INTRODUCTION

China has made considerable progress in the response to the AIDS epidemic in the past years, particularly in terms of commitment by the national leadership, the establishment of a supportive policy framework, improved understanding of the key elements of the epidemic, and provision of treatment, care and support to people living with HIV. Several challenges and constraints, however, remain – as identified in the Government/UN Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China (2004) 1. To meet the challenges and overcome the constraints need joint efforts, strength and resourcefulness. China's commitment to AIDS owes much to the persistence of national and international partners who over the years have conducted patient, evidence-based advocacy in favor of an increased response. The UN system has been actively involved in this process with activities ranging from technical assistance and policy formulation to supporting innovative or strategically important pilot projects.

THREE DOCUMENTS GUIDE UN SYSTEM'S RESPONSE TO AIDS IN CHINA

The millennium development goals (MDGs)

In September 2000 at the UN, the world leaders reached a historic agreement on the Millennium Declaration and subsequently eight universal Millennium Development Goals (MDGs) 2. Each MDG goal addresses aspects of poverty reduction and is expected to be achieved by 2015. The China 2004 MDG progress report highlights areas that require particular attention, for example: halting and reversing AIDS and tuberculosis, and malaria. On the basis of the Chinese government's vision of a harmonious, all round and moderately prosperous society “Xiaokang”, the MDGs and the Millennium Declaration, the UN system in China has identified AIDS as a particular areas of focus.

The united nations general assembly special session (UNGASS) on HIV/AIDS

At the close of the groundbreaking United Nations General Assembly Special Session (UNGASS) 3 on HIV/AIDS in June 2001, 189 Member States adopted the Declaration of Commitment on HIV/AIDS. The Declaration Commitment reflects global consensus on a comprehensive framework to achieve the MDG of halting and beginning to reverse the HIV/AIDS epidemic by 2015. Recognizing the need for multisectoral action on a range of fronts, the Declaration of Commitment addresses global, regional and country-level responses to prevent new HIV infections, expand health-care access and mitigate the epidemic's impact. The United Nations system is committed to facilitating greater international cooperation on AIDS with China to meet the goals and targets of the Declaration of Commitment of the Special Session of the UN General Assembly on HIV/AIDS.

The UN's development assistance framework (UNDAF)

The UN's Development Assistance Framework (UNDAF) 4 is an expression of the UN's continuing commitment to cooperation with the Government of China. UNDAF is a planning framework that aims to harmonise the operational activities for the UN in China, and provides a summary of the UN system's joint goals, objectives and strategies. In the 2006-2010 UNDAF, the UN commits itself to a number of outcomes, including: “HIV/AIDS, tuberculosis and malaria infection and disease rates reduced, care and support for those infected and improved the rights of those living with HIV and AIDS.”

THE UN THEME GROUP ON AIDS

For nearly two decades the United Nations system has been at the forefront of the international response to the AIDS pandemic.

The UN Theme Group on AIDS is the principle vehicle for planning, managing and monitoring a coordinated UN response to AIDS at country level. In China, the UN Theme Group was established in early 1996. Composed of representatives from ten agencies (Cosponsors of UNAIDS) with offices in Beijing, it operates under the aegis of the UN Resident Coordinator. The UN Theme Group Chair is elected by consensus by its members, ideally for two years. The UN agencies in China work closely with other programmes and funding mechanisms such as the Global Fund to Fight AIDS, TB and malaria and interact with other non-UN system major stakeholders through an 'Expanded' Theme Group, which welcomes representatives from the Ministry of Health and other ministries, international NGOs and foundations – for example, Clinton, Gates and Ford foundations, Family Health International, Future Groups, Global Business Coalition, and Save the Children Fund – interested bilateral agencies – for example, Australian Agency for International Development (AusAID), UK Department for International Development (DfID), Canadian International Development Agency (CIDA), US Centers for Diseases Control and Prevention Global AIDS Program (US CDC GAP) – and, increasingly, national NGOs and often directly involves people living with AIDS. Meetings are held once a month and the agenda is set jointly by the Ministry of Health and the UN Theme Group.

