workers from different social sectors (see Table 1). Table 2 Number of Persons Interviewed

Unit/occupation No. Unit/occupation No.

Home of Drivers 1 tailor 3 CDC 1 pedicab driver 1 Women and Children Development Center 2 porter 15 (NGO) AIDS Care China 2 sex worker 7 (NGO) Ruikang Yuan (NGO) 1 carpenter 3 motorcycle jade trader 3 4 mechanic freigt office 1 foot massage 4 construction peer education worker 4 2 worker Wood Plant Ruili Health Bureau 1 20 Workers Entry-Exit Inspection IDU (Injection 1 8 and Quarantine Bureau Drug User) Ruili Maternal and Child Care Service 1 lorry driver 10 Center Total 95

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35. Table 2 shows that 11 persons interviewed are from governmental offices or NGO in Ruili. The rest of them are Burmese migrant workers from different social sectors. The interview among these people has the following findings.

 Ruili has established some cooperation with Muse in the prevention of HIV/AIDS and other infectious diseases through joint meetings, coordination and information exchange;  Ruili has donated some equipment to Muse and trained the relevant persons in Muse so as to establish finger-print system in which HIV/AIDS infection information can be shared timely.  HIV/AIDS prevention activities are mainly focusing on drug users, sex workers, lorry drivers, pregnant women and MSM. A huge percentage of migrant workers are not properly monitored in terms of infectious disease control.  Ruili, as a county-level city, has no right to initiate higher level cooperation between Myanmar and The PRC. It can only explore some cooperation with Muse. But a lot of migrant workers are from the south of Myanmar so that the effect of such a cooperation is limited  The different social system and socio-cultures in Myanmar and in the PRC create a gap between the two sides. For example, when some Burmese are told they have to wait a while to get their “Health Certificate”, they realize that quite possibly they have been infected with diseases, so they run away. The Burmese side is not able to trace the person. Although there are NGOs working on both sides (they do share some information), most of the information is not shared either at NGO level or at governmental level.  A lot of Burmese migrant workers cross the border. They can easily move in and out without going through the national gates. This makes the control of infectious diseases difficult.

1.2 The Implementation of the TA 36. This TA provides the 10 communities with a series of participatory workshops aimed at increasing HIV knowledge, changing discriminatory attitudes and encouraging communities to discuss HIV/AIDS more openly. 20 one-day training workshops were provided in 10 communities, complemented by 8 two-day training for youth. The youth workshops included components on life skills, particularly decision-making. In all, more than 1,000 people received direct training from the TA team. In partnership with the Communist Youth League, the TA also held a peer educators workshop for youth and supported 12 peer educators in outreach activities. 37. The research consultant observed the empirical training in some of the communities. The training mode in Nansan Village may serve as an example to show how the training from this TA is different from that of the government propaganda.

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 The trainers starting the training by asking each participant to write his/her name on a piece of paper and then attach it on their clothes.  All the participants discuss to make the rules (such as what time to have break, lunch, dinner, how many minutes for each break etc.) and what is the punishment if someone breaks the rule.  Ask the participants some basic questions: such as what do you know about HIV/AIDS? Do you feel scared when someone around you get infected with HIV/AIDS?  “Games to show how HIV attacks the human body”.  The trainer explains the meaning of this game.  Identifying “risky behavior” (each participant get a piece of paper on which one behavior is written, the participant is supposed to put the piece of paper in either the category of “high risk”, “mid risk” or “low risk” ,and then discuss why they think that behavior should put under certain category. Finally the trainers will give some comment on the discussion.  “Game of exchanging water”. 12 participants are standing in two lines. Each participant is holding a bottle of water. The trainers have put some soda in one of the 12 bottles, but the participants do not know. Each participant is asked to pour some water from his/her bottle into another participant’s bottle and vice versa. After each participant exchange with three different persons, the trainers add a chemical into each bottle. Those bottles which change into red color indicate the infection.  “Game of peer pressure”. One participant is sitting in the middle and supposed to be infected with HIV/AIDS. Some other participants standing around him/her, saying some discriminating words to him/her. Then he/she is asked to tell about his/her feelings.  Demonstration of condom use. 38. The empirical apply of the training method may differ in different context, but the general mode is similar in community, community youth, construction sites and Burmese migrant worker training. In general, the consultant gave a positive comment on the training methods, effect and villagers’ participation based on the following main facts:

 It is different from governmental propaganda. Normally the “working team” from the local government adopt three ways in propaganda: 1) call for a meeting, and tell people how important it is to prevent HIV/AIDS; 2) ask some professional persons to give lectures to the villagers; 3) show films. In the interview, the villagers say that the previous two methods are boring. The third one is not very effective because people just want to see the story film, not caring about HIV/AIDS film (in most case the story films are out of date, people are not interested in it). On the contrary, the training provided by this TA is full of interaction, performance, laughing and talking.

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 The villagers participate actively in the training. In average, each village have about 40 participants, but it is often the case, more than 40 people come to the training. For example in Feihai Village, the village head asks that at least one from each family should come to the training, but quite a number of the family have two persons to come which makes the actual number reaches about 100. This owes much to the fact that when free meal is provided, the villagers take it more as a gather-together where they can have fun.  The training is implemented with games, performances and various activities so that the villagers do not feel it boring. In laughing, they come to know the knowledge.  And also, games and activities make the villagers feel more comfortable to talk about HIV/AIDS and sex openly.  In some villages, men and women are separated in the training under the request of the villagers, but in some villages, men and women are mixed. But in either way, the training seem very suitable for the villagers. After the training, some villagers realize “the training is like this”. In the pre-survey, some said that they had some training, later it is found that what they meant by “training” previously is actually the meeting-like propaganda from the “working team”. 39. The mobile testing team also visited the 10 target communities as well as other communities along the roadside. As of 24 November 2014, a total of 526 people had been tested, of whom one was found to be HIV positive and referred to local health authorities for treatment. One case of Hepatitis C was found. Since that time, the team has completed a further 800 tests, using all the remaining tests kits. 40. To reinforce the knowledge provided at the workshops and encourage ongoing communication, HIV/AIDS billboards were placed in the 10 communities under this TA. The villagers say that the billboards are useful because they help remind the villagers of the knowledge they learn at the training. 41. This TA also provided on-site training and testing to all 27 construction sites. This comprised training for management staff, training for construction workers and voluntary counseling and testing for HIV/AIDS as well as voluntary testing for Hepatitis C, blood pressure and sugar levels. From 624 tests, there were no cases of HIV and three of Hepatitis C. The other major activities under this output were a TOT workshop for safety officers from all sites and two TOT workshops for peer educators, in which the trainees developed workplans, which they will continue to implement after TA completion. The TA also reproduced tailored materials from previous TAs including an induction training DVD, a field educator’s guide, and two posters. These complemented materials developed and produced by LREC. Health kits for workers are distributed to the construction workers. 42. Nine training workshops were held among Burmese migrant workers, covering more than 350 migrants. Two workshops were held at the government service center for migrants and

25 seven in large factories dominated by migrant workers from Myanmar. As well as providing training for migrants, these have allowed TA team members to build links with factory owners with potential for follow-up activities. As with the testing and training, local government has been extremely supportive of the team’s work as filling an important gap. The health kits, which include dual language IEC materials, are also distributed to migrants. 43. Three workshops (one for domestic supervision offices, one for mid-term and one final), one TOT for safety persons from different contractors were held in LREC during the implementation of this TA.

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2. THE IMPACT ASSESSMENT

2.1 End-line Survey 44. In November and early December 2014 when the TA is coming to end, the research consultant, with the help of three local research assistants, conducted end-line survey in communities, migrant workers and construction workers in Ruili and Mangshi. Six sample villages have been surveyed with both questionnaire and interview. 11 Burmese migrant workers have been interviewed by group discussion. Six managerial persons or construction workers from six contractors are individually interviewed. The consultant also talked in details with Mr. Xiao Tianxiang, the section leader who is responsible for safety, land acquisition, environmental issues and the designated person from LREC to coordinate for this TA, about the effect of the training and testing on the construction sites. 45. Although the research consultant tries to balance between different gender groups, age groups, leaders and ordinary persons, the fact is that women are more active and talkative than men (this is part of local culture, particularly Dai culture). The middle aged people (between the age of 35--60) are more cooperative than the younger ones (under the age of 35). The younger ones often think that they “know about all these things” or “not much related to my life”. 46. All the participants, either in individual interview or in group discussion, gave very positive comment on the training and testing provided by this TA. Though the responses vary in different context, the following are the general comments in the end-line survey interview.

 Almost 100% of the Chinese persons interviewed say that they have never had this type of training before. Surprisingly a few Burmese migrant workers admit that they have had once or twice the similar training when they were in Myanmar.  All the persons interviewed think they have learned more details about HIV/AIDS through interesting games and demonstrations. Before this training they had some vague impression about HIV/AIDS either through TV programs or through governmental propaganda, but not in details. Now through the training, they know in more details. For example, the head of Women Association in a village says “I did not know condom can help prevent HIV/AIDS, I thought it was just for contraception”. A man from Nangai village says that “I thought mosquito bite could transmit HIV, now I know it does not matter so much with mosquito bite, having dinner with HIV/AIDS-infected. But psychologically, as you know, I still cannot help feeling scared. It takes time.”  Each person who participated in the training admit in the interview that he/she has talked to at least 3--5 other persons after the training though it is hard to calculate because they often talk about the training on occasions such as wedding, funeral, or other gatherings. This is counter proved by those who did not participate in the training. In interview, they also say that they have learned some knowledge through chatting with those who participated in the training. 27

 100% of the persons interviewed hope that there will be more similar training in the future. They all say that they would like to participate if there is similar training in the future.  80% of the persons feel quite satisfactory with the training and give 90--100 in the evaluation, 15% give 80--89, 5% give 79 and lower, the lowest 60.  Most of the persons interviewed think that people should give more care to the HIV-infected persons.  In terms of the training, some persons interviewed suggest that, in addition to HIV/AIDS, the training should include training of the knowledge about other health issues, for example how, in everyday life, to prevent cancer, sexual diseases, blood pressure, hepatitis C, etc.  On-the-spot testing is particularly appreciated by the construction workers and the managerial persons on construction sites. These people are constantly moving from one place to another, and wherever they go, the local health departments do not have the budget for them (because they are not the registered local residents). 47. These positive comments from community people, Burmese migrant workers and construction workers well indicate the direct effect of the training and testing provided by this TA. Some community people say that the local health department (CDC) comes to give free testing every year, but they do not see the need to test. Now after the training, they realize how important it is to have regular test. Almost all the persons interviewed hope that more similar training and testing will come in the future. 2.2 Comparison on Pre & Post Surveys 48. A total number of 240 (40 copies x 6 villages) copies of questionnaire are collected in the end-line survey. The experience in the baseline survey shows that some of the questions are not very useful (or people feel difficult to answer), so in the end-line survey some of the questions are dropped (see in Appendices 5). Thus in the final comparison table, these questions are also dropped. 49. The questionnaire is distribute randomly to persons in the villages though the research consultant tries to balance between different ages, gender and educational background without considering whether he/she participated in the training under this TA.

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Table 3a: Knowledge Changes in Knowledge from Baseline to Endline

Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12

-

using

Village Male

Total test?

Name Female bite?

blood?

feeding

condom?

Can Can HIV be

prevented?

Transmission

sharingfood?

HIVby looking?

Transmissionby Transmissionby Transmissionby

sharing needles?

Know whereKnow to get

Preventionby

Infected mosquito by

Transmissionbreast pre/duringchildbirth? Nansan 20 21 16 26 32 31 8 22 30 25 29 34 Baseline 14 62% 47% 76% 94% 91% 24% 65% 88% 74% 85% Nansan end- 5 38 39 36 35 38 35 38 11 31 34 40 line 35 95% 98% 90% 88% 95% 88% 95% 28% 78% 85% Change 54% 107% 18% -7% 4% 272% 47% -69% 5% 0% Jinghan 11 15 20 26 35 35 20 24 29 24 27 36 Baseline 25 42% 56% 72% 97% 97% 56% 67% 81% 67% 75% Jinghan 22 34 34 38 38 38 20 15 34 36 37 40 Endline 18 85% 85% 95% 95% 95% 50% 95% 85% 90% 93% Change 104% 53% 32% -2% -2% -10% 42% 6% 35% 23% Hannong 19 22 32 22 37 36 20 19 29 27 32 40 Baseline 21 55% 80% 55% 93% 90% 50% 48% 73% 68% 80% Hannong 19 26 37 32 40 38 35 25 25 35 29 40 Endline 21 65% 93% 80% 100% 95% 88% 95% 63% 88% 73% Change 18% 16% 45% 8% 6% 75% 100% -14% 30% -9% Feihai 13 26 25 27 29 31 24 23 31 22 27 32 Baseline 19 81% 78% 84% 91% 97% 75% 72% 97% 69% 84% Feihai 14 37 37 36 36 36 24 18 37 37 37 40 Endline 26 93% 93% 90% 90% 95% 60% 95% 93% 93% 93% Change 14% 18% 7% -1% -2% -20% 32% -5% 35% 10% Nangai 22 37 24 37 40 41 21 31 30 30 39 49 Baseline 27 76% 49% 76% 82% 84% 43% 63% 61% 61% 80% Nangai 16 34 35 38 36 36 32 30 33 38 35 40 Endline 14 85% 88% 95% 90% 95% 80% 95% 83% 95% 88% Change 13% 79% 26% 10% 14% 86% 50% 35% 55% 10% Neimangguai 20 31 20 36 36 37 17 19 31 28 33 43 Baseline 23 72% 47% 84% 84% 86% 40% 21% 72% 65% 77% Neimangguai 18 37 36 34 27 25 23 21 35 35 39 40 Endline 22 93% 90% 92% 75% 74% 85% 84% 152% 167% 111% Change 28% 94% 10% -10% -15% 115% 301% 111% 156% 45% 105 152 137 174 209 211 110 138 180 156 187 Baseline 234 129 65% 59% 74% 89% 90% 47% 59% 77% 67% 80% 94 206 218 214 212 211 169 147 175 212 211 Endline 240 136 86% 91% 89% 88% 88% 70% 61% 73% 88% 88% Change 32% 55% 20% -1% -3% 50% 4% -5% 33% 10%

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Table 3b: Sentiments and attitudes

Changes in Sentiments/Attitudes from Baseline to Endline

Sentiments Attitude

Q13 Q14 Q15 Q16 Q17 Q18 Q19 Q20 Q21

Village Male Total Name

Femaie HIV?

people

relatives

channels

infecetd? infected?

treatment

hildren with HIV+ HIV+ with hildren

Anybody can be be can Anybody

Schools can ban ban can Schools

c

HIV only affects bad affects only HIV

3 main transmission transmission 3 main

Worried about being being about Worried

Are you frightened by you frightened Are

HIV infection is for life for is infection HIV

Health depts can refuse refuse can depts Health PLHIV shoud be isolated be shoud PLHIV Nansan 20 28 15 8 17 14 21 12 31 29 34 Baseline 14 82% 44% 24% 50% 41% 62% 35% 91% 85% Nansan end- 5 33 20 36 16 6 31 10 36 35 40 line 35 83% 50% 90% 40% 15% 78% 25% 90% 88% Change 0% 13% 282% -20% -64% 25% -29% -1% 3% Jinghan 11 21 18 4 13 14 19 12 36 33 36 Baseline 25 58% 50% 11% 36% 39% 53% 33% 100% 92% Jinghan 22 34 22 30 20 21 35 27 39 39 40 Endline 18 85% 55% 75% 50% 53% 88% 68% 98% 98% Change 46% 10% 575% 38% 35% 66% 103% -3% 6% Hannong 19 23 23 6 13 14 18 10 36 37 40 Baseline 21 58% 58% 15% 33% 35% 45% 25% 90% 93% Hannong 19 35 22 13 9 19 27 22 39 37 40 Endline 21 88% 55% 33% 23% 48% 68% 55% 98% 93% Change 52% -4% 117% -31% 36% 50% 120% 8% 0% Feihai 13 24 12 6 12 18 14 18 29 27 32 Baseline 19 75% 38% 19% 38% 56% 44% 56% 91% 84% Feihai 14 38 29 11 34 28 39 38 38 39 40 Endline 26 95% 73% 28% 85% 70% 98% 95% 95% 98% Change 27% 93% 47% 127% 24% 123% 69% 5% 16% Nangai 22 27 24 4 23 17 30 21 37 39 49 Baseline 27 55% 49% 8% 47% 14% 61% 43% 76% 80% Nangai 16 34 29 25 30 24 34 26 39 39 40 Endline 14 85% 73% 63% 75% 60% 85% 65% 98% 98% Change 54% 48% 662% 60% 320% 39% 52% 29% 22% Neimanggua 20 25 16 7 13 14 23 16 35 36 43 i Baseline 23 58% 37% 16% 30% 33% 53% 37% 81% 84% Neimanggua 18 29 24 7 36 17 38 25 40 39 40 i Endline 22 73% 60% 24% 150% 243% 106% 147% 105% 156% Change 25% 61% 48% 396% 646% 97% 295% 29% 86% 105 148 108 35 91 91 125 89 204 201 Baseline 234 129 63% 46% 15% 39% 39% 53% 38% 87% 86% 94 203 146 122 145 115 204 148 231 228 Endline 240 136 85% 61% 51% 60% 48% 85% 62% 96% 95% Change 34% 32% 240% 55% 23% 59% 62% 10% 11% 50. In Tables 3a and 3b, the data in green highlight are the percentage of correct answer to each question (Q1, Q2....) in the baseline survey. The data highlighted in blue is the result of end-line survey. The third column shows that in baseline survey each village has different number of people surveyed. But in the end-line survey, each village has 40 copies of questionnaire.

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51. If we look at each column, we can see that the correct answers to the 19 questions (from Q3 to Q22) are mostly increasing (some of them are going down). To make the comparison easy, the research consultant sums up the result of the two surveys in three sectors (knowledge, sentiments and attitude) (see Table 4). Table 4

52. Table 4 shows that in general the knowledge, sentiment and attitude are all improving in each village though in Table 3 the correct answers to some individual questions are going down. If we compare the three, we find that ‘knowledge’ has the higher percentage than the other two. This may be understood as changing knowledge is easier and faster than changing sentiment and attitude. But the improvement in all the three categories is significant. 53. Another question which is not convenient to be listed in the tables is “Where do you usually get your knowledge of HIV/AIDS from?” In the baseline survey over 85 percent of the answer is ‘TV and other mass media’, ‘propaganda’, ‘relatives and friends’. In the end-line survey, most of the answers are ‘TV and other mass media’, ‘propaganda’, and ‘training’. The last one has changed from ‘relatives and friends’ to ‘the training’. This change well shows the positive result of the training. 54. The result of these quantitative survey counter-prove the findings in the above- mentioned interview in which people give very positive comment on the training and testing provided by this TA. 2.3 General Assessment 55. This TA, in general, has met most of its planned targets. Its impact is obvious and positive based on the following main factors:

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 The training and testing are well complementary to the existing Chinese system of HIV/AIDS prevention. As introduced earlier, Chinese government has been making all efforts, either legally or pro-actively, to contain the increase of HIV/AIDS prevention in the last two decades, particularly in the last ten years. But the annual budget for HIV/AIDS prevention is often made according the number of the registered residents. The migrant people are not included in the budget. Thus construction workers, Burmese migrant workers have no access to training and testing, particularly in Ruili where the number of Burmese migrant workers reaches 50,000-60,000 annually. In the communities, propaganda with community meetings is the common method employed. This TA provides with training and testing in communities, among Burmese migrant workers, construction workers. The qualitative research shows that all these are well appreciated  Safety officers from construction sites are trained in TOT so that they not only learn about HIV/AIDS knowledge, but also know how to train their workers properly. This makes significant difference. In the past, they just warned the workers against HIV/AIDS at meetings, put on post, deliver pamphlets, playing cards, and never cared about the effect though their obligation is written in the contract. Now they know HIV/AIDS prevention activities can be more interesting and more productive. When the participants from the Final Workshop were visiting construction site of Contractor 8, the two trainers were from the safety offices of the contractor. They also learn how to make work plan and how to integrate HIV/AIDS prevention activities into their regular works, particularly in the induction training of the newly employed workers in the future.  This TA also reproduced tailored materials from previous TAs including an induction training DVD, a field educator’s guide, and two posters. These complemented materials developed and produced by LREC. 3,900 health kits with IEC materials (in both Chinese and Burmese) are made to distribute to construction workers, Burmese migrant workers and community people. This gives more alternatives in disseminating HIV/AIDS knowledge in the future.  Over 1,000 people from communities, Burmese migrant workers and construction workers have been trained under this TA. If each participant has talked to 3--5 persons (as people admit in the end-line survey), at least more than 3,000 people have learned directly or indirectly from the training.  Over 1,000 people, in total, have been tested for HIV-infection, hepatitis C, blood pressure, blood sugar. Some construction sites claim proudly that all their workers ‘have been tested’. Some construction sites require that more test should be provided on their construction sites because some of their workers have not had the chance to be tested. This indicates the positive impact of the testing on construction sites.

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 The training with games, performances and various activities play a vital role in encouraging the participants to discuss HIV/AIDS more openly and to learn more details about HIV/AIDS.  The youth workshops are particularly significant in the sense teenagers are regarded as the most risky group in local social life. The baseline research finds that young people in this area are facing several challenges: 1) quit school in early age and idle about; 2) easy access to drugs, particularly ephedrine, owing to the fact that the villages are quite close to the national border; 3) young ladies mostly leave for big cities, leaving young men difficult to find girl friends; 4) easy to be influenced by behavior of the people around them; 5) most of the young people think condom is just used for contraception. The training under this TA tries not only to help the young people know about HIV/AIDS, but also helps them know about life skills, particularly decision-making. In partnership with the Communist Youth League, the TA also held a peer educators workshop for youth and supported 12 peer educators in outreach activities. Most parents say that they worry mostly about their children, but they feel very difficult to communicate with these rebellious children. But they think the trainers have better communication with the children. ‘They listen to the trainers, but not us’ some parents say.  10 HIV/AIDS billboards have been made for communities so as to reinforce the knowledge provided at the workshops and encourage ongoing communication. Its impact is hard to estimate because it has just been set up.  By providing tailored health kits to injecting drug users (IDUs), this TA complement the NGO AIDS Care China’s health education programme which targets IDUs from both sides of the border, promoting general health care and safe behaviors.  Baseline and end-line surveys were conducted to monitor the impact of the TA activities. Findings from the baseline helped to guide TA activities, including through a focus on reducing the silence around this issue in roadside communities. The tentative findings of the end-line suggest clear improvements in knowledge and indicate that the training activities have successfully stimulated discussion among the wider community. The training complements government fundraising efforts. The end-line also highlighted that construction workers and other migrant workers had found the testing very beneficial.  By providing training to the Burmese migrant workers in various factories and governmental service centers in Ruili, this TA helps to initiate the cooperation between local CDC and factories, the service center in the future HIV/AIDS prevention activities, and hence strengthen cross-border prevention.

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2.4 The Proposed quality assurance approach for HIV/AIDS interventions on the road project

56. Although it is essential to suggest to the provincial government that some extra budget should be provide each year for migrant workers of various kind, road construction companies can also play active roles in HIV/AIDS or other infectious diseases.

 Integrating on-the-site HIV/AIDS activities into the existing system by cooperating closely with local health institutions, particularly NGOs so that safety officers are trained properly with the introduction of the empirical situation about local infectious diseases.  By cooperating with CDC and NGO, try to provide some free (or cheaper) testing, condom to the construction workers;  By cooperating with CDC and NGO, try to establish a network of joint prevention of HIV/AIDS and other infectious diseases in local communities, entertainment places and construction sites;  Strengthening the capacity of safety officers or other managerial persons to assess properly the possible risks on site, including HIV/AIDS, other infectious diseases and many other health issues;  Developing proper company policy and plan for the prevention of HIV/AIDS and other infectious diseases;  Integrating the knowledge of HIV/AIDS and other infectious diseases into induction training for all the road construction workers, in which field educators are identified and properly trained;  Using existing materials (such as tailored materials from the previous construction sites or projects) in HIV/AIDS prevention activities;  Integrating the monitoring of site HIV prevention work into routine safe production management, and external monitoring should be planned;  Establish and maintain site HIV prevention records;  Getting some special fund from higher authorities to support the prevention of HIV/AIDS and other infectious diseases.

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APPENDICES

1. Baseline survey questions

1.1 Semi-Structure Interview

The questions here serve mainly as guidance in the interview. The empirical questions may be various depending on different persons interviewed under different circumstances.

1. Have you heard of HIV/AIDS?

2. Is there HIV/AIDS in your community today?

3. Does the existence of HIV/AIDS affect this community? How?

4. How can you protect yourself from HIV?

5. How aware do you think your community is of issues related to HIV and other communicable diseases? Should this awareness be increased? Why? How？

6. What do you think are the main risk factors for HIV/AIDS in this community?

7. Do you talk about HIV and other STIs at home? In the community? Do you feel embarrassed to talk about HIV and STIs at home?

8. Do you know of/have you known any programs on HIV awareness?

9. Has there ever been an HIV awareness program in your community or in your workplace? Why/why not? What do you think of it?

10. Do you see any risks/problems in implementing these programs in the community/workplace?

11. Who are the PLHIV in XXX today? What kind of people are they?

12. Can PLHIV continue with the same life they had when they were HIV negative? Should they receive medical assistance the same way as everyone else?

13. Should PLHIV continue to work? Should they work together with other people?

14. Let’s imagine a scenario. You will find out tomorrow that one of your friend/family member/work colleague is HIV positive. What feelings relate to this?

15. Which problems could PLHIV experience in the community? In the workplace?

16. What help do you expect from relevant departments/organizations in terms of HIV/AIDS prevention?

17. What do you think would make for a good or successful HIV program?

18. What kind of resistance or problems could one face when implementing these programs? 35

1.2 Questionnaire in baseline survey

General Information

1. Gender: male, female, age;

2. Education: （1）senior middle school (professional training) （2）junior middle school （3）primary school （4）uneducated;

Knowledge

3. Can people tell who has HIV/AIDS simply by looking at them?

a) Yes b) No c) Not sure

4. Can a person become infected from a mosquito bite?

a) Yes b) No c) Not sure

5. Can HIV be transmitted by eating together with a person with HIV/AIDS?

a) Yes b) No c) Not sure

6. Can a person become infected from infected blood?

a) Yes b) No c) Not sure

7. Can HIV be transmitted by sharing syringes (needles used to inject drugs) with a person with HIV/AIDS?

a) Yes b) No c) Not sure

8. Can a person prevent HIV infection by using a condom correctly?

a) Yes b) No c) Not sure

9. Is there a cure for HIV?

a) Yes b) No c) Not sure

10. Can you get infected with HIV after one single intercourse?

a) Yes b) No c) Not sure

11. Can HIV be transmitted from an HIV+ mother to a child during pregnancy or child birth?

a) Yes b) No c) Not sure

12. Can HIV be transmitted from an HIV+ mother to a child during breast-feeding?

a) Yes b) No c) Not sure

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Now, we are going to ask you some questions about HIV/AIDS testing. Please remember that you do not have to answer if you do not feel comfortable.

13. Do you know your HIV status?

a) Yes b) No c) do not want to know

14. Do you know where you can be tested?

a) Yes b) No c) do not want to know

15. Have you ever had HIV test?

a) Yes b) No c) do not want to say

16. If you have not done it before, would you like to be tested?

a) Yes b) No c) not sure d) do not want to say

17. Is it true that sharing needles during drug use can transmit not only HIV/AIDS but also hepatitis and other diseases?

a) Yes b) No c) not sure

18. Once a person is infected with HIV virus, he (she) will be infective all through the life, right?

a) Yes b) No c) not sure

19. Can HIV/AIDS be prevented?

a) Yes b) No c) not sure

20. Whose responsibility it is to prevent HIV/AIDS?

a) the whole society b) health department c) government d) community and family

21. What are the three channels for transmitting HIV/AIDS?

a) blood transmission, b) sexual transmission, c) saliva transmission, d) mother-baby transmission

22. Would you buy fruit and vegetables from a person with HIV/AIDS?

a) Yes b) No c) Not sure

23. Suppose you come across an AIDS patient whose hand has been cut and needs help urgently, how would you react?

a) help him to wrap

b) find an excuse and leave

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c) advise him to go to hospital

Sentiments

24. Do you feel nervous, frightened when HIV/AIDS is mentioned?

a). Yes b). No c). Not sure

25. Do you feel worried that you may infected with HIV virus

a）Yes b）A little bit c）Not at all

Attitude

26. Do you agree with the following statements? One answer for each statement.

Statement Agree Disagree Not sure

only those who are morally bad can be infected with HIV/AIDS

Anybody can be infected with HIV/AIDS

HIV/AIDS infected persons/patients should be separated from the healthy people

to protect the interest of the majority, we should not over-stress the protection of the HIV/AIDS infected/patients’ private right

We should set some limit on the opportunities of the HIV/AIDS infected/patients in finding jobs or promoting

We should eliminate or limit the right of the HIV/AIDS infected/patients in using public transport or participating in public activities

Health department can refuse to give treatment to HIV/AIDS infected/patients

Schools have the right to refuse to take in the children whose parents or relatives are infected with HIV/AIDS

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27. Do you think HIV/AIDS prevention has anything to do with you?

a）Yes b）No c）Not sure

28. Suppose some HIV infected persons or AIDS patients are found in your community/work site, what would be your suggestion?

a）discuss the issue openly and strengthen the prevention

b）should not discuss openly, and take some preventing measures secretly

c）It does not matter

d）do not know how to deal with it

Activities

29. Where do you usually get your knowledge of HIV/AIDS from?

a）newspaper/magazine

b）TV

c）dissemination activities organized by the relevant departments

d）gossip of relatives, friends and neighbors

2. Name List of the Persons who Participate in the Group Discussion or Who are Interviewed in Baseline Survey

(i) Nansan Village（40 persons participate in the discussion/are interviewed）

Time：February 11, 2014

Place: Meeting House of the Village

AIDs Bureau: Bin Li (Mr)

Village Head: A’Yue (Mr)

Deputy Village Head：Ladu (Mr), A’San (Mr)

Women Head: Yumeng (Ms)

Villagers (Men) ： Yanleng, Yanzhanbu, Yanwangla, Yanbao, Yanbi, Long, Yantun, Yanxiang, Yanwangsha, Longkai, Guoming Ma, Baocai Feng, Yan, Liqiang Zhang, Yanling, Nonglong, A’Ying, Fei Dong, Weixiang Li

Villagers (Women): Anbu, Jin, Leng, Shuang, Yemo, Duo, Xiao’e Zhang, Jingdanyue, Anshi, Anzhi, Yezhan, Lirui Ma, Xiangli Ma, Xiangye, La, Yexiang

(ii) Nongmulai Village (20 persons participate in the discussion）

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Time：February 12, 2014

Place: Meeting House of the Village

Township Doctor: Jiachun Guo (Mr)

Village Head: Yituan (Mr)

Village Party Sectetary: Yiliang (Mr)

Village Accountant: Mengmin (Mr)

Villagers (Men): Gui, Yanliang, Kaihua Chen, Yanwangsha, Xinglong Li

Villagers (Women): Ruiji, Hanhuang, Tuan, Tuiwang, Hanmiehuan, Miexin

Villagers (Teenages): Lameng, Yanying (who has been working in Shandong for 3 years), Yanmeng, Yanjia

(iii) Hannong Village（21 persons participate in the discussion）

Time：February 13, 2014

Place: Meeting House of the Village

Village Doctor: Xinghua Chen (Mr)

Village Head: Yuexiangsansuo (Mr)

Deputy Village Head: Yilun (Mr)

Village Accountant: Yanming (Mr)

Villagers (Men): Yanjian, Yanliang, Bengjian, San, Yansheng, Yansha, Yanhuan, Yilun, Banwang

Villagers (Women): Hanliangxin, Huan, Hanmei, Hanliang, Xiangguo, Wanghan, Hansha, Hanrui

(iv) Jinghan Village（18 persons participate in the discussion）

Time：February 14, 2014

Place: Meeting House of the Village

Village Doctor: Guotuan (Ms)

Village Accountant: Huan (Mr)

Deputy Village Head: Sanlun (Mr)

Women Head: Hanbao

40

Villagers (Men): San, Yanguo, Yanliang, Lading, Sanleng, Yanjian

Villagers (Women): Hanbao, Zuoqing, Zuoxin, Yuxiangcong, Yuxiang, Yixiang, Qiuli, Xiangwo

(v) Guangti Village（31 persons participate in the discussion）

Time：February 15, 2014

Place: Meeting House of the Village

Village Doctor: Hengfu Zhang (Mr)

Village Head: (village leaders are busy so that they do not have time to participate in the discussion/interview)

Villagers (Men): Leixiaoer, Mengjin, Yuhui Yang, Chaoming Yang, Zhanmian, Zhanrun, Sanyan, Yanhan, Miexin

Villagers (Women): Zuoying, An, Tuanmie, Laying, Ruihan, Lunding, Ruiben, Meixin, Wang, Zuoxin, Jian, Meng, Anpai, Hanjing, Lijin, Fenglun, Yujuan Chen, fengluan, Zuodan, Yansuo

(vi) Xinping Villag（4 village leaders and 1 local doctor participate in the discussion）

Time: February 16, 2014

Place: Village Party Secretary Yuhua Yao’s House

Village Doctor: Guotuan

Village Head: Xiangdong Wang (Mr)

Village Party Secretary: Yuhua Yao (Mr)

Women Head：Huiju Li

Villagers are all busy with selling vegetables and meet in the market, it is impossible to organize villagers for discussion/interview. Thus, after meeting and discussing with the village leaders, each village leader brings a survey person to visit the villagers either in the market or door by door to conduct questionnaire survey or interview individually.

