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ASIA–PACIICAsia–Pacific Population & Policy POPULATION AND HEALTH STUDIES & July 2002 & Number 62 POPULATION POLICYPOLICY HIV/AIDS in China: Survey Provides Guidelines for Improving Awareness

Asia-Pacific Population hina stands “on the precipice paigns have had an effect—most peo- & Policy summarizes of a potential AIDS catastro- ple in China who know about HIV/ research on population phe.” So reported the Global AIDS learned about the disease from and reproductive health C HIV Prevention Working Group (2002) the media. But the survey also shows for policymakers and others concerned with to the July 2002 International Confer- how much more needs to be done— the Asia-Pacific region. ence on AIDS in Barcelona. many people have a poor understand- The U.S. National Intelligence ing of HIV, and others have not heard

This publication was made Council (2002) reports that, “China has of the disease at all. possible through support significantly raised its official estimate from the William and Flora of the number of HIV-positive people over Hewlett Foundation. The the last two years from 600,000 to one ABOUT THE SURVEY opinions expressed do not million. The U.N. now estimates that necessarily reflect the views 1.5 million are infected, while other ex- According to spokesperson, Zhao Baige, of the East-West Center or of its supporters. perts believe the number probably is the State Family Planning Commission closer to 2 million or even higher.” The of China is reorienting its large staff Council goes on to project that China and resources toward reproductive Writers: Chen Sheng Li, Zhang Shi Kun, will have 10–15 million HIV/AIDS cas- health and HIV/AIDS: “We have a very Mo Li Xia, and Yang Shu Zhang es by 2010, or 1–2 percent of the pro- big, complicated, and very effective net- jected adult population. work in China, with 400,000 staff….

Series Editor: In response to rising prevalence lev- We have the whole system from the Sidney B. Westley els, the Chinese government is placing provincial, county, and township to vil- increasing emphasis on HIV/AIDS pre- lage level. We first focused on popula-

Editorial Committee: vention. The State Council has set up tion development and then moved to re- Tim Brown a national committee for HIV/AIDS productive health including HIV/AIDS.” Minja Kim Choe control with members from 26 minis- The December 2000 survey marks Philip Estermann tries and commissions. an important step in the State Family Robert D. Retherford Public awareness is a key component Planning Commission’s reorientation. of any prevention strategy, and China It covered five rural and two urban ar- ISSN 0891-6683 has an HIV/AIDS awareness program in eas, chosen to include locations with place with an emphasis on mass media. varying levels of economic development As part of this effort, the State Family and HIV prevalence. Correspondence address: Planning Commission conducted a sur- The survey interviewed 7,053 peo- East-West Center, Research Program vey on AIDS awareness in December ple age 15–49, about half women and Population and Health Studies 2000. The objective was to provide half men. Fourteen percent were un- 1601 East-West Road baseline information for expanding married. Support for the survey came Honolulu, HI 96848-1601, USA HIV/AIDS prevention activities. from the United Nations Children’s Telephone: (808) 944-7482 Fax: (808) 944-7490 The results of the survey, summa- Fund (UNICEF), the Ford Foundation, E-mail: [email protected] rized in this issue of Asia-Pacific Pop- and the Joint United Nations Program Internet site: www.eastwestcenter.org ulation & Policy, show that media cam- on HIV/AIDS (UNAIDS). 2

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100 96 94 tion with reused equipment and rein- about HIV/AIDS and sexually trans- 80 fusion, fewer than one in five (17 per- mitted infections (STIs). As with 76 80 72 cent) mentioned avoiding unnecessary knowledge, perception of risk is high- 60 blood transfusions as a way to prevent er in urban areas than in rural areas. HIV (Table 1). Respondents who had heard of HIV/

Percent 40 In the country as a whole, more than AIDS were asked what they would do 20 half of respondents (53 percent) either if they suspected they were infected. do not know that AIDS can be avoid- The largest proportion (70 percent) 0 Rural Rural Urban Urban Total ed, cannot name a single way to avoid mentioned that they would seek med- men women men women infection, or have not heard of AIDS at ical attention. Fifteen percent said that Respondents who have heard of HIV/AIDS all. The proportion with such poor they would avoid sex. igure 1 Awareness of HIV/AIDS knowledge is 64 percent in rural areas