The Expanded Theme Group has created technical working groups (known familiarly as “baby theme groups”) to address various issues, such AIDS and children, youth, treatment and care, injecting drug use, and the business and workplace response to HIV and AIDS. Among other important activities, the Expanded Theme Group is actively supporting civil society engagement in the response to AIDS in China.

Key achievements of the collective and combined efforts of UNAIDS and its ten Cosponsors, with support from the partners of the Expanded Theme Group, in the response to AIDS in China include:

1) Strengthened leadership and political commitment to response to AIDS

2) Improved HIV and AIDS surveillance and information

3) Expanded and more effective prevention efforts

4) Improved treatment, care and support to people living with HIV and AIDS

5) Increased investments in AIDS programs and international collaboration

The main activities and achievements by the UN Theme Group in 2004 and 2005 are:

1) Developed and launched a Joint Assessment of HIV/AIDS Prevention, Treatment and Care in China (2004) – by State Council AIDS Working Commit tee Office and UN Theme Group on HIV/AIDS in China.

2) Supported a number of high-level advocacy and assessment missions that further advanced China's response against HIV/AIDS, for example by: UN Secretary-General, Executive Directors of the Global Fund, UNODC, UNAIDS, US Global AIDS Coordinator, Gates Foundation, Global Business Coalition, Center for Strategic and International Studies.

3) Secured buy-in and support from all stakeholders of the principles of the ‘three ones’ and the concepts of national ownership, multisectorality, mainstreaming, harmonization and coherence as a basis for international support.

4) Supported and mobilized Chinese top level Government and NGO participation in the International AIDS Conference in Bangkok in July 2004, and Asia Pacific AIDS Conference in Kobe in July 2005.

5) Empowered China's AIDS Goodwill Ambassadors by supporting and encouraging their participation in a number of high profile advocacy events in China and abroad.

6) Supported and actively participated in a number of key events during World AIDS campaigns that brought heightened attention to HIV/AIDS.

7) Promoted strong leadership in the provinces, counties, townships, villages and engaging different sectors and leaders from the senior most levels of the central Government to the villages in the response to HIV/AIDS.

8) Continued support to overall planning as well as data collection, analysis, estimations, and utilization of data for policy and programme development.

9) Continued advocacy, capacity building, networking and legal reform to address the issues of stigma, discrimination and civil society engagement.

10) Provided technical support and strengthened monitoring and evaluation of targeted interventions to decrease the vulnerability and reduce harm among high risk groups.

11) Facilitated access to international experience and local best practice, e.g., on needle exchange and metha done treatment for injecting drug users, condom use among sex workers, awareness raising among migrants, life-skills based education for young people, business involvement, and income generation for people living with HIV/AIDS.

12) Intensified efforts to provide access to treatment for people living with HIV/AIDS as well as care and support to those affected by HIV/AIDS, including children.

AIDS is more than a medical disaster; it is one of the most pressing and complex development challenges of our time. In the response against AIDS, no individual approach is sufficient, and no single sector of society can undertake the required work alone. The ongoing dialogues, as well as concrete activities by individual UN agencies, have contributed to China's commitment to expand its response against AIDS.

TEN UN AGENCIES AND UNAIDS SECRETARIAT'S MAIN RESPONSIBILITIES 5

United Nations High Commissioner for Refugees (UNHCR)

UNHCR is a humanitarian, non-political organization with two basic and closely related aims: to protect refugees, and to help them restart their lives in a normal environment. It has substantial HIV/AIDS programs to reach refugees and their surrounding host communities, which are often located in remote areas. In recent years, its HIV/AIDS programs have expanded to include voluntary counseling and testing and the prevention of mother-to-child transmission. In China, UNHCR's activities are centered on the follow-up to local integration as well as other durable solutions for Vietnamese refugees in six southern provinces and capacity-building and co-operation with Government authorities on issues related to China's adhesion to the Refugee Convention.