(vii) Feihai Village（34 persons participate in the discussion）

Time：February 17, 2014

Place: Meeting House of the Village

AIDs Bureau: Shanshan Yuan (Ms)

Village Head: Li’er (Mr)

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Villagers (Men): Daoyanhanguo, Xian’er, Yinlaiwang, Teng’erbao, Tengyan, Lailiu, Shixiaosan, Laixiaosan, Laiyan, Suowang

Villagers (Women): Xian’ansuo, Xiaoxin Ma, Xiaozhao Cao, Liyuhanguo, Xianyuesuoxiang, Lailinwotuan

Villagers (Teenages): Yan]erwang (Mr), Li’ersuo (Mr), Gaokewang (Mr), Liwangmei, Gaosuomie, Lichuang, Lihanliang, Xianyue’erwang, Laisuoping, Liwameng, Daosuolian, Tengsuoping, Laiyesuobao

(viii) Nangai Village（35 persons participate in the discussion）

Time：February 18, 2014

Place: Meeting House of the Village

AIDs Bureau: Shanshan Yuan (Ms)

Township Doctor: Xianyuexiangsuo (Ms)

Village Doctor: Jinyuan Hu (Ms)

Village Head: Meng’er (Mr)

Villagers (Men): Wangyanguomin, Xianhehong, Xianranquan, Dao, Jingxiangsuo, Shaoben’an, Hongduxi, Buyouxing, Fengxiao’e, Hongtao Liu, Hongwu Liu

Villagers (Women): Xiantuanrong, Xiansuohui, Daobaotuan, Jingxiangsuo, Benan Zhao, Zuoxin Peng, Youxian Lan, Xiaolu Feng, Fangyebaozuo, Fangyanpa

Villagers (Teenages): Banxiangfang (18), Mengyuehebao (22), Tenghanduo (15), Hongyanwobao (13), Mengchunran (14), Tengyanbaoguo (19), Fangyanchun (18), Xianxiangxin, Fangjinglai, Xianbaowang

(ix) Neimangguai Village（24 persons participate in the discussion）

Time：February 19, 2014

Place: Meeting House of the Village

AIDs Bureau: Shanshan Yuan (Ms)

Township Doctor: Xianyuexiangsuo (Ms)

Village Doctor: Xiefang Lu (Ms)

Villagers (Men and Women): Jinxiangsuo, Yexiangjin, Fangaihua, Fangyubao, Shangyuefang, Shangyanshan, Shangsaibu, Yanping Guo, Jinbaoyan, Aihong Fang, Yueaimen

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Villagers (Teenages): Leixiaoyan, Fengaibaoliang, Tengyanguobao, Shangsanzuo, Liang, Xiangxin, Tengbaoliang, Jinli, Wangyanbao, Tengyueming

(x) Chudonggua No.4 Village（18 persons participate in the discussion）

Time：February 20, 2014

Place: Meeting House of the Village

AIDs Bureau: Shanshan Yuan (Ms)

Township Doctor: Xianyuexiangsuo (Ms)

Villagers (Men and Women): Lila’er, Yuguo Zhao, Xianyiyan, Libaosuo, Lilahong, Hehuilan, Lilatun, Luohuicai, Liyu, Layong Zhao, Shaodenghua, Libaoyu, Hongwen He

(xi) Gazhong Village（32 persons participate in the discussion）

Time：February 21, 2014

AIDs Bureau: Shanshan Yuan (Ms)

Township Doctor: Yueying Zhou (Ms)

Villagers (Men and Women): Banyinenbao, Fengliezuo, Xubaolan, Zhanglengling, Xianxiaojing, Banyuejing, Xianyanbao, Shaohua Zhu, Jianrong Li, Yongjun Qi, Xiaoguo Xiang, Yansuo Zhou, Baozhen Feng, Yanming Jin, Qinhan Lan, Xianhanrun, Xianling Zhu, Jinhanyan, Lianying Xu, Qienzuolie, Meilun Yue, Yuting Xiang, Xiangyandongyan, Shuangfei Jin, Wenhua Xiang, Erwang Fang, Suomin Jin, Tunsheng Fang, Yanxiang Zhang

(xii) Manglai Village （30 persons participate in the discussion）

Time：February 22, 2014

Place: Meeting House of the Village

The persons who conduct the survey, discussion and interview: Guilan Chen (Ms), Hua Wen (Ms), Jiansheng Huang (Mr), Weisong Zhang (Mr), Ran Hai (Ms), Jie Huang (Mr)

AIDs Bureau: Shanshan Yuan (Ms)

Township Doctor: Xianyuexiangsuo (Ms)

Village Head: Langyanbao (Mr)

Villagers (Men and Women): Xiaoliang Fang, Langsaixiang, Jinyanbai, Xiangyanjinbao, Yueshanmen, Xianyanzuo, Yueyanliang, Mengxiaoai, Mengbao Li, Langbanliang, Xiaoyutuan, Yinxiaoyu, Langyanwangbao, Langyanbao, Fangyuexiangbao

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Villagers (Teenages): Langyanwanxiang, Mengyanbaonian, Yueyanhande, Langshan, Xiangyaowang, Xianxiangtuan, Langyuexiangman, Jingshan, Langxiangshi, Yuesuowang, Xianyantuan, Xianxianglun

3. The Fundamental Questions for Qualitative Research in baseline survey

3.1 To leaders of Contractors 2, 3, 9, 14, 21, 22 in baseline survey

a) How many construction workers do you have? How many managerial persons? How many of them work here less than 6 months? How many of bring their spouses with them?

b) Where do most of your construction workers come from? Are they relatives, from the same villages, friends? Or they did not know each other before coming to work here?

c) What is the average monthly income for technical workers and non-technical workers? How many hours do they have to work each day? How many off-work days do they normally have in a week/month?

d) What do they usually do in their spare time?

e) What are the general rules of your company in terms of the administration workers in their spare time?

f) Is there a staff member responsible for HIV prevention?

g) Are there written HIV/AIDS prevention regulations and are these displayed on site?

h) Is there a written list of HIV/AIDS prevention activities (including HIV/AIDS and STIs IEC campaign activities, testing and support information)?

i) Is HIV knowledge included in induction education for all incoming staff and construction workers?

j) Has HIV/AIDS information material been distributed to workers covering:

 basic information about HIV/AIDS and how to prevent its spread  Information on testing and counseling  Information on stigma

k) Are condoms available on site? (Always, sometimes, never)

l) Is the site keeping updated records of HIV/AIDS activities?

m) Do you have any cooperation with AIDS Bureau or CDC? In what ways?

n) Do you know if there is anyone who is infected with HIV among your workers?

44 o) Do you think any of your staff or workers are at risk from HIV/AIDS infection? Why/why not? p) Do you have a company policy on HIV/AIDS? If so, can we have a copy? q) What do you think can be the main causes of HIV/AIDS infection among the construction workers? r) What do you think are the main difficulties (or challenges) in terms of HIV/AIDS prevention among your workers? s) If some training on HIV/AIDS prevention is to be implemented, do you think it necessary? Why or why not? t) Do you have any monitoring or supervision on HIV/AIDS among your workers? u) Can you suggest some effective ways in HIV/AIDS prevention among construction workers? v) Are there any aspects of your HIV/AIDS prevention work that you would like assistance on from the project team? If so, please give details. w) Are there any other health related issues you would like to be included in any activities?

3.2 To the construction workers from Contractors 2, 3, 9, 14, 21, 22 in baseline survey a) How long have you been working here? Have you ever worked in other construction sites? If yes, what do you think are the main differences (if there are any)? b) Is your spouse working here with you? If not, where he (she) is working? How many times you can meet each other in a year? c) May I know how much can you get in a month? Do you have children or any other persons to take care with your salary? d) How many off-work days do you in a week/month? What do you usually do in your spare time? Do you often visit the city or villages nearby? What do you usually do there? e) Have you ever heard of HIV/AIDS? When and how? f) Have you received or seen any information about HIV/AIDS while working on this project? In what ways? From whom? g) Have you received training about HIV/AIDS while working on this project? What kind of training? From whom?

45 h) Have you received any training from HIV/AIDS prior to working on this project? What kind of training? From whom? i) Do you know where to access condoms? Can you get them on site? j) Do you know where to get an HIV/AIDS test? k) Do you often talk about HIV/AIDS among your colleagues? If yes, what do you usually talk about? l) Do you know how serious the HIV infection is in this region? Do you know how HIV is infected? m) Do you feel worried or scared about HIV/AIDS infection? Why or why not? n) Do you know anybody (among your friends, neighbors, colleagues or persons you know) who has been infected with HIV/ AIDS? If yes, how he (she) is infected? What’s your comment on this person? o) Do you think any of your co-workers are at risk from HIV/AIDS infection? Why/why not? p) Do you feel worried if you eat food, drink, swim with a person who is infected with HIV/AIDS? Why or why not? q) How can a person prevent being infected with HIV/AIDS?

3.3 To leaders/persons from local AIDS Bureau/CDC in Ruili a) What are the national policies and general strategies toward HIV/AIDS prevention in this region? b) What are your general approaches in preventing HIV/AIDS among the migrant workers (including migrant workers from other parts of China and from Myanmar)? c) Do your prevention and intervention of HIV/AIDS include the Burmese migrant workers? If so, who is paying for the activities? If not, why? d) Do your prevention and interventions for HIV/AIDS include Burmese people living in Yunnan? If so, who is paying for the activities? If not, why? e) What do you know about the HIV/AIDS infection among the Burmese migrant workers/Burmese residents in Yunnan? Is it serious? f) What do you think are the main causes of HIV/AIDS infection among the Burmese migrant worker/Burmese residents in Yunnan? Do you have any specific cases to prove them (you do not have to tell the real names of the persons related)? g) Do you think it important to take the same measure to prevent HIV/AIDS among

46 the migrant workers as you do among the local residents? Why or why not? h) What do you think are the main difficulties (obstacles or challenges) in HIV/AIDS prevention among the migrant workers? i) Have you (or your department) had any cooperation (or joint action) with Burmese side to prevent HIV/AIDS in the last 5—10 years? This includes information sharing, joint trainings, programs targeting populations from Myanmar in Yunnan. j) What’s your comment on the current situation along the Sino-Burmese border in terms of HIV/AIDS issues? Do you think we can have some other ways to do it better? Do you have any specific suggestions on this? k) Do you have HIV information materials for migrants from Myanmar? What languages are they in?

3.4 To leaders/persons from NGOs in baseline survey a) When was your NGO first established? How many people are working in your NGO? b) What is the main scope of your work as an NGO? c) What do you know about the current situation of Burmese migrant workers and local Burmese residents in this region? d) Do you think HIV/AIDS infection among Burmese migrant workers/local Burmese residents is more serious than that among Chinese citizens? Why or why not? e) How does your organization work to prevent HIV infection among Burmese workers//local Burmese residents or conduct some activities in relation to Burmese migrant workers? f) Where do you usually get funds from? Chinese government or other social organizations? g) Have you ever had any cooperation with Burmese side in terms of HIV/AIDS (or other infectious diseases) prevention? If yes, how? From when? This includes information sharing, joint trainings, programs targeting populations from Myanmar in Yunnan. h) Have you ever had any cooperation or joint work with any Chinese governmental offices? If yes, how? i) Do you think it important to prevent HIV/AIDS infection among Burmese migrant workers/local Burmese residents? Why or why not? j) What do you think are the main difficulties, challenges and obstacles in your work

47 in HIV/AIDS prevention along Sino-Burmese border? k) If your organization is given another chance, what would you do and how are you going to do it to prevent HIV/AIDS more effectively? l) What kind of roles, do you think, NGO can play in HIV/AIDS prevention among both Chinese and Burmese migrant workers? m) How do you look at the interrelationship between Chinese government, Burmese government, NGOs and other social organizations in terms of HIV-AIDS prevention? n) Do you have HIV information materials for migrants from Myanmar? What languages are they in?

3.5 To Burmese migrant workers in baseline survey a) How long have been working in Ruili? Do you often (how many times) go back to your home place in Myanmar? Is your home close to the border? Where do you live when you are working here in Ruili? Do you miss your family? b) What is your ethnicity? What is your first language? Can you read Burmese? Can you read Chinese? c) What made you decide to come to work in China? How many Burmese friends and Chinese friends do you have when you are working here? Do you often visit to each other? d) When you get your salary, do you send it back to your family or spend it here in China? If spend in Ruili, how do you normally spend it? e) How many off-work days do you have in a week/month? What do you usually do in your spare time (off-work time, weekend, holiday and evening)? f) Have you ever heard of HIV/AIDS? If yes, from when? From whom? g) Do you know how HIV/AIDS is transmitted? Where did you get this knowledge? h) Do you know anybody among the persons you know who has been infected with HIV/AIDS? If yes, how he (she) is infected? (you do not have to tell his/her name). i) When your friends, neighbors and colleagues suspect that they may be infected with HIV/AIDS, where do they usually go for (checking or) help? j) Do you have regular physical check-up? If yes, who gives you the check and where? Is it free or do you have to pay? k) Have you ever participated in any training in terms of HIV/AIDS prevention? Who gives the training?

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l) Have you ever read any materials or watch video tapes in relation to HIV/AIDS? If yes, where and how?

m) Do you think it necessary to provide you some training, blood test and other medical care?

n) Do you know who (which department) you should go for help if you suspect that you are infected with HIV/AIDS?

4. Name List of the Persons Interviewed in baseline survey

4.1 From Contractors and Construction Site

4.1.1 Contractor 2

Yang, Heping (63, the Party secretary)

Shen, (35, deputy general manager)

Yang, (32, project manager)

Cao, Ning (22, construction worker from Hubei)

Li, Wei (30, construction worker from Chuxiong Yunnan)

Cao, Guangquan (47, team leader from Hubei)

4.1.2 Contractor 3

Xxx (director of safety assurance and monitoring)

Du, Yanbin (25, technical person from Kunming)

Guo, Zhen (49, team leader from Hunan)

Tang, Changyong (40, Construction worker from Hunnan)

4.1.3 Contractor 9

Sun, Daofa (40, director of safety assurance and monitoring)

Lv, Hualin (25, assistant of Safety assurance and monitoring)

Li, Changkun (30, team leader from Chuxiong Yunnan)

Gui, Yiping (50, construction worker from Hunan)

Zhang, Zhongping (40, subcontractor from Hunan)

Gui, Lisheng (56, team leader from Hunan)

Shen, Jiachang (35, construction worker from Jinping County Yunnan)

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Shi, Lingcang (43, construction worker from Shiping County Yunnan)

4.1.4 Contractor 14

Liu, Weiqun (30, director of safety assurance an d monitoring)

Yang, Zhihua (35, project manager)

Yang, Huabo (31, deputy project manager)

Zhang, Xin (39, team leader from Heqing County Yunnan)

Peng, Zhengjin (42, construction worker from Longling County Yunnan)

Yang, Jiacai (18, construction worker from Longling County Yunnan)

Li, Weixin (43 construction worker from Longling County Yunnan)

Hong, Guoliang (37, both he and his wife work at the construction site)

4.1.5 Contractor 21

Pan, Yanhui (female, 30, director of administration office)

Yang, Xiaotong (33, director of safety assurance and monitoring)

Yang, Jiatong (23, Burmese migrant worker who can speak Chinese)

Pusu (38, Burmese migrant worker)

Lei, Lida (45, team leader from Zhaotong Yunnan)

Xu, Jinxue (35, construction worker)

Huang, Lishui (57, construction worker from Fujian)

4.1.6 Contractor 22

Shi, Jiahong (45, director of safety assurance and monitoring)

Xu, Fucai (34, construction worker from Sichuan)

Zhou, Chengli (43, team leader from Sichuan)

Li, Hu (25, construction worker from Sichuan)

Zhou, Weimin (36, team leader from Shidian County Yunnan)

Cheng, Jiyun (35, team leader from Zhaotong Yunnan)

Yang, Tao (23, construction worker from Zhaotong Yunnan)

Xu, Xuecheng (31, construction worker from Shidian CountyYunnan)

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Qilin Duji (24, Tibetan, construction worker from Xiangerila)

4.2 Persons Interviewed for Cross-border HIV/AIDS Prevention in baseline survey

4.2.1 Ruili CDC

Li, Zhoulin (deputy director who is responsible for HIV/AIDS prevention)

4.2.2 Women and Children Development Center

Tang, Jingmei (35, the Jingpo, F., in peer education for 7 years)

Li, Letui (42, the Jingpo, M., in peer education for 2 years)

Wang, Ying (32, the Dai, F., in peer education for 7 years)

Yang, Yunlan (42, the Han, F., team leader, in peer education for 7 years)

Zhang, Lu (F., staff member)

4.2.3 AIDS Care China

Zhang, Lin (F.)

Guo, Liang (M.)

4.2.4 Ruikangyuan (An NGO under AIDS Bureau to provide services to Burmese sex workers)

Chang, Jilin (F. 45）

4.2.5 Pedicab driver (M. 50, From Sichuan, both his wife and him are pedicab driver)

4.2.6 Burmese Migrant Workers

Puka (M. Freight Office staff)

Mamawen （F. 36, tailor, has been in Ruili for 16 years）

Mamawen’s cousin (F. 31, tailor, in Ruili for 4 years)

Mamawen’s cousin (F. 25, tailor, in Ruili for 2 months)

4.2.7 Jade Traders

(two male and one female, have been in Ruili for 3 years, frequently travel between Myanmar and China, they are not willing to give the names)

4.2.8 Burmese porter

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(15 Burmese porters are interviewed on the street of Jiegao, but they do not want to tell the true names).

4.2.9 Burmese sex workers in Ruili

(to respect the interviewed persons’ privacy, their names are not asked, English alphabet is used to represent each person)：

A. 28，from Magwe, in China for over one year；

B. 28，from Rangoon, has a son of 5, in China for 2 months；

C. 25，from Magwe, in China for half a month;

D. 39，from Magwe, has two sons (one 16, another 6), in China for 9 years

E. 15，from Magwe, in China for 6 months

F. 17，from Magwe, in China for one and a half year；

The boss (female, 45, from Magwe)

4.2.10 Carpenters for making staircase

Gulin （M. 22，in China for 2 years）

Dansuowu （M. 23, in China for 2 years）

Kimonen （M. 19, in China for 2 years）

4.2.11 Ruili Entry-Exit Inspection and Quarantine Bureau

Wang, Guolong (Director of Health Inspection Sector)

4.2.12 Burmese Lorry Driver

Zhang, Guangneng (Chinese Burmese, caring for “Home of Drivers”)

4.2.13 Motocycle mechanic

Mimiwu （16，motocycle mechanic

Dojdoji（20，motocycle mechanic）

Chigu（20，motocycle mechanic）

N.（18，motocycle mechanic）

4.2.14 Lorry Drivers

Yelaiwen（21）

Soumowin（32）

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Yelim（30）

Kyluzim（29）

Yedui（22）

4.2.15 Director of Ruili Health Bureau

Zhang, Miaoyun (F.)

4.2.16 IDU Persons

8 persons participated in the interview. 2 of them are volunteers who are taking care of “the 19th Floor” (one of them is Chinese, and another is Burmese). Two aged Chinese IDU (one 70, another 60) . The rest are all Burmese who live in Muse, coming to Jiele to do some work as porters or garbage salvagers. To respect their privacy, their names are not given.

4.2.17 Ruili Maternal and Child Care Service Center

Dr. Xiong (F.)

4.2.18 Burmese Workers at Wood Plant

20 Burmese workers (2 women) participated in the group interview. 6 of them have been here for 4 months, the rest have been here for 2—4 years. Since the plant is not very cooperative in the interview, the Burmese workers do not give their names.

5. End-line Survey Questions

5.1 Questions for semi-structured interviews

1. Did you participate in the HIV/AIDS knowledge training provided by this TA in your place? Had you participated in the similar training before?

2. Did you participate in the HIV/AIDS, hepatitis C testing and blood pressure? What’s your comment on these activities provided by this TA?

3. What is the most important knowledge you have learned in this training? Please tell in details. (or what is (are) the most impressive part(s) in this training? Please give an example.)

4. After the training, have you ever talked (discussed) about HIV/AIDS with others? If yes, how many times (or how many persons you have talked to)?

5. Do you still feel worried (frightened with) about HIV/AIDS? Why or why not?

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6. How aware do you think your community is of issues related to HIV and other communicable diseases? Should this awareness be increased? Why? How？

7. What do you think are the main risk factors for HIV/AIDS in this community?

8. Do you talk about HIV and other STIs at home? In the community? Do you still feel embarrassed to talk about HIV and STIs at home?

9. How can you prevent yourself from being infected with HIV/AIDS?

10. Do you feel more comfortable to talk about HIV/AIDS and sexual transmitted diseases in your community (or at home)?

11. What requirements or suggestions do you have for HIV/AIDS knowledge or prevention in the future?

12. What’s your comment on this training in general? From 0 to 100 points, how many points you would like to give to this training?

5.2 Questionnaire for quantitative survey

General Information

1. Gender: male, female, age;

2. Education: （1）senior middle school (professional training) （2）junior middle school （3）primary school （4）uneducated;

Knowledge

3. Can people tell who has HIV/AIDS simply by looking at them?

a) Yes b) No c) Not sure

4. Can a person become infected from a mosquito bite?

a) Yes b) No c) Not sure

5. Can HIV be transmitted by eating together with a person with HIV/AIDS?

a) Yes b) No c) Not sure

6. Can a person become infected from infected blood?

a) Yes b) No c) Not sure

7. Can HIV be transmitted by sharing syringes (needles used to inject drugs) with a person with HIV/AIDS?

a) Yes b) No c) Not sure

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8. Can a person prevent HIV infection by using a condom correctly?

a) Yes b) No c) Not sure

9. Can HIV be transmitted from an HIV+ mother to a child during pregnancy or child birth?

a) Yes b) No c) Not sure

10. Can HIV be transmitted from an HIV+ mother to a child during breast-feeding?

a) Yes b) No c) Not sure

Now, we are going to ask you some questions about HIV/AIDS testing. Please remember that you do not have to answer if you do not feel comfortable.

11. Do you know where you can be tested?

a) Yes b) No c) do not want to know

12. Can HIV/AIDS be prevented?

a) Yes b) No c) not sure

13. What are the main channels for transmitting HIV/AIDS? a) blood transmission, b) sexual transmission, c) saliva transmission, d) mother-baby transmission

Sentiments

14. Do you feel nervous, frightened when HIV/AIDS is mentioned?

a) Yes b). No c). Not sure

15. Do you feel worried that you may infected with HIV virus

a）Yes b）A little bit c）Not at all

Attitude

16. Do you agree with the following statements? One answer for each statement

Statement Agree Disagree Not sure

Only those who are morally bad can be infected with HIV/AIDS

Anybody can be infected with HIV/AIDS

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HIV/AIDS infected persons/patients should be separated from the healthy people

To protect the interest of the majority, we should not over-stress the the protection of the HIV/AIDS infected/patients’ private right

Health department can refuse to give treatment

to HIV/AIDS infected/patients

Schools have the right to refuse to take in the children whose parents or relatives are infected with HIV/AIDS

Activities

17. Where do you usually get your knowledge of HIV/AIDS from?

a）newspaper/magazine

b）TV

c）dissemination activities organized by the relevant departments

d）gossip of relatives, friends and neighbors

e) training

6. Name list of the Persons interviewed in end-line survey

6.1 Nansan Village

The following persons are interviewed in Nansan Village in the end-line survey.

Those who participated in the TA training: Dong Qiuping, Yuxiang, Zhang Caiyu, Yumen, Dongleng, Anwang, Li Xueying, Aizhan

Those who did not participated in the TA training: Yilun, Yela, Aimo, Yesui, Mulu.

6.2 Jinghan Village

The following persons are interviewed in Jinghan Village in the end-line survey.

Those who participated in the TA training: Xiangmen, Caihuan, Lian, Mengban, Mieting, Hanbao, Hanying, Anping, Hanbi, Hanmen, Yuxiang

Those who did not participated in the TA training: Hanmeng, Yan Xiaolin

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6.3 Hangnong Village

The following persons are interviewed in Hangnong Village in the end-line survey.

Those who participated in the TA training: Yandengrui, Yantun, Meixin, Ruituan, Yanxi, Wangjian, Yandanming, Yixiang, Hanshun

Those who did not participated in the TA training: Mei, Yanming

6.4 Nangai Village

The following persons are interviewed in Nangai Village in the end-line survey.

Those who participated in the TA training: Meng’er, Fangboyanguoshi, Feng Xiao’e, Qiu Anmao, Wangyanguomin, Xianranquan, Dao, Jingxiangsuo, Banxiangfang, Mengyuehebao, Fang Yanchun

Those who did not participated in the TA training: Meng’ai, Zhao Ben’an.

6.5 Neimangguai Village

The following persons are interviewed in Neimangguai Village in the end-line survey.

Those who participated in the TA training: Shangsanzuo, Tengyanguobao, Jiaoyantuanlian, Fang Yubao, Shang Yuefang, Shang Yanshan, Fang Yanhuan, Jin Xiangsuo, Ye Xiangjin, Lei Xiaoyan, Fengaibaoliang, Tengyanguobao.

Those who did not participated in the TA training: No

6.6 Feihai Village

The following persons are interviewed in Feihai Village in the end-line survey.

Those who participated in the TA training: Liyuhanguo, Daoyanhanbu, Xian’ansuo, Gaokewang, Xian’er, Enlaiwang, Laixiaosan, Laiyan, Suowang

Those who did not participated in the TA training: Tengsanbao, Xianyizuoxiang, Tengyan, Lailiu, Shi Xiaosan

6.7 Burmese Migrant Workers

The following persons are interviewed among Burmese migrant workers in the end-line survey.

Those who participated in the TA training: Maoji, Zanming, Jieye, Puming, Neiyingrong, Xinmarong, Tingmeng, Karan, Botu, Niuniu, Yang Caizhi (Chinese Burmese, interpreter), Zhou Weiying (Chinese, Manger)

Those who did not participated in the TA training: No.

6.8 Construction Sites

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The following persons from the construction sites are interviewed in the end-line survey.

Those who participated in the TA training: Wang Junwen (Contract Section 2); Cao Linhong (Contract Section 3); Lv Hualing (Contract Section 9); Sheng Ningjiang (Contract Section 21); Sun Liang (Contract Section 22); Li Shaohai (domestic supervision office 3)

Those who did not participated in the TA training: No

In addition to the above 6 persons, Mr Xiao Tianxiang from LREC has had detailed discussion with the consultant.

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APPENDIX 4: NEEDS ASSESSMENT – Construction Sites and Cross-border Activities

- Assessment of HIV/AIDS prevention on transport sites - Cross-border cooperation on HIV/AIDS prevention

Jiansheng (Jason) Huang

April 26—May 8, 2014 59

Content

ABBREVIATIONS 60

BACKGROUND 61

1. THE ASSESSMENT OF HIV/AIDS PREVENTION ON CONSTRUCTION SITES 65 Main Findings 68 Recommendations 69

2. CROSS-BORDER COOPERATION IN HIV/AIDS PREVENTION: THE STATUS QUO 70 2.1 Governmental policies/strategies and general practice 70 2.2 NGOs in Ruili 73 2.3 Burmese migrant workers 74 Main findings: 76 Recommendations 76

3. COMMUNITY TRAINING 78

APPENDICES: 80 A. Timetable for This Mission 80 B. The Fundamental Questions for Qualitative Research 80 C. Name List of the Persons Interviewed 84 60

ABBREVIATIONS

AIDS Acquired immune deficiency syndrome CDC Centers for Disease Control and Prevention HIV Human immunodeficiency virus IQB Entry-Exit inspection and Quarantine Bureau LREC Longling-Ruili Expressway Company MSM Men who have sex with men NGO Non-governmental organization WCDC Women & Children Development Center 61

SUMMARY AND IMPLICATIONS1

Construction sites  Based on interviews from a cross-section of sites (6 of 18) and supplementary information from LREC, there are few people from the communities employed on construction sites and limited interaction.  Informants suggested the risk behavior among construction workers was quite limited. This was supported by sex worker interviews (which is different from other projects).  Under instruction from CDC, LREC disseminates pamphlets, cartoons, posters, playing- cards –  LREC distributes condoms to the safety assurance persons from each contractor. Some put small boxes at sites while others simply distribute to team leaders.  Only Contractor 9 could demonstrate written records of activities  Some construction workers (including managerial persons) doubt the effectiveness of the current HIV/AIDS prevention on the basis that (1) IEC materials are not suitable – too wordy and the posters blow away (2) condom distribution is not necessary because they don’t have a chance to use and even if they did, sex workers would provide and (3) the trainings are knowledge based on they already know the risks: “knowing it is one thing and doing is another”.  No testing is available. CDC does not have budget for migrant construction workers.  No actual training is provided to workers

Implications for TA  Does not appear at this point to be value added for condom distribution.  On the other hand, promoting opportunities for testing appears very important  TA materials in production – consisting of DVDs, site-based interactive exercises and industrial strength posters – appear to be appropriate.  Need to promote the monitoring and reporting guidelines refined during the domestic supervisor workshop because these are not currently in place.

Cross-border  In the past three years, 60-80% of newly diagnosed HIV/AIDS are people from Myanmar. This is despite the fact that not all migrants are covered by testing.  Since 2007, Ruili Health Department has been endeavoring to establish a joint control system with Muse (adjacent to Ruili). A regular coordination meeting, two bilateral meetings, and four epidemic briefings are to be held each year. However, many migrant workers are from the south of Myanmar and Ruili can only engage in cooperation at country level.

1 This section added by Phil to draw out key issues for TA implementation. 62

 A finger-print system is in place to help share information and assist treatment of people with HIV. This is reportedly voluntary and confidential.  There is reportedly a ‘cultural reluctance’ among people form Myanmar to have a test.  The Entry-Exit Inspection and Quarantine Bureau (IQB) is doing regular tests at the national gates every day for fever and will transfer any infected person to hospital.  When a Burmese person is identified as HIV positive, he (she) will receive the preliminary treatment for free and then will be transferred to Myanmar together with his (her) profile;  There are 3 active NGOs – Women and Child Development Centre (Ms. Chen’s NGO), AIDS Care China, which includes a methadone program (mainly for Burmese IDU) and Ruikangyuan, which is giving services to Burmese sex workers.  IQB also set up a “Home of Drivers” and employed two Chinese Burmese to take care of it. Home of Drivers is located in a huge square where all the Burmese lorries are parked. It provides a space where drivers can come to chat, drink, watch TV, play games. There are weekly HIV activities but there is nothing similar for Chinese drivers.  Most Burmese migrants do not appear to have access to HIV education or to testing. This includes jade traders, who were listed along with drivers, as major clients of sex workers.

Implications for TA  There does not appear to be a need for advocacy on the importance of cross-border cooperation, at least not locally The China side is well aware of this and initiatives are in place.  Gaps remain in the coverage of Burmese migrant workers and this appears to be an area of priority. It is proposed that the TA look to work with these groups, on HIV/AIDS training, accompanied by health checks. This may require the engagement of Burmese trainers.  There are no suitable IEC materials for truck drivers. It is proposed to develop a DVD and a health/safety kit (that includes condoms and gloves), and to investigate the possibility of outreach at the hotels where these drivers stay.

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BACKGROUND

From February 8 to February 25, a comprehensive survey including questionnaire, group interview, individual interview, qualitative assessment as well as the training needs assessment was conducted in the 12 rural communities along the alignment of Longling-Ruili Expressway (Longrui Expressway). In the survey, most of the community people admit that few community people are working at the construction sites, and there is not much contact between the community people and the construction workers, except now and then, a few construction workers come to buy vegetables or daily necessities in the villages.

On February 22, after consulting with Xiao, Tianxiang, the director of Administration Office of Longling-Ruili Expressway Company (LREC), Contractors 2, 3, 9, 14, 21, 22 were selected as the 6 case-study construction sites for qualitative assessment. The justification for such a choice is that Longling, Mangshi, Zhefang and Ruili are the only bigger cities or towns on the alignment of Longrui Expressway. The construction sites closer to these places are estimated to be the places which may have higher risks to construction workers in terms of HIV/AIDS and other infectious diseases owing to the fact that the construction worker may have more chances to access to cities/towns or sex workers and more contact with people (either from different parts of China or from Myanmar side). Contractors 2 & 3 are closer to Longling City, Contractor 9 to Mangshi, Contractor 14 to Zhefang, and Contractor 21 to Ruili. Contractor 22 is adjacent to Sino-Myanmar border so that many cross-border issues may involve (see the location in Map 1). Map 1

Based on the information and findings of the first comprehensive survey in communities in February, another assessment is arranged for the selected construction sites and cross-border migrant workers so as to make an overall assessment. This mission to Mangshi and Ruili between April 26 and May 8, 2014 includes three different activities: 1) Assessment of cross- border issues and cooperation on HIV/AIDS; 2) Assessment of existing HIV/AIDS prevention activities on selected Longrui Expressway construction sites; 3) Observation of TA community training. 64

With the assistance of Xiao, Tianxiang (LREC) and Yang, Jizhou (deputy team leader of TA 6321), leaders of all the 6 contractors gave full support to Huang Jiansheng’s (the consultant for qualitative research of TA 6321) interview of contractor leaders, team leaders and construction workers. A total number of 43 persons (one woman) have been interviewed either individually or in group. Most of these people are team leaders or construction workers who are doing manual work on construction sites (see Table 1)

Table 1 Number of Persons Interviewed safety contractor construction Contractor assurrance team leaders Leaders workers leaders No. 2 3 2 2 No. 3 1 1 2 No. 9 2 3 3 No. 14 2 1 1 4 No. 21 2 1 4 No. 22 1 3 5

In Ruili, with Chen Guilan’s help, Huang Jiansheng is able to interview 95 persons for the cross- border issues on HIV/AIDS prevention (see Table 2 for details).