Source: Chen et al. 2001. and 26 percent in urban areas. People living with HIV. The survey asked about attitudes toward people living with HIV or AIDS. Although The survey shows that knowledge of PERCEPTIONS AND ATTITUDES many respondents expressed sympathy, AIDS is low, particularly in rural ar- others reported that they would “avoid eas. Results also provide information Risk perception. The survey asked re- contact” with an acquaintance living on how people learn about AIDS and spondents about the risk behavior of with HIV/AIDS (37 percent) or would what communication channels could others and their own perception of per- “detest” (11 percent) or “blame” (5 per- be better utilized to improve AIDS sonal risk. Men and women in every cent) such a person. awareness. survey area noted some level of risk be- Some people may have negative at- havior in their neighborhoods (Figure 3). titudes toward people living with HIV More than one-fourth of respondents because they have a poor understand- AWARENESS AND KNOWLEDGE (29 percent) are worried that they might ing of how the virus is transmitted. Six become infected with HIV. And three- percent of survey respondents believe, Overall, one-fifth (20 percent) of sur- fourths (76 percent) want information erroneously, that they can become in- vey respondents have never heard of 42 Limit sex to one AIDS (Figure 1). Awareness is much 32 partner lower in rural areas than in urban ar- 66 eas and slightly lower among women 14 Use condoms than among men. 9 correctly As with general AIDS awareness, 28 Total knowledge of each of the four major 16 Avoid unnecessary Rural ways to avoid HIV is higher in urban 9 blood transfusions Urban areas than in rural areas (Figure 2). 34

Among the survey sites, knowledge of 12 Use disposable or 6 ways to avoid HIV is highest in Sanya sterilized needles City and is also generally high in Shang- 27 hai’s Jing An District (Table 1). 24 Don't know any way to 32 Among respondents who have heard avoid of AIDS, the most frequently men- 11 tioned way to avoid HIV infection is to 0 20406080100 have only one sex partner (Figure 2). Percent aware of a way to avoid infection x Much smaller proportions mentioned using condoms, avoiding unnecessary igure 2 Awareness of ways to avoid HIV infection blood transfusions, or using clean nee- Note: Percentages are of people who have heard of HIV/AIDS and who know that it is pos- dles. Even in Shang Cai County, Henan sible to prevent infection. Among specific ways to avoid infection, multiple responses Province, where many people have been were allowed. infected with HIV through blood dona- Source: Chen et al. 2001. 3

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Table 1 Awareness of ways to avoid HIV infection in seven locations of China

Percentage having heard of HIV who are aware of a way to avoid infection

Urban areas Rural areas

County Jing An Sanya Chang Ping Dong Ning Shang Cai Hui Dong Bai Se Province or municipality Shanghai Hainan Beijing Heilongjiang Henan Guangdong Guangxi

Limit sex to one partner 79 78 67 55 39 72 62 Use condoms correctly 18 51 6 11 11 36 20 Avoid unnecessary blood transfusions 30 53 10 20 17 20 18 Use disposable or sterilized needles 19 48 4 10 10 16 19 Don’t know any way 14 7 28 37 50 16 34

