成都同志社区艾滋病防治行动计划.doc

成都同志社区艾滋病防治行动计划（20072009年）成都同乐健康咨询服务中心2006.6一、背景目前，我国的艾滋病流行已进入快速增长期，而男同性恋人群一直是受艾滋病影响严重的人群。根据卫生部2005年中国艾滋病疫情与防治工作进展报告数据显示，男男性接触人群（含异性恋有同性性行为之男性）中艾滋病病毒感染者和病人约4.7万人，占感染者总人数（65万人）的7.3%。根据在部分大中型城市针对这一人群的监测数据表明，全国各地的男同性恋人群中均已发现艾滋病感染者，并且感染率远高于普通大众人群。四川省自1991年发现首例艾滋病病毒感染者以来，感染人数以较快速度增长，目前，感染者报告数已居全国第6位，加强艾滋病的预防和控制，已刻不容缓。在过去几年中，我省积极开展的防治艾滋病工作，初步遏制了艾滋病蔓延的势头。特别是在男同性恋人群中，在全国针对这一人群开展的工作还较薄弱的情况下。我省在成都、南充、乐山等地，大力发动目标人群参与，使同性恋人群积极行动起来，以发展社区非政府组织为依托，开展了大量的社区艾滋病防治工作，取得了明显效果。成都作为西南重要的中心城市，有宽松、和谐的社会氛围，包容、闲适的市民文化，为创造良好的防治工作环境提供了条件。在此基础上，20022006年，在省、市各级政府的领导下，卫生防疫机构和社区非政府组织积极配合，在成都同志社区开展了由同志人群自我主导的艾滋病干预工作。建立起了一支20名核心成员，150名志愿者，专业社会工作者和志愿者相结合，了解社区情况，具备多学科知识、参与防艾工作热情持续高涨的社区防艾队伍，并全面负担起；逐步形成了环境营造、能力建设、干预、监测、关怀、治疗有机互动的综合干预体系。在社区开展干预工作，4年干预累计覆盖近10000人；发展同伴教育者50名，开展同伴教育工作近30000人次；在社区近20个场所开展了安全套推广活动，发放安全套70000余只，发放宣传资料近50000份；与专业机构合作建立同志性病服务定点门诊，为500多位同志提供了规范友好的性病治疗服务；与CDC合作开展VCT工作，建立社区咨询采血点1个，累计检测619人次。干预工作初见成效，被干预人群安全套坚持使用率从2002年的3.30%上升到2005年的44.02%，目标人群参与艾滋病工作的热情持续高涨。初步探索形成了：“以目标人群为主导，同志社区NGO为平台，从同性恋亚文化特征出发，以“赋权”为理论指导”的MSM干预模式。但同时，还存在许多问题：干预队伍不稳定，能力还需提高：干预是持续性的工作，而目前社区组织法律地位不明确，固定工作人员缺乏，志愿者容易流失，从而造成干预队伍不稳定。同时也不利于工作人员能力的提高。干预覆盖面不足：目前我们估计成都同志人群规模在710万人，我们干预覆盖仅仅达到10左右，对艾滋病在同志人群中的蔓延不能起到遏制作用。干预深度不够：由于干预队伍专业性不够，稳定性不强，难以开展干预技术和方法的深入探索，导致干预方法缺乏多样性，不适应同志社区多阶层、多亚群体的现状。干预资源不稳定：由于政府目前缺乏对同志社区艾滋病干预工作的稳定财政投入，干预工作主要依靠国际项目支持，缺乏持续性和稳定性。同时，感染者关怀帮助工作还处于起步阶段，面临资源、技术等诸多问题亟待解决。因此，成都同志社区艾滋病蔓延形式仍很严峻，2003年2005年哨点监测结果，人群HIV感染率呈逐年上升趋势（2003年：0.64%；2004年：1；2005年：2.18%）。综上所述，全面规划同志社区艾滋病防治工作，并在切实保障的前提下，有计划、有步骤的推动同志社区艾滋病防治将是我们下一阶段的工作重点。