Table 2

Number of Persons Interviewed

Unit/occupation No. Unit/occupation No.

Home of Drivers 1 tailor 3 CDC 1 pedicab driver 1 Women and Children Development Center 2 porter 15 (NGO) AIDS Care China 2 sex worker 7 (NGO) Ruikang Yuan (NGO) 1 carpenter 3 motorcycle jade trader 3 4 mechanic freigt office 1 foot massage 4 construction peer education worker 4 2 worker Wood Plant Ruili Health Bureau 1 20 Workers Entry-Exit Inspection IDU (Injection 1 8 and Quarantine Bureau Drug User) Ruili Maternal and Child Care Service 1 lorry driver 10 Center Total 95

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THE ASSESSMENT OF HIV/AIDS PREVENTION ON CONSTRUCTION SITES

All the six selected contractors have managerial persons and workers from different parts of China. As Table 3 indicates that each contractor may have comparatively more workers from certain areas. For example, Contractor 2 is from Hubei, it has more workers from Hubei. Contractor 14 has more workers from Heqing, Contractor 21 has more workers from Zhaotong. A common fact, however, is that few people from the communities on the alignment are employed on all the construction sites. The main reasons include: 1) Each team leader prefers to choose those who have had required technical skills and who have been working with him for several years. On the one hand, the technically skillful worker will ensure that the work be finished timely and meet the required quality. An unskilled worker may delay the work and the quality cannot be ensured. On the other hand, a mutual trust has been established among the team leader and his “followers” so that the management can be more effective; 2) As ethnic minorities, the local community people often have a lot of traditional festivals and holidays so that they often ask for absence to celebrate different festivals; 3) When their families are close to the construction sites, the community people constantly involve in different local affairs so that they cannot guarantee to work regularly. These may affect the construction schedule.

Each contractor, owing to the different progress of land acquisition, started the construction work at different times so that their current progress is quite different. Contractor 14, for example, has finished more than 80% of its work, while some others (such as Contactor 22) have still a lot more work to do. So the number of workers is always changing. The symbol“＞” in the table means “a little bit more than”. This means contractor 2 has a little bit more than 700 workers (including managerial persons) working on the construction sites at the moment, while contractor 9 has only a little bit more than 100 workers.

Table 3 Basic Information of the Six Contractors Burmese Construction No. of Main Origin of Contractor Migrant Work(Km) Workers the Workers Workers Hubei, Sichuan, No. 2 8.72 ＞700 Hunan, Chuxiong Chuxiong , No. 3 4.6 ＞200 Qujing, Chuxiong, Hunan, Honghe,Hunan No. 9 8.5 ＞100 Kunming, Qujing Heqing, Longling, No. 14 8 ＞200 Baoshan, No. 21 19 500 Zhaotong,Kunming 20-50 Kunming, No. 22 17.65 ＞300 Sichuan, Chuxiong

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Different from the information got from the previous survey, there are not many Burmese migrant workers working on the construction sites of Longrui Expressway, only contractor 21 has 20—50 Burmese migrant workers. The reason of not employing, in addition to the above- mentioned explanation of not employing local community people, includes: 1) Mobility. It is often the case that Burmese workers seldom work long on construction sites for various reasons. They work for a few months or even a few weeks, and then leave. This makes construction management difficult. 2) Non-technical. Burmese migrant workers do not have any technological skills required for construction. They can only do some non-technological work, such as sweeping floor, loading and unloading at concrete batching plant. Since they move a lot, it is hardly possible to help them learn some skills. 3) Difficult communication. Some of the Chinese Burmese can speak Chinese, but most of the Burmese migrant workers cannot so that communication is difficult. 4) Different food. Burmese migrant workers have their own food preference so that they cannot share food with Chinese workers. 5) Most of the Burmese migrant workers do not have work permission, so they have to go to the border gate to “stamp” both at Myanmar passport control and Chinese passport control once a week. Most of the construction sites choose not to employ Burmese migrant workers.

Most of the construction workers of the six contractors are between 20 and 45. Team leaders often bring their wives with them (except some whose children are going to school or the aged parents need to be cared of), while most of the construction workers have to leave their wives at home. They can visit their wives once or twice (during Spring Festival, or in raining season when the construction work has to stop).

Both the managerial and construction workers guess that there may be someone who goes to sex workers in cities now and then, but the number is quite small and the percentage is very low. First of all, as it is mentioned previously, each team leader prefers to bring his own workers who are mostly neighbors, relatives (even father and son or brothers) and friends. On the one hand, most of the team leaders feel that they have the responsibility to ensure that their workers are safe. One team leader from Chuxiong says that the village committee in his hometown had him trained (including HIV/AIDS and other safety issues) before they came to the construction sites, gave him pamphlets, and instructed him to “bring back your workers safely”. “Their parents entrust them to me, I cannot see them get any harm. Otherwise, I have no face to see their parents” the team leader says in the interview. “I monitor them not only on HIV/AIDS prevention, but also on drug use or the relations with the local community people. We have contact with only the shop owner in the village and our host, not any other people. In our leisure time, we drink, chat or play cards, and seldom go to the cities. If anyone is found involving in drug use or any other ‘bad’ behavior, I will immediately dismiss him because I do not want him affect other people”. This does not mean all the team leaders are monitoring on their workers in such a strict and self-conscious way. But this indicates the untold constraints among these team leaders and their construction workers. On the other hand, some construction workers admit that the “gossip

67 may go back to their hometown and damage their social images there”. So they try not to involve in any scandals.

Economic factor plays the key role in preventing construction workers from visiting sex workers. “Most of us are sacrificing a lot to come here for the purpose of earning more money to support the family, how can we spend money like that?” some construction workers say. Such a saying is counter-proved by the interview with sex workers in Ruili City. The sex workers admit that most of their customers are drivers or jade traders and some community men. They hardly see construction workers. It may happen that the sex workers cannot identify properly who are the construction workers, but the percentage is comparatively low because the sex workers are sure that over 90% of the customers are not construction workers.

HIV/AIDS prevention among the construction workers is implemented as the follows:

Diagram 1

Diagram 1 shows the general framework of HIV/AIDS prevention on Longrui Expressway construction sites. First of all, LREC in cooperation with Dehong Prefectural AIDS Bureau and Dehong Center for Disease Control (CDC) formulates its work plan for HIV/AIDS prevention according to China’s Law of HIV/AIDS Prevention and the relevant national/regional policies. LREC integrates the training of HIV/AIDS prevention into its safety training programs in which persons who are responsible for safety assurance are regularly trained. There is no special session or individual persons responsible for HIV/AIDS or other infectious diseases, the trainers often stress the importance of caring for HIV/AIDS prevention among the construction worker.

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Under the instruction of CDC, LREC disseminates pamphlets, cartoons, posters, playing-cards as well as distributes condoms to the safety assurance persons from each contractor. The safety assurance persons ensure that posters and cartoons are put up by contractor offices and construction sites, and pamphlets, playing-cards, condoms are distributed to team leaders who give to construction workers. Some contractors distribute condoms by putting small boxes on construction sites so that the workers can get them more conveniently (such as Contractor 9), while others simply give them to the team leaders.

This assessment mission finds that all the selected six contractors are doing HIV/AIDS prevention activities according to the requirements of LREC. Most of the contractors claim that they keep the profiles of the activities and have their own rules and regulations in terms of HIV/AIDS prevention. But few of them can show the documents except Contractor 9 who has the written records of all the activities with pictures in terms of HIV/AIDS prevention. On most construction sites, it is the leaders of different levels who propaganda or state it again and again at different meetings that it is important to prevent HIV/AIDS and other infectious diseases.

Some construction workers (including managerial persons) doubt about the effectiveness of the current HIV/AIDS prevention. First of all, whether condom distribution is really necessary? Most of the construction workers claim that they do not have chances to use the condoms. Even if they happen to go to sex workers, “they provide with free condoms”, thus it is unnecessary for the construction workers to bring condoms with them. Secondly, the posters put up on the walls at construction sites cannot stay long. “Usually the wind blows them away in 2 or 3 days”. Thirdly, most of the construction workers do not want to read pamphlets or posters either owing to their educational background or owing to their exhausted work in the day time. Finally, the construction workers say that “knowing it is one thing and doing is another”. All those who take risks to go to sex workers know that HIV/AIDS is transmitted through blood and sex.

Main Findings Through extensive interviews within three days, the assessment has the following findings:  LREC, under the supervision of AIDS Bureau and CDC, distributes posters, pamphlets, cartoons, playing cards to each contractor, who in turn distributes them to safety assurance leaders, then to team leaders, and finally to construction workers. All the six contractors have followed the instructions.  The awareness of HIV/AIDS among leaders and construction workers is high. Almost all the leaders, construction workers interviewed know what HIV/AIDS is, and how they are transmitted.  People from the local communities are seldom employed on construction sites, and the construction workers hardly have any contact with the community people. Though some construction workers may visit sex workers in cities, the chance and number are quite limited and small.

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 Not one case of HIV/AIDs infection has been identified among the construction workers so far;  The local AIDS Bureau and CDC do not have any direct contact with contractors, rather they entrust LREC to disseminate or distribute all the relevant materials.  The construction workers all say that they are busy with their work, and feel exhausted after work. The posters or pamphlets are not very useful because they never want to read.  The construction workers do not have any blood test in terms of HIV/AIDS prevention. This is largely because, on the one hand, the construction workers are not included in the budget of the local CDC so that extra budget is needed if the local CDC wants to give free blood test to the construction workers, and on the other hand, the construction workers move frequently. Each team comes for a specific part of the work. In a few months, they finish it and move on to another project. This makes HIV/AIDS prevention/intervention difficult.  There is no special staff member who is responsible for health issue (particularly HIV/AIDS and other infectious diseases) in each contractor. Normally, it is the section of Safety Assurance or Administration Office that is taking the responsibility for health issues.  There is no specific measure or indicator for supervising or monitoring of HIV/AIDS infection on construction sites. When asked, all the contractor leaders or team leaders say they have done some work on HIV/AIDS prevention. But it is difficult to evaluate the real effect.  There is no training on HIV/AIDS prevention among the construction workers. Section leaders, team leaders are all told about HIV/AIDS prevention at different meetings. Usually the Party secretary, Trade Union leader warn the safety assurance leaders, team leaders and construction workers against HIV/AIDS or other infectious diseases.

Recommendations  Give some training to the safety assurance leaders, office workers and team leaders on how to monitor the infection of HIV/AIDS or other diseases.  Visual materials are more useful to help the construction workers to get HIV/AIDS knowledge, and the proper way of prevention.  In cooperation with (or entrust) the local CDC, have some free, voluntary blood test among the construction workers, particularly the Burmese construction workers on construction sites.  Establish a system of monitoring on HIV/AIDS and other infectious diseases with some specific indicators/measures.

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CROSS-BORDER COOPERATION IN HIV/AIDS PREVENTION: THE STATUS QUO

As Table 2 shows, 95 persons from different departments in Ruili and Burmese migrant people have been interviewed in this mission in terms of cross-border HIV/AIDS prevention.

No department in Ruili has the precise number of people who cross the border and who live in Ruili because crossing the Sino-Myanmar border around Ruili is very easy so that a lot of people do not go through the national gate. It is officially estimated that about 30,000—50,000 Burmese people are living in Ruili and 20,000—30,000 cross the border each day. In 2011-2013, about 60—80% of the HIV/AIDS infections identified in Ruili are from Burmese migrant people. Owing to the capacity of Ruili health departments, only about 4,000 Burmese migrants can be tested each year, and the test focuses mainly on drug users, sex workers, pregnant women and MSM.

2.1 Governmental policies/strategies and general practice Chinese government pays high attention to the prevention of HIV/AIDS, malaria, dengue and plague in this region. Since 2004, a national campaign on anti-drug and HIV/AIDS (called “People’s War against Drugs and HIV/AIDS Prevention”) has been launched. Each year, a large number of leaders from different departments at provincial, prefectural and county levels are mobilized to organize into “working teams” which take the relevant responsibilities for certain number of communities. And big amount of money is budgeted for anti-drugs and HIV/AIDS prevention. In 2013 alone, Yunnan provincial government gave 700,000-yuan support, plus 1 million yuan of transfer payment, to Dehong prefecture to prevent HIV/AIDS.

In terms of the HIV/AIDS prevention among cross-border migrant people, the general policies are: 1) those who get the permission to stay in China for one year or longer (red visa holders) can have the blood test (for free) on voluntary basis; 2) In case they are HIV positive in blood test, they will receive preliminary treatment for free and then be transferred to the relevant department in their own countries. In case syphilis is identified in the test, Chinese doctors can also provide them with treatment, but they need to pay; 3) those who get the permission to stay only one week or less, do not have to have blood test unless they are drug users, sex workers, or lorry drivers, who are tested twice a year if they frequently come into Ruili.

Taking into consideration the serious situation of HIV/AIDS and other infectious diseases among Burmese migrant people, Ruili government has always exploring the new possibilities to cooperate with Burmese side. Since 2007, Ruili Health Department has been endeavoring to establish a joint control system with Muse (a Burmese prefecture that is adjacent to Jiegao Ruili). Now it has agreed that a regular coordination meeting, two bilateral meetings, and four epidemic briefings are hold each year. In 2013, Ruili municipal government donated some equipment worth more than 200,000 yuan to Muse and trained the relevant persons, inviting them to visit the laboratory, testing equipment, testing process, and management model in Ruili. Since 2013, 71 a finger-print system is being established. Anyone who is found HIV positive will enter the finger print system so that both sides can share the information and provide relevant treatment. But several factors blocked the way of efficient cooperation: 1) the relevant departments in Muse cannot afford the materials needed in testing even though Ruili has donated them the main equipment; 2) the capacity of the relevant persons and departments is comparatively low on Myanmar side so that the cooperation is “unbalanced”; 3) the principle of “being voluntary” makes it possible that a number of infected people cannot be identified earlier under the cultural context that a lot of Burmese people are not willing to have blood test.

In general, the main framework of preventing HIV/AIDS and other infectious diseases can be briefly summed up in Diagram 2:

Municipal government takes the lead in the prevention of HIV/AIDS and other infectious diseases according to the national policies and the guidance from provincial and prefectural government. Under the leadership of the municipal government, Ruili Health Bureau coordinates AIDS Bureau which is a governmental agency and CDC (defined as public service unit) which is focusing on the empirical prevention or intervention by giving blood test and providing some preliminary services. If CDC identifies some infections, it will profile through finger-print system and transfer the patient to hospitals. The hospitals, after some preliminary treatment, will transfer to relevant departments in Myanmar or seek NGOs for help. In other words, both CDC and hospitals are working closely with NGOs to provide comprehensive treatment. If the AIDS-infected person is Chinese, he (she) will receive treatment for free. If he (she) is Burmese, after the preliminary treatment, he (she) will be transferred to relevant departments in Myanmar. CDC also share some information with Doctors Without Borders and other NGOs on Myanmar side.

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Diagram 2

Entry-Exit Inspection and Quarantine Bureau

Profiling

Hospitals

Myanmar

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CDC, however, is not the only department that is doing the testing. Entry-Exit Inspection and Quarantine Bureau (IQB) is doing regular check or test at the national gates every day. In case any infection is found, they will transfer the infected person to hospital.

Hospitals do not just receive the infected persons from CDC or IQB, the hospitals also do the testing among the patients.

To sum up:  CDC, IQB and hospitals are doing the testing to identify the persons who are infected with HIV/AIDS and other infectious diseases;  It is impossible to include every migrant workers in the testing, drug users (particularly IDU), sex workers, pregnant women, lorry drivers and MSM are the main focus;  When a Burmese is identified as HIV positive, he (she) will receive the preliminary treatment for free and then will be transferred to Myanmar together with his (her) profile;  Three NGOs are playing important roles by working closely with CDC and IQB;  Only a small percentage of migrant workers in Ruili have test.

2.2 NGOs in Ruili There are fundamentally three NGOs which are involved constantly in HIV/AIDS prevention/intervention in Ruili: 1) Women and Children Development Center (WCDC); 2) AIDS Care China; 3) Ruikang Yuan. Each of these has its own focus and financial resources though all of them cooperate with Ruili government and gets a little bit of financial support from the local government. Most of their fund is from non-governmental resources.

Since CDC does not have enough professional persons, skills, equipment and fund to deal with all the issues, CDC often has close cooperation with different NGOs. Each of these NGOs focuses more on a specific field though it may occasionally extend its services to other fields.

1) Women & Children Development Center (WCDC) tends to give more services to peer education, knowledge dissemination, training, etc. though it has involved extensively in many fields, such as preliminary treatment, delivery of condoms to sex workers. 2) AIDS Care China has three offices: Red Ribbon, Treatment office, the 19th Floor Service. Red Ribbon gives general care and services to HIV/AIDS infected persons, and disseminates knowledge. Treatment Office gives medical treatment and methadone treatment (mainly to Burmese, but also include some Chinese AIDS patients) or provides some consultation. The 19th Floor Service provides some free breakfast, shower, clothes, shoes, clean needles for IDUs (80% of them are Burmese who are living on Burmese side). It has some information sharing with Doctors Without Borders on Myanmar side

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3) Ruikangyuan is giving services to Burmese sex workers (such as providing consultation, disseminating knowledge, giving free condoms etc.). It gets more fund and support from CDC. 4) In addition to the three NGOs, IQB also set up a “Home of Drivers” and employed two Chinese Burmese to take care of it. Home of Drivers is located in a huge square where all the Burmese trucks are parking. It provides a space where drivers can come to chat, drink, watch TV, play games. On the walls of the room (about 100 square meters) hang a lot of HIV/AIDS posters (in bother Chinese and Burmese), cartoons. Pamphlets in Burmese and Chinese are provided in the room. Each week, there is a lecture or training on HIV/AIDS knowledge and prevention approaches for free. It is very successful that Ms. Peng, Liyuan (the Chinese President’s Xu Jinping’s wife) visited “Home of Drivers”.

2.3 Burmese migrant workers Among the 95 persons interviewed during this mission in terms of cross-border issues, most of them are Burmese migrant workers (See Table 2). 1) Lorry drivers: 10 persons, frequently travel between Myanmar and China (normally 3 times a month between Mandalay /Rangoon and Ruili). Most of them have blood test once or twice a year and get HIV/AIDS knowledge from TV, disseminated materials and lectures. 2) Women Tailors: have been in Ruili for 16 years (another one for 3 years, and still another for 2 months), but they frequently travel back and forth between Ruili and Mandalay. So far they have never had any blood test and seldom participate in HIV/AIDS prevention activities. 3) Porters: These are Burmese men who are living in Muse. Each morning they cross the border by climbing over the fences to escape the fee and check at the national gates. Their income is never stable depending on the luck. They estimate that there are more than 500 Burmese porters who are doing loading and unloading in Jiegao. In the evening, they mostly go back to Muse. They have never had any blood test and never participate in HIV/AIDS prevention activities 4) Sex Workers: of the 7 sex workers interviewed, some have been in Ruili for 7 years, and one comes here for only 2 months. The oldest is 39, and the youngest is 15. They appreciate that persons from Ruikangyuan often give them free condoms, consultation, sometimes food and other necessities. They have blood test once or twice a year. 90% of their customers are Chinese (drivers, jade traders or local community men). In the last two months, Chinese police are taking tougher measures to eliminate sex services. These sex workers say they will wait to see and decide whether they will go back to Myanmar (mostly from the south of Myanmar). 5) Carpenters: These carpenters are all young men (around 20 years old) who learned the skills of making staircases in Ruili. They have been in Ruili for three years and have

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never had any blood test and never participate in HIV/AIDS prevention activities. They admitted that their salary here is 2—3 times higher than that in Myanmar. 6) Jade traders: they have been in China for 3—4 years. But they frequently travel between Myanmar and China, buying and selling jade stones. They have never had any blood test, and seldom participate in HIV/AIDS prevention activities. They get HIV knowledge from TV programs. 7) Motorcycle mechanic: These young people in their 20s are mainly working on assembling new motorbikes for shops. They often visit Home of Drivers to chat or get fun. They have never had any blood test though they get some “education” at Home of Drivers”. 8) Foot massage women: These are young Burmese ladies who can speak a little bit Chinese. Each day, they can earn about 100—200 yuan (depending on the number of persons served). Most of them have been in Ruili for 3—5 years. A few of them come here for only a few months. They have never had any blood test and seldom participate in HIV/AIDS prevention activities. 9) Construction workers: these people never work long on construction sites. On the one hand, they are not used to the Chinese food, on the other hand, they do not have the technical skills. What they can do is usually some easy work which does not need many people. Also they are mostly “green visa” holders who should go to the border to stamp once a week. In some sense, they are “illegal” migrant workers, so they mostly stay at construction sites, and seldom go to the cities. They are afraid of police. These people have never had any blood test, and they seldom have any contact with Chinese people other than their colleagues at construction sites. 10) Wood Plant workers: Most of the wood plants are located by local villages. Each plant has several hundred Burmese workers. The one which is interviewed has more than 300 Burmese workers. All the wood plants have strict rules and guard so that a strange has no way to get inside the plant. Normally, Burmese workers have their Burmese cooks. So Chinese workers and Burmese workers have different food. Owing to this food and good salary, the workers here do not move much. More than a half of the Burmese workers have been working here since the opening of the plant 4 years ago. And most of the workers are relatives or country fellows who introduce each other. When they are sick, they often go to the hospitals on Burmese side (20 minutes by motorbike) because they cannot speak Chinese. Some of them had blood test in 2012, but the rest of them have never had any blood test. 11) IDU: 80% of these people are Burmese who live in Muse. Most of them come in the day time to have free breakfast, take shower, use methadone, exchange needles. They have regular blood test.

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Main findings:  Ruili has established some cooperation with Muse in the prevention of HIV/AIDS and other infectious diseases through joint meetings, coordination and information exchange;  Ruili has donated some equipment to Muse and trained the relevant persons in Muse so as to establish finger-print system in which HIV/AIDS infection information can be shared timely.  HIV/AIDS prevention activities are mainly focusing on drug users, sex workers, lorry drivers, pregnant women and MSM. A huge percentage of migrant workers are not properly monitored in terms of infectious disease control.  Ruili, as a county-level city, has no right to initiate higher level cooperation between Myanmar and China. It can only explore some cooperation with Muse. But a lot of migrant workers are from the south of Myanmar so that the effect of such a cooperation is limited  The different social system and socio-cultures in Myanmar and in China create a gap between the two sides. For example, when some Burmese are told they have to wait a while to get their “Health Certificate”, they realize that quite possibly they have been infected with diseases, so they run away. The Burmese side is not able to trace the person. Although there are NGOs working on both sides (they do share some information), most of the information is not shared either at NGO level or at governmental level.  A lot of Burmese migrant workers cross the border. They can easily move in and out without going through the national gates. This makes the control of infective diseases difficult.

Recommendations  The short-term migrant workers are more at risks owing to the fact that they are not included in the monitoring system unless they have been identified as belonging to “high-risk social groups”. So doing some training, intervention among these workers is critical and urgent.  Visual materials are more useful than written materials because most of these migrant workers have not had much education.  Chinese lorry drivers and jade traders can still be at higher risks though drivers have been taken by the local government as one of the targeted groups. Burmese sex workers admit that most of their customers are from these two groups. A possible suggestion is that a Home of Drivers can be set up for Chinese drivers (the one in Jiegao is for Burmese drivers), through which more services can be provided.  ADB can propose a new project to work on both sides in HIV/AIDS prevention. Working on one side only seems not very effective. Taking into consideration, the 60—80% of the newly discovered HIV/AIDS infections are Burmese, it is quite necessary that the

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Myanmar side and Chinese side do not work individually. Of course, this needs high level initiatives.  Provide some free blood test to those who are “green visa” holders but actually work in Ruili for some time. And then by cooperating with CDC, integrated the information of those infected persons into the finger-print system.

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COMMUNITY TRAINING

The training in Hangnong Village (also called Hannong Village) on May 7, 2014 is very successful on the following accounts: 1) 28 young men from two villages participated in the training (women are trained on May 8). The Party secretary says that all these young men are “the social elite” of the villages (most of the young ladies go to cities to find jobs). 2) As Table 4 indicates that the time is arranged properly and the trainees participate in the training actively. The trainers give some explanation, but never too abstract and too long. Most of the time is spared for discussion or games. 3) Taking into consideration that most of the participants are not well-educated, the training is arranged in such an easy way that the trainees can accept more conveniently. 4) The training is full of laugh so that it is never boring. Games, discussions and explanations are arranged in interval order so that the trainees are mostly attentive to the training. 5) Drinking is prohibited during lunch or dinner. Some trainees feel uncomfortable, but sets up a good example. 6) If more pictures or other visual materials are used, the training can be more effective. 7) To sum up, the training is organized on the basis of full understanding of local cultural context, and the process is precisely controlled. The training in general is effective. 79

Table 4 Preliminary Evaluation of the Training in Community (Hangnong Village) Procedure Content Time Used Morning Session 1 Self-Introduction (Name, village, personal hobby) 10 m 2 What do you wish to learn at this training? 14 m Discuss the time for lunch and the time to start afternoon 3 10 m session Introducing HIV/AIDS infection in China, and the status quo in 4 10 m Ruili 5 Playing game (in which how virus attack human immune system) 20 m 6 Explain what is HIV/AIDS, how it is transmitted 10 m Playing game (what kind of social pressure a HIV/AIDS-infected 7 15 m person has in daily life) Explain what are sexually transmitted diseases, how they are 8 25 m transmitted Afternoon Session The trainees are divided into 3 groups: what are the positive 9 34 m and negative impact of Heroine, Kaku and ephedrine. A representative from each group reports the findings of their 10 15 m discussions 11 Comment on the discussion 20 m 12 Introducing why people take drugs? (ephedrine, heroine) 16 m group discussion: Group 1 (what are the impact of drugs on 13 individual body?); Group 2 (what are the impact of drugs on 10 m family?); Group 3 (what are the social impact of drug use?) A representative from each group reports the findings of their 14 10 m discussions 15 Comment on the discussion 5 m 16 Sum-up comment on the training 12 m 17 Questionaire test 7 m 18 Demonstrate the proper use of condom 20 m 80

APPENDICES

A. Timetable for This Mission Table 4

Schedule for Jason's trip to Mangshi & Ruili (April 26-May 8)

26-Apr Kunming-Mangshi Stay in Mangshi 27-Apr visit to Contractors 2、3 Stay in Mangshi 28-Apr visit to Contractors 9、14 Stay in Ruili 29-Apr visit Contractors 21、22 Stay in Ruili

interview AIDS Bureau, CDC, peer educators in Women and 30-Apr Stay in Ruili Children Development Center

1-May Interview AIDS Care China, porters, Burmese sex workers Stay in Ruili

Burmese foot massage people, carpenters, observe the 2-May Stay in Ruili inspection at the National Gate in Jiegao

3-May Visit Burmese settlement around Xin'an Road in Ruili Stay in Ruili

4-May Interview Ruikangyuan, carpenters, pedicab driver, tailors Stay in Ruili

Interview IQB, Home of Drivers, Porters, Maternal & Child 5-May Stay in Ruili Health Care Center Interview Health Bureau, migrant workers in wood plant in 6-May Stay in Ruili Nongdao 7-May Participate in the Training in Hangnong Village Stay in Mangshi

8-May Mangshi to Kunming

B. The Fundamental Questions for Qualitative Research (i) To leaders of Contractors 2, 3, 9, 14, 21, 22 a) How many construction workers do you have? How many managerial persons? How many of them work here less than 6 months? How many of bring their spouses with them? b) Where do most of your construction workers come from? Are they relatives, from the same villages, friends? Or they did not know each other before coming to work here? c) What is the average monthly income for technical workers and non-technical workers? How many hours do they have to work each day? How many off-work days do they normally have in a week/month? d) What do they usually do in their spare time? e) What are the general rules of your company in terms of the administration workers in their spare time? f) Is there a staff member responsible for HIV prevention? g) Are there written HIV/AIDS prevention regulations and are these displayed on site?

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h) Is there a written list of HIV/AIDS prevention activities (including HIV/AIDS and STIs IEC campaign activities, testing and support information)? i) Is HIV knowledge included in induction education for all incoming staff and construction workers? j) Has HIV/AIDS information material been distributed to workers covering:  basic information about HIV/AIDS and how to prevent its spread  Information on testing and counseling  Information on stigma k) Are condoms available on site? (Always, sometimes, never) l) Is the site keeping updated records of HIV/AIDS activities? m) Do you have any cooperation with AIDS Bureau or CDC? In what ways? n) Do you know if there is anyone who is infected with HIV among your workers? o) Do you think any of your staff or workers are at risk from HIV/AIDS infection? Why/why not? p) Do you have a company policy on HIV/AIDS? If so, can we have a copy? q) What do you think can be the main causes of HIV/AIDS infection among the construction workers? r) What do you think are the main difficulties (or challenges) in terms of HIV/AIDS prevention among your workers? s) If some training on HIV/AIDS prevention is to be implemented, do you think it necessary? Why or why not? t) Do you have any monitoring or supervision on HIV/AIDS among your workers? u) Can you suggest some effective ways in HIV/AIDS prevention among construction workers? v) Are there any aspects of your HIV/AIDS prevention work that you would like assistance on from the project team? If so, please give details. w) Are there any other health related issues you would like to be included in any activities? (ii) To the construction workers from Contractors 2, 3, 9, 14, 21, 22 a) How long have you been working here? Have you ever worked in other construction sites? If yes, what do you think are the main differences (if there are any)? b) Is your spouse working here with you? If not, where he (she) is working? How many times you can meet each other in a year? c) May I know how much can you get in a month? Do you have children or any other persons to take care with your salary? d) How many off-work days do you in a week/month? What do you usually do in your spare time? Do you often visit the city or villages nearby? What do you usually do there? e) Have you ever heard of HIV/AIDS? When and how? f) Have you received or seen any information about HIV/AIDS while working on this project? In what ways? From whom? g) Have you received training about HIV/AIDS while working on this project? What kind of training? From whom? h) Have you received any training from HIV/AIDS prior to working on this project? What kind of training? From whom? i) Do you know where to access condoms? Can you get them on site? j) Do you know where to get an HIV/AIDS test? k) Do you often talk about HIV/AIDS among your colleagues? If yes, what do you

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usually talk about? l) Do you know how serious the HIV infection is in this region? Do you know how HIV is infected? m) Do you feel worried or scared about HIV/AIDS infection? Why or why not? n) Do you know anybody (among your friends, neighbors, colleagues or persons you know) who has been infected with HIV/ AIDS? If yes, how he (she) is infected? What’s your comment on this person? o) Do you think any of your co-workers are at risk from HIV/AIDS infection? Why/why not? p) Do you feel worried if you eat food, drink, swim with a person who is infected with HIV/AIDS? Why or why not? q) How can a person prevent being infected with HIV/AIDS? (iii) To leaders/persons from local AIDS Bureau/CDC in Ruili a) What are the national policies and general strategies toward HIV/AIDS prevention in this region? b) What are your general approaches in preventing HIV/AIDS among the migrant workers (including migrant workers from other parts of China and from Myanmar)? c) Do your prevention and intervention of HIV/AIDS include the Burmese migrant workers? If so, who is paying for the activities? If not, why? d) Do your prevention and interventions for HIV/AIDS include Burmese people living in Yunnan? If so, who is paying for the activities? If not, why? e) What do you know about the HIV/AIDS infection among the Burmese migrant workers/Burmese residents in Yunnan? Is it serious? f) What do you think are the main causes of HIV/AIDS infection among the Burmese migrant worker/Burmese residents in Yunnan? Do you have any specific cases to prove them (you do not have to tell the real names of the persons related)? g) Do you think it important to take the same measure to prevent HIV/AIDS among the migrant workers as you do among the local residents? Why or why not? h) What do you think are the main difficulties (obstacles or challenges) in HIV/AIDS prevention among the migrant workers? i) Have you (or your department) had any cooperation (or joint action) with Burmese side to prevent HIV/AIDS in the last 5—10 years? This includes information sharing, joint trainings, programs targeting populations from Myanmar in Yunnan. j) What’s your comment on the current situation along the Sino-Burmese border in terms of HIV/AIDS issues? Do you think we can have some other ways to do it better? Do you have any specific suggestions on this? k) Do you have HIV information materials for migrants from Myanmar? What languages are they in? (iv) To leaders/persons from NGOs a) When was your NGO first established? How many people are working in your NGO? b) What is the main scope of your work as an NGO? c) What do you know about the current situation of Burmese migrant workers and local Burmese residents in this region? d) Do you think HIV/AIDS infection among Burmese migrant workers/local Burmese residents is more serious than that among Chinese citizens? Why or why not? e) How does your organization work to prevent HIV infection among Burmese workers//local Burmese residents or conduct some activities in relation to Burmese migrant workers?

