By 2000, China will have 1.2 million people infected with HIV and 33,000 people with AIDS. While HIV infection has been reported from almost all provinces and occupational groups in the country, HIV prevalence is highest among IV drug users in Yunnan province. The major source of infection elsewhere in China is through the receipt of tainted blood products and heterosexual intercourse. A National AIDS Committee was formed in October 1986 to advise the government on AIDS policy, and since 1990 to coordinate all AIDS prevention activities. The National Strategies Plan for AIDS/STD Prevention in China during 1996-2000 was prepared in 1995. China's in-country migrant labor population may become the most vulnerable to HIV infection. There are currently about 120 million migrant workers in China, of whom about half are registered, nonpermanent residents working in the fastest developing regions. The open nature of China's economy relative to recent past decades has made it difficult to monitor and control internal migration. Floating populations are the most difficult to reach with preventive health education and they tend to be deprived of access of health care. 61.4% of the migrant population is male and 40% are aged 20-24 years. China's traditional trade routes may be a factor in HIV infection. HIV/AIDS epidemiology, the synergy of STDs and AIDS in China, the international partnership in HIV/AIDS prevention in China, the role of international nongovernmental organizations in China, Hong Kong's contribution to AIDS prevention in China, awareness of the problems associated with HIV infection in China, and the challenges for AIDS-related work in China are discussed.
Tanzania has since the mid-1980s experienced some of the highest rates of HIV infection in the world, with data now showing the mean levels of HIV seroprevalence nationwide to be greater than 13%, and even higher than 30% in some districts. By 2000, as many as 2.4 million Tanzanians will be infected with HIV and more than 850,000 Tanzanian children will be orphaned by the epidemic. The Tanzania AIDS Project (TAP), funded by the US Agency for International Development (USAID), was implemented through the AIDS Control and Prevention (AIDSCAP) Project by Family Health International (FHI) during 1993-97. TAP will receive support throughout 1998 through a cooperative agreement between USAID and FHI. Nongovernmental organization (NGO) representatives meet on a regular basis in Dar es Salaam and in 8 other regions of the country to plan and coordinate the major aspects of TAP's HIV/AIDS prevention activities in each area. The author describes the evolution of the idea to bring NGOs together into geographic clusters, the diversity of talents enjoyed from using the cluster concept, building institutional capacity, the challenges facing TAP's 9 clusters, and working with traditional communities.
Hatred and fear of homosexuals, together with a fear of losing tourism revenue, drove many high-level policymakers in the Caribbean to ignore the HIV/AIDS in its infancy. With an annual incidence rate of at least 146.6 people per 100,000, the Bahamas now has one of the highest AIDS rates in the world and the highest such rate in the English-speaking Caribbean. AIDS has become the major cause of death for men and women aged 20-44 in the Bahamas. Indeed, throughout the Caribbean, countries like the Bahamas must now cope with a growing AIDS epidemic. UN AIDS Program figures indicate that at least 310,000 people in the Caribbean have either HIV infection or AIDS, and that the prevalence rate among adults is almost 2%. This compares with an estimated 7.4% of the adult population of sub-Saharan Africa which is infected and 0.6% of adults in North America. 65% of reported AIDS cases in the region result from heterosexual intercourse. While the annual number of AIDS cases has been falling in North America over the last several years and rates in Latin America have leveled off, rates in the Caribbean are increasing sharply. Poverty, the population's lack of awareness, low levels of education, internal and international migration, crack cocaine use, promiscuity, high levels of STDs, prostitution, and tourism are also facilitating the spread of HIV in the Caribbean. Social conservatism, mainly in the English-Caribbean, about discussing sex impedes the implementation and success of HIV/AIDS prevention interventions.
CARE-Niger's AIDS and Migration project was launched in 1993 with primary funding from the European Union and is based in Tahoua, Niger. The project's overall goal is to reduce the rate of STD/HIV infection among the more than 1 million Nigerian migrants who leave their villages annually in search of work in the large coastal cities of West Africa, especially Abidjan. Most migrants are separated from their families for at least 9 months of the year, returning to Niger in May or June to help with Niger's only planting season. Upon completion of the millet harvest, the men return to Abidjan in search of additional work. CARE has trained more than 100 peer educators to provide STD/HIV prevention information to migrants before, during, and after their voyages to Abidjan. In the villages of Tahoua, CARE staff train and supervise volunteer peer educators, including the male migrants, their wives, the prostitutes they encounter along the 2500 km migration route, and the Muslim religious leaders who preach weekly in mosques scattered throughout Tahoua. During the 4-day bus trip back to Abidjan, the bus driver has a range of educational cassettes which he can play, while Abidjan-based migrant peer educators await the men at their ultimate destination. AIDS and Migration project staff traveled by bus from Abidjan to Tahoua to better understand some of the obstacles Nigerian migrants face along the route. If funds can be secured, CARE will help provide STD care in Abidjan, install video and cassette-radio equipment on the Nigerian buses which make the trek between Tahoua and Abidjan, and buy and equip a bus to attract younger migrants.
An estimated 10% of Haiti's urban population and 4% of the rural population is infected with HIV. As recent as a few years ago, few commercial sales outlets for condoms existed in Haiti, even in the cities. Now, however, Pante condoms are accessible to Haitians at all hours of the day even in remote areas of the country. Pante is the brand name of the condom that Population Services International (PSI) introduced in Haiti in 1990, and began packaging, promoting, and selling a year later through a condom social marketing (CSM) program funded by the AIDS Control and Prevention (AIDSCAP) Project. The CSM program allows Pante to be sold at 10% of the cost of commercial condoms. Even in the context of political instability and economic crisis which followed the overthrow of Haiti's elected government in 1991, monthly sales of Pante during 1991-95 increased from an average of 3000 to more than 400,000, and more than 16 million units were sold over the 4-year period.