United Nations Children's Fund (UNICEF)

UNICEF's global mandate is to promote and protect children's rights. Since 1996, its HIV/AIDS-related work in China has emphasized planning and policy development, innovative projects, and mobilizing resources. Prevention education for young people both in and out of school is a special priority. A Life Skills curriculum developed with UNICEF support has been adopted by the Ministry of Education and implemented in over 400 pilot high schools. The Ministry is now scaling up training for provincial facilitators in seven provinces. One important focus area is preventing mother-to-child transmission (PMTCT) of HIV. Since 2001, UNICEF has supported a pilot project in Henan Province, which has significantly influenced the Ministry of Health's new national PMTCT protocol. With partners like the National AIDS Centre, the CCDC's Women and Child Health Centre, Medecins sans Frontieres and the Clinton Foundation, UNICEF is supporting the development of guidelines and policies for care and treatment of HIV-positive children. Its community approach has also had notable success in improving patient compliance with antiretroviral treatment. Influenced by the pilot's success, the Ministry of Civil Affairs is now planning a national policy framework for children orphaned by AIDS.

World Food Program (WFP)

Recognizing that the epidemic can be both a cause and a consequence of food insecurity, WFP includes HIV/AIDS interventions in its development programs and emergency operations around the world. In China, it has emphasized increasing HIV/AIDS awareness in the seven provinces where it has been active, which include some of the most remote parts of the country. Many of the villagers in these regions migrate to find work in other parts of the country during the winter months when farming work is minimal. Since 2001, over 300,000 people have received HIV/AIDS awareness training as part of WFP food-for-training programs and skills-based literacy activities. Over 500 medical staff from WFP project clinics have received training in HIV/AIDS prevention. WFP has also developed sex education and HIV/AIDS education curricula for school children in Guizhou province. Partners in these various activities have included the Ministry of Agriculture, Ministry of Health, and AusAID, and a number of teaching materials and promotional posters have been developed especially for rural populations. WFP will conclude its activities in China in 2005. However some of its training activities, including HIV/AIDS awareness will be continued by WFP's local partners.

United Nations Development Program (UNDP)

UNDP supports China's efforts to build a multisectoral response to the epidemic. A central priority is creating a policy and legal environment which enables effective prevention and care programming at all levels while protecting the rights of HIV-positive people. There is a direct line from a UNDP workshop on policy and law in 2002 andthe HIV/AIDS policy forum hosted by the National People's Congress (NPC) in January 2004. In August 2004, the amended law on contagious disease prevention and control was enacted by the NPC, which stipulates strengthened measures on HIV/AIDS prevention, and outlaws discrimination against people living with HIV/AIDS. Committed to getting all levels involved, the NPC has organized HIV/AIDS policy workshops for provincial legislators in Guangxi, Sichuan, Hubei and Shaanxi provinces. Another UNDP focus is alleviating the epidemic's economic impact. Built on the traditional strength in poverty reduction, UNDP tries to address and link the root cause with HIV/AIDS by developing county and village development plans that integrate HIV/AIDS at community levels in Guizhou and Guangxi provinces.

United Nations Population Fund (UNFPA)

UNFPA has worked for many years with China on reform of its reproductive health program, and has included HIV/AIDS prevention in this effort since the late-1990s. Working closely with the National Population and Family Planning Commission and NGO partners, UNFPA promotes a comprehensive approach to HIV prevention through China's family planning system. This includes both high-level policy work and support to community level efforts to raise HIV/AIDS awareness of both service providers and the general public. In 2001, the Ministry of Railways invited UNFPA to provide technical support for its HIV prevention program. Over a billion trips are made on China's railways every year by young people and a “floating population” largely composed of male workers seeking work – a prime target population for HIV/AIDS prevention. Funded by CIDA, the program includes condom social marketing and information, education and communication activities for travelers and HIV/AIDS training and condom social marketing for staff.

United Nations Office on Drugs and Crime (UNODC)

UNODC has been working with China since the mid-1980s. In the field of AIDS, in line with its mandate, UNODC's activities focus on injecting drug use in prison settings and in compulsory drug abuse treatment and rehabilitation centers. UNODC is currently working with the National Narcotic Control Commission (NNCC) to review China's criminal-justice approaches, use in compulsory drug abuse treatment and rehabilitation centers, in light of international best practices. Redefining drug addition as primarily a health problem will lead to reduced stigma and discrimination against drug users, improved treatment outcomes, and finally reduced HIV infections.