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f) Where do you usually get funds from? Chinese government or other social organizations? g) Have you ever had any cooperation with Burmese side in terms of HIV/AIDS (or other infectious diseases) prevention? If yes, how? From when? This includes information sharing, joint trainings, programs targeting populations from Myanmar in Yunnan. h) Have you ever had any cooperation or joint work with any Chinese governmental offices? If yes, how? i) Do you think it important to prevent HIV/AIDS infection among Burmese migrant workers/local Burmese residents? Why or why not? j) What do you think are the main difficulties, challenges and obstacles in your work in HIV/AIDS prevention along Sino-Burmese border? k) If your organization is given another chance, what would you do and how are you going to do it to prevent HIV/AIDS more effectively? l) What kind of roles, do you think, NGO can play in HIV/AIDS prevention among both Chinese and Burmese migrant workers? m) How do you look at the interrelationship between Chinese government, Burmese government, NGOs and other social organizations in terms of HIV-AIDS prevention? n) Do you have HIV information materials for migrants from Myanmar? What languages are they in? (v) To Burmese migrant workers a) How long have been working in Ruili? Do you often (how many times) go back to your home place in Myanmar? Is your home close to the border? Where do you live when you are working here in Ruili? Do you miss your family? b) What is your ethnicity? What is your first language? Can you read Burmese? Can you read Chinese? c) What made you decide to come to work in China? How many Burmese friends and Chinese friends do you have when you are working here? Do you often visit to each other? d) When you get your salary, do you send it back to your family or spend it here in China? If spend in Ruili, how do you normally spend it? e) How many off-work days do you have in a week/month? What do you usually do in your spare time (off-work time, weekend, holiday and evening)? f) Have you ever heard of HIV/AIDS? If yes, from when? From whom? g) Do you know how HIV/AIDS is transmitted? Where did you get this knowledge? h) Do you know anybody among the persons you know who has been infected with HIV/AIDS? If yes, how he (she) is infected? (You do not have to tell his/her name). i) When your friends, neighbors and colleagues suspect that they may be infected with HIV/AIDS, where do they usually go for (checking or) help? j) Do you have regular physical check-up? If yes, who gives you the check and where? Is it free or do you have to pay? k) Have you ever participated in any training in terms of HIV/AIDS prevention? Who gives the training? l) Have you ever read any materials or watch video tapes in relation to HIV/AIDS? If yes, where and how? m) Do you think it necessary to provide you some training, blood test and other medical care? n) Do you know who (which department) you should go for help if you suspect that you

84

are infected with HIV/AIDS?

C. Name List of the Persons Interviewed 1.1 From Contractors and Construction Site 1.1.1 Contractor 2 Yang, Heping (63, the Party secretary) Shen, (35, deputy general manager) Yang, (32, project manager) Cao, Ning (22, construction worker from Hubei) Li, Wei (30, construction worker from Chuxiong Yunnan) Cao, Guangquan (47, team leader from Hubei)

1.1.2 Contractor 3 Xxx (director of safety assurance and monitoring) Du, Yanbin (25, technical person from Kunming) Guo, Zhen (49, team leader from Hunan) Tang, Changyong (40, Construction worker from Hunnan)

1.1.3 Contractor 9 Sun, Daofa (40, director of safety assurance and monitoring) Lv, Hualin (25, assistant of Safety assurance and monitoring) Li, Changkun (30, team leader from Chuxiong Yunnan) Gui, Yiping (50, construction worker from Hunan) Zhang, Zhongping (40, subcontractor from Hunan) Gui, Lisheng (56, team leader from Hunan) Shen, Jiachang (35, construction worker from Jinping County Yunnan) Shi, Lingcang (43, construction worker from Shiping County Yunnan)

1.1.4 Contractor 14 Liu, Weiqun (30, director of safety assurance and monitoring) Yang, Zhihua (35, project manager) Yang, Huabo (31, deputy project manager) Zhang, Xin (39, team leader from Heqing County Yunnan) Peng, Zhengjin (42, construction worker from Longling County Yunnan) Yang, Jiacai (18, construction worker from Longling County Yunnan) Li, Weixin (43 construction worker from Longling County Yunnan) Hong, Guoliang (37, both he and his wife work at the construction site)

1.1.5 Contractor 21 Pan, Yanhui (female, 30, director of administration office) Yang, Xiaotong (33, director of safety assurance and monitoring) Yang, Jiatong (23, Burmese migrant worker who can speak Chinese) Pusu (38, Burmese migrant worker) Lei, Lida (45, team leader from Zhaotong Yunnan) Xu, Jinxue (35, construction worker) Huang, Lishui (57, construction worker from Fujian)

85

1.1.6 Contractor 22 Shi, Jiahong (45, director of safety assurance and monitoring) Xu, Fucai (34, construction worker from Sichuan) Zhou, Chengli (43, team leader from Sichuan) Li, Hu (25, construction worker from Sichuan) Zhou, Weimin (36, team leader from Shidian County Yunnan) Cheng, Jiyun (35, team leader from Zhaotong Yunnan) Yang, Tao (23, construction worker from Zhaotong Yunnan) Xu, Xuecheng (31, construction worker from Shidian CountyYunnan) Qilin Duji (24, Tibetan, construction worker from Xiangerila)

Persons Interviewed for Cross-border HIV/AIDS Prevention Ruili CDC Li, Zhoulin (deputy director who is responsible for HIV/AIDS prevention) Women and Children Development Center Tang, Jingmei (35, the Jingpo, F., in peer education for 7 years) Li, Letui (42, the Jingpo, M., in peer education for 2 years) Wang, Ying (32, the Dai, F., in peer education for 7 years) Yang, Yunlan (42, the Han, F., team leader, in peer education for 7 years) Zhang, Lu (F., staff member) AIDS Care China Zhang, Lin (F.) Guo, Liang (M.) Ruikangyuan (An NGO under AIDS Bureau to provide services to Burmese sex workers) Chang, Jilin (F. 45） Pedicab driver (M. 50, From Sichuan, both his wife and him are pedicab driver) Burmese Migrant Workers Puka (M. Freight Office staff) Mamawen （F. 36, tailor, has been in Ruili for 16 years） Mamawen’s cousin (F. 31, tailor, in Ruili for 4 years) Mamawen’s cousin (F. 25, tailor, in Ruili for 2 months) Jade Traders (two male and one female, have been in Ruili for 3 years, frequently travel between Myanmar and China, they are not willing to give the names) Burmese porter (15 Burmese porters are interviewed on the street of Jiegao, but they do not want to tell the true names). Burmese sex workers in Ruili (to respect the interviewed persons’ privacy, their names are not asked, English alphabet is used to represent each person)： A. 28，from Magwe, in China for over one year； B. 28，from Rangoon, has a son of 5, in China for 2 months； C. 25，from Magwe, in China for half a month; D. 39，from Magwe, has two sons (one 16, another 6), in China for 9 years E. 15，from Magwe, in China for 6 months F. 17，from Magwe, in China for one and a half year；

86

The boss (female, 45, from Magwe) Carpenters for making staircase Gulin （M. 22，in China for 2 years） Dansuowu （M. 23, in China for 2 years） Kimonen （M. 19, in China for 2 years） Ruili Entry-Exit Inspection and Quarantine Bureau Wang, Guolong (Director of Health Inspection Sector) Burmese Lorry Driver Zhang, Guangneng (Chinese Burmese, caring for “Home of Drivers”) Motocycle mechanic Mimiwu （16，motocycle mechanic Dojdoji（20，motocycle mechanic） Chigu（20，motocycle mechanic） N.（18，motocycle mechanic） Lorry Drivers Yelaiwen（21） Soumowin（32） Yelim（30） Kyluzim（29） Yedui（22） Director of Ruili Health Bureau Zhang, Miaoyun (F.) IDU Persons 8 persons participated in the interview. 2 of them are volunteers who are taking care of “the 19th Floor” (one of them is Chinese, and another is Burmese). Two aged Chinese IDU (one 70, another 60) . The rest are all Burmese who live in Muse, coming to Jiele to do some work as porters or garbage salvagers. To respect their privacy, their names are not given. Ruili Maternal and Child Care Service Center Dr. Xiong (F.) Burmese Workers at Wood Plant 20 Burmese workers (2 women) participated in the group interview. 6 of them have been here for 4 months, the rest have been here for 2—4 years. Since the plant is not very cooperative in the interview, the Burmese workers do not give their names

87

Appendix 5: STATISTICS FROM TRAINING PRE- AND POST-TESTS Tables 1-3 summarize the pre and post-test results for the training workshops undertaken by the TA. The figures in green represent pre-test results, and the figures in blue post-test results. Change is present in two ways: increase in correct answers and reduction in incorrect answers. 1

Pre and Post Test results - communities

Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12

by by

d be d be

Male l by by Village Tot HIV Fema Name al

le

blood?

get HIV get

Okay to to Okay

isolated

looking?

person person

Infected by by Infected

from PLHIV from

Identify Identify

discriminate discriminate

children with with children

Transmission Transmission

HIV+ relatives

Prevention Prevention

sharing food? sharing

against PLHIV against

mosquito bite? mosquito

mother to to child mother

using condom? using

Would buy food food buy Would

Only bad people people bad Only

Transmission by by Transmission by Transmission by Transmission shou PLHIV ban can Schools sharing needles? sharing 100 100 100 9 % % 77% 76% 62% 69% 83% 83% 81% 76% 62% % Nansan 64 100 100 100 100 100 100 55 % % 91% 90% 84% 93% % 83% % 97% % % Increase in correct N/A N/A 18% 18% 35% 35% 20% 0% 23% 28% 61% N/A answers Reduction in incorrect 100 100 100 N/A N/A 61% 58% 58% 77% 0% 88% N/A answers % % % 28 86% 82% 61% 50% 45% 66% 48% N/A N/A N/A N/A N/A Hannong 59 100 100 31 % % 89% 70% 82% 90% 95% N/A N/A N/A N/A N/A Increase in correct 16% 22% 46% 40% 82% 36% 98% N/A N/A N/A N/A N/A answers Reduction in incorrect 100 100 72% 40% 67% 71% 90% N/A N/A N/A N/A N/A answers % % 35 51% 49% 30% 57% 35% 51% 54% 30% 46% 49% 35% 85% Chudongg 69 100 100 100 100 ua 34 88% 93% 72% 85% % 83% % 75% % 83% 72% % Increase in correct 140 186 150 117 106 73% 90% 49% 63% 85% 69% 18% answers % % % % % Reduction in incorrect 100 100 100 100 76% 86% 60% 65% 65% 64% 67% 57% answers % % % % 100 100 23 % % 82% 50% 63% 71% 75% 48% 53% 53% 59% 72% Guangti 64 100 100 41 % % 91% 82% 89% 86% 91% 75% 89% 84% 77% 93% Increase in correct N/A N/A 11% 64% 41% 21% 21% 56% 68% 58% 31% 29% answers Reduction in incorrect N/A N/A 50% 64% 70% 52% 64% 52% 77% 66% 44% 75% answers 6 98% 98% 63% 42% 71% 50% 89% N/A N/A N/A N/A N/A Jinghan 57 100 100 100 51 % % 80% 80% 98% % 98% N/A N/A N/A N/A N/A

1 Some data is omitted from early trainings when the pre and post-test system was not standardized. Individual workshop results were not disaggregated by sex but analysis across workshops with different gender breakdowns suggests the results do not differ significantly.

88

Pre and Post Test results - communities

Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12

by by

d be d be

Male l by by Village Tot HIV Fema Name al

le

blood?

get HIV get

Okay to to Okay

isolated

looking?

person person

Infected by by Infected

from PLHIV from

Identify Identify

discriminate discriminate

children with with children

Transmission Transmission

HIV+ relatives

Prevention Prevention

sharing food? sharing

against PLHIV against

mosquito bite? mosquito

mother to to child mother

using condom? using

Would buy food food buy Would

Only bad people people bad Only

Transmission by by Transmission by Transmission by Transmission shou PLHIV ban can Schools sharing needles? sharing Increase in correct 100 2% 2% 27% 90% 38% 10% N/A N/A N/A N/A N/A answers % Reduction in incorrect 100 100 100 46% 66% 93% 82% N/A N/A N/A N/A N/A answers % % % 50 71% 73% 56% 44% 36% 34% 48% 13% 26% 34% 55% 25% Feihai 80 100 100 100 100 100 100 30 96% 98% 90% % % 95% % 39% 94% % % % Increase in correct 127 178 179 108 200 262 194 300 35% 34% 61% 82% answers % % % % % % % % Reduction in incorrect 100 100 100 100 100 100 86% 93% 77% 92% 30% 92% answers % % % % % % 31 42% 42% 43% 24% 39% 41% 39% 0% 38% 38% 0% 70% Nangai 74 100 100 100 100 100 100 43 96% 98% 90% % % 95% % 39% 94% % % % Increase in correct 100 answers 65% 68% 72% 81% 73% 82% 77% 65% 66% 76% 70% % Reduction in incorrect 100 100 100 100 100 100 93% 97% 82% 92% 39% 90% answers % % % % % % 41 80% 81% 57% 53% 46% 45% 60% 35% 51% 45% 46% 57% Gazhong 74 100 33 86% 91% 84% 95% 91% 86% 88% 47% 95% % 76% 87% Increase in correct 122 7% 12% 47% 79% 98% 91% 47% 34% 86% 65% 53% answers % Reduction in incorrect 100 30% 53% 63% 89% 83% 75% 70% 18% 90% 56% 70% answers % 43 77% 51% 51% 58% 56% 22% 72% 49% 52% 38% 34% 68% Mangguai 86 43 79% 76% 72% 63% 79% 72% 73% 57% 72% 79% 69% 83% Increase in correct 227 108 103 3% 49% 41% 9% 41% 1% 16% 38% 22% answers % % % Reduction in incorrect 9% 51% 43% 12% 52% 64% 4% 16% 42% 66% 53% 47% answers 266 72% 69% 53% 46% 46% 46% 58% 32% 43% 42% 36% 60% TOTAL 627 361 86% 87% 77% 78% 84% 82% 86% 52% 81% 81% 74% 83% Increase in correct 104 20% 27% 46% 69% 82% 78% 49% 61% 86% 93% 39% answers % Reduction in incorrect 51% 59% 52% 59% 70% 66% 67% 29% 66% 67% 60% 58% answers

89

Pre and Post Test results - community youth trainings

Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12

?

Male

Village Tota Femal

Name l child

e bite?

PLHIV

isolated

relatives

condom?

sharingfood

againstPLHIV

HIV by HIV looking?

PLHIV PLHIV beshoud

Transmission byTransmission byTransmission banSchoolscan

sharingneedles?

childrenHIV+ with

Preventionby using

Okayto discriminate

Infected by mosquito Infectedby from food buy Would

Transmission mother to motherTransmission to

Only bad people get Onlybad HIV people Transmission byTransmissionblood? 34 98% 98% 71% 63% 53% 63% 67% 65% 55% 51% 41% 76% Dengxiu 52 100 100 18 % % 83% 75% 90% 83% 95% 88% 90% 85% 73% 83% Increase in correct answers 2% 2% 17% 19% 70% 32% 42% 35% 64% 67% 78% 9% Reduction in incorrect 100 100 41% 32% 79% 54% 85% 66% 78% 69% 54% 29% answers % % 36 98% 98% 76% 71% 57% 69% 81% 58% 67% 65% 52% 77% Hannon 52 100 100 g 16 % % 88% 77% 85% 89% 98% 74% 90% 88% 72% 80% Increase in correct answers 2% 2% 16% 8% 49% 29% 21% 28% 34% 35% 38% 4% Reduction in incorrect 100 100 50% 21% 65% 65% 89% 38% 70% 66% 42% 13% answers % % 100 100 34 % % 79% 72% 39% 75% 83% 83% 83% 77% 60% 89% Huyu 51 100 100 17 % % 90% 93% 93% 79% 100% 83% 100% 95% 79% 98% Increase in correct answers N/A N/A 14% 29% 138% 5% 20% 0% 20% 23% 32% 10% Reduction in incorrect N/A N/A 52% 75% 89% 16% 100% 0% 100% 78% 48% 82% answers 100 100 26 % % 82% 50% 63% 71% 75% 48% 53% 53% 59% 72% Guangti 47 100 100 21 % % 91% 82% 89% 86% 91% 75% 89% 84% 77% 93% Increase in correct answers N/A N/A 11% 64% 41% 21% 21% 56% 68% 58% 31% 29% Reduction in incorrect N/A N/A 50% 64% 70% 52% 64% 52% 77% 66% 44% 75% answers 100 100 7 % % 57% 83% 81% 51% 77% 46% 87% 78% 82% 96% Jinghan 45 100 100 38 % % 84% 91% 100% 87% 97% 91% 100% 89% 100% 100% Increase in correct answers N/A N/A 47% 10% 23% 71% 26% 98% 15% 14% 22% 4% Reduction in incorrect N/A N/A 63% 47% 100% 73% 87% 83% 100% 50% 100% 100% answers 100 100 25 % % 77% 76% 62% 69% 83% 83% 81% 76% 62% 100% Nansan 44 100 100 19 % % 91% 90% 84% 83% 100% 83% 100% 97% 100% 100% Increase in correct answers N/A N/A 18% 18% 35% 20% 20% 0% 23% 28% 61% 0%

90

Pre and Post Test results - community youth trainings

Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12

?

Male

Village Tota Femal

Name l child

e bite?

PLHIV

isolated

relatives

condom?

sharingfood

againstPLHIV

HIV by HIV looking?

PLHIV PLHIV beshoud

Transmission byTransmission byTransmission banSchoolscan

sharingneedles?

childrenHIV+ with

Preventionby using

Okayto discriminate

Infected by mosquito Infectedby from food buy Would

Transmission mother to motherTransmission to

Only bad people get Onlybad HIV people Transmission byTransmissionblood? Reduction in incorrect #DIV/ N/A N/A 61% 58% 58% 45% 100% 0% 100% 88% 100% answers 0! Gazhon 9 90% 78% 59% 80% 73% 59% 81% 45% 69% 29% 29% 45% 41 g 32 93% 81% 67% 81% 86% 62% 86% 60% 76% 83% 60% 60% Increase in correct answers 3% 4% 14% 1% 18% 5% 6% 33% 10% 186% 107% 33% Reduction in incorrect 30% 14% 20% 5% 48% 7% 26% 27% 23% 76% 44% 27% answers 171 98% 97% 72% 70% 60% 66% 78% 62% 70% 62% 55% 80% TOTAL 332 161 99% 98% 85% 84% 90% 82% 95% 79% 92% 89% 80% 88% Increase in correct answers 1% 1% 18% 19% 48% 25% 22% 29% 31% 44% 45% 10% Reduction in incorrect 54% 30% 47% 46% 74% 47% 80% 47% 74% 71% 55% 41% answers

91

Pre and Post Test results – migrants2

Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12

Migrant Male Tot training Femal al

number e bancan ls

blood?

ngneedles?

getHIV

Okayto

isolated

relatives

Infectedby

fromPLHIV

discriminate

Transmission

Preventionby

sharingfood?

againstPLHIV

mosquito bite?

motherchild to

using condom?

HIV by HIV looking? food buy Would

PLHIV PLHIV beshoud

Only bad people Onlybad people

Transmission byTransmission byTransmission byTransmission Schoo

shari childrenHIV+ with 64 18 Training 64% 69% 56% % 64% 58% 28% 67% 83% 86% 64% 83% 36 1 100 100 75 18 % % 83% % 90% 83% 95% 88% 90% 85% 73% 83% Increase in correct 17 239 56% 45% 48% 41% 43% 31% 8% -1% 14% 0% answers % % Reduction in incorrect 31 N/A N/A 61% 72% 60% 93% 64% 41% -7% 25% N/A answers % 65 27 Training 45% 84% 41% % 32% 64% 41% 45% 27% 45% 11% 39% 44 2 100 100 100 98 100 100 100 100 100 100 100 17 % % % % 91% % % % % % % % Increase in correct 122 144 51 184 144 19% 56% N/A N/A N/A N/A N/A answers % % % % % Reduction in incorrect 100 100 100 94 100 100 87% N/A N/A N/A N/A N/A answers % % % % % % 73 0 Training 78% 93% 65% % 60% 75% 88% 48% 83% 52% 0% 66% 40 3 100 100 95 100 100 40 % % 97% % 85% % % 75% 98% 75% 70% 93% Increase in correct 31 29% 8% 49% 42% 33% 14% 58% 18% 44% N/A 41% answers % Reduction in incorrect 100 100 82 100 100 91% 63% 52% 86% 48% 70% 78% answers % % % % % 55 24 Training 78% 85% 53% % 50% 73% 75% 48% 83% 23% 13% 73% 40 4 100 100 93 100 100 100 100 16 % % 75% % 98% 95% % % % 80% 95% % Increase in correct 69 108 248 631 28% 18% 43% 96% 30% 33% 20% 37% answers % % % % Reduction in incorrect 100 100 84 100 100 100 100 47% 96% 81% 74% 94% answers % % % % % % % 55 30 Training 68% 85% 63% % 50% 73% 75% 75% 83% 50% 70% 80% 40 5 100 93 100 100 10 98% % 88% % 98% 95% % 95% % 88% 83% 90% Increase in correct 44% 18% 40% 69 96% 30% 33% N/A N/A N/A N/A N/A

2 The TA team believes the post-test results in the initial four migrant trainings to be inflated by assistance provided by the interpreter to the respondents. The team considers this issue was resolved after discussion with the interpreter.

92

Pre and Post Test results – migrants2

Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12

Migrant Male Tot training Femal al

number e bancan ls

blood?

ngneedles?

getHIV

Okayto

isolated

relatives

Infectedby

fromPLHIV

discriminate

Transmission

Preventionby

sharingfood?

againstPLHIV

mosquito bite?

motherchild to

using condom?

HIV by HIV looking? food buy Would

PLHIV PLHIV beshoud

Only bad people Onlybad people

Transmission byTransmission byTransmission byTransmission Schoo

shari childrenHIV+ with answers % Reduction in incorrect 100 84 100 94% 68% 96% 81% N/A N/A N/A N/A N/A answers % % % 60 12 Training 78% 80% 65% % 58% 65% 40% 65% 73% 38% 33% 63% 40 6 100 95 100 100 28 98% % 95% % 85% % % 75% 88% 93% 95% 98% Increase in correct 58 150 145 188 26% 25% 46% 47% 54% 15% 21% 56% answers % % % % Reduction in incorrect 100 88 100 100 91% 86% 64% 29% 56% 89% 93% 95% answers % % % % 73 20 Training 90% 95% 75% % 58% 53% 80% 55% 33% 38% 58% 63% 40 7 100 90 20 95% % 93% % 98% 80% 93% 75% 83% 83% 80% 85% Increase in correct 81 100 answers 65% 68% 72% % 73% 82% 77% 65% 66% 76% 70% % Reduction in incorrect 100 63 50% 72% 95% 57% 65% 44% 75% 73% 52% 59% answers % % 75 28 Training 82% 70% 75% % 50% 53% 75% 45% 60% 53% 75% 63% 40 8 100 90 12 90% % 93% % 85% 80% 88% 75% 83% 75% 80% 78% Increase in correct 20 10% 43% 24% 70% 51% 17% 67% 38% 42% 7% 24% answers % Reduction in incorrect 100 60 44% 72% 70% 57% 52% 55% 58% 47% 20% 41% answers % % 28 88% 70% 75% 73 38% 38% 75% 58% 75% 53% 58% 63% Training 40 100 100 90 100 9 12 % % 88% % 80% % 95% 80% 88% 75% 80% 75% Increase in correct 23 111 163 14% 43% 17% 27% 38% 17% 42% 38% 19% answers % % % Reduction in incorrect 100 100 63 100 52% 68% 80% 52% 52% 47% 52% 32% answers % % % % 66 187 74% 81% 63% % 51% 61% 64% 56% 66% 48% 42% 65% TOTAL 360 100 91 173 98% % 90% % 90% 93% 97% 85% 92% 84% 84% 89% Increase in correct 39 101 32% 23% 44% 77% 51% 51% 52% 40% 74% 37% answers % % Reduction in incorrect 100 74 92% 74% 80% 81% 91% 66% 77% 69% 73% 69% answers % %

93

Project Number: TA-6321 REG December 2014

People’s Republic of China: Fighting HIV/AIDS in Asia and the Pacific

ADB TA6321-REG: HIV Prevention in the Transport Sector in Yunnan and Guangxi

Supplementary Appendixes

1

Table of Contents

Supplementary Appendix A: Report on Mid-Term Workshop 2 Supplementary Appendix B: Community and youth training report – Nongmulai 7 Supplementary Appendix C: Community training report – Hannong 15 Supplementary Appendix D: Community training report – Jinghan 21 Supplementary Appendix E: Community training report – Guangti 26 Supplementary Appendix F: Community training report – Nangai 31 Supplementary. Appendix G: Community training report – Neimangguai 36 Supplementary Appendix H: Community training report – Feihai 40 Supplementary Appendix I: Community training report – Chudongguai 44 Supplementary Appendix J: Community training report – Nansan 49 Supplementary Appendix K: Community training report – Gazhong 55 Supplementary Appendix L: Community youth training report – Dengxiu 59 Supplementary Appendix M: Community youth training report – Gazhong 64 Supplementary Appendix N: Community youth training report – Huyu 69 Supplementary Appendix O: Community youth training report – Nansan 74 Supplementary Appendix P: Community youth training report – Hannong 80 Supplementary Annex Q: Community youth training report – Jinghan 84 Supplementary Appendix R: Community youth training report – Guangti 89 Supplementary Appendix S: Migrant Training Report – 1 94 Supplementary Appendix T: Migrant Training Report – 2 98 Supplementary Appendix U: Migrant Training Report – 3 102 Supplementary Appendix V: Migrant Training Report – 4 106 Supplementary Appendix W: Migrant Training Report – 5 110 Supplementary Appendix X: Migrant Training Report – 6 114 Supplementary Appendix Y: Migrant Training Report – 7 119 Supplementary Appendix Z: Migrant Training Report – 8 123 Supplementary Appendix AA: Migrant Training Report – 9 127 Supplementary Appendix BB: Community Youth Peer Educators Training 131 Supplementary Appendix CC: Contents of Health Kit 135 Supplementary Appendix DD: Community Bulletin Boards 136 Supplementary Appendix EE: IEC Materials reproduced by TA 137 Supplementary Appendix FF: TA training photos 138

2

Supplementary Appendix A: Report on Mid-Term Workshop

Report on TA6321-7LR Mid-term Workshop, Mangshi, 29 July 2014

Introduction

The mid-term workshop was held on the afternoon of 29 July, 2.30pm – 6pm, immediately following the 1.5 day training of trainers (TOT) workshop for safety officers from construction sites. The latter is reported on in Annex 1.

Participants

The meeting was attended by the following:

Ms. Mei, Section Director of the Dehong Prefecture Heath Bureau Mr. Cao Linhong, Domestic Supervision Consultant 1 Cheng Hongwen, Domestic Supervision Consultant 2 Li Shaohai, Domestic Supervision Consultant 3 Mr. Li Runsheng, Contractor 4. Mr. Xiao Tianxiang, Deputy Director of Resettlement Coordination Division Mr. He Jianguo, ADB Affairs Management Office Mr. Tulsi Bisht, Social Safeguards Specialist, ADB Ms. Tina Luo, AIDS Care China Mr. Phil Marshall, International Team Leader, ADB TA6321-7 Ms. Chen Gulian, Project Officer, ADB TA6321-7 Mr. Jiansheng (Jason) Huang, M&E expert. ADB TA6321-7

Discussion

The TA team reported on progress as follows:

Output 1: Extend the existing contractor HIV/AIDS education with value-added activities.

Activities to date included: a workshop for domestic supervision consultants; site visits to all 22 contractors; an assessment of existing responses, knowledge and risks on 6 selected sites; and the reproduction of materials (field educators’ guide, posters, DVDs). Further activities were delayed by the construction schedule and then by the resignation of the Deputy Team Leader.

The TOT workshop noted above marked the start of a more concentrated set of activities. All present highlighted that the workshop had been extremely successful both in conveying HIV knowledge and introducing participatory training methods, which they saw as being suitable for sites. Several companies sent more than one representative, while the five new paving contractors also sent staff. In all, there were 47 participants. In terms of follow-up, company requests in broad teams were as follows:

 Training for management staff – 16 companies  Assistance with development peer educators network – 7  Mobile testing services – 14

3

 Health kits – 21  Assistance with other health issues – 6  More IEC materials, DVDs – all companies

There was strong support at the mid-term workshop for the health kits, and it was suggested that IEC materials and DVDs could be incorporated into these kits. The TA team has more details on all of these requests and will follow up directly with each company. The team noted that IEC materials produced to date had used the Yunnan Highway Development and Investment Co. logo so that they could be re-used on other projects, but at the request of LREC, the health kits would have the LongRui logo.

Output 2: Mobilize communities to reduce threats of HIV/AIDS through people-centered methodologies.

Eight training workshops had been completed in four communities and one workshop for youth. Following the ironing out of administrative issues, it is aimed to complete the remaining six communities in August and September and then concentrate on development of youth educator network, in partnership with the Communist Youth League. As well as HIV/AIDS, the trainings are focusing on drug use, particularly ephedrine which does carry the same risks as injectable drugs but is a major concern to these communities. Youth trainings have a strong focus on decision-making skills.

Output 3: Develop measures to strengthen cross-boundary collaboration on mobility-related HIV issues.

Following an assessment by Jiansheng Huang and further discussions with local officials and NGOs, four areas have been identified in which (1) migrant populations are underserved; (2) the project could make a meaningful contribution in the remaining project period, without creating potential problems relating to sustainability. Activities are proposed in each of these areas as follows:

 HIV training for official migrants. The TA will work with the government service center for migrants, which has testing facilities but no training capacity.  Voluntary testing and counseling for mobile populations. Migrant and other migrant populations are greatly underserved by testing services. Working with AIDS Care China, which has existing experience in this area, the project will seek to expand coverage among: construction workers; Burmese migrants; truck drivers and other mobile populations.  Health management for HIV positive injecting drug users. Health management for IDUs is extremely important not just for IDUs themselves, but also because of the potential for positive users to pass on not just HIV but other communicable diseases such as TB. This component will pilot an approach with Burmese IDUs consisting of training and basic medical supplies. It is envisaged that this could potentially be a model to be adopted cross-border as capacity evolves on the Myanmar side.

Ms. Mei, Section Director of the Dehong Prefecture Heath Bureau, endorsed these areas as priorities for the government, noting that the rapid expansion of migrant workers was creating difficulties for them in terms of coverage.

Output 4: Monitoring and evaluation

4

Baseline assessments have been carried out for all components and a project monitoring system developed, which includes pre- and post-test surveys for all activities. Work to streamline the reporting against this system will be completed with in the next week.

A range of lessons have been learned on this and previous TAs that could be useful for transport and health authorities from other provinces. It is proposed that the final workshop be expended to invite participants from other parts of PRC. The final workshop would also provide an opportunity to launch the Chinese version of the case study on HIV prevention from the previous TA in Guangxi and Yunnan.

Implementation Arrangements

As well as its work supporting HIV material and condom distribution with government health officials, LREC continues to provide strong support to the TA, through in-kind support such as meeting rooms for holding workshops and training programs and liaising with the project contractors. Following the TOT workshop, the TA team is now in a position to work directly with the companies.

Conclusion

The meeting concluded with government representatives re-stating their support for activities planned for the remaining TA period, particularly testing and the health kits. ADB and the TA team expressed their appreciation for the ongoing support of government staff, LREC and the supervising consultants. The meeting closed at 5.45 pm and was followed by dinner.

Budget

It was initially anticipated that the workshop would be attended by TOT participants but the much greater participation in that workshop than expected made that unrealistic. Provision was also made for a participant from the Yunnan Highway Development and Investment Co. Investment, but he was unable to attend due to other commitments. Transport costs for participants were already covered by the As a result, while the initial budget was more than $2000, actual expenditure was just $89!

5

Annex 1: Report on Training of Trainers Workshop for Transport Company Staff, Mangshi, 28-29 July

Overview and objectives The trainer of trainers (TOT) was organised for safety offices from road construction companies. This workshop aimed to: 1. Help participants better understand HIV/AIDS and related diseases 2. Highlight how and why raised awareness does not necessarily lead to behaviour change and introduce some basic principles of behaviour change. 3. Assist participant better understand the importance of HIV/AIDS prevention activities on the worksite that go beyond awareness raising and highlight possible areas of TA support. 4. Introduce HIV/AIDS education exercises suitable for the worksite and provide participants with the opportunity to practice running these.

Programme

The workshop was loosely divided into three parts. The morning of the first day was concerned with providing information on HIV/AIDS and related diseases. The afternoon session was more participatory, looked at barriers to behaviour change and introduced some exercises that were adapted for use in a construction context. These were drawn from the field educator’s guide, Health and Safety with Me, developed on the previous TA. Also during the afternoon session, various tips were provided for running future trainings.

Participants were then divided into 3 groups consisting of 3 teams each. Each group was assigned an exercise and practiced running these. The exercises concerned; using condoms and effects of alcohol; stigma and discrimination and ladder of risk, in which participants rate different behaviours as high, low or medium risk. The following day, the groups were divided again so that each group now had a team with experience in each exercise, that is one who had practiced the condom exercise, one the stigma and one the ladder of risk. They ran these exercises for the each two teams in their group. Trainers provided ongoing mentoring and feedback. Most participants proved very capable of understanding and running the exercises.

On the first evening, the TA team described a list of different types of support that the TA could provide and asked participants to reflect overnight. At the end of the workshop, they were asked to write down the types of assistance they were seeking. The results are included in the mid- term workshop report. A copy of the agenda is included as Annex 2a.

