EXECUTIVE SUMMARY

To achieve the overall objective of the China's Action Plan for Reducing and Preventing the Spread of HIV/AIDS (2006-2010), the Chinese government strengthened leadership in the prevention and control of the HIV epidemic, developed comprehensive prevention, treatment, care and support initiatives, and monitored on-going progress. This report, prepared by State Council AIDS Working Committee Office and the United Nations Theme Group on AIDS, covers the epidemic situation and the response since 2006, and identifies the ongoing challenges from which recommendations for future guidance are formulated.

1. The AIDS situation in China

The cumulative number HIV positives reported at the end of October 2007 was 223,501, including 62,838 AIDS cases and 22,205 recorded deaths. In 2007 the Ministry of Health, UNAIDS and WHO have prepared this updated assessment of the AIDS epidemic in China. The estimation result showed by the end of 2007, approximately 700,000 are now HIV positive (range 550,000-850,000). The HIV infection rate among China's population is 0.05 per cent (range 0.04-0.07%). The estimated number of AIDS cases is 85,000 (range 80,000-90,000).The estimated new HIV infections in 2007 are 50,000 (range 40,000 -60,000) and there are estimated 20,000 AIDS-related deaths (range 15,000-25,000). Among the living HIV positives, 40.6 per cent were infected through heterosexual transmission.

Currently, China's HIV epidemic remains one of low prevalence overall, but with pockets of high infection among specific sub-populations and in some localities. The characteristic of the epidemic in China are: The epidemic continues to expand, but the rate is slowing; sexual transmission is now the main mode for the spread of HIV; geographic distribution is highly varied; and the epidemic continues to be driven by high-risk behaviour within particular sub-populations.

In high-prevalence locations there are apparent impacts on individuals and families affected by AIDS, but data from applied research surveys on the social and economic impacts is limited.

2. Accomplishments of the AIDS response
The State Council strengthened the AIDS policy framework by issuing the Regulations on AIDS Prevention and Control and the new Five Year Action Plan for Reducing and Preventing the Spread of AIDS (2006-2010) in early 2006. The Chinese Government actively demonstrated commitment to international society and implemented the 'Three Ones' principle. National leaders, including Premier Wen Jiabao and Vice-Premier Wu Yi, continuously set examples of supporting people living with HIV and children affected by AIDS through personal actions.

The government's resource commitments to AIDS have continued to increase and comprehensive training to strengthen the HIV awareness of leaders is being implemented. An achievement during the past two years has been strengthened coordination and integration across sectors to plan and implement HIV awareness and prevention campaigns and similar activities, including the National HIV Education and Communication Campaign among Rural Migrant Workers, the Chinese Campaign on HIV Prevention among Children and Youth , and a National University Students' Lecture Competition on HIV Knowledge.

Mass organizations, civil society organizations and business enterprisesare actively involved in the national response to AIDS. Their range of involvement has become broader in its scope and depth. The number of community-based organizations is increasing and becoming an indispensable force in the national response to the epidemic. The role of celebrities in HIV awareness campaigns has helped generate interest among target groups.

Comprehensive HIV prevention initiatives are increasingly focused on behavioural change among the most-at-risk populations (MARPs). Coverage of interventions aimed at behavioural change by sex workers and their clients has increased and interventions to men who have sex with men were also strengthened through pilot projects. Among injecting drug users, the methadone maintenance treatment programme has been expanded, along with clean needle exchange in locations with high injecting drug use. HIV transmission through blood (plasma) donation and transfusion was effectively contained and the coverage of prevention of mother-to-child transmission was expanded. Voluntary counselling and testing services were progressively expanded.

Expanding access to free antiretroviral treatment under the 'Four Free One Care' policy has been a priority, with coverage extended to 1,190 counties in 31 provinces (autonomous regions and municipalities). Standardized ART was strengthened, the national drug resistance monitoring system was established and a pilot second-line drug trial was launched. Comprehensive treatment models, prevention of opportunistic infection treatment and traditional Chinese medicine treatment were under exploration, while care and support have been further intensified.

Strengthening the national surveillance system continues. A Comprehensive Response Management Information Systen was developed to integrated data and information on AIDS. Development of a National Monitoring and Evaluation system for AIDS is a priority area.  A significant step was achieved when the national AIDS Monitoring and Evaluation Protocol was formally issued.

Other measures implemented include strengthened resource integration and utilization; and better integration of international cooperation resources with national priorities. China has also played an increasing role in providing international assistance in the field of AIDS. Scientificresearch has been further developed.

3. Challenges and recommendations

While there have been impressive achievements in the national response to AIDS, a number of core challenges remain. These are outlined under seven key areas, namely: (1) programme management and accountability; (2) awareness campaigns and anti-discrimination; (3) comprehensive interventions; (4) treatment, care and support; (5) all society involvement; (6) capacity-building of response teams; and (7) monitoring and evaluation systems.

From the challenges, a series of action recommendations have been formulated. These are presented in Chapter 3.