International Labor Organization (ILO)

ILO's global area of responsibility is the world of work, which it addresses in “tripartite” cooperation with governments, employers, and workers. Its Code of Practice on HIV/AIDS and the World of Work is the policy foundation for HIV/AIDS workplace efforts around the world. In China, ILO has built a strong tripartite relationship with its counterparts: the Ministry of Labor and Social Security (MOLSS), the All-China Federation of Trade Unions (ACFTU) and China Enterprise Confederation (CEC). ILO's principle role is to build its counterparts' capacity to create policies and programs which will (a) prevent HIV-related risk behaviors among workers and their families and (b) combat stigma and discrimination against HIV-positive persons in both the workplace and the community. A new initiative funded by the US Department of Labor begins in 2005, initially in three provinces. A tripartite Project Advisory Board will steer the project, which will pay special attention to combating discrimination against men and women living with or affected by HIV/AIDS in the workplace and to reduction of risk behaviors of targeted workers.

United Nations Educational, Scientific and Cultural Organization (UNESCO)

In line with its international responsibility for education, UNESCO has prioritized the mainstreaming of HIV/AIDS in all aspects of Chinese educational policy. To this end, it mobilizes the multi-disciplinary strengths of its education, sciences, human and social sciences, culture and information communication technology sections, and works closely with a wide partner network that includes Ministries, mass organizations, professional associations, academic and research institutes, and other UN agencies. Key tool is the publication HIV/AIDS and Education - Advocacy Toolkit for Ministries of Education, developed by UNESCO for the Asia Pacific Region and recently adapted specifically for China. Focusing Resources for Effective School Health (FRESH) Initiative was launched by UNESCO, UNICEF, WHO, World Bank, Education International and WFP in 2000, and offers a number of advantages in rural and resource-poor districts. From 2002 to 2004, UNESCO executed a CIDA-funded training-of-trainers program for China's medical schools and continuing medical education system.

World Health Organization (WHO)

The overall aim of the HIV/AIDS-related work of WHO is to strengthen the ability of national health systems to mount comprehensive responses to the epidemic. In China, WHO is rapidly expanding its activities with a wide range of partners, including health authorities at the highest levels, and is forging strong linkages with international institutions and agencies.

WHO is providing a range of support to China's efforts to scale up care and treatment for HIV-positive people through the expertise of WHO's “3 by 5” initiative. WHO has strongly promoted second generation surveillance, which includes HIV sentinel data and behavioural surveys. Since 2001, WHO has provided technical and financial support for 100% Condom Use Programmes (CUP) among sex workers and clients, with successful pilot projects in Hubei, Jiangsu, Hunan and Hainan provinces. Scaling up and expanding to other provinces is under way, and the recently announced national strategy for national condom promotion includes provisions for 100% CUP.

Word Bank

Although it has included HIV/AIDS components in its health sector work in China since 1992, the World Bank began a major effort on HIV/AIDS in 1999 with its Health Nine Project, in partnership with the Ministry of Health. Along with improving maternal and child health in poor areas of China and supporting early child development, Health Nine includes substantial financing for HIV prevention and control in Fujian, Guangxi, Xinjiang, and Shanxi provinces. With support from Australia and Japan, the project also established a fund to promote NGO participation in the HIV/AIDS response. Tuberculosis kills more HIV-positive people than any other opportunistic infection. In 2002, the World Bank signed an agreement with the Ministry of Finance, Ministry of Health, and DfID to implement the China TB Control Project. The World Bank continues to work closely with Government of China in favor of balanced development, with a focus on poverty alleviation, thereby addressing the socio-economic risk factors for HIV/AIDS.