Participant Feedback

Participant feedback was very very positive. The vast majority of participants expressed appreciation for the type of training methods. Responses highlighted the participatory methods and that the games played were both fun and an effective way of learning, and complemented by presentation. Only a small number of complaints were received, mainly about the shortness of breaks and the shortness of the workshop. The nature of the feedback also suggests a little more time should have been devoted to questions. A full set of comments is included in Annex 2b.

6

Pre- and Post test

Pre- and post test results showed an increase in knowledge from an already strong base. The full results are currently being collated and will be included in M&E reporting.

Follow-up Once the new Deputy Team Leader is on board, she will immediately contact all companies to arrange follow-up activities which will comprise:  Training for company leaders (workshops in Mangshi and Ruili)  Training for peer educators (workshops in Mangshi and Ruili)  On-site training and testing  Distribution of health kits (currently being worked on by the TA team)

7

Supplementary Appendix B: Community and youth training report – Nongmulai

Report on HIV/AIDS Prevention Training Program along Longling-Ruili Highway Program Name: HIV/AIDS Prevention Program along Longling-Ruili Highway Training Time: 19th -22nd April, 2014 Training Adolescent Sexual Health Education to Teenagers and HIV/AIDS Training Content： for Villagers Training 2nd Floor of the Public House of Nongmulai Location: Number of Teenagers(47 on 19th, 44 on the 20th ）, 68 villagers Trainees: Trainer: Chen Guilan Report Writer： Chen Guilan

8

I. Adolescent Sexual Health Training （一）Objectives and Contents of Training

1. To help teenagers acquire correct knowledge about adolescent physiology and psychology; teach them to get to know themselves and accept themselves so as to cultivate their self-awareness; let them understand that no one is perfect in this world and only when they see their own advantages can they develop an optimistic and healthy personality, and thus become a happy and confident person.

2. To learn to listen and express themselves; to help them understand that to improve interpersonal skills, one has to adopt a peaceful, friendly and modest attitude towards others, and deal with problems and conflicts arising in personal communication in a tolerant, fair and reasonable way. 3. Get to know emotions, and learn to relieve stress. Help them learn to relieve mental stress and know how to release emotions and relax themselves. 4. To understand and support others, and train perspective-taking skills, which means to walk in other people’s shoes. 5. To cultivate and train their problem-solving skills so as to help them find effective solution to problems; help them realize the objectivity of the appearance as well as the existence of problems and encourage them to seek breakthroughs and approaches to solve problems through discussion, negotiation, exploration and experimentation. 6. Avoid aggressive language and behaviors. Help them build self-discipline, and be strict with themselves. Remind them not to mock others, get furious over violation of interest, or resort to violence. And help them to learn to replace aggressive behaviors with peaceful methods.

7. Introduce the varieties of drugs popular in Ruili, analyze the reasons why teenagers take drugs and teach them effective ways to reply to peer pressure.

8. Introduce AIDS in Ruili, its transmission, prevention and treatment, as well as the “Four Frees and One Care” policy, and where to seek help in Ruili.

9. Explain the plan to select peer educators in the future and enroll those who are willing to participate.

（二）Results

9

The results of pre and post-test (see questionnaires for questions in detail) are shown in the following figure（see questionnaires for 1-9）

Pre and post test of adolescent sexual health training

青春期性健康培训前后测试

120%

100%

80% 培训前（ % ） 60% 培训后 （ % ） 40%

20%

0% 1 2 3 4 5 6 7 8 9

before training after training

At the end of the training, the trainer introduced the subsequent arrangement of the program--- peer education, which was in want of peer educators. Two teenagers were willing to participate in the activities of peer education.

The following are some comments after training :“ I learned how to use condoms correctly from the training”; “I learned how to get along with other people”；“Only when you respect others will they respect you”; “Now I know how we (human beings) were brought into this world”；“I learned how to become a popular person”; “Think of the consequences before doing anything”.

II. Training of Villagers in Knowledge about HIV/AIDS

（一）Objectives and Contents of Training

1. To know the prevalence of HIV/AIDS in Ruili, and realize that HIV/AIDS is not far away from each one of us.

2. To know that AIDS is caused by HIV virus, and the differences between HIV virus and AIDS.

10

3. To know in which body fluid HIV survives, transmission and prevention of HIV/AIDS, and that HIV/AIDS does not transmit through daily life.

4. To know the “Four Frees and One Care” policy, and where to seek help in Ruili after infection of the disease, and lessen fear for HIV/AIDS.

5. To build correct attitudes towards HIV patients, realize that there exists discrimination against them, and it needs the effort of everyone to reduce and fight against the discrimination.

6. Which are the most popular drugs in Ruili? What are the impacts of drugs on families, individuals and the society? And discuss what mechanism could villages establish to prevent the prevalence of drugs.

7. To know the main syndromes of some common sexually transmitted diseases, correct treatments, and how to choose and use condoms correctly.

8. To know the relationship between drugs, sexually transmitted diseases and HIV/AIDS.

（二）Results

Results of pre and post-test are as follows (see questionnaires for questions in detail):

1. Accuracy rate of their knowledge about transmission of HIV/AIDS is shown in the following figure:

100%

95%

90% 培训前（%） 培训后（%） 85%

80%

75% 血液传播 共用注射器 不安全性行为 怀孕 喂奶 艾滋病的传播途径

before training after training

11

血液传播 blood transmission 共用注射器 Sharing injection needles

不安全性行为 Unprotected sexual contact 怀孕 pregnancy

喂奶 Breast feeding

艾滋病传播途径 Mode of HIV Transmission

2、Accuracy rate of three key points of the knowledge is shown in the following figure.

105% 100% 95% 培训前（人） 90% 85% 培训后（人） 80%

75%

蚊虫叮咬

坚持使用安全套

否感染了艾滋病 从表面是否能看出是 关键知识的正确认识率

从表面是否看得出是否感染了艾滋病 We can tell if a person is infected with HIV by simply looking at them.

蚊虫叮咬 bite of mosquitoes

坚持使用安全套 Keeping using condoms

3. Attitudes towards HIV patients are shown in the following figure:

12

60% 50% 40% 培训前（人） 30% 培训后（人） 20% 10%

0%

憎恨 同情 安慰 帮助 其他

看不起 避免和他接触 对待艾滋病人的态度

培训前 before training 培训后 after training

对待艾滋病人的态度 attitudes towards HIV patients

看不起 scorn 避免和他接触 avoid contact

憎恨 hate 同情 sympathize

安慰 comfort 帮助 help 其他 others

4. Their biggest worry for being infected with HIV/AIDS is shown in the following figure:

13

45% 40% 35% 30% 25% 培训前（人） 20% 培训后（人） 15% 10% 5%

0%

无所谓

被人知道 拖累家人 花钱治病

被人看不起 受病痛折磨 感染艾滋病后最担心的问题

培训前 before training 培训后 after training 被人知道 being known 被人看不起 being scorned 拖累家人 becoming a burden of the family 花钱治病 money for treatment 受病痛折磨 torture of the disease 无所谓 don't care 感染艾滋病后最担心的问题 the biggest worry after getting AIDS

On the whole, people’s knowledge about HIV/ AIDS has been improved, particularly knowledge about three key aspects, which was probably because the test was taken right after the training. As to attitudes towards infection of HIV, people show more worries and pressure towards the supposed infection of HIV themselves than of others. The following are some comments of participants: “Before the training I only knew three methods of transmission, but now I know more about each method of transmission”；“We should be more cautious about getting a tattoo, especially getting one in Myanmar”; “ Although the state policy is good, the fact of having to take medicine for the whole life once getting AIDS is scaring”；“Each family should educate their children well, keeping this village free from the disease”; “Taking ephedrine will lead to mental disorder, for which there’s no cure, so after going back home it’s necessary to tell children about it”; “Generally speaking , the village is under good condition, but neither village-level cadres nor parents should relax vigilance against drug problems”. （三）Problems and challenges

14

Since these teenagers are from two different villages, there is a big difference in age, with the youngest being 11, and the oldest 22, so their concerns are quite different. During the interactive process, younger ones were afraid to express their opinions unless being repeatedly encouraged. Besides, some of them only took part in the 2-day training for one day, as a result of which the pre and post-test could not tell the effects of the training exactly. Some teenagers were sent for the training by their parents, whose presence outside the training room also brought pressure to them. Knowledge about drugs and HIV/AIDS was not included in the pre and post test, which should be added in the next training. Moreover, the picture was taken after meal, when some teenagers had already left, so parents who accompanied their children to the training were invited to take a picture together. In general, adult villagers turned out to be active participants. It is unclear whether village cadres have only informed a selected few of the training. Furthermore, compared with the total number of villagers, the number of participants only took up a small proportion, which was not persuasive enough to stand for the whole village. （四）Uses of Funds（Based on the approved ADB budget）

Program Budget Appropriation ($) Use Surplus （RMB） （RMB） （RMB） Adolescent 15873 - 12484 - Sexual Health Training HIV/AIDS 12463 - 10200 - Training Total 28336 $4975(RBM30743) 22684 8059

15

Supplementary Appendix C: Community training report – Hannong

Training Report on HIV/AIDS Prevention Program along Longling-Ruili Highway Program Name: HIV/AIDS Prevention Program along Longling-Ruili Highway Training Time: 8th -9th May, 2014 Training Content： HIV/AIDS Training for Villagers Training Location: 2nd Floor of the Public House of Hannong Number of Trainees: 59（28 male, 31 female） Trainer: Chen Guilan Report Writer： Chen Guilan

I. Objectives and Contents of Training

1. To know the prevalence of HIV/AIDS in Ruili, and realize that HIV/AIDS is not far away from each one of us.

2. To know that AIDS is caused by HIV, and the differences between HIV and AIDS.

3. To know in which body fluid HIV survives, transmission and prevention of HIV/AIDS, and that HIV/AIDS does not transmit through daily life.

4. To know the “Four Frees and One Care” policy, and where to seek help in Ruili after infection of the disease, and lessen fear for HIV/AIDS.

5. To build correct attitudes towards HIV patients, realize that there exists discrimination against them, and it needs the effort of everyone to reduce and fight against the discrimination.

6. To know the most popular drugs in Ruili, the impacts of drugs on families, individuals and the society, and discuss what mechanism could villages establish to prevent the prevalence of drugs.

7. To know the main syndromes of some common sexually transmitted diseases, correct treatments, and how to choose and use condoms correctly.

8. To know the relationship between drugs, sexually transmitted diseases and HIV/AIDS.

16

（二）Results

Results of pre and post-test are as follows (see questionnaires for questions in detail):

1、 Accuracy rate of their knowledge about transmission of HIV/AIDS is shown in the following figure:

120.0% 100.0% 80.0% 培训前% 60.0% 培训后% 40.0% 20.0% 0.0% 血液传播 共用注射器 不安全性行为 怀孕 喂奶 艾滋病的传播途径

培训前 before training 培训后 after training

血液传播 blood transmission 共用注射器 Sharing injection needles

不安全性行为 Unprotected sexual contact 怀孕 pregnancy

喂奶 Breast feeding

艾滋病传播途径 Mode of HIV Transmission

2. Accuracy rate of three key points of the knowledge is shown in the following figure.

17

100.0% 90.0% 80.0% 70.0% 60.0% 培训前% 50.0% 40.0% 培训后% 30.0% 20.0% 10.0%

0.0%

蚊虫叮咬

艾滋病

染了艾滋病

从表面是否能看出是否感 坚持使用安全套可以预防 3个关键知识的正确认识率

培训前 before training 培训后 after training

从表面是否看得出是否感染了艾滋病 We can tell if a person is infected with HIV by simply looking at them.

蚊虫叮咬 bite of mosquitoes

坚持使用安全套 Keeping using condoms

3. Accuracy rate of other knowledge is shown in the following figure.

100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 培训前%

培训后%

可以预防

目前可以治愈

一起吃饭会感染

感染上HIV

握手不会感染HIV

性交后清洗下身就不会 与艾滋病病人或感染者 其他知识的正确认识

18

培训前 before training 培训后 after training

一起吃饭会感染 HIV HIV can be transmitted by eating together with a person living with HIV/AIDS or an AIDS patient

性交后清洗下身就不会感染 HIV Cleaning private parts after having sex would protect you from HIV.

与艾滋病人或感染者握手不会感染 HIV Handshakes with PLHIV or AIDS patients would not transmit HIV.

目前可以治愈 it could be cured

可以预防 it could be prevented

其他知识的正确认识 Accuracy of other knowledge

4. Attitudes towards HIV patients are shown in the following figure:

60.0% 50.0% 40.0% 培训前% 30.0% 20.0% 培训后% 10.0%

0.0%

厌恶 憎恨 同情 安慰 帮助 其他

看不起 无所谓

不知道 不知道 避免和他接触 对待艾滋病人的态度

培训前 before training 培训后 after training

对待艾滋病人的态度 attitudes towards HIV patients

看不起 scorn 避免和他接触 avoid contact

憎恨 hate 同情 sympathize

安慰 comfort 帮助 help 其他 others

4. The biggest worry after getting HIV/AIDS is shown in the following figure:

19

30.0% 25.0% 20.0% 培训前% 15.0% 培训后% 10.0% 5.0%

0.0%

无所谓 不知道

被人知道 失去工作 拖累家人 花钱治病 生命短暂

被人看不起 受病痛折磨 感染艾滋病后最担心的问题

培训前 before training 培训后 after training 被人知道 being known 被人看不起 being scorned 失去工作： losing job 拖累家人 becoming a burden to the family 花钱治病 money for treatment 受病痛折磨 torture of the disease 生命短暂：shortened life span 无所谓 don’t care 不知道 not sure 感染艾滋病后最担心的问题 the biggest worry after getting AIDS On the whole, people’s knowledge about various aspects of HIV/ AIDS has been improved. The training was organized with the help of the township government of Jiexiang. Believing that there was use of ephedrine in both Hannong and Babie, village committee members decided to ask villagers from Babie to attend the training. All attendants on the first day were male, with the youngest being 18 and the oldest 38. Their common misunderstandings about drugs were exposed during discussion. For example, they thought drugs could increase libido, extend lifespan and dispel the effects of alcohol. It had also been mentioned that they were prone to peer pressure. Participants on the second day of the training were all female, with the youngest being 19 and the oldest 40. Compared with their male counterparts, the reasons for taking drugs seemed vague to them. But they showed great concern about drug-taking in the community, worrying that their children or husbands might take drugs. According to them, drugs (mainly ephedrine) were usually used during weddings and funerals, without which, they said, no one would be willing to stay up late (to stand as guards at the bier or to prepare meals for the next day), and thus the progress and quality of the preparation work would be affected. When it comes to how to prevent their husbands from using ephedrine, those women said frankly that they dared not interfere, for otherwise, it would break family relationships, or even

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lead to family violence. They assumed that maybe so many men chose to take ephedrine because of ignorance of its harmfulness. It had been revealed in men’s discussion on the first day of training that men did have some wrong conceptions about the harmfulness of ephedrine. To effectively prevent people from taking the drug, a ban on the use of ephedrine in weddings and funerals should be issued by the township government, as is advised by women. After training, some participants commented that: “Before the training I only knew three modes of HIV transmission, but now I know more about each mode.” “From the training, I know that sexually transmitted diseases don’t require complicated treatment.” “ I’ve got new understanding about the harmfulness of ephedrine”；“Though the living standard has been improved, we are under huge pressure due to the prevalence of ephedrine in the village.” “ Hope you could report the use of ephedrine in the village to leaders in the township government or municipal government. Please help us.” “It is the first time I knew how to use a condom after 20 years’ marriage.”“The game we played makes me realize the tremendous pressure of an AIDS patient, so don’t despise AIDS patients.”

（三）Problems and challenges

The use of ephedrine is so prevalent in the village that it needs the government to take effective measures against it. It is found from the demand assessment that villagers of Hannong hold strong discrimination against AIDS patients, but since there were participants from another village, the plan to invite people living with HIV/AIDS in the village to eat together with other villagers was abandoned.

（ 四）Uses of Funds（Based on the approved ADB budget） Program Budget Appropriation ($) Use Surplus （RMB） （RMB） （RMB） HIV/AIDS 12463 - 9300 4039 Training

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Supplementary Appendix D: Community training report – Jinghan

The Report on AIDS Prevention Training Project along Longrui Highway

Project Name: AIDS Prevention Training Project along Longrui Highway Training Date: May 21-22, 2014 Training Content： Training of AIDS knowledge for the villagers Training Location: 2nd Floor in Jinghan Public House Number of Trainees: 57 in total（6 male，51 female） Trainer: Guilan Chen Reported by： Guilan Chen

1. Objectives and Contents of the Training:

(1) To understand AIDS epidemic trend in Ruili and the fact that AIDS is not far from us

(2) To understand that AIDS is caused by HIV and to know about the differences between AIDS and HIV.

(3) To understand what HIV exists in, the routes of transmission, methods for prevention, and to know that AIDS will not transmit in daily lives

(4) To understand the national policy of “Four Exemption and One Concern”, to know how to ask for assistance and service after infection so as to reduce fear towards AIDS.

(5) To build right attitude towards AIDS patients and be aware of the discrimination and actively against it from ourselves.

(6) To know about the main types of drug in Ruili, the influence of drugs on families, individuals and the society, and to discuss how to set up effective drug defense mechanism in villages.

(7) To know about the cardinal symptom and treatment of the common sexually transmitted diseases and how to choose and use condoms.

(8) To understand the relationship among drugs, sexually transmitted diseases and AIDS.

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2. Results

Through after training tests (Details of the questions can be seen in the test):

(1) Rate of correct understanding of the transmission routes of AIDS:

(2) Rate of correct understanding of the three key points:

(3) Rate of correct understanding of other knowledge:

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(4)Attitude towards AIDS patients:

(5)The most worrying problems when infected with AIDS:

24

Although the village is close to the city, the villagers’ knowledge about HIV/AIDS is no better than the former 2 villages. The training has improved all participants’ awareness rate on the related knowledge, among which, “using condoms can prevent AIDS” was increased the most, from 48% to 100%. Among all participants, there were 6 male and 51 female with the age of 17-50. The head of village said that generally, common matters are decided by women. Usually, women would come for the village meeting, which is very rare in Dai people’s villages. Only on major events like discussing about compensation for land acquisition that men would participate. The communication with villagers also revealed that there is no drug use in public occasions. Besides, due to the land acquisition, everyone now has a sense of crisis and are all working hard to make money. When discussed about drugs, women had thought that it was only men who liked to use. They don’t know the situation in other villages. Most young women were interested in knowledge about STDs.

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Some of the trainees commented: “Before the training, we only know there are three transmitting routes of AIDS, but now we know more details about each routes” ; “before the training, we had no idea the use of ephedrine in other villages, we would tell our husbands and children about it once we got home”; “we like this kind of training very much! It is funny and we can learn something”; “today is just like a festival, people get together to play games, have nice food and learn!”; “it is only today that I know how to use condom correctly”; “if there is someone have AIDS, we should treat them nicely”; “now, I am clear about the relationship among drug, STDs and HIV/AIDS”; “men need to work to support family, most of them have a regular job so they cannot come for the training”(the head of the village).

3. Problems and Challenges

There are more than 70 households in Jinghan Village. Before the training, the contact was conducted through government—administrative village—head of the village. The village head paid much attention to the activity. He informed the villagers through video a day before and the day for training again. But still, the number of trainees didn’t reach 70.

4. Use of budget (Estimate according to ADB approved budget) Project Budget Appropriate money Actual cost Balance （RMB） (USD $) （ $10 （RMB） （RMB） remittance fee was deducted） Training of AIDS 12463 - 9000 3463 knowledge

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Supplementary Appendix E: Community training report – Guangti

Training Report on HIV/AIDS Prevention Program along Longling-Ruili Highway - Guangti

Project Name: AIDS Prevention Training Project along Long-Rui Highway Training Date: July 10-July 11, 2014 Training Content： Training of AIDS knowledge for the villagers Training Location: Guangti Public House Number of Trainees: 64 in total（23 male，41 female） Trainer: Guilan Chen Reported by： Guilan Chen

1. Objectives and Contents of the Training:

(1) To understand AIDS epidemic trend in Ruili and the fact that AIDS is not far from us

(2) To understand that AIDS is caused by HIV and to know about the differences between AIDS and HIV.

(3) To understand what HIV exists in, the routes of transmission, methods for prevention, and to know that AIDS will not transmit in daily lives

(4) To understand the national policy of “Four Exemption and One Concern”, to know how to ask for assistance and service after infection so as to reduce fear towards AIDS.

(5) To build right attitude towards AIDS patients and be aware of the discrimination and actively against it from ourselves.

(6) To know about the main types of drug in Ruili, the influence of drugs on families, individuals and the society, and to discuss how to set up effective drug defense mechanism in villages.

(7) To know about the cardinal symptom and treatment of the common sexually transmitted diseases and how to choose and use condoms.

(8) To understand the relationship among drugs, sexually transmitted diseases and AIDS.

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2. Results

Through after training tests (Details of the questions can be seen in the test):

(1) Rate of correct understanding of the transmission routes of AIDS:

(2) Rate of correct understanding of the three key points:

(3) Rate of correct understanding of other knowledge:

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(4)Attitude towards AIDS patients:

(5)The most worrying problems when infected with AIDS:

29

In general, the rate of understanding all knowledge has increased in various degrees. The rate of knowing “using condoms can prevent AIDS” was increased the most, from 11.7% to 76.4%. Besides, the rate of knowing “Can it be seen from the surface whether one is infected with AIDS or not” was increased from 31.3% to 70%. Among all the trainees, 10 wives of the local people are Burmese who have never gotten Chinese education. Their questionnaires before and after training are completed with others people’s help. In the training, their understanding is relatively low. Since the village is generally good in social conduct, when discussing the reasons of using drug, the villagers could not list the reasons. But they say that they know there were many other villages using ephedrine. “When we visit people in other villages, we find many of them are using drugs.” the villagers said.

Some of the trainees commented: “Before the training, we only know there are three transmitting routes of AIDS, but now we know more details about each routes.” Some said: “We know that it must be treated in time if one gets sexually transmitted disease.” Some said: “We don’t know ephedrine is a kind of drug before the training, and we will tell the children about this.” Some said: “We now know how to use condoms.” Some said: “Training about this knowledge should be provided every 2 years. And it is a good warning to all of the people by mention it frequently.” Some said: “It doesn’t matter if one has sex with others; the key is to use condoms.”

3. Problems and Challenges

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The organization and training went on smoothly, no problems and difficulties were encountered.

4. Use of budget (Estimate according to ADB approved budget) Project Budget Appropriate money Actual cost Balance （RMB） (USD $) （ $10 （RMB） （RMB） remittance fee was deducted） Training of AIDS 11440 2085 9800 3130 knowledge

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Supplementary Appendix F: Community training report – Nangai

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention Among the Communities along the Longrui Expressway Date: October28-29, 2014 Content： HIV/AIDS Knowledge for Community People Venue: The Public House of Nangai Village No. of Participants: 74 (31 male, 43 female) Trainer Chen, Guilan Reporter： Chen Guilan

1. Objective and Content

1) To learn about the epidemic trend in Dehong Prefecture so as to realize how close HIV/AIDS is to everyone of us;

2) To learn that AIDS is caused by HIV virus and to know the difference between HIV and AIDS；

3) To learn in what body fluids HIV virus can survive, to learn about the main ways of HIV/AIDS transmission and the proper ways of prevention, as well as the fact that HIV/AIDS cannot be transmitted in normal daily life;

4) To explain the National policy of ‘four-free, one-care1’ and howtoseek for proper services after being infected with HIV/AIDS so as to reduce the fear of AIDS;

5) To have a correct attitude toward HIV/AIDS patients and realize the existence of discrimination so as to reduce or stand against such discrimination. This is the due obligation of everybody;

1 Interpreter’s explanation: ‘four-free and one-care’ refers to 1) free anti-virus treatment to those HIV/AIDS infected persons who have not joined the national medical care system and in financial difficulties; 2) free consultation and screening test for all those who would like to accept HIV/AIDS consultation and test voluntarily; 3) free maternal- child block drug and detection reagent for the HIV/AIDS infected pregnant women; 4) free schooling for the children whose parents have been infected with HIV/AIDS. ‘One care’ means that the government should take care of those HIV/AIDS-infected persons and their families who are in poverty by giving proper subsidies and to help those who can work to rely on themselves so as to eliminate the discriminations against HIV/AIDS-infected persons.

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6) What are the common drug abuses in Ruili? To learn about the negative impact of drug use upon family, individual and society and to discuss how communities can build preventing system;

7) To learn about the main symptoms of sexual transmitted diseases, proper treatment, proper buying and using condom;

8) To learn about the interrelations between drug use, sexual transmitted diseases and HIV/AIDS.

2. Training Evaluation

1) The General Situation

74 persons participate in the training, among them 31 are male and 43 are female. The youngest one is 23, and the oldest one is 73. All the participants have the ethnic identity of the Dai.

2) Pre & Post Tests

2.1) The Means of HIV/AIDS Transmission

100.0%

50.0% Total number of participants--64 (9 male, 0.0% 55 female) 培训前% pretest (%) Total number of

participants--64 (9 male, through pregnancy 55 female) 培训后% post-

needles test (%)

through blood through through sharing through Different means of HIV/AIDS The graph shows that the awareness of blood transmission is 41.8% and the rate rises to 64.8% after the training. The rate of knowing sharing needles may transmit HIV/AIDS is 41.8% before the training and the rate goes up to 67.5 after the training. 43.2% of the participants know that HIV/AIDS can be transmitted through pregnancy and this goes up to 72.0% after the training.

3.2) the Awareness of the three Key Knowledge

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90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0%

pretest (%) post-test (%)

simplyby

mosquito bite

transmisstion

Canpeople tell

Usingcondom can preventHIV/AIDS lookingat them? whohas HIV/AIDS the correct understanding of the 3 key knowledges

Before the training, 24.3% of the participants know that by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS. This rate goes up to 81% after the training. The rate of knowing mosquito bite does not transmit HIV/AIDS raises from 39.1% to 72.8% after the training；and the correct answers for using condom to prevent HIV/AIDS transmission increases from 40.5% to 82.4%.

3.3) the Awareness of the other knowledge

0.8 0.7 0.6 Content of the training 0.5 0.4

0.3 pretest (%) 0.2 post-test (%) 0.1 0 1 2 3

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS rises from 39.1% to 77.2% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS is 0% before the training and 56.7% after the training. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 0% of the participants say that it is not necessarily true, and this rate rises to 64.8% after the training.

3.4) Attitude toward HIV/AIDS-Infected Persons

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1 0.9 0.8 0.7 content of the training 0.6 0.5 0.4 pretest (%) 0.3 post-test (%) 0.2 0.1 0 1 2 3 4

37.9% of the participants say that they do not care about buying fruits from HIV/AIDS- infected persons. After the training, the rate rises up to 66.2%. 37.9% of the participants say that HIV/AIDS-infected persons should not be isolated, the rate rises up to 75.5% after the training. Before the training 0% of the participants believe that there should be no discrimination against HIV/AIDS-infected persons, and 70.2% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 70.2% and 100% relevantly.

The trainees’ words: “I knew the three means of HIV/AIDS transmission through television programs. After the training today, I realize that there are many more details to be taken care of in everyday life”, “I thought mosquito bite could transmit HIV virus, I know now that it cannot”. “People of my age have never participated in such training. I feel it fun to look at those pictures, just like teachers teach the students in television programs.” “People of my generation have never seen condom, this is the first time to see.” “It is very good that the aged people can also participate in the training. They may educate their grandchildren”.

4. Main Problems and Findings

The youngest participant is 23. Among the participants, 15 are above the age of 60. Owing to their age, most of them have difficulties in understanding Mandarin Chinese properly. So the person from local town administration has to serve as interpreter. We have to ask them to line up and do the pre & post tests.

4. The Cost of the Training (As ADB permitted)

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Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Migrant 18,897 0 15,379 3,518 Worker Training

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Supplementary. Appendix G: Community training report – Neimangguai

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention Among the Communities along the Longrui Expressway Date: November 5—6, 2014 Content： HIV/AIDS Knowledge for Community People Venue: The Public House of Neimangguai Village No. of Participants: 86 (43 male, 43female) Trainer Chen, Guilan Reporter： Chen Guilan

1. Objective and Content

1) To learn about the epidemic trend in Dehong Prefecture so as to realize how close HIV/AIDS is to everyone of us;

2) To learn that AIDS is caused by HIV virus and to know the difference between HIV and AIDS；

3) To learn in what body fluids HIV virus can survive, to learn about the main ways of HIV/AIDS transmission and the proper ways of prevention, as well as the fact that HIV/AIDS cannot be transmitted in normal daily life;

4) To explain the National policy of ‘four-free, one-care2’ and howtoseek for proper services after being infected with HIV/AIDS so as to reduce the fear of AIDS;

5) To have a correct attitude toward HIV/AIDS patients and realize the existence of discrimination so as to reduce or stand against such discrimination. This is the due obligation of everybody;

2 Interpreter’s explanation: ‘four-free and one-care’ refers to 1) free anti-virus treatment to those HIV/AIDS infected persons who have not joined the national medical care system and in financial difficulties; 2) free consultation and screening test for all those who would like to accept HIV/AIDS consultation and test voluntarily; 3) free maternal- child block drug and detection reagent for the HIV/AIDS infected pregnant women; 4) free schooling for the children whose parents have been infected with HIV/AIDS. ‘One care’ means that the government should take care of those HIV/AIDS-infected persons and their families who are in poverty by giving proper subsidies and to help those who can work to rely on themselves so as to eliminate the discriminations against HIV/AIDS-infected persons.

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6) What are the common drug abuses in Ruili? To learn about the negative impact of drug use upon family, individual and society and to discuss how communities can build preventing system;

7) To learn about the main symptoms of sexual transmitted diseases, proper treatment, proper buying and using condom;

8) To learn about the interrelations between drug use, sexual transmitted diseases and HIV/AIDS.

2. Training Evaluation

1) The General Situation

86 persons participate in the training, among them 43 are male and 43 are female. The youngest one is 20, and the oldest one is 59. Among the participants, 70 have the ethnic identity of the Dai and the other 16 are the Han.

2) Pre & Post Tests

2.1) The Means of HIV/AIDS Transmission

100.0% 90.0% 80.0% 70.0% 60.0% pretest (%) 50.0% 40.0% post-test (%) 30.0% 20.0% 10.0% 0.0% through blood through sharing through pregnancy needles Different means of HIV/AIDS transmission

The graph shows that the awareness of blood transmission is 76.7% and the rate rises to 79% after the training. The rate of knowing sharing needles may transmit HIV/AIDS is 51.1% before the training and the rate goes up to 75.5% after the training. 51.1% of the participants know that HIV/AIDS can be transmitted through pregnancy and this goes up to 72.0% after the training.

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3.2) the Awareness of the three Key Knowledge

100.0% 90.0% 80.0% 70.0% 60.0% pretest (%) 50.0% 40.0% post-test (%) 30.0% 20.0% 10.0% 0.0% Can people tell who has mosquito bite Using condom can prevent HIV/AIDS simply by HIV/AIDS transmisstion looking at them? the correct understanding of the 3 key knowledges

Before the training, 58.1% of the participants know that by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS. This rate goes up to 62.7% after the training. The rate of knowing mosquito bite does not transmit HIV/AIDS rises from 55.8% to 78.5% after the training；and the correct answers for using condom to prevent HIV/AIDS transmission increases from 22.0% to 72.0%.

3.3) the Awareness of the other knowledge

1 0.9 0.8 Content of the training 0.7 0.6 0.5 0.4 pretest (%) 0.3 post-test (%) 0.2 0.1 0 1 2 3

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS rises from 72.0% to 73.2% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS is 22.0% before the training and 61.6% after the training. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 48.8% of the participants say that it is not necessarily true, and this rate rises to 56.9% after the training.

3.4) Attitude toward HIV/AIDS-Infected Persons

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1.2

1 content of the training 0.8

0.6 pretest (%) 0.4 post-test (%) 0.2

0 1 2 3 4

52.3% of the participants say that they do not care about buying fruits from HIV/AIDS- infected persons. After the training, the rate rises up to 72.0%. 38.1% of the participants say that HIV/AIDS-infected persons should not be isolated, the rate rises up to 79.0% after the training. Before the training 33.7% of the participants believe that there should be no discrimination against HIV/AIDS-infected persons, and 68.1% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 69.0% and 82.5% relevantly.

The trainees’ words: “I knew there were 3 means of HIV/AIDS transmission, now I can relate this knowledge to my everyday life”. “The mothers who have been infected with HIV/AIDS cannot breast-breed their children.”

