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 i 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