Note: Percentages are of people who have heard of HIV/AIDS and who know that it is possible to prevent infection. Among specific ways to avoid infection, multiple responses were allowed. Source: Chen et al. 2001. fected by touching an infected person. like to learn about HIV/AIDS from Five percent believe that they can be- health and family planning providers POLICY RECOMMENDATIONS come infected by touching an infected (20 percent) than currently receive in- person’s clothes. Misinformation about formation from this source (7 percent). This survey shows that many men and HIV transmission is more common in Most men and women feel that women in China have a poor under- urban than in rural areas. young people should learn about sexu- standing of how they can protect them- ality, reproductive health, and HIV/ selves from HIV/AIDS or have not AIDS prevention in school. Eighty-two heard of the disease at all. Most people SOURCES O INORMATION percent think that Chinese schools feel that they need to know about HIV/ should teach about HIV/AIDS preven- AIDS and would like to learn about the Questions about exposure to mass me- tion, and 77 percent think that the disease from television. Yet one-third dia show that television reaches a wide schools should provide sex education. do not watch television regularly. proportion of the Chinese population. About two-thirds of rural (68 percent) 26 and urban (65 percent) residents watch Commercial sex in 21 television regularly. Nearly one-half (49 your neighborhood? 38 percent) of urban residents read news- 17 Illegal drugs in your Total papers regularly. Exposure to all other 9 neighborhood? Rural 39 media is much lower. Urban Most people who know about AIDS 8 Selling blood in your 6 heard of the disease from television neighborhood? 11 (Figure 4). Newspapers are another im- portant source of information, partic- Worried that you might 29 become infected with 26 ularly in urban areas. Few learned about HIV? 35 AIDS from health workers or through Do you need to know 76 lectures or print materials provided by about HIV/AIDS, 74 the family planning system. STIs? 79 Preferences for learning about HIV/ 0 20406080100 AIDS are similar to current sources of Percent perceiving risk information (Figure 5). Television is a popular source everywhere, and books igure 3 Perception of HIV/AIDS risk and newspaper are popular in urban ar- Note: Percentages are of all respondents. eas. Interestingly, more people would Source: Chen et al. 2001.ource: Chen et al. 2001. 4

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73 ness campaign should make full use of Television 76 these media. 68 The survey shows, however, that 38 one-third of respondents—in both ru- 25 Newspapers ral and urban areas—do not watch tele- 62 vision regularly. And regular exposure 18 to other media is much lower. Radio 14 27 In addition to mass media campaigns Total aimed at the general population, experi- 9 Lectures, information Rural 5 ence in other Asian countries suggests materials Urban 17 the importance of focusing prevention 7 efforts on groups engaged in risk behav- Health personnel 4 ior such as sex work or injecting drug 14 use. This approach has proven effective 0 1020304050607080in efforts to limit new infections. Percent who learned about HIV/AIDS from source There are thus compelling reasons igure 4 Sources of information about HIV/AIDS for improving the information on HIV/ AIDS available through China’s health Note: Percentages are of respondents who have heard of HIV/AIDS. Multiple responses and family planning systems. Face-to- were allowed. face meetings with health and family Source: Chen et al. 2001. planning personnel, supported by ap- Source: Chen et al. 2001. Most of these men and women are mation will not only help people avoid propriate information materials, appear probably not at high risk of HIV infec- infection, but should also improve their to be a particularly promising—and un- tion, but they may be at some risk. Re- attitude toward people living with HIV. derexploited—avenue for increasing sults show some degree of risk behav- Findings on people’s current and pre- AIDS awareness. ior—as perceived by respondents—in ferred sources of information point to every location covered by the survey. the importance of mass media—and of The general lack of knowledge about television in particular. Newspapers are URTHER READING HIV/AIDS and how to protect oneself also an important source of informa- is thus a serious concern. Better infor- tion in urban areas. Any AIDS aware- Brown, Tim. 2002. HIV/AIDS in Asia. In East-West Center. The future of

65 population in Asia. Honolulu: East- Television 65 West Center. 66 Chen Sheng Li, Zhang Shi Kun, Mo 30 Li Xia, and Yang Shu Zhang. 2001. Books/newspapers 20 Results of baseline survey for IEC in 56 HIV/AIDS prevention project. 16 Radio 12 Total Beijing: State Family Planning Com- 27 Rural mission of China. Urban 6 Global HIV Prevention Working Group. Lectures, information 3 materials 2002. Global mobilization for HIV 13 prevention: A blueprint for action. 17 20 September 2002. http://www.gates Health personnel 16 32 foundation.org/nr/downloads/global health/aids/hivprevreport_final.pdf. 0 1020304050607080 National Intelligence Council. 2002. Percent who want to learn about HIV/AIDS from source The Next Wave of HIV/AIDS: Nige- igure 5 PerferredPreferred sources of information about HIV/AIDS ria, Ethiopia, Russia, India, and Note: Percentages are of all respondents. Multiple responses were allowed. China. ICA 2002-04 D. Washington, Source: Chen et al. 2001.ource: Chen et al. 2001. DC: National Intelligence Council.