4. Main Problems and Findings

The training is well organized. 10 more people than expected participate in the training. Like those in the villages nearby, people in this village can understand Mandarin Chinese well, but have some difficulties in expressing properly. Owing to the age difference, most of them are embarrassed to talk about sexual activities. In the Dai traditional culture, it is not respectable to the aged persons to talk about sex in front of the aged.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Migrant 18,897 0 16,979 1,918 Worker Training

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Supplementary Appendix H: Community training report – Feihai

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention Among the Communities along the Longrui Expressway Date: October31-November 3, 2014 Content： HIV/AIDS Knowledge for Community People Venue: The Public House of Feihai Village No. of Participants: 80 (50 male, 30 female) Trainer Chen, Guilan Reporter： Chen Guilan

1. Objective and Content

1) To learn about the epidemic trend in Dehong Prefecture so as to realize how close HIV/AIDS is to everyone of us;

2) To learn that AIDS is caused by HIV virus and to know the difference between HIV and AIDS；

3) To learn in what body fluids HIV virus can survive, to learn about the main ways of HIV/AIDS transmission and the proper ways of prevention, as well as the fact that HIV/AIDS cannot be transmitted in normal daily life;

4) To explain the National policy of ‘four-free, one-care3’ and howtoseek for proper services after being infected with HIV/AIDS so as to reduce the fear of AIDS;

5) To have a correct attitude toward HIV/AIDS patients and realize the existence of discrimination so as to reduce or stand against such discrimination. This is the due obligation of everybody;

3 Interpreter’s explanation: ‘four-free and one-care’ refers to 1) free anti-virus treatment to those HIV/AIDS infected persons who have not joined the national medical care system and in financial difficulties; 2) free consultation and screening test for all those who would like to accept HIV/AIDS consultation and test voluntarily; 3) free maternal- child block drug and detection reagent for the HIV/AIDS infected pregnant women; 4) free schooling for the children whose parents have been infected with HIV/AIDS. ‘One care’ means that the government should take care of those HIV/AIDS-infected persons and their families who are in poverty by giving proper subsidies and to help those who can work to rely on themselves so as to eliminate the discriminations against HIV/AIDS-infected persons.

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6) What are the common drug abuses in Ruili? To learn about the negative impact of drug use upon family, individual and society and to discuss how communities can build preventing system;

7) To learn about the main symptoms of sexual transmitted diseases, proper treatment, proper buying and using condom;

8) To learn about the interrelations between drug use, sexual transmitted diseases and HIV/AIDS.

2. Training Evaluation

1) The General Situation

80 persons participate in the training, among them 50 are male and 30 are female. The youngest one is 21, and the oldest one is 43. All the participants have the ethnic identity of the Dai.

2) Pre & Post Tests

2.1) The Means of HIV/AIDS Transmission

100.0% 90.0% 80.0% 70.0% 60.0% 50.0% Total 40.0% number of participants-- 30.0% 20.0% 64 (9 male, 55 female) 10.0% pretest (%) 0.0% Total number of participants--

blood 64 (9 male, 55 female)

through through sharing needles

through post-test (%) pregnancy Different means of HIV/AIDS transmission

The graph shows that the awareness of blood transmission is 71.2% and the rate rises to 96.2% after the training. The rate of knowing sharing needles may transmit HIV/AIDS is 72.5% before the training and the rate goes up to 97.5 after the training. 56.2% of the participants know that HIV/AIDS can be transmitted through pregnancy and this goes up to 90.0% after the training.

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3.2) the Awareness of the three Key Knowledge

100.0%

50.0%

0.0% pretest (%) post-test (%)

whohas… prevent…

mosquito bite

Canpeople tell Using condom can the correct understanding of the

Before the training, 43.75% of the participants know that by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS. This rate goes up to 100% after the training. The rate of knowing mosquito bite does not transmit HIV/AIDS raises from 36.2% to 100% after the training；and the correct answers for using condom to prevent HIV/AIDS transmission increases from 33.7% to 95.0%.

3.3) the Awareness of the other knowledge

1

0.8 Content of the training

0.6

0.4 pretest (%) 0.2 post-test (%) 0 1 2 3 4

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS rises from 47.5% to 100% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS is 18.7% before the training and 37.4% after the training. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 12.5% of the participants say that it is not necessarily true, and this rate rises to 38.7% after the training.

3.4) Attitude toward HIV/AIDS-Infected Persons

43

1 content of the 0.8 training 0.6

0.4 pretest (%) 0.2 post-test (%) 0 1 2 3 4

26.2% of the participants say that they do not care about buying fruits from HIV/AIDS- infected persons. After the training, the rate rises up to 93.7%. 33.7% of the participants say that HIV/AIDS-infected persons should not be isolated, the rate rises up to 100% after the training. Before the training 55.0% of the participants believe that there should be no discrimination against HIV/AIDS-infected persons, and 25% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 100% and 100% relevantly.

The trainees’ words: “I know the harm of sexual-transmitted diseases now”, “I was not sure whether HIV/AIDS could be transmitted by eating with HIV/AIDS-infected persons. Now I get the knowledge”. “I know now that it is the best to use one condom each time.” “It is very important to know the details of HIV/AIDS knowledge.”

4. Main Problems and Findings

All the participants are between the age of 21—43, they all participate fully in the training.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Migrant 18,897 0 16,779 3,118 Worker Training

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Supplementary Appendix I: Community training report – Chudongguai Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention Among the Communities along the Longrui Expressway Date: November 10—11, 2014 Content： HIV/AIDS Knowledge for Community People Venue: The Village Committee of Chudonggua Village No. of Participants: 69 (35 male, 34 female) Trainer Chen, Guilan Reporter： Chen Guilan

1. Objective and Content

1) To learn about the epidemic trend in Dehong Prefecture so as to realize how close HIV/AIDS is to everyone of us;

2) To learn that AIDS is caused by HIV virus and to know the difference between HIV and AIDS；

3) To learn in what body fluids HIV virus can survive, to learn about the main ways of HIV/AIDS transmission and the proper ways of prevention, as well as the fact that HIV/AIDS cannot be transmitted in normal daily life;

4) To explain the National policy of ‘four-free, one-care4’ and howtoseek for proper services after being infected with HIV/AIDS so as to reduce the fear of AIDS;

5) To have a correct attitude toward HIV/AIDS patients and realize the existence of discrimination so as to reduce or stand against such discrimination. This is the due obligation of everybody;

4 Interpreter’s explanation: ‘four-free and one-care’ refers to 1) free anti-virus treatment to those HIV/AIDS infected persons who have not joined the national medical care system and in financial difficulties; 2) free consultation and screening test for all those who would like to accept HIV/AIDS consultation and test voluntarily; 3) free maternal- child block drug and detection reagent for the HIV/AIDS infected pregnant women; 4) free schooling for the children whose parents have been infected with HIV/AIDS. ‘One care’ means that the government should take care of those HIV/AIDS-infected persons and their families who are in poverty by giving proper subsidies and to help those who can work to rely on themselves so as to eliminate the discriminations against HIV/AIDS-infected persons.

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6) What are the common drug abuses in Ruili? To learn about the negative impact of drug use upon family, individual and society and to discuss how communities can build preventing system;

7) To learn about the main symptoms of sexual transmitted diseases, proper treatment, proper buying and using condom;

8) To learn about the interrelations between drug use, sexual transmitted diseases and HIV/AIDS.

2. Training Evaluation

1) The General Situation

69 persons participate in the training, among them 35 are male and 34 are female. The youngest one is 19, and 6 of the participants are over 60. All the participants have the ethnic identity of the De’ang.

2) Pre & Post Tests

2.1) The Means of HIV/AIDS Transmission

100.0% 90.0% 80.0% 70.0% 60.0% pretest (%) 50.0% 40.0% post-test (%) 30.0% 20.0% 10.0% 0.0% through blood through sharing through pregnancy needles Different means of HIV/AIDS transmission

The graph shows that the awareness of blood transmission is 50.7% and the rate rises to 88.4% after the training. The rate of knowing sharing needles may transmit HIV/AIDS is 49.2% before the training and the rate goes up to 92.7% after the training. 30.4% of the participants know that HIV/AIDS can be transmitted through pregnancy and this goes up to 72.4% after the training.

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3.2) the Awareness of the three Key Knowledge

90.0% 80.0% 70.0% 60.0% 50.0% pretest (%) 40.0% post-test (%) 30.0% 20.0% 10.0% 0.0% Can people tell who mosquito bite Using condom can has HIV/AIDS simply prevent HIV/AIDS by looking at them? transmisstion the correct understanding of the 3 key knowledges

Before the training, 56.5% of the participants know that by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS. This rate goes up to 85.1% after the training. The rate of knowing mosquito bite does not transmit HIV/AIDS rises from 34.7% to 100% after the training；and the correct answers for using condom to prevent HIV/AIDS transmission increases from 50.7% to 82.6%.

3.3) the Awareness of the other knowledge

1.2

1 Content of the training 0.8

0.6

0.4 pretest (%) post-test (%) 0.2

0 1 2 3

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS rises from 53.6% to 100% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS is 58% before the training and 86% after the training. In terms of the

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question “only the morally bad person can be infected with HIV/AIDS”, 30.4% of the participants say that it is not necessarily true, and this rate rises to 75.3% after the training.

3.4) Attitude toward HIV/AIDS-Infected Persons

1.2

1 content of the training 0.8

0.6

0.4 pretest (%) post-test (%) 0.2

0 1 2 3 4 5 6 7 8

46.3% of the participants say that they do not care about buying fruits from HIV/AIDS- infected persons. After the training, the rate rises up to 100%. 49.2% of the participants say that HIV/AIDS-infected persons should not be isolated, the rate rises up to 82.6% after the training. Before the training 34.7% of the participants believe that there should be no discrimination against HIV/AIDS-infected persons, and 85.0% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 72.4% and 100% relevantly.

The trainees’ words: “I know now that condom can help prevent HIV/AIDs”, “I know the details about HIV/AIDS transmission in everyday life”.

4. Main Problems and Findings

The previous survey shows that Chudonggua village No. 4 has a total population of 144. So it is decided that about 70 people should be trained. But quite a number of the villagers are working in cities, and some of them are still kids. Thus we try to mobilize the aged people to participate in the training. Among the participants, the youngest is 19, and the oldest is 80. During the pre & post test, 21 participants can read the questionnaire, the others are illiterate. So we have to line them up and do the tests through interpreter.

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4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Migrant 18,897 0 17,139 1,758 Worker Training

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Supplementary Appendix J: Community training report – Nansan

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention along the Longrui Expressway Date: August 2—3, 2014 Content： HIV/AIDS Knowledge for Community People Venue: The Public House of Nansan Village No of Participants: 64（Male 9，Female 55） Trainer Chen Guilan Reporter： Chen Guilan 1. Objective and Content

1) To learn about the epidemic trend in Ruili so as to realize how close HIV/AIDS is to everyone of us;

2) To learn that AIDS is caused by HIV virus and to know the difference between HIV and AIDS；

3) To learn in what body fluids HIV virus can survive, to learn about the main ways of HIV/AIDS transmission and the proper ways of prevention, as well as the fact that HIV/AIDS cannot be transmitted in normal daily life;

4) To explain the National policy of ‘four-free, one-care5’ and how to seek for proper services after being infected with HIV/AIDS so as to reduce the fear of AIDS;

5) To have a correct attitude toward HIV/AIDS patients and realize the existence of discrimination so as to reduce or stand against such discrimination. This is the due obligation of everybody;

6) What are the common drug abuses in Ruili? To learn about the negative impact of drug use upon family, individual and society and to discuss how communities can build preventing system;

5 Interpreter’s explanation: ‘four-free and one-care’ refers to 1) free anti-virus treatment to those HIV/AIDS infected persons who have not joined the national medical care system and in financial difficulties; 2) free consultation and screening test for all those who would like to accept HIV/AIDS consultation and test voluntarily; 3) free maternal- child block drug and detection reagent for the HIV/AIDS infected pregnant women; 3) free schooling for the children whose parents have been infected with HIV/AIDS

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7) To learn about the main symptoms of sexual transmitted diseases, proper treatment, proper buying and using condom;

8) To learn about the interrelations between drug use, sexual transmitted diseases and HIV/AIDS.

2. Training Evaluation

A comparison between Pre and Post Tests (see details in Pretest and Posttest)：

2、 Correct Understanding of HIV/AIDS Transmission：

图表标题

120.0% 100.0% 80.0% 60.0%

40.0% 坐标轴标题 20.0% 0.0% through sharing through unsafe through through breast- through blood needles behavior pregnancy feed baby 血液传播 共用注射器 不安全性行为 怀孕 喂奶 Different means of HIV/AIDS transmission 艾滋病的传播途径 培训前% pretest (%) 96.9% 100.0% 96.9% 76.5% 89.0% 培训后% post-test (%) 98.4% 100.0% 98.4% 96.9% 96.9%

2、Correct Understanding of the 3 Key Knowledge Questions

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图表标题

120.0%

100.0%

80.0%

60.0% 坐标轴标题

40.0%

20.0%

0.0% Can people tell who has HIV/AIDS simply Using condom can prevent HIV/AIDS mosquito bite by looking at them? transmission 从表面是否能看出是否感染了艾滋病 蚊虫叮咬 坚持使用安全套可以预防艾滋病 the correct understanding of the 3 key knowledges 3个关键知识的正确认识率 培训前% pretest (%) 73.4% 90.6% 73.4% 培训后% post-test (%) 93.7% 96.4% 93.7%

3、 Correct Understanding of Other Knowledges

图表标题

120.0%

100.0%

80.0%

60.0% 坐标轴标题

40.0%

20.0%

0.0% by washing genital after sex, by shaking hands with HIV- can be infected by eating with HIV/AIDS can be cured one can avoid being infected infected or AIDS patients, one HIV/AIDS can be prevented HIV/AIDS infected persons nowadays with HIV will not be infected 性交后清洗下身就不会感染上 与艾滋病病人或感染者握手不 一起吃饭会感染 目前可以治愈 可以预防 HIV 会感染HIV Proper understanding of other knowledge 其他知识的正确认识 培训前% pretest (%) 90.6% 71.8% 93.7% 59.3% 95.3% 培训后% post-test (%) 96.8% 82.8% 93.7% 90.6% 98.4%

4、The attitude toward HIV/AIDS patient

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图表标题

45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0%

坐标轴标题 10.0% 5.0% 0.0% avoid look down disgusting contacting hate sympathy consolation help ignore not sure others upon with him 看不起 厌恶 避免和他接触 憎恨 同情 安慰 帮助 无所谓 不知道 其他 attitude toward HIV/AIDS patient 对待艾滋病人的态度 培训前% pretest (%) 0.0% 0.0% 4.6% 0.0% 34.3% 25.0% 20.3% 4.6% 1.5% 0.0% 培训后% post-test (%) 1.6% 3.1% 0.0% 1.6% 42.1% 26.5% 23.4% 0.0% 0.0% 0.0%

5、What is the most worried about after being infected with HIV/AIDS?

图表标题

90.0% 80.0% 70.0% 60.0% 50.0% 40.0%

30.0% 坐标轴标题 20.0% 10.0% 0.0% be known by be looked down bring troubles to cost for medical suffer from the it does not lose job life is short not sure others upon the family treatment sick matter 被人知道 被人看不起 失去工作 拖累家人 花钱治病 受病痛折磨 生命短暂 无所谓 不知道 What is the most worried about after being infected with HIV/AIDS? 感染艾滋病后最担心的问题 培训前% pretest (%) 78.0% 23.4% 3.0% 17.0% 17.0% 6.2% 23.4% 4.6% 3.0% 培训后% posttest (%) 21.8% 31.2% 14.0% 18.7% 15.6% 12.5% 26.5% 6.2% 7.8%

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Of the 5 selected communities for this TA in Ruili, Nansan is the only village of De’ang ethnic identity. Almost half of the married women in the village are from Myanmar. Ruili Health Bureau, as a member of ‘Working Team of Anti-Drug and AIDS Prevention, is working regularly in Nansan Village so that the villagers had had some HIV/AIDS trainings before this TA. The result of the pre and post tests show that people in this village have similar understanding of HIV/AIDS as those in other villages. But one factor has to take into account, most of the Burmese women do not understand Chinese language properly so that their pre and post tests are completed with the help from trainers or some educated women in the village. This does not absolutely exclude the possibility of ‘being guided’ to some degree.

Among the 55 participants, only 9 are men. The main reason is that the information was delivered by the head of Women in the village, thus those who come to the training are mostly women (the villagers think when the head of women is calling for a meeting, it must have something to do with women only)

The trainee’s comments:

‘We already know that there are three ways which can transmit HIV/AIDS, through this training we learn in more details about the transmission’, ‘Nobody has ever explain to us HIV/AIDS in such details as you are doing today’, ‘After this training, we have a more detailed knowledge about HIV/AIDS and know how to take care of what we are doing in daily life’, ‘In terms of condom, every woman should try to persuade her husband to use condom because this is the safest way’, ‘There have been a lot of propaganda about HIV/AIS in the village. But most of the previous ones just taught us lessons. You are different, your attitude is great and makes us feel at home’, ‘Women’s sexual infected diseases are brought home by men, they should come to the training’.

3. Problems and Challenges

The paddy field in this village has all been expropriated. All the villagers are busy planting trees on mountains in July and August which are the best season. Before this training, the trainer had contacted the village leader several times without any progress. Later, the trainer contacted the township government which coordinate the village leader. Finally in mid July, the village leader agreed to have the training. When the trainer got the village as agreed, however, the villagers all went to the mountain to plant trees. The training had to be cancelled. After several contacts again, the village leader, on July 31, finally agreed to have the training.

4. Expenses (according to the permission from ADB)

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Item Budget Appropriation($) Actual Balance （RMB） expense （RMB） （RMB） HIV/AIDS 11440 11440 9800 1640 Knowledge Taining

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Supplementary Appendix K: Community training report – Gazhong

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention Among the Communities along the Longrui Expressway Date: November 13—14, 2014 Content： HIV/AIDS Knowledge for Community People Venue: The Public House of Gazhong Village No. of Participants: 74 (41 male, 33 female) Trainer Chen, Guilan Reporter： Chen Guilan

1. Objective and Content

1) To learn about the epidemic trend in Dehong Prefecture so as to realize how close HIV/AIDS is to everyone of us;

2) To learn that AIDS is caused by HIV virus and to know the difference between HIV and AIDS；

3) To learn in what body fluids HIV virus can survive, to learn about the main ways of HIV/AIDS transmission and the proper ways of prevention, as well as the fact that HIV/AIDS cannot be transmitted in normal daily life;

4) To explain the National policy of ‘four-free, one-care6’ and how to seek for proper services after being infected with HIV/AIDS so as to reduce the fear of AIDS;

5) To have a correct attitude toward HIV/AIDS patients and realize the existence of discrimination so as to reduce or stand against such discrimination. This is the due obligation of everybody;

6 Interpreter’s explanation: ‘four-free and one-care’ refers to 1) free anti-virus treatment to those HIV/AIDS infected persons who have not joined the national medical care system and in financial difficulties; 2) free consultation and screening test for all those who would like to accept HIV/AIDS consultation and test voluntarily; 3) free maternal- child block drug and detection reagent for the HIV/AIDS infected pregnant women; 4) free schooling for the children whose parents have been infected with HIV/AIDS. ‘One care’ means that the government should take care of those HIV/AIDS-infected persons and their families who are in poverty by giving proper subsidies and to help those who can work to rely on themselves so as to eliminate the discriminations against HIV/AIDS-infected persons.

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6) What are the common drug abuses in Ruili? To learn about the negative impact of drug use upon family, individual and society and to discuss how communities can build preventing system;

7) To learn about the main symptoms of sexual transmitted diseases, proper treatment, proper buying and using condom;

8) To learn about the interrelations between drug use, sexual transmitted diseases and HIV/AIDS.

2. Training Evaluation

1) The General Situation

74 persons participate in the training, among them 41 are male and 33 are female. The youngest one is 25, and the oldest one is 50. Among the participants, 70 have the ethnic identity of the Dai, 2 are from the Han and 2 are from the Jingpo.

2) Pre & Post Tests

2.1) The Means of HIV/AIDS Transmission

100.0% 90.0% 80.0% 70.0% 60.0% pretest (%) 50.0% 40.0% post-test (%) 30.0% 20.0% 10.0% 0.0% through blood through sharing through pregnancy needles Different means of HIV/AIDS transmission

The graph shows that the awareness of blood transmission is 79.7% and the rate rises to 86.4% after the training. The rate of knowing sharing needles may transmit HIV/AIDS is 81.0% before the training and the rate goes up to 90.5% after the training. 56.7% of the participants know that HIV/AIDS can be transmitted through pregnancy and this goes up to 83.9% after the training.

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3.2) the Awareness of the three Key Knowledge

100.0% 90.0% 80.0% 70.0% 60.0% pretest (%) 50.0% 40.0% post-test (%) 30.0% 20.0% 10.0% 0.0% Can people tell who has mosquito bite Using condom can prevent HIV/AIDS simply by HIV/AIDS transmisstion looking at them? the correct understanding of the 3 key knowledges

Before the training, 52.7% of the participants know that by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS. This rate goes up to 94.5% after the training. The rate of knowing mosquito bite does not transmit HIV/AIDS rises from 45.9% to 91.0% after the training；and the correct answers for using condom to prevent HIV/AIDS transmission increases from 44.6% to 86.4%.

3.3) the Awareness of the other knowledge

1 0.9 0.8 Content of the training 0.7 0.6 0.5 0.4 pretest (%) 0.3 post-test (%) 0.2 0.1 0 1 2 3

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS rises from 60.0% to 87.8% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS is 27.0% before the training and 43.2% after the training. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 35.1% of the participants say that it is not necessarily true, and this rate rises to 46.8% after the training.

3.4) Attitude toward HIV/AIDS-Infected Persons

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1.2

1 content of the training 0.8

0.6 pretest (%) 0.4 post-test (%) 0.2

0 1 2 3 4

51.3% of the participants say that they do not care about buying fruits from HIV/AIDS- infected persons. After the training, the rate rises up to 94.5%. 44.5% of the participants say that HIV/AIDS-infected persons should not be isolated, the rate rises up to 100% after the training. Before the training 45.9% of the participants believe that there should be no discrimination against HIV/AIDS-infected persons, and 56.7% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 75.6% and 87.3% relevantly.

The trainees’ words: “I did not know that HIV/AIDS can be transmitted through breast- feeding”, “I just knew that condom can prevent pregnancy, I know today that it can help prevent HIV/AIDS (head of women association in Gazhong) ”. “I thought only morally-bad persons could be infected with HIV/AIDS, I know now that it is related to everybody”

4. Main Problems and Findings

The training is implemented with the coordination of village committee, so people from Gazhong, Nanbeng, Guangla and Palian villages come to participate in the training. Among the participants, 20 are married-in women from Myanmar. They do not know Mandarin Chinese so that they have to finish the pre & post tests with help from others.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Migrant 18,897 0 17,097 1,818 Worker Training

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Supplementary Appendix L: Community youth training report – Dengxiu

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention along the Longrui Expressway Date: August 19—20, 2014 Content： Community Youth Training Venue: Meeting Room of Dengxiu Village No. of Participants: Participants (49 persons on August 19, and 41 on August 20) Trainer Chen Guilan Reporter： Chen Guilan

1. Objective and Content 1) To help the youth to understand properly their own physical and psychological nature, to enhance the capacity of self-awareness, recognizing and accepting their own selves. To help them understand that nobody in this world is perfect in every way, one has to identify his (her) own advantages so as to develop an optimistic, perfect and happy personality. 2) To learn to listen to others and to be good at expressing the self properly. To improve the capacity of communicating with others and to learn to be friendly toward others with a refrained attitude, to handle various problems or conflicts that occur in the communications, with generosity, equity and respect. 3) To learn about the emotion and to enhance the capacity of releasing the emotional pressure. 4) To learn how to reject the pressure from the peers. 5) To know the main types of drugs currently in common use in Ruili region. To analyze the reason of drug abuse among the young people and learn to reject effectively the pressures from the peers. To know about the common sexually transmitted diseases and where to go when being infected with. 6) To learn about the HIV/AIDS status, transmission, prevention and treatment in Ruili. To know about the national policy of “four-free & one-care7”, get to know where to seek for services, to understand the interrelations between STD, HIV/AIDS and drugs. 7) To select peer educators

2. Training Evaluation

1) The General Situation

7 Interpreter’s explanation: ‘four-free and one-care’ refers to 1) free anti-virus treatment to those HIV/AIDS infected persons who have not joined the national medical care system and in financial difficulties; 2) free consultation and screening test for all those who would like to accept HIV/AIDS consultation and test voluntarily; 3) free maternal- child block drug and detection reagent for the HIV/AIDS infected pregnant women; 4) free schooling for the children whose parents have been infected with HIV/AIDS. ‘One care’ means that the government should take care of those HIV/AIDS-infected persons and their families who are in poverty by giving proper subsidies and to help those who can work to rely on themselves so as to eliminate the discriminations against HIV/AIDS-infected persons.

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This training is carried out in cooperation with the Youth League so that it is easier to organize. 49 participants (34 male, 15 female) from 4 villages come to the training on August 19, and 41 (23 male and 18 female) come to the training on August 20. The youngest is 13 years old and the oldest is 29. Since the age gap is big, what they care for is different so that the trainer has to make some temporary adjustment in content.

At the beginning of the training, it is announced that 6 peer educators will be chosen at the end of the training. The relevant responsibilities of peer educators are also explained. After the training 6 peer educators (3 male and 3 female) are selected.

2) Pre & Post Tests

2.1) The Means of HIV/AIDS Transmission

图表标题

60

50

40

30 坐标轴标题 20

10

0 1 2 3 4 血液传播 through blood 48 98.0% 41 100.0% 共用注射器 through sharing 48 98.0% 41 100.0% needles 母婴传播 through pregnancy 35 71.0% 34 82.9%

The graph shows that the awareness of blood transmission and sharing needles reached 98%. 71% of the participants know that HIV/AIDS can be transmitted through pregnancy and this goes up to 82% after the training.

2.2) the Awareness of the three Key Knowledge

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图表标题

40

35

30

25

20 坐标轴标题 15

10

5

0 1 2 3 4 从外表能判断谁是艾滋病人 Can people tell 31 63.2% 31 75.0% who has HIV/AIDS simply by looking at them? 蚊虫叮咬 mosquito bite 26 53.0% 37 90.2% 正确使用安全套可以预防艾滋病 Using 31 63.2% 34 82.9% condom can prevent HIV/AIDS transmisstion

Before the training, 63% of the participants know that by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS. This rate goes up to 75% after the training. The rate of knowing mosquito bite do not transmit HIV/AIDS raises from 53% to 90.2% after the training；and the correct answers for using condom to prevent HIV/AIDS transmission increases from 63.2% to 82.9%.

2.3) the Other knowledge

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图表标题

45

40

35

30

25

20 坐标轴标题 15

10

5

0 1 2 3 4 一起吃饭会感染HIV can be infected by 33 67.3% 39 95.1% eating with HIV/AIDS infected persons 任何人都可能感染HIV anybody can be 25 51.0% 29 70.7% infected with HIV 道德败坏的人才会得艾滋病 only the morally bad person can be infected with 32 65.3% 36 87.8% HIV

2.4) Attitude Toward HIV/AIDS-Infected Persons

图表标题

40

35

30

25

20

坐标轴标题 15

10

5

0 1 2 3 4 愿意从艾滋病人买水果和蔬菜 willing to buy fruits and vegetables from HIV/AIDS- 27 55.0% 37 90.2% infected persons 应该将HIV/AIDS 隔离 should 25 51.0% 35 85.3% separateHIV/AIDS-infected persons 限制HIV/AIDS就业和提拔 should limit the employment or promotion of the 20 40.8% 30 73.1% HIV/AIDS-infected persons 拒绝艾滋病人子女上学 should reject the children of HIV/AIDS-infected persons at 37 75.5% 34 82.9% school

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The training participants’ words: “The training helps me understand my own body (sexual organ and its functions)”, “I have learned how to reject some bad suggestions from the peers (peer pressure)”, “I am still young, if boy friend asks me to have sex in the future, I know how to communicate with him or refuse”, “Before the decision, we have to think of the consequence more carefully”, “I was fed up with my parents’ words, now I understand them better”, “I have known the interrelations between STD, HIV/AIDS and drug use”, “HIV/AIDS is related to everybody, including myself”.

3. Main Problems and Discoveries

All the participants claim that they have learned about HIV/AIDS at schools. The pretest shows however that it is true most of the people know that blood and sharing needles can transmit HIV/AIDS, but the rest of the test do not get the expected answers. The participants are not very clear about the knowledge quite possibly owns to their lower level of understanding Han Chinese. In the future training, the trainer may read the pre & post tests aloud to all the participants so that they fully understand the meaning of each test and make the choice. By doing in this way, the result may be different.

4. The Cost of the Training(As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Community 11,580 - 11,580 0 Youth Training

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Supplementary Appendix M: Community youth training report – Gazhong

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention along the Longrui Expressway Date: November 17—18, 2014 Content： Community Youth Training Venue: Meeting Room of Gazhong Village No. of Participants: 41 Participants Trainer Chen Guilan Reporter： Chen Guilan

1. Objective and Content 1) To help the youth to understand properly their own physical and psychological nature, to enhance the capacity of self-awareness, recognizing and accepting their own selves. To help them understand that nobody in this world is perfect in every way, one has to identify his (her) own advantages so as to develop an optimistic, perfect and happy personality. 2) To learn to listen to others and to be good at expressing the self properly. To improve the capacity of communicating with others and to learn to be friendly toward others with a refrained attitude, to handle various problems or conflicts that occur in the communications, with generosity, equity and respect. 3) To learn about the emotion and to enhance the capacity of releasing the emotional pressure. 4) To learn how to reject the pressure from the peers. 5) To know the main types of drugs currently in common use in Ruili region. To analyze the reason of drug abuse among the young people and learn to reject effectively the pressures from the peers. To know about the common sexually transmitted diseases and where to go when being infected with. 6) To learn about the HIV/AIDS status, transmission, prevention and treatment in Ruili. To know about the national policy of “four-free & one-care8”, get to know where to seek for services, to understand the interrelations between STD, HIV/AIDS and drugs. 7) To select peer educators

2. Training Evaluation

1) The General Information

8 Interpreter’s explanation: ‘four-free and one-care’ refers to 1) free anti-virus treatment to those HIV/AIDS infected persons who have not joined the national medical care system and in financial difficulties; 2) free consultation and screening test for all those who would like to accept HIV/AIDS consultation and test voluntarily; 3) free maternal- child block drug and detection reagent for the HIV/AIDS infected pregnant women; 4) free schooling for the children whose parents have been infected with HIV/AIDS. ‘One care’ means that the government should take care of those HIV/AIDS-infected persons and their families who are in poverty by giving proper subsidies and to help those who can work to rely on themselves so as to eliminate the discriminations against HIV/AIDS-infected persons.

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2) Pre & Post Tests

Just like the community training in Gazhong village, the training is organized with the coordination of the village committee so that the participants are from Gazhong, Nanbeng, Guangla and Palian villages. All of them are between the age of 19—25. The person from the village committee think that most of the young ladies in the villages go to work in cities so that the young men in the villages have to find wives from Myanmar. In general, the Burmese women know little about HIV/AIDS. So among the 41 participants, 15 are Burmese. The head of women from Guangla Village (at the age of 41), a Burmese woman, stays with the training from the very beginning to the end.

2.1) The Means of HIV/AIDS Transmission

100.0% 90.0% 80.0% 70.0% 60.0% pretest (%) 50.0% 40.0% post-test (%) 30.0% 20.0% 10.0% 0.0% through blood through sharing through needles pregnancy Different means of HIV/AIDS transmission

The graph shows that the awareness of blood transmission is 90.0% before the training and this rate goes up to 92.8% after the training. The awareness of sharing needles may transmit HIV/AIDS rises from 78% before the training to 80.9% after the training.58.5% of the participants know that HIV/AIDS can be transmitted through pregnancy and this goes up to 66.6% after the training.

2.2) the Awareness of the three Key Knowledge

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90.0% 80.0% 70.0% 60.0% 50.0% pretest (%) 40.0% post-test (%) 30.0% 20.0% 10.0% 0.0% Can people tell who has mosquito bite Using condom can prevent HIV/AIDS simply by HIV/AIDS transmisstion looking at them? the correct understanding of the 3 key knowledges

Before the training, 80.4% of the participants know that by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS. This rate goes up to 80.9% after the training. The rate of knowing mosquito bite does not transmit HIV/AIDS rises from 73% to 85.7% after the training；and the correct answers for using condom to prevent HIV/AIDS transmission increases from 59.5% to 61.9%.

2.3) the Other knowledge

0.9 0.8 0.7 Content of the training 0.6 0.5 0.4 0.3 pretest (%) 0.2 post-test (%) 0.1 0 1 2 3

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS raises from 80.9% to 85.7% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS rises from 26.1% to 57.9%. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 45.2% of the participants say that it is not necessarily true, and this rate rises to 59.5% after the training.

2.4) Attitude toward HIV/AIDS-Infected Persons

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69% of the participants say that they do not care about buying fruits from HIV/AIDS-infected persons. After the training, the rate rises up to 76.1%. 29% of the participants say that HIV/AIDS-infected persons should not be isolated, the rate rise up to 82.9% after the training. Before the training 28.6% of the participants believe that there should be no discrimination against HIV/AIDS-infected persons, and 69% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 59.5% and 73.8% relevantly.

The training participants’ words: “I never had the chance to participate in the training when in Myanmar. I know today that mother can transmit HIV to her baby”; “I get to know the HIV/AIDS is anything unique here, it is a problem of the world”. “It is very difficult to reject the peer pressure. But I get to know some approaches today, I will try in the future”.

3. Main Problems and Findings

The improvement of the knowledge awareness is the lowest among all the previous trainings. Through talking to the participants, the trainer learns that most of the participants have got education for 4—6 years, few of them have got into junior middle school (8 years’ education). Owing to this lower educational background, they have some difficulties to understand the questionnaire properly. Those Burmese women can participate in the group discussion actively and they can understand Mandarin Chinese. But they cannot write in Chinese so that they need help to finish their pre & post tests.