UNAIDS secretariat

The Joint United Nations Program on HIV/AIDS (UNAIDS) coordinates and facilitates the work of UN agencies working in the field of AIDS. UNAIDS supports the work of the ten UN agencies and serves as the Secretariat to UN Theme Group. Through its Cosponsors and partners, UNAIDS has been instrumental in bringing about Chinese Government acknowledgement of the magnitude of the AIDS challenge, and in outlining a framework for collective action necessary in order to mount an effective response against the epidemic. In China, the focus of the work of the UNAIDS is on:

a) Leadership and advocacy for effective action on AIDS

b) Production and distribution of strategic information

c) Tracking, monitoring and evaluation of the epidemic and actions responding to it

d) Civil society engagement and partnership development

e) Financial, technical and political resource mobilization

FUTURE EXPECTATIONS OF THE UN SYSTEM'S RESPONSE TO AIDS

For the UN system in China to effectively support the response to HIV/AIDS in China over the next several years, plans of different agencies need to be developed further and brought together into a joint program – a “unified UN country support program on AIDS”. The program will be characterized by:

Empowering inclusive national leadership and ownership

Under national leadership and ownership, the program aims at strengthening the planning of local AIDS responses, using existing strategic frameworks as the basis for development of operational plans that drive implementation.

Alignment and harmonization

The joint program is proposed to use joint participatory reviews of the national AIDS program as its primary monitoring and evaluation modality and recommends that other international organizations do the same.

Reform for a more effective multilateral response

The development of a joint program will be supported by a UN team on AIDS under the leadership of the Resident Coordinator. This will be complemented by a problem-solving body at global level to assist in removing bottlenecks that may impede a more effective response to AIDS.

Accountability and oversight

It is proposed that national stakeholders formally review the joint program using a scorecard-style accountability. It is also proposed that the joint program aligns indicators and performance appraisal with national monitoring and evaluation systems which are under development.

The UN system will provide critical support to China's response to AIDS on six priority areas, in close collaboration with the international community (NGOs, private sector, bilateral and international donors).

SUPPORTING THE ‘THREE ONES’

This becomes increasingly important in light of the growing number of international agencies showing interest in supporting AIDS efforts in China. For international assistance to be effective it has to be embedded in the national response to AIDS. The ‘three ones’, essentially consist of one national plan on AIDS supported by provincial plans that provide the basis for the response to AIDS; one national coordinating authority for AIDS with a broad based multi-sectoral mandate; and, one agreed monitoring and evaluation system.

INCREASING AWARENESS OF AIDS AND REDUCING STIGMA AND DISCRIMINATION

AIDS associated stigma and discrimination is a major problem across China. It is essential to develop and implement innovative methods, relevant to local conditions and realities, to increase awareness among all sectors of society, with a view to change attitudes towards AIDS and people living with HIV/AIDS.

REDUCING VULNERABILITY AND RISK BEHAVIOUR AMONG SPECIFIC GROUPS

In China today, a priority must be to reduce the vulnerability and empower the most at-risk populations in the country to protect themselves from getting infected by HIV. Specific interventions, different from the approaches aimed at raising the awareness of the general population, are required to reach injecting drug users, sex workers, men who have sex with men and migrants.

PROVIDING IMPROVED TREATMENT, CARE AND SUPPORT FOR PEOPLE LIVING WITH AIDS

In the absence of a cure for AIDS, providing long term medical care as well as social and psychological support to those who are already infected by HIV become priorities. In this effort, both the health care system and the community at large have to be involved.

PROMOTING STRONGER ENGAGEMENT BY CIVIL SOCIETY

The AIDS problem cannot be solved by the health sector alone. The many dimensions of AIDS are well known. Efforts to effectively implement government policies and commitment will require most active involvement of NGOs and people living with HIV/AIDS.

ADDRESSING THE GENDER DIMENSIONS OF AIDS

Across the world, women are becoming more and more vulnerable to AIDS. And the last few years have shown a significant increase in the proportion of women and girls infected by HIV in China as well. This calls for more gender specific prevention efforts focused on poor and often marginalised women and girls.

The UN is ready to work with everyone and will spare no effort in supporting the fight against AIDS in China. China is a global leader in many fields. In a few years time, China can be a global leader in the fight against AIDS as well.