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4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Community 19,582 - 16,847 1,968 Youth Training

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Supplementary Appendix N: Community youth training report – Huyu

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention along the Longrui Expressway Date: September 2—3, 2014 Content： Community Youth Training Venue: Meeting Room of Yinshan Village （Huyu） No. of Participants: Participants (47 persons on September 2, and 42 on September 3) Trainer Chen Guilan Reporter： Chen Guilan

1. Objective and Content 1) To help the youth to understand properly their own physical and psychological nature, to enhance the capacity of self-awareness, recognizing and accepting their own selves. To help them understand that nobody in this world is perfect in every way, one has to identify his (her) own advantages so as to develop an optimistic, perfect and happy personality. 2) To learn to listen to others and to be good at expressing the self properly. To improve the capacity of communicating with others and to learn to be friendly toward others with a refrained attitude, to handle various problems or conflicts that occur in the communications, with generosity, equity and respect. 3) To learn about the emotion and to enhance the capacity of releasing the emotional pressure. 4) To learn how to reject the pressure from the peers. 5) To know the main types of drugs currently in common use in Ruili region. To analyze the reason of drug abuse among the young people and learn to reject effectively the pressures from the peers. To know about the common sexually transmitted diseases and where to go when being infected with. 6) To learn about the HIV/AIDS status, transmission, prevention and treatment in Ruili. To know about the national policy of “four-free & one-care9”, get to know where to seek for services, to understand the interrelations between STD, HIV/AIDS and drugs. 7) To select peer educators

2. Training Evaluation

1) The General Situation

9 Interpreter’s explanation: ‘four-free and one-care’ refers to 1) free anti-virus treatment to those HIV/AIDS infected persons who have not joined the national medical care system and in financial difficulties; 2) free consultation and screening test for all those who would like to accept HIV/AIDS consultation and test voluntarily; 3) free maternal- child block drug and detection reagent for the HIV/AIDS infected pregnant women; 4) free schooling for the children whose parents have been infected with HIV/AIDS. ‘One care’ means that the government should take care of those HIV/AIDS-infected persons and their families who are in poverty by giving proper subsidies and to help those who can work to rely on themselves so as to eliminate the discriminations against HIV/AIDS-infected persons.

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47 participants (34 male, 13 female) from 12 villages come to the training on September 2, and 42 (25 male and 17 female) come to the training on September 3. The youngest is 17 years old and the oldest is 32. Among them, the majority are Jingpo people with a few Han and De’ang people by ethnic identity.

At the beginning of the training, it is announced that 6 peer educators will be chosen at the end of the training. The relevant responsibilities of peer educators are also explained. After the training 6 peer educators (4 male and 2 female) are selected.

2) Pre & Post Tests

2.1) The Means of HIV/AIDS Transmission

120.0% 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% 血液传播 共用注射器 母婴传播 培训前% Different means of HIV/AIDS transmission 培训后% 艾滋病的传播途径

The graph shows that the awareness of blood transmission and sharing needles is 100% before the training. 78.7% of the participants know that HIV/AIDS can be transmitted through pregnancy and this goes up to 90.4% after the training.

2.2) the Awareness of the three Key Knowledge

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100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0%

0.0%

蚊虫叮咬

病

从外表能判断谁是艾滋病人 正确使用安全套可以预防艾滋 the correct understanding of the 3 key knowledges

3个关键知识的正确认识率 培训前% 培训后%

Before the training, 72.4% of the participants know that by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS. This rate goes up to 92.8% after the training. The rate of knowing mosquito bite do not transmit HIV/AIDS raises from 38.8% to 92.8% after the training；and the correct answers for using condom to prevent HIV/AIDS transmission increases from 74.7% to 78.5%.

2.3) the Other knowledge

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100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0%

培训前%

培训后%

一起吃饭会感染

任何人都可能感染艾滋病 只有道德败坏的人才会的艾滋病 其他知识的正确认识

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS raises from 82.9% to 100% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS rises from 38.2% to 73.8%. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 82.9% of the participants say that it is not necessarily true, and this rate rises to 83.3% after the training.

2.4) Attitude Toward HIV/AIDS-Infected Persons

120.0% 100.0% 80.0% 60.0% 40.0% 20.0%

0.0%

隔离

女上学

业和提拔

买水果和蔬菜

愿意从艾滋病人 应该将HIV/AIDS 限制HIV/AIDS就 拒绝艾滋病人子 attitude toward HIV/AIDS patient 对待艾滋病人的态度 培训前% 培训后%

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82.9% of the participants say that they do not care about buying fruits from HIV/AIDS- infected persons. After the training, the rate rises up to 100%. 76.5% of the participants say that HIV/AIDS-infected persons should not be isolated, the rate rise up to 95.2% after the training. Before the training 59.5% of the participants believe that there should be no discrimination against HIV/AIDS-infected persons, and 89.3% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 78.5% and 97.6% relevantly.

The training participants’ words: “I did not know that HIV/AIDS could be transmitted through pregnancy, now I know it”; “I will tell the other friends in the village about what I have learned here”. “The social morality is going worse, we are the model of the young people in the village, we should take our due obligations to promote social justice”.

3. Main Problems and Findings

The change in the participants’ knowledge about the connection of HIV/AIDS transmission with “mosquito bite” and “anybody can be infected with HIV/AIDS” is dramatic after the training (from 38.8% to 92.8%, and 38.2% to 73.8%).

The 12 villages are scattered so that some of the participants were late for taking group picture. And after the training, it was forgotten to take the group picture again so that some participants are not in the group picture.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Community 11,580 - 11,580 0 Youth Training

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Supplementary Appendix O: Community youth training report – Nansan

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention along the Longrui Expressway Date: September 23—24, 2014 Content： Community Youth Training Venue: Meeting Room of Mengxiu Town （ Nansan is under the administration of Mengxiu Town）） No. of Participants: 42 Participants on September 23, and 43 on September 24 Trainer Chen Guilan Reporter： Chen Guilan

1. Objective and Content 1) To help the youth to understand properly their own physical and psychological nature, to enhance the capacity of self-awareness, recognizing and accepting their own selves. To help them understand that nobody in this world is perfect in every way, one has to identify his (her) own advantages so as to develop an optimistic, perfect and happy personality. 2) To learn to listen to others and to be good at expressing the self properly. To improve the capacity of communicating with others and to learn to be friendly toward others with a refrained attitude, to handle various problems or conflicts that occur in the communications, with generosity, equity and respect. 3) To learn about the emotion and to enhance the capacity of releasing the emotional pressure. 4) To learn how to reject the pressure from the peers. 5) To know the main types of drugs currently in common use in Ruili region. To analyze the reason of drug abuse among the young people and learn to reject effectively the pressures from the peers. To know about the common sexually transmitted diseases and where to go when being infected with. 6) To learn about the HIV/AIDS status, transmission, prevention and treatment in Ruili. To know about the national policy of “four-free & one-care10”, get to know where to seek for services, to understand the interrelations between STD, HIV/AIDS and drugs. 7) To select peer educators

2. Training Evaluation

10 Interpreter’s explanation: ‘four-free and one-care’ refers to 1) free anti-virus treatment to those HIV/AIDS infected persons who have not joined the national medical care system and in financial difficulties; 2) free consultation and screening test for all those who would like to accept HIV/AIDS consultation and test voluntarily; 3) free maternal- child block drug and detection reagent for the HIV/AIDS infected pregnant women; 4) free schooling for the children whose parents have been infected with HIV/AIDS. ‘One care’ means that the government should take care of those HIV/AIDS-infected persons and their families who are in poverty by giving proper subsidies and to help those who can work to rely on themselves so as to eliminate the discriminations against HIV/AIDS-infected persons.

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1) The General Information

42 participants (25 male, 17 female) from 8 villages come to the training on September 23, and 43 (24 male and 19 female) come to the training on September 24. The youngest is 19 years old and the oldest is 35. Most of the participants are from the four ethnic minority groups (the Jingpo, De’ang, Lisu and Han).

At the beginning of the training, it is announced that 6 peer educators will be selected at the end of the training. The relevant responsibilities of peer educators are also explained. After the training 7 peer educators (3 male and 4 female) are selected.

2) Pre & Post Tests

2.1) The Means of HIV/AIDS Transmission

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The graph shows that the awareness of blood transmission and sharing needles is 100% before the training.76.9% of the participants know that HIV/AIDS can be transmitted through pregnancy and this goes up to 90.6% after the training.

2.2) the Awareness of the three Key Knowledge

Before the training, 76.1% of the participants know that by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS. This rate goes up to 90.4% after the training. The rate of knowing mosquito bite does not transmit HIV/AIDS raises from 61.9% to 83.7% after the training；and the correct answers for using condom to prevent HIV/AIDS transmission increases from 69% to 93.0%.

2.3) the Other knowledge

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100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 培训前%

培训后%

一起吃饭会感染

任何人都可能感染艾滋病 只有道德败坏的人才会的艾滋病 其他知识的正确认识

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS raises from 82.9% to100% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS rises from 38.2% to 73.8%. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 82.9% of the participants say that it is not necessarily true, and this rate rises to 83.3% after the training.

2.4) Attitude toward HIV/AIDS-Infected Persons

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120.0% 100.0% 80.0% 60.0% 40.0% 20.0%

0.0%

隔离

女上学

业和提拔

买水果和蔬菜

愿意从艾滋病人 应该将HIV/AIDS 限制HIV/AIDS就 拒绝艾滋病人子 attitude toward HIV/AIDS patient 对待艾滋病人的态度 培训前% 培训后%

80.9% of the participants say that they do not care about buying fruits from HIV/AIDS- infected persons. After the training, the rate rises up to 100%. 76.1% of the participants say that HIV/AIDS-infected persons should not be isolated, the rate rise up to 96.6% after the training. Before the training 61.9% of the participants believe that there should be no discrimination against HIV/AIDS-infected persons, and 100% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 100% and 100% relevantly.

The training participants’ words: “On March 8 this year over 800 women gather together, it is a good opportunity to disseminate such knowledge. I hope you can disseminate the knowledge on next March 8 so that more women can learn”; “I find the trainer has prepared many small cards which indicates a well preparation before the training. This is something I should learn from. If we get well prepared, we can do anything successfully”. “I have learned that it is the safest to use one condom at a time”.

3. Main Problems and Findings

Nansan is a village under the administration of Mengxiu Town. It is one of the few villages located in non-mountainous areas in the town. The town government office is located in the center of the villages under its administration. So the training was carried out at the meeting room of the town government so that the participants from each village feel more convenient. It

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was raining on September 23, the participants from two of the villages could not come on time owing to the muddy condition of the roads. So the training had to be postponed till 10:00 am.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Community 11,580 - 11,580 0 Youth Training

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Supplementary Appendix P: Community youth training report – Hannong

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention along the Longrui Expressway Date: August 26—27, 2014 Content： Community Youth Training Venue: Meeting Room of Hannong Village No. of Participants: Participants (42 persons on August 26, and 47 on August 27) Trainer Chen Guilan Reporter： Chen Guilan

1. Objective and Content 1) To help the youth to understand properly their own physical and psychological nature, to enhance the capacity of self-awareness, recognizing and accepting their own selves. To help them understand that nobody in this world is perfect in every way, one has to identify his (her) own advantages so as to develop an optimistic, perfect and happy personality. 2) To learn to listen to others and to be good at expressing the self properly. To improve the capacity of communicating with others and to learn to be friendly toward others with a refrained attitude, to handle various problems or conflicts that occur in the communications, with generosity, equity and respect. 3) To learn about the emotion and to enhance the capacity of releasing the emotional pressure. 4) To learn how to reject the pressure from the peers. 5) To know the main types of drugs currently in common use in Ruili region. To analyze the reason of drug abuse among the young people and learn to reject effectively the pressures from the peers. To know about the common sexually transmitted diseases and where to go when being infected with. 6) To learn about the HIV/AIDS status, transmission, prevention and treatment in Ruili. To know about the national policy of “four-free & one-care11”, get to know where to seek for services, to understand the interrelations between STD, HIV/AIDS and drugs. 7) To select peer educators

2. Training Evaluation

11 Interpreter’s explanation: ‘four-free and one-care’ refers to 1) free anti-virus treatment to those HIV/AIDS infected persons who have not joined the national medical care system and in financial difficulties; 2) free consultation and screening test for all those who would like to accept HIV/AIDS consultation and test voluntarily; 3) free maternal- child block drug and detection reagent for the HIV/AIDS infected pregnant women; 4) free schooling for the children whose parents have been infected with HIV/AIDS. ‘One care’ means that the government should take care of those HIV/AIDS-infected persons and their families who are in poverty by giving proper subsidies and to help those who can work to rely on themselves so as to eliminate the discriminations against HIV/AIDS-infected persons.

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1) The General Situation

42 participants (26 male, 16 female) from 5 villages come to the training on August 26, and 47 (36 male and 11 female) come to the training on August 27. The youngest is 15 years old and the oldest is 25. Among them, 2 are with the Han ethnic identity and all the rest have the Dai identity.

At the beginning of the training, it is announced that 6 peer educators will be chosen at the end of the training. The relevant responsibilities of peer educators are also explained. After the training 7 peer educators (4 male and 3 female) are selected.

2) Pre & Post Tests

2.1) The Means of HIV/AIDS Transmission

120.0% 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% 血液传播 共用注射器 母婴传播 培训前% Different means of HIV/AIDS transmission 培训后% 艾滋病的传播途径

The graph shows that the awareness of blood transmission and sharing needles raised from 98% to 100%. 76.1% of the participants know that HIV/AIDS can be transmitted through pregnancy and this goes up to 88% after the training.

2.2) the Awareness of the three Key Knowledge

82

100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0%

0.0%

蚊虫叮咬

滋病

从外表能判断谁是艾滋病人 正确使用安全套可以预防艾 the correct understanding of the 3 key knowledges

3个关键知识的正确认识率 培训前% 培训后%

Before the training, 71.4% of the participants know that by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS. This rate goes up to 76.5% after the training. The rate of knowing mosquito bite do not transmit HIV/AIDS raises from 57.1% to 85.1% after the training；and the correct answers for using condom to prevent HIV/AIDS transmission increases from 69% to 89.3%.

2.3) the Other knowledge

100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 培训前%

培训后%

一起吃饭会感染

任何人都可能感染艾滋病 只有道德败坏的人才会的艾滋病 其他知识的正确认识

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2.4) Attitude Toward HIV/AIDS-Infected Persons

100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0%

0.0%

应该将HIV/AIDS 隔离 应该将HIV/AIDS

拒绝艾滋病人子女上学

限制HIV/AIDS就业和提拔 愿意从艾滋病人买水果和蔬菜

attitude toward HIV/AIDS patient 培训前% 培训后% 对待艾滋病人的态度

The training participants’ words: “I come to know how to become a popular 培 person”; “I know now how to use condom and the importance of using condom. It will be useful all through my life”.

3. Main Problems and Findings

All the participants claim that they have learned about HIV/AIDS at schools. The pretest shows however that it is true most of the people know that blood and sharing needles can transmit HIV/AIDS, but the rest of the test do not get the expected answers. The participants are not very clear about the knowledge quite possibly owns to their lower level of understanding Han Chinese. In this training, the trainer read out the pre & post tests and gave some explanations about the questions so that the answers may well reflect the participants’ understanding of the knowledge.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Community 11,580 - 11,580 0 Youth Training

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Supplementary Annex Q: Community youth training report – Jinghan

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention along the Longrui Expressway Date: September 16—17, 2014 Content： Community Youth Training Venue: Meeting Room of Jinghan No. of Participants: 45 Trainer Chen Guilan Reporter： Chen Guilan

1. Objective and Content 1) To help the youth to understand properly their own physical and psychological nature, to enhance the capacity of self-awareness, recognizing and accepting their own selves. To help them understand that nobody in this world is perfect in every way, one has to identify his (her) own advantages so as to develop an optimistic, perfect and happy personality. 2) To learn to listen to others and to be good at expressing the self properly. To improve the capacity of communicating with others and to learn to be friendly toward others with a refrained attitude, to handle various problems or conflicts that occur in the communications, with generosity, equity and respect. 3) To learn about the emotion and to enhance the capacity of releasing the emotional pressure. 4) To learn how to reject the pressure from the peers. 5) To know the main types of drugs currently in common use in Ruili region. To analyze the reason of drug abuse among the young people and learn to reject effectively the pressures from the peers. To know about the common sexually transmitted diseases and where to go when being infected with. 6) To learn about the HIV/AIDS status, transmission, prevention and treatment in Ruili. To know about the national policy of “four-free & one-care12”, get to know where to seek for services, to understand the interrelations between STD, HIV/AIDS and drugs. 7) To select peer educators

2. Training Evaluation

1) The General Information

12 Interpreter’s explanation: ‘four-free and one-care’ refers to 1) free anti-virus treatment to those HIV/AIDS infected persons who have not joined the national medical care system and in financial difficulties; 2) free consultation and screening test for all those who would like to accept HIV/AIDS consultation and test voluntarily; 3) free maternal- child block drug and detection reagent for the HIV/AIDS infected pregnant women; 4) free schooling for the children whose parents have been infected with HIV/AIDS. ‘One care’ means that the government should take care of those HIV/AIDS-infected persons and their families who are in poverty by giving proper subsidies and to help those who can work to rely on themselves so as to eliminate the discriminations against HIV/AIDS-infected persons.

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45 participants (7 male, 38 female) from 4 villages come to the training both on September 16 and 17. The youngest is 18 years old and the oldest is 39. Most of the participants are from the three ethnic minority groups (the Jingpo, Dai and Han).

2) Pre & Post Tests

2.1) The Means of HIV/AIDS Transmission

The graph shows that the awareness of blood transmission and sharing needles is 100% before the training.56.7% of the participants know that HIV/AIDS can be transmitted through pregnancy and this goes up to 84.4% after the training.

2.2) the Awareness of the three Key Knowledge

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Before the training, 83.3% of the participants know that by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS. This rate goes up to 90.9% after the training. The rate of knowing mosquito bite does not transmit HIV/AIDS rises from 80.5% to 100% after the training；and the correct answers for using condom to prevent HIV/AIDS transmission increases from 51.1% to 86.6%.

2.3) the Other knowledge

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS rises from 77.1% to97.4% after the training. The correct answer to the question that anybody may be

87

infected with HIV/AIDS rises from 53.3% to 75.5%. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 46.4% of the participants say that it is not necessarily true, and this rate rises to 90.6% after the training.

2.4) Attitude toward HIV/AIDS-Infected Persons

86.6% of the participants say that they do not care about buying fruits from HIV/AIDS- infected persons. After the training, the rate rises up to 100%. 77.7% of the participants say that HIV/AIDS-infected persons should not be isolated, the rate rise up to 88.8% after the training. Before the training 82.2% of the participants believe that there should be no discrimination against HIV/AIDS-infected persons, and 95.5% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 100% and 100% relevantly.

The training participants’ words: “I thought I had known about HIV/AIDS. After the training, I come to realize that I did not know much in details”; “Now ephedrine abuse is becoming a serious problem in our place, I hope we all come to take care of the youth”.

3. Main Problems and Findings

This training had a difficult time in the sense that the first two times were cancelled due to some unexpected events in the village. The Youth League felt sorry for that. Fortunately, after some effort the training was implemented at the third time. Most of the participants demanded that they participate in the training for two days. Since all the land in this community has been expropriated and most of the young people have gone to cities for employment, some people as

88

old as 39 come to the training. Although they think this training helps them improve the capacity to communicate with their kids, it is completely in line with the requirement of the project.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Community 11,580 - 11,580 0 Youth Training

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Supplementary Appendix R: Community youth training report – Guangti

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention along the Longrui Expressway Date: September 11—12, 2014 Content： Community Youth Training Venue: Meeting Room of Guangti Village （Guangti） No. of Participants: Participants (44) Trainer Chen Guilan Reporter： Chen Guilan

1. Objective and Content 1) To help the youth to understand properly their own physical and psychological nature, to enhance the capacity of self-awareness, recognizing and accepting their own selves. To help them understand that nobody in this world is perfect in every way, one has to identify his (her) own advantages so as to develop an optimistic, perfect and happy personality. 2) To learn to listen to others and to be good at expressing the self properly. To improve the capacity of communicating with others and to learn to be friendly toward others with a refrained attitude, to handle various problems or conflicts that occur in the communications, with generosity, equity and respect. 3) To learn about the emotion and to enhance the capacity of releasing the emotional pressure. 4) To learn how to reject the pressure from the peers. 5) To know the main types of drugs currently in common use in Ruili region. To analyze the reason of drug abuse among the young people and learn to reject effectively the pressures from the peers. To know about the common sexually transmitted diseases and where to go when being infected with. 6) To learn about the HIV/AIDS status, transmission, prevention and treatment in Ruili. To know about the national policy of “four-free & one-care13”, get to know where to seek for services, to understand the interrelations between STD, HIV/AIDS and drugs. 7) To select peer educators

2. Training Evaluation

1) The General Information

13 Interpreter’s explanation: ‘four-free and one-care’ refers to 1) free anti-virus treatment to those HIV/AIDS infected persons who have not joined the national medical care system and in financial difficulties; 2) free consultation and screening test for all those who would like to accept HIV/AIDS consultation and test voluntarily; 3) free maternal- child block drug and detection reagent for the HIV/AIDS infected pregnant women; 4) free schooling for the children whose parents have been infected with HIV/AIDS. ‘One care’ means that the government should take care of those HIV/AIDS-infected persons and their families who are in poverty by giving proper subsidies and to help those who can work to rely on themselves so as to eliminate the discriminations against HIV/AIDS-infected persons.

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44 participants (23 male, 21 female) from 3 villages come to the training on September 11, and 44 (26 male and 18 female) come to the training on September 12. The youngest is 18 years old and the oldest is 42. Among them, the majority are the Dai people with 3 Han by ethnic identity.

At the beginning of the training, it is announced that 6 peer educators will be chosen at the end of the training. The relevant responsibilities of peer educators are also explained. After the training 7 peer educators (4 male and 3 female) are selected.

2) Pre & Post Tests

2.1) The Means of HIV/AIDS Transmission

120.0% 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% 血液传播 共用注射器 母婴传播 培训前% Different means of HIV/AIDS transmission 培训后% 艾滋病的传播途径

The graph shows that the awareness of blood transmission and sharing needles is 100% before the training. 81.8% of the participants know that HIV/AIDS can be transmitted through pregnancy and this goes up to 90.9% after the training.

2.2) the Awareness of the three Key Knowledge

91

100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0%

0.0%

蚊虫叮咬

病

从外表能判断谁是艾滋病人 正确使用安全套可以预防艾滋 the correct understanding of the 3 key knowledges

3个关键知识的正确认识率 培训前% 培训后%

Before the training, 50% of the participants know that by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS. This rate goes up to 81.8% after the training. The rate of knowing mosquito bite does not transmit HIV/AIDS raises from 63.3% to 88.6% after the training；and the correct answers for using condom to prevent HIV/AIDS transmission increases from 70.5% to 86.3%.

2.3) the Other knowledge

100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 培训前%

培训后%

一起吃饭会感染

任何人都可能感染艾滋病 只有道德败坏的人才会的艾滋病 其他知识的正确认识

92

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS raises from 75% to 90.9% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS rises from 40.9% to 77.2%. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 47.7% of the participants say that it is not necessarily true, and this rate rises to 75% after the training.

2.4) Attitude Toward HIV/AIDS-Infected Persons

100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0%

0.0%

应该将HIV/AIDS 隔离 应该将HIV/AIDS

拒绝艾滋病人子女上学

限制HIV/AIDS就业和提拔 愿意从艾滋病人买水果和蔬菜

attitude toward HIV/AIDS patient 培训前% 培训后% 对待艾滋病人的态度

53.3% of the participants say that they do not care about buying fruits from HIV/AIDS- infected persons. After the training, the rate rises up to 88.6%. 53.3% of the participants say that HIV/AIDS-infected persons should not be isolated, the rate rise up to 84% after the training. Before the training 59% of the participants believe that there should be no discrimination against HIV/AIDS-infected persons, and 72.3% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 77.2% and 93.1% relevantly.

The training participants’ words: “Such knowledge is very useful to us young people”; “I come to know now why my children are so disobedient”.

3. Main Problems and Findings

Since the training is implemented in a time of harvest season, some of the participants in the first day were replaced by some others in the second day owing to the labor exchange.

93

Among them, 4 mothers strongly requested to participate in the training after learning that the training is about the knowledge of teenager education.

In the group discussion, persons in some groups cannot write in Chinese.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Community 11,580 - 11,580 0 Youth Training

94

Supplementary Appendix S: Migrant Training Report – 1

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention Among the Burmese Migrant Workers along the Longrui Expressway Date: September 3, 2014 Content： HIV/AIDS Knowledge Venue: Ruili Foreigners’ Service Center No. of Participants: 36 (18 male, 18 female) Trainer Chen Guilan (Ms) Co-trainer Wen Hua (Ms) Interpreter Li Caifeng (Ms) Reporter： Wen Hua (Ms); (Chen Guilan proof-reading)

1. Objective and Content Objective: to improve HIV/AIDS knowledge among the Burmese migrant workers so as to enhance their self-consciousness of HIV/AIDS prevention Content: HIV/AIDS knowledge

2. General Information On September 3, the first training among the Burmese migrant workers in Ruili was held at Ruili Foreigners’ Service Center. The training focuses mainly on HIV/AIDS knowledge through participation approaches. One Burmese interpreter was invited to facilitate the training. The training starts with an introduction of the HIV/AIDS epidemic trend in the world, in China and in Ruili, with an emphasis on the infection rate among the migrant workers in Ruili. After the introduction, the training further explains the definition of HIV, AIDs and their interrelations, the main features of HIV, the AIDS treatment, different periods of AIDS symptom, the transmission, prevention, most of the daily activities won’t transmit HIV, the relations between non-discrimination, STD and HIV/AIDS.

3. Pre & Post Tests Analysis

3.1) The Means of HIV/AIDS Transmission

95

120.0% 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% 血液传播 共用注射器 母婴传播 培训前% Different means of HIV/AIDS transmission 培训后% 艾滋病的传播途径

The graph shows that the awareness of blood transmission, sharing needles and pregnancy is 64%, 69% and 56% before the training. And all of them rise up to 100% after the training.

3.2) the Awareness of the three Key Knowledge

120.0% 100.0% 80.0% 60.0% 40.0% 20.0%

0.0%

蚊虫叮咬

病

从外表能判断谁是艾滋病人 正确使用安全套可以预防艾滋 the correct understanding of the 3 key knowledges

3个关键知识的正确认识率 培训前% 培训后%

Before the training, the awareness of the three key knowledge (by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS, knowing mosquito bite does not transmit HIV/AIDS ,and the correct answers for using condom to prevent HIV/AIDS) among the training participants is 64%, 64% and 58% equivalently. They rise up to 97%, 92% and 83% after the training.

3.3) the Awareness of the Other knowledge

96

100.0% 80.0% 60.0% 40.0% 20.0% 0.0% 培训前%

培训后%

HIV

染HIV

会得艾滋病

一起吃饭会感染 任何人都可能感 道德败坏的人才 其他知识的正确认识

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS rises from 28% to 97% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS rises from 28% to 89%. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 67% of the participants say that it is not necessarily true, and this rate rises to 97% after the training.

3.4) Attitude Toward HIV/AIDS-Infected Persons

120.0% 100.0% 80.0% 60.0% 40.0% 20.0%

0.0%

隔离

女上学

业和提拔

买水果和蔬菜

愿意从艾滋病人 应该将HIV/AIDS 限制HIV/AIDS就 拒绝艾滋病人子 attitude toward HIV/AIDS patient 对待艾滋病人的态度 培训前% 培训后%

83% of the participants say that they do not care about buying fruits from HIV/AIDS-infected persons. After the training, the rate rises up to100%. 86% of the participants say that HIV/AIDS- infected persons should not be isolated, the rate rise up to 97% after the training. Before the training 64% of the participants believe that there should be no discrimination against HIV/AIDS- infected persons, and 83% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 83% and 100% relevantly.

97

The training participants’ words: “I know how to become a popular person”; “I know now how to use condom and the importance of using condom. These knowledge will be useful all through my life”.

4. Main Problems and Findings

The Problems: 1) The training room can seat only 40—50 persons. In the training, the space is limited so that some games cannot be played as planned. 2) Since most of the participants are the Burmese who come to register, some come earlier and some come later. Those who are late for the training do not have a full knowledge from the training.

Future improvement: To consult with CDC and other departments, hoping that all the participants will come at the same time.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Migrant 7,436 0 6360 1076 Worker Training

98

Supplementary Appendix T: Migrant Training Report – 2

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention Among the Burmese Migrant Workers along the Longrui Expressway Date: September 9, 2014 Content： HIV/AIDS Knowledge Venue: Ruili Foreigners’ Service Center No. of Participants: 44 (27 male, 17female) Trainer Chen Guilan (Ms) Co-trainer Wen Hua (Ms) Interpreter Li Caifeng (Ms) Reporter： Wen Hua (Ms); (Chen Guilan proof-reading)

3. Objective and Content Objective: to improve HIV/AIDS knowledge among the Burmese migrant workers so as to enhance their self-consciousness of HIV/AIDS prevention Content: HIV/AIDS knowledge

4. General Information Based on the experience in the First Training, Ruili CDC requests that all the Burmese migrant workers who come to get their Health Certificate on September 9 should participate in the training. So all the participants on September 9 are on time for the training. The training includes an introduction of the HIV/AIDS epidemic trend in the world, in China and in Ruili, with an emphasis on the infection rate among the migrant workers in Ruili, the definition of HIV, AIDs and their interrelations, the main features of HIV, the AIDS treatment, different periods of AIDS symptom, the transmission, prevention, most of the daily activities won’t transmit HIV, the relations between non-discrimination, STD and HIV/AIDS.

3. Pre & Post Tests Analysis

3.1) The Means of HIV/AIDS Transmission

120.0% 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% 血液传播 共用注射器 母婴传播 培训前% Different means of HIV/AIDS transmission 培训后% 艾滋病的传播途径

99

The graph shows that the awareness of blood transmission, sharing needles and pregnancy is 45%, 84% and 41% before the training. And all of them rise up to 100% after the training.

3.2) the Awareness of the three Key Knowledge

120.0% 100.0% 80.0% 60.0% 40.0% 20.0%

0.0%

蚊虫叮咬

艾滋病人

以预防艾滋病

从外表能判断谁是 正确使用安全套可 the correct understanding of the 3 key knowledges 3个关键知识的正确认识率 培训前% 培训后%

Before the training, the awareness of the three key knowledge (by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS, knowing mosquito bite does not transmit HIV/AIDS ,and the correct answers for using condom to prevent HIV/AIDS) among the training participants is 0%, 32% and 0% equivalently. They rise up to 98%, 91% and 100% after the training.

3.3) the Awareness of the Other knowledge

100

100.0% 90.0% 80.0% 70.0% 其他知识的正确认识 一起 60.0% 吃饭会感染HIV 50.0% 其他知识的正确认识 任何 人都可能感染HIV 40.0% 其他知识的正确认识 道德 30.0% 败坏的人才会得艾滋病 20.0% 10.0% 0.0% 培训前% 培训后%

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS rises from 41% to 100% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS rises from 45% to 91%. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 45% of the participants say that it is not necessarily true, and this rate rises to 100% after the training.

3.4) Attitude Toward HIV/AIDS-Infected Persons

120.0% 100.0% 80.0% 60.0% 40.0% 20.0%

0.0%

隔离

女上学

业和提拔

买水果和蔬菜

愿意从艾滋病人 应该将HIV/AIDS 限制HIV/AIDS就 拒绝艾滋病人子 attitude toward HIV/AIDS patient 对待艾滋病人的态度 培训前% 培训后%

27% of the participants say that they do not care about buying fruits from HIV/AIDS-infected persons. After the training, the rate rises up to100%. 45% of the participants say that HIV/AIDS- infected persons should not be isolated, the rate rise up to 100% after the training. Before the training 11% of the participants believe that there should be no discrimination against HIV/AIDS- infected persons, and 100% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 39% and 100% relevantly.

4. Main Problems and Findings

101

The Problems: Although all the participants come on time. During the training some of them have to go to the Service Center to get their certificates so that there are always someone going out or coming in. This interfere the training to some extent. The trainer decides that the training should be carried out at wood factory or construction sites so as to make it more effective.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Migrant 7,436 0 7160 276 Worker Training

102

Supplementary Appendix U: Migrant Training Report – 3

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention Among the Burmese Migrant Workers along the Longrui Expressway Date: September 23, 2014 Content： HIV/AIDS Knowledge Venue: Ruili Dried Beef Processing Plant No. of Participants: 40 (0 male, 40 female) Trainer Chen Guilan (Ms) Co-trainer Wen Hua (Ms) Interpreter Li Caifeng (Ms) Reporter： Wen Hua (Ms); (Chen Guilan proof-reading)

5. Objective and Content Objective: to improve HIV/AIDS knowledge among the Burmese migrant workers so as to enhance their self-consciousness of HIV/AIDS prevention Content: HIV/AIDS knowledge

6. General Information Based on the experience in the previous 2 trainings, this training is changed to Ruili Dried Beef Processing Plant. The training includes an introduction of the HIV/AIDS epidemic trend in the world, in China and in Ruili, with an emphasis on the infection rate among the migrant workers in Ruili, the definition of HIV, AIDs and their interrelations, the main features of HIV, the AIDS treatment, different periods of AIDS symptom, the transmission, prevention, most of the daily activities won’t transmit HIV, the relations between non-discrimination, STD and HIV/AIDS.

3. Pre & Post Tests Analysis

3.1) The Means of HIV/AIDS Transmission

120.0% 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% 血液传播 共用注射器 母婴传播 培训前% Different means of HIV/AIDS transmission 培训后% 艾滋病的传播途径

103

The graph shows that the awareness of blood transmission, sharing needles and pregnancy is 77.5%, 92.5% and 65% before the training. And the rate rises up to 100% , 100% and 97% after the training.

3.2) the Awareness of the three Key Knowledge

120.0% 100.0% 80.0% 60.0% 40.0% 20.0%

0.0%

蚊虫叮咬

病

从外表能判断谁是艾滋病人 正确使用安全套可以预防艾滋 the correct understanding of the 3 key knowledges

3个关键知识的正确认识率 培训前% 培训后%

Before the training, the awareness of the three key knowledge (by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS, knowing mosquito bite does not transmit HIV/AIDS ,and the correct answers for using condom to prevent HIV/AIDS) among the training participants is 72.5%, 60% and 75% equivalently. They rise up to 95%, 85% and 100% after the training.

3.3) the Awareness of the Other knowledge

104

100.0% 80.0% 60.0% 40.0% 20.0% 0.0% 培训前%

培训后%

HIV

染HIV

会得艾滋病

一起吃饭会感染 任何人都可能感 道德败坏的人才 其他知识的正确认识

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS rises from 87.5% to 100% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS rises from 47.5% to 75%. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 72.5% of the participants say that it is not necessarily true, and this rate rises to 82.5% after the training.

3.4) Attitude toward HIV/AIDS-Infected Persons

120.0% 100.0% 80.0% 60.0% 40.0% 20.0%

0.0%

就

AIDS

/

AIDS

/

HIV

隔离

HIV 女上学

业和提拔

买水果和蔬菜

愿意从艾滋病人 应该将 限制 拒绝艾滋病人子 attitude toward HIV/AIDS patient 对待艾滋病人的态度 培训前% 培训后%

82.5% of the participants say that they do not care about buying fruits from HIV/AIDS- infected persons. After the training, the rate rises up to 97.5%. 52% of the participants say that HIV/AIDS-infected persons should not be isolated, the rate rise up to 75% after the training. Before the training 0% of the participants believe that there should be no discrimination against HIV/AIDS-infected persons, and 70% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 65.5% and 92.5% relevantly.

105

The trainees’ words: “I know now how to become a popular person”, “I know now how to use condom, and the importance of using condom. Such knowledge will be useful all through my life”, “Through the training, I come to know different ways of birth control. It is really very useful”, “I did not have much knowledge about HIV/AIDS. After the training, I get to know more so as to protect myself better”.

4. Main Problems and Findings

Based on the experience of the previous two trainings, this training is carried out by cooperating with the processing plant so that it is much easier to organize Burmese migrant workers. And the participants all stay from the very beginning to the end so that the effect is greatly improved. But the room provided by the plant is just enough for 30—40 persons so that some of the activities cannot achieve the planned goal. Also the plant does not want to interrupt their regular work in the day time so that the training has to be done during the night. The dim light reduces the effect of the training to some extent.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Migrant 7,436 0 6760 676 Worker Training

106

Supplementary Appendix V: Migrant Training Report – 4

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention Among the Burmese Migrant Workers along the Longrui Expressway Date: September 24, 2014 Content： HIV/AIDS Knowledge Venue: Ruili Dried Beef Processing Plant No. of Participants: 40 (24 male, 16 female) Trainer Chen Guilan (Ms) Co-trainer Wen Hua (Ms) Interpreter Li Caifeng (Ms) Reporter： Wen Hua (Ms); (Chen Guilan proof-reading)

7. Objective and Content Objective: to improve HIV/AIDS knowledge among the Burmese migrant workers so as to enhance their self-consciousness of HIV/AIDS prevention Content: HIV/AIDS knowledge

8. General Information Based on the experience in the previous 3 trainings, this training is carried out in cooperation with Ruili Dried Beef Processing Plant. The training includes an introduction of the HIV/AIDS epidemic trend in the world, in China and in Ruili, with an emphasis on the infection rate among the migrant workers in Ruili, the definition of HIV, AIDs and their interrelations, the main features of HIV, the AIDS treatment, different periods of AIDS symptom, the transmission, prevention, most of the daily activities won’t transmit HIV, the relations between non-discrimination, STD and HIV/AIDS.

3. Pre & Post Tests Analysis

3.1) The Means of HIV/AIDS Transmission

120.0% 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% 血液传播 共用注射器 母婴传播 培训前% Different means of HIV/AIDS transmission 培训后% 艾滋病的传播途径

107

The graph shows that the awareness of blood transmission, sharing needles and pregnancy is 77.5%, 85% and 52.5% before the training. And the rate rises up to 100% , 100% and 75% after the training.

3.2) the Awareness of the three Key Knowledge

100.0% 80.0% 60.0% 40.0% 20.0% 0.0% 培训前%

培训后%

蚊虫叮咬

是艾滋病人

从外表能判断谁 正确使用安全套 可以预防艾滋病 3个关键知识的正确认识率

Before the training, the awareness of the three key knowledge (by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS, knowing mosquito bite does not transmit HIV/AIDS ,and the correct answers for using condom to prevent HIV/AIDS) among the training participants is 55%, 50% and 72.5% equivalently. They rise up to 92.5%, 97.5% and 95% after the training.

3.3) the Awareness of the other knowledge

108

100.0% 80.0% 60.0% 40.0% 20.0% 0.0% 培训前%

培训后%

HIV

染HIV

会得艾滋病

一起吃饭会感染 任何人都可能感 道德败坏的人才 其他知识的正确认识

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS rises from 75% to 100% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS stays 100% before and after the training. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 0% of the participants say that it is not necessarily true, and this rate rises to 100% after the training.

3.4) Attitude toward HIV/AIDS-Infected Persons

120.0% 100.0% 80.0% 60.0% 40.0% 20.0%

0.0%

隔离

女上学

业和提拔

买水果和蔬菜

愿意从艾滋病人 应该将HIV/AIDS 限制HIV/AIDS就 拒绝艾滋病人子 attitude toward HIV/AIDS patient 对待艾滋病人的态度 培训前% 培训后%

82.5% of the participants say that they do not care about buying fruits from HIV/AIDS- infected persons. After the training, the rate rises up to 100%. 22.5% of the participants say that HIV/AIDS-infected persons should not be isolated, the rate rises up to 80% after the training. Before the training 12.5% of the participants believe that there should be no discrimination against HIV/AIDS-infected persons, and 72.5% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 95% and 100% relevantly.

109

The trainees’ words: “I know now the importance of using condom. Such knowledge will be useful all through my life”, “I had some impartial knowledge about HIV/AIDS. Through the training, I get to know more, particularly I know the importance of using condom in sexual behaviors”, “ I knew that sexual behavior can transmit sexual diseases, after the training, I know that it can also transmit HIV/AIDS, I know how to protect myself”.

4. Main Problems and Findings

This training is carried out in the open. There is enough space for all activities. But the light is dim. The trainer will discuss with the coordinating person from process plant to make the necessary arrangement so that the training can be more effective.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Migrant 7,436 0 6760 676 Worker Training

110

Supplementary Appendix W: Migrant Training Report – 5

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention Among the Burmese Migrant Workers along the Longrui Expressway Date: September 28, 2014 Content： HIV/AIDS Knowledge Venue: Ruili Wood Processing Plant No. of Participants: 40 (30 male, 10 female) Trainer Chen Guilan (Ms) Co-trainer Wen Hua (Ms) Interpreter Li Caifeng (Ms) Reporter： Wen Hua (Ms)

9. Objective and Content Objective: to improve HIV/AIDS knowledge among the Burmese migrant workers so as to enhance their self-consciousness of HIV/AIDS prevention Content: HIV/AIDS knowledge

10. General Information 40 Burmese migrant workers participate in the training in Ruili Wood Processing Plant. The training includes an introduction of the HIV/AIDS epidemic trend in the world, in China and in Ruili, with an emphasis on the infection rate among the migrant workers in Ruili, the definition of HIV, AIDs and their interrelations, the main features of HIV, the AIDS treatment, different periods of AIDS symptom, the transmission, prevention, most of the daily activities won’t transmit HIV, the relations between non-discrimination, STD and HIV/AIDS.

3. Pre & Post Tests Analysis

3.1) The Means of HIV/AIDS Transmission

111

The graph shows that the awareness of blood transmission, sharing needles and pregnancy is 67.5%, 85% and 62.5% before the training. And the rate rises up to 97.5% , 100% and 87.5% after the training.

3.2) the Awareness of the three Key Knowledge

Before the training, the awareness of the three key knowledge (by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS, knowing mosquito bite does not transmit HIV/AIDS ,and the correct answers for using condom to prevent HIV/AIDS) among the training participants is 55%, 50% and 72.5% equivalently. They rise up to 92.5%, 97.5% and 95% after the training.

112

3.3) the Awareness of the other knowledge

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS rises from 75% to 100% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS is 45% before the training and 85% after the training. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 75% of the participants say that it is not necessarily true, and this rate rises to 95% after the training.

3.4) Attitude toward HIV/AIDS-Infected Persons

82.5% of the participants say that they do not care about buying fruits from HIV/AIDS- infected persons. After the training, the rate rises up to 100%. 50% of the participants say that

113

HIV/AIDS-infected persons should not be isolated, the rate rises up to 87.5% after the training. Before the training 70% of the participants believe that there should be no discrimination against HIV/AIDS-infected persons, and 80% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 82.5% and 90% relevantly.

The trainees’ words: “The training helps me know the knowledge which I did not get in the past”, “The training is very good. I did not know much about these. Now I know how to protect myself”.

4. Main Problems and Findings

Before the training, we got to know that the Plant organizes cultural activities once a month. This training is taken as the cultural activity in this month. So the training is arranged in the day time. The training effect is better than that in the evening.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Migrant 7,436 0 6760 676 Worker Training

114

Supplementary Appendix X: Migrant Training Report – 6

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention Among the Burmese Migrant Workers along the Longrui Expressway Date: October 13, 2014 Content： HIV/AIDS Knowledge Venue: Ruili Daiwang Dried Beef Processing Plant No. of Participants: 40 (12 male, 28 female) Trainer Chen, Guilan (Ms Co-trainer Wen Hua (Ms) Interpreter Li Caifeng (Ms) Reporter： Wen Hua (Ms); (Chen Guilan proof-reading)

11. Objective and Content Objective: to improve HIV/AIDS knowledge among the Burmese migrant workers so as to enhance their self-consciousness of HIV/AIDS prevention Content: HIV/AIDS knowledge

12. General Information This training is implemented in cooperation with Ruili Dried Beef Processing Plant. The training includes an introduction of the HIV/AIDS epidemic trend in the world, in China and in Ruili, with an emphasis on the infection rate among the migrant workers in Ruili, the definition of HIV, AIDs and their interrelations, the main features of HIV, the AIDS treatment, different periods of AIDS symptom, the transmission, prevention, most of the daily activities won’t transmit HIV, the relations between non-discrimination, STD and HIV/AIDS.

3. Pre & Post Tests Analysis

3.1) The Means of HIV/AIDS Transmission

115

100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% pretest (%) 0.0%

post-test (%)

blood

through through sharing needles

through pregnancy Different means of HIV/AIDS transmission

The graph shows that the awareness of blood transmission, sharing needles and pregnancy is 77.5%, 80.0% and 65.0% before the training. And the rate rises up to 97.5% , 100% and 95.0% after the training.

3.2) the Awareness of the three Key Knowledge

100.0% 80.0%90.0% 60.0%70.0% 40.0%50.0% 20.0%30.0% 10.0%0.0%

pretest (%)

post-test (%)

Can people Can

can prevent can

tell who has who tell condom Using mosquito bite mosquito the correct understanding of the 3 key

Before the training, the awareness of the three key knowledge (by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS, knowing mosquito bite does not transmit HIV/AIDS ,and the correct answers for using condom to prevent HIV/AIDS) among the

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training participants is 60.0%, 57.5% and 65.0% equivalently. They rise up to 95.0%, 85.0% and 100.0% after the training.

3.3) the Awareness of the other knowledge

100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% pretest (%)

post-test (%)

by

washing genital

can be can

infected by eating by Proper understanding of other knowledge

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS rises from 40% to 100% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS is 65% before the training and 97.5% after the training. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 65% of the participants say that it is not necessarily true, and this rate rises to 75% after the training.

3.4) Attitude toward HIV/AIDS-Infected Persons

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100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% pretest (%) 20.0% post-test (%) 10.0% 0.0% attitude toward HIV/AIDS patient

72.5% of the participants say that they do not care about buying fruits from HIV/AIDS- infected persons. After the training, the rate rises up to 87.5%. 37.5% of the participants say that HIV/AIDS-infected persons should not be isolated, the rate rises up to 92.5% after the training. Before the training 32.5% of the participants believe that there should be no discrimination against HIV/AIDS-infected persons, and 72.5% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 95.0% and 97.5% relevantly.

The trainees’ words: “I did not know how to use condom. Now I know the importance of using condom and how to use it. I will be useful in the rest of my life”, “I had some general knowledge about HIV/AIDS. Through the training I have got some specific knowledge, and I know the importance of using condom in sexual activities”. “I knew that sexual activities may transmit sexual diseases. Through this training, I come to know that HIV/AIDS can be transmitted not just through sexual behaviors, it can be transmitted through other means. It is terrible. I will better protect myself.”

4. Main Problems and Findings

In the previous trainings, we ask the participants to put up their hands if they agree with certain answer/answers in pre & post test. The rate of correct answer was quite high, but it did not reflect the empirical situation. This time, we ask the participants to choose to stand in different queue when they hear certain answer. That is, when the trainer read a certain question, the participants should choose either to stand in the queue of “know”, or “not know”, or “not sure”, “agree”, “not agree” or “not sure”. This seems working better. But still there are some participants who are hesitating before they make the choices. So their final choice may not well

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reflect their knowledge. After discussion, the trainers decide that printed questionnaire will be used next time. The trainers read the questions one by one, and the participants will tick the correct answers based on their own judgment. The trainers will see if this is a better way of doing pre & post test.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Migrant 7,436 0 6760 676 Worker Training

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Supplementary Appendix Y: Migrant Training Report – 7

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention Among the Burmese Migrant Workers along the Longrui Expressway Date: October 22, 2014 Content： HIV/AIDS Knowledge Venue: Ruili Huangting Food Processing Factory No. of Participants: 40 (20 male, 20 female) Trainer Chen, Guilan (Ms) Co-trainer Wen Hua (Ms) Interpreter Li Caifeng (Ms) Reporter： Wen Hua (Ms); (Chen Guilan proof-reading)

13. Objective and Content Objective: to improve HIV/AIDS knowledge among the Burmese migrant workers so as to enhance their self-consciousness of HIV/AIDS prevention Content: HIV/AIDS knowledge

14. General Information This is the first training of Burmese migrant workers in cooperation with Ruili Food Processing Factory. The training includes an introduction of the HIV/AIDS epidemic trend in the world, in China and in Ruili, with an emphasis on the infection rate among the migrant workers in Ruili, the definition of HIV, AIDs and their interrelations, the main features of HIV, the AIDS treatment, different periods of AIDS symptom, the transmission, prevention, most of the daily activities won’t transmit HIV, the relations between non-discrimination, STD and HIV/AIDS.

3. Pre & Post Tests Analysis

3.1) The Means of HIV/AIDS Transmission

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100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% pretest (%) 0.0%

post-test (%)

blood

through through sharing needles

through pregnancy Different means of HIV/AIDS transmission

The graph shows that the awareness of blood transmission, sharing needles and pregnancy is 90.0%, 95.0% and 75.0% before the training. And the rate rises up to 95.0% , 100% and 92.5% after the training.

3.2) the Awareness of the three Key Knowledge

100.0% 80.0%90.0% 60.0%70.0% 40.0%50.0% 20.0%30.0% 10.0%0.0%

pretest (%)

post-test (%)

Can people Can

can prevent can

tell who has who tell condom Using mosquito bite mosquito the correct understanding of the 3 key

Before the training, the awareness of the three key knowledge (by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS, knowing mosquito bite does not transmit HIV/AIDS ,and the correct answers for using condom to prevent HIV/AIDS) among the

121

training participants is 72.5%, 57.5% and 52.5% equivalently. They rise up to 90.0%, 97.5 % and 80.0% after the training.

3.3) the Awareness of the other knowledge

100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% pretest (%)

post-test (%)

by

washing genital

can be can

infected by eating by Proper understanding of other knowledge

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS rises from 80% to 92.5% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS is 62.5% before the training and 77.5% after the training. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 55.0% of the participants say that it is not necessarily true, and this rate rises to 75.0% after the training.

3.4) Attitude toward HIV/AIDS-Infected Persons

90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% pretest (%) 20.0% post-test (%) 10.0% 0.0% attitude toward HIV/AIDS patient

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32.5% of the participants say that they do not care about buying fruits from HIV/AIDS- infected persons. After the training, the rate rises up to 82.5%. 37.5% of the participants say that HIV/AIDS-infected persons should not be isolated, the rate rises up to 82.5% after the training. Before the training 57.5% of the participants believe that there should be no discrimination against HIV/AIDS-infected persons, and 62.5% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 80% and 85% relevantly.

The trainees’ words: “The training is very useful to us, we will better protect ourselves in the future”, “I have better knowledge about HIV/AIDS. And I know the importance of using condom in sexual activities”. “I had some knowledge about HIV/AIDS, after this training, I have understood HIV/AIDS better.” “I am very happy to know that we (Burmese) can also get medical treatment in Ruili if we are infected with HIV/AIDS”.

4. Main Problems and Findings

The training is implemented in the evening and the Food Processing Factory does not have meeting room. So the training has to be done outside the buildings. Although we have more space which is good for games and activities, the light is dim.

To make the pre & post tests more accurate, the trainer reads the questions one by one so that the participants can make their own judgment. Such survey is more accurate, we will use such approach in the future.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Migrant 7,436 0 6760 676 Worker Training

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Supplementary Appendix Z: Migrant Training Report – 8

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention Among the Burmese Migrant Workers along the Longrui Expressway Date: October 23, 2014 Content： HIV/AIDS Knowledge Venue: Ruili Ruifeng Wood Processing Plant No. of Participants: 40 (28 male, 12 female) Trainers Chen, Guilan (Ms); Co-trainer Wen Hua (Ms) Interpreter Li Caifeng (Ms) Reporter： Wen Hua (Ms); (Chen Guilan proof-reading)

15. Objective and Content Objective: to improve HIV/AIDS knowledge among the Burmese migrant workers so as to enhance their self-consciousness of HIV/AIDS prevention Content: HIV/AIDS knowledge

16. General Information This training is implemented in cooperation with Ruili Ruifeng Wood Processing Plant. The training includes an introduction of the HIV/AIDS epidemic trend in the world, in China and in Ruili, with an emphasis on the infection rate among the migrant workers in Ruili, the definition of HIV, AIDs and their interrelations, the main features of HIV, the AIDS treatment, different periods of AIDS symptom, the transmission, prevention, most of the daily activities won’t transmit HIV, the relations between non-discrimination, STD and HIV/AIDS.

3. Pre & Post Tests Analysis

3.1) The Means of HIV/AIDS Transmission

124

100.0% 80.0% 60.0% 40.0% 20.0% 0.0% pretest (%)

post-test (%)

blood

through through sharing

through pregnancy Different means of

The graph shows that the awareness of blood transmission, sharing needles and pregnancy is 82.0 %, 70.0% and 75.0% before the training. And the rate rises up to 90.0 % , 100% and 92.0% after the training.

3.2) the Awareness of the three Key Knowledge

100.0% 80.0% 60.0% 40.0% 20.0% 0.0% pretest (%)

bite post-test (%)

Using

mosquito

tell who tell

Can people Can can condom the correct understanding

Before the training, the awareness of the three key knowledge (by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS, knowing mosquito bite does not transmit HIV/AIDS ,and the correct answers for using condom to prevent HIV/AIDS) among the training participants is 75.0%, 50% and 52.5% equivalently. They rise up to 90.0%, 85.0% and 80.0% after the training.

3.3) the Awareness of the other knowledge

125

100.0% 80.0% 60.0% 40.0% 20.0% 0.0% pretest (%)

by post-test (%) can be can Proper understanding

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS rises from 75.0% to 87.5% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS is 45.0% before the training and 70.0% after the training. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 45.0% of the participants say that it is not necessarily true, and this rate rises to 75.0% after the training.

3.4) Attitude toward HIV/AIDS-Infected Persons

100.0% 80.0% 60.0% 40.0% 20.0% pretest (%) 0.0% post-test (%) attitude toward HIV/AIDS patient

60.0% of the participants say that they do not care about buying fruits from HIV/AIDS- infected persons. After the training, the rate rises up to 82.5%. 52.5% of the participants say that HIV/AIDS-infected persons should not be isolated, the rate rises up to 75.0% after the training.

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Before the training 75.5% of the participants believe that there should be no discrimination against HIV/AIDS-infected persons, and 62.5% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 80.0% and 77.5% relevantly.

The trainees’ words: “This is a quite meaningful day because I have learnt some knowledge which I did not know”, “Your training is very useful, I have learnt a lot”. “HIV/AIDS is not that horrible. I think I will not be scared when I find somebody has been infected with it.”

4. Main Problems and Findings

Because the meeting room of the plant is too small for 40 participants, the training has to be done at the parking lot. The participants all sit on the ground. In general, this is not a problem with the training, but the trainers think it would be better if we can provide some chairs for the participants.

If another training is planned for this plant, the trainers hope that the plant will solve the problem of training room.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Migrant 7,436 0 7111 325 Worker Training

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Supplementary Appendix AA: Migrant Training Report – 9

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention Among the Burmese Migrant Workers along the Longrui Expressway Date: November 21, 2014 Content： HIV/AIDS Knowledge Venue: Ruili Ruifeng Wood Processing Plant No. of Participants: 40 (28 male, 12 female) Trainer Chen Guilan (Ms) Co-trainer Wen Hua (Ms) Interpreter Li Caifeng (Ms) Reporter： Wen Hua (Ms), (Chen Guilan proof-reading)

17. Objective and Content Objective: to improve HIV/AIDS knowledge among the Burmese migrant workers so as to enhance their self-consciousness of HIV/AIDS prevention Content: HIV/AIDS knowledge

18. General Information This training is also implemented in cooperation with Ruili Ruifeng Wood Processing Plant. The training includes an introduction of the HIV/AIDS epidemic trend in the world, in China and in Ruili, with an emphasis on the infection rate among the migrant workers in Ruili, the definition of HIV, AIDs and their interrelations, the main features of HIV, the AIDS treatment, different periods of AIDS symptom, the transmission, prevention, most of the daily activities won’t transmit HIV, the relations between non-discrimination, STD and HIV/AIDS.

3. Pre & Post Tests Analysis

3.1) The Means of HIV/AIDS Transmission

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100.0% 80.0% 60.0% 40.0% 20.0% 0.0% pretest (%)

post-test (%)

blood

through through sharing

through pregnancy Different means of

The graph shows that the awareness of blood transmission, sharing needles and pregnancy is 87.5 %, 70.0% and 75.2% before the training. And the rate rises up to 100 % , 100% and 87.5% after the training.

3.2) the Awareness of the three Key Knowledge

100.0% 80.0% 60.0% 40.0% 20.0% 0.0% pretest (%)

bite post-test (%)

Using

mosquito

tell who tell

Can people Can can condom the correct understanding

Before the training, the awareness of the three key knowledge (by looking at a person, one cannot tell whether he (she) has been infected with HIV/AIDS, knowing mosquito bite does not transmit HIV/AIDS ,and the correct answers for using condom to prevent HIV/AIDS) among the training participants is 72.5%, 37.5% and 37.5% equivalently. They rise up to 90.0%,80.0% and 100% after the training.

3.3) the Awareness of the other knowledge

129

100.0% 80.0% 60.0% 40.0% 20.0% 0.0% pretest (%)

by post-test (%) can be can Proper understanding

The rate of knowing that eating with HIV/AIDS-infected persons won’t transmit HIV/AIDS rises from 75.0% to 95% after the training. The correct answer to the question that anybody may be infected with HIV/AIDS is 50% before the training and 75% after the training. In terms of the question “only the morally bad person can be infected with HIV/AIDS”, 57.5% of the participants say that it is not necessarily true, and this rate rises to 80% after the training.

3.4) Attitude toward HIV/AIDS-Infected Persons

100.0% 80.0% 60.0% 40.0% 20.0% pretest (%) 0.0% post-test (%) attitude toward HIV/AIDS patient

75% of the participants say that they do not mind buying fruits from HIV/AIDS-infected persons. After the training, the rate rises up to 87.5%. 52.5% of the participants say that HIV/AIDS-infected persons should not be isolated, the rate rises up to 75.0% after the training. Before the training 57.5% of the participants believe that there should be no discrimination against HIV/AIDS-infected persons, and 62.5% think that HIV/AIDS-infected persons’ children should not be rejected in schools. These rates rise up to 80.0% and 75% relevantly.

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The trainees’ words: “The knowledge I get from the training today is very useful. I like this kind of training”, “The training helps me understand what I did not know. I have learnt a lot”. “I thought only those who had extra-marital sexual activities can be infected with HIV. After the training, I know it is not true.”

4. Main Problems and Findings

The training site is very spacious so that the participants all join the games and activities actively. The atmosphere of the training is very good.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Migrant 7,436 0 6,733 703 Worker Training

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Supplementary Appendix BB: Community Youth Peer Educators Training

Report on the Training of HIV/AIDS Prevention on Longrui Expressway Project: HIV/AIDS Prevention along the Longrui Expressway Date: October 16—17, 2014 Content： Community Youth Peer Educators Training Venue: Meeting Room of Longrui Hotel （Ruili） No. of Participants: Participants 46 ( female 28, male 18) Trainer Chen Guilan Reporter： Chen Guilan

1. Objective and Content 1.1 Objectives 1) To clarify the concept of peer education; 2) To reach common understanding in terms of the content, approaches of peer education; 3) To enhance the confidence and capacity of the peer educators

1.2 The Main Content and Procedure 1) The municipal secretary of the Communist Youth League says in his speech that all the participants should study seriously in the 2-day training. He hopes that through the peer education, more young people can be gradually integrated into the main social stream and change some of their bad behaviors. 2) The participants are helped to learn the importance of cooperation through games. The trainers write on cards with “cooperation, share, and double-increase” and put on them on the top of the board so that the participants can see the ideals all through the training. In the process of the training, the three concepts are constantly stressed. 3) By brain storming, the participants discuss what peer education is. The people who can be participants of peer education include: people of the same age, fellows, brothers and sisters, those who have similar interests, those who have some contacts or often play together, the kins of the same age, those who share similar experiences, those who have similar social positions (or have similar performance in schools) and those who have similar family background. 4) To clarify the working ways of peer educators through group discussion. Such ways should be relaxed, equal, communicating, exploring, informal, unlimited by time and place, flexible, interesting, and personal. The content includes the correct knowledge about sex and sexual health, and proper living techniques. 5) Ask two participants to share their unforgettable or most embarrassing experiences during their adolescence, to share their experience of being rejected by the girls who they were in love owing to their short body at the age of 12, and how they felt when they were ridiculed by their fellows. The participants are asked to reflect, through brain storming, on their physical, psychological and behavioral features in adolescence. The peer educators should learn to respect the participants’

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psychological features. 6) Each participant is asked to write 3 notes to list the most serious problems among the teenagers in Ruili. And then 2 participants are asked to come forward to categorize and combine similar problems. After that, the participants select 6 the most serious problems by voting (drug use, unprotected pre-marital sex, internet games, poor capacity to bear psychological problems, have no sense of responsibility, have no life goal). One of the reasons for unprotected sex is that the access to condoms in the villages is limited to some degree. 7) To introduce “problem tree” to the participants. Each group is asked to analyze the 6 selected problems with the approach of “problem tree” and the causes leading to these problems, what will happen if these problems are not solved. 8) Go on with the group discussion to analyze the causes of the 6 problems, and how can these causes be eliminated through the work of peer educators. That is, what can the peer educators do? It is hoped that through this process, the participants can learn to analyze the causes, and consequences of a problem when they are encountering a social phenomenon. In terms of peer education, we need to analyze the background of each person, to find out the causes behind his (or her) behavior, and to intervene accordingly. 9) To avoid the peer educators try to intervene in a boring way, the participants are taught to analyze the 6 problems with “T” approach. The trainers try to help them learn how to look at the problems from the perspective of teenagers. No matter how we cannot understand their behavior, they must have some “good reasons” to justify their behaviors from their perspectives. So we need to analyze the problems from their perspectives. Otherwise, they would not like to “listen to our preaches”. 10) Through group discussion, the participants are required to further explore how to do the peer education well, what knowledge we need, what knowledge we have already had, what more skills do we need. Further discussion and explanation are contributed to deal with the knowledge and skills which the participants believe they do not possessed at the moment. 11) Through games, the trainers help the participants to learn that human individuals may lose the control on their behaviors and take some high-risky behaviors under the circumstance of over-using alcohol and drugs so as to pass on to teenagers the knowledge of the harm which alcohol and drugs may bring to them. 12) Behavior change. The trainers, through games, help the participants to realize that a person’s behavior change is influenced by knowledge, consciousness and action. A person’s behavior is not only influenced by his (her) knowledge and consciousness, but is even more influenced by the social milieu and the peers. So peer education is never an easy task, we need persistence. 13) To discuss about the safety (including environmental safety, protection of privacy, transport safety etc.), and how to clarify the content and purpose of peer education to the parents so as to gain their understanding and support. 14) To discuss about the information which the peer educators have to record: time, place, name, gender, age, ethnic identity, the brief content etc. The requirement is that each peer educator should visit 10—15 persons/month. 15) The next revisit will be done in the middle of November. After the revisit, the peer educators should submit their working record book. 16) As discussed previously, the teenagers have the wishes of getting condoms in an easier way, so each peer educator gets some condoms (totally 2,000 are delivered). In addition, each peer educator gets a notebook, pen, and Manual of Peer Education as well as a brief introduction of the manual.

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2. Training Evaluation

The training preparation is designed on the basis of the previous trainings. In the preparation, I keep communicating with the Communist Youth League and focus closely on the work which the peer educators may be doing. Step by step, the knowledge, skills and the other issues are trained according to the plan.

In terms of the training strategy, an ice-breaking game is designed at the very beginning so as to separate the young people from different towns. All through the training, participation is the main approach. The participants share the information and experience from different communities so that they all have a better understanding of the teenagers in Ruili. In participation, the young people have enhanced their confidence and capacity.

When discussing about the timing and the next 2 revisits, some participants think that November and December are the season when people are busy with tobacco and winter maize plantation. They worry that they may not be able to come to participate in the revisit. So only 12 participants agree to do peer education.

To learn about the participants’ opinion on the effect of the training, the participants are asked about their assessment on the content, timing, and approaches of the training. The result shows that only one participant thinks the training is just OK, all the rest think that the training is satisfying. One of them suggests that the trainers should speak louder. So in the training of the second day, the trainer tries to walk frequently among the participants so that they can hear clearly. After the second day, all the participants feel satisfied with the training.

The participants’ words: “After this training, I become braver, not like that in the previous training in the village”; “We should have similar training to the students in schools, but we do not have such skills. I learn how to communicate with students equally, it is very useful”. “From this training, I learn about the different reasons behind the behaviors of different ethnic young people. I have learned a lot”.

3. Main Problems and Findings

The participants of this training are mostly the volunteers who were chosen from the previous trainings. When the training starts, however, some people find that they have to be busy with their farm work (e.g. planting tobacco), meanwhile some other persons request to participate in the training when they get the information. For example, one teacher from Jiexiang

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Middle school, and 3 health training persons from the Municipal Health Bureau come to participate in the training.

Owing to the fact that ADB has not given the final approval whether we need to do the follow-up revisit, I have to tell the participant about the uncertainty in terms of the revisit. In other words, I cannot tell for sure whether there will be follow-up visit. This partly influences the young people’s choice so that not many people would like to participate in the follow-up visit.

4. The Cost of the Training (As ADB permitted) Item Budget Allocate($) Empirical balance （RMB） cost （RMB） （RMB） Community 23,518 - 21,160 2,358 Youth TOT Training

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Supplementary Appendix CC: Contents of Health Kit A total of 3900 kits were provided for construction and migrant workers through LREC. The kits comprised the following:

1. 1 first aid bag 2. 1 triangular bandage 3. 1 respiratory membrane 4. 1 crepe bandage 5. 2 medical gauze 6. 1 tourniquet 7. 1 scissor 8. 1 clinical gloves 9. 1 adhesive tape 10. 10 plasters 11. 1 bow cap 12. 1 iodine tincture 13. 1 cotton swab 14. 1 essential balm 15. 10 condoms 16. 1 illustrated first aid manual 17. 1 ageratum capsule 18. 1 information brochure on HIV/AIDS (dual language

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Supplementary Appendix DD: Community Bulletin Boards

Neimangguai Nangai

Guangxi Gazhong

Nansan Guangti

Nongmulai Jinghan

Hannong Feihai

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Supplementary Appendix EE: IEC Materials reproduced by TA Poster targeted to migrant workers – letter by migrant worker to his family telling him that he is taking care of himself. This is based on evidence that workers are often more concerned with the health of their families than themselves.

Poster targeted at construction workers with the message ‘Safe in the day, safe at night’. Message equates use of condoms with use of safety hats which is well engrained on construction sites.

Field educators guide and training exercises specifically geared for road construction site context. Guide also provided in hard copy.

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Supplementary Appendix FF: TA training photos