二、工作原则1、政府主导，社区引导，同志为主，多方合作，吸纳不同人群参与，努力将艾滋病的危害降到最低水平。2、坚持合作原则，与政府部门、专业机构、国际机构、非政府组织展开多方面、多层次的广泛合作。2、科学务实，立足成都同志社区实际，注重实效，不搞形式主义。3、坚持平等、无歧视与不评判原则，努力消除社会歧视及社区内部歧视，提倡包容与和谐。4、严格遵循自我决策原则，提供信息、服务，帮助分析后果和影响，尊重个人意愿。5、坚持保密原则，严格尊重个人隐私。四、总目标发动社区人群参与艾滋病防治，协助政府建立健全由政府领导，多部门合作和全社会参与的艾滋病预防与控制体系。积极配合政府及相关部门遏制艾滋病在同志人群中的传播。五、工作指标至2009年底：1. 完成社区非政府组织（NGO）注册及组织机构建设。以之为平台，为政府全面掌握我市同志人群艾滋病流行特征及其流行规律提供信息和资料，协助政府开展同志人群艾滋病防治工作，促进同志人群防治工作经费纳入政府预算。2. 同伴教育者人数增加到100人，且100%接受过系统培训。3. 志愿者人数发展到300人，其中的80%接受过防治艾滋病基础知识及相关社会学知识的系统培训。并建立完善的志愿者管理系统。4. 扩大干预覆盖面，将干预覆盖人数达到2万人。5. 促进同志人群对自愿咨询检测服务的利用，使接受VCT人数每年增加30%，至2009年底达到每年500人。6. 促进同志人群对规范性病服务的利用，使同志人群对性病门诊知晓率上升到50。7. 将接受干预的同志人群的安全套使用率提高到80%。其中男性性工作者安全套使用率达到90%，流动人口中的男男性接触者、同志人群中低收入低文化水平群体安全套使用率比基线提高20。8. 为当地同志艾滋病病毒感染者的50提供关怀服务。9. 将同志人群的性病艾滋病知识知晓率提高到90。10. 推广成都市同志人群防治艾滋病模式，在四川省内3至5个城市建立同志人群艾滋防治工作网络。六、行动措施（一）加强与政府部门、专业机构的交流合作，为防治工作创造政策环境1、定期邀请政府部门、专业机构官员到同志社区考察，使政府和专业机构更多了解同志社区的情况。2、通过多种渠道向政府反映同志社区艾滋病流行和防治情况。为政府制定相关政策提供依据。3、与专业机构合作，利用专业机构的技术优势、在同志社区开展艾滋病防治的调查研究。4、积极配合国家艾滋病防治的总体部署，发挥社区组织的特长联系同志人群，帮助政府机关、专业机构把同志人群艾滋病防治的任务落实到社区人群中。5、积极与政府部门沟通，完成社区非政府组织的注册工作。在民主公开原则的指导下，完成社区非政府组织的机构、制度建设，建立社区监督体系和社会监督机制。为防治工作搭建平台。（二）加强防治队伍能力建设1、培养一批专业社会工作者，通过相关的培训和实践锻炼，使其在干预工作的策划、管理、实施、督导评估等方面具备专业水平，并负担起干预工作的组织管理任务。2、大力招募有意愿参与艾滋病防治工作的志愿者，鼓励来自社会不同阶层、不同职业、不同年龄、不同群体的志愿者参与到艾滋病防治工作中来。根据个人的实际情况，提供相应的培训，安排在合适的岗位上，参与防治工作。3、为社会工作者、志愿者提供更多定期、不定期、专项等多种形式的培训，不断提高其参与艾滋病防治工作的能力。4、对社会工作者、志愿者的工作开展多形式的督导评估，并督促其根据督导评估意见改善工作状况，提高工作质量。5、密切合作伙伴关系，积极争取专业机构的技术支持，提高社区干预能力，合理配置资源，扩大干预成效。（三）开展公众教育，在社会大众中树立同志人群客观正面的形象，为防治工作创造良好的社会环境。1、积极开展媒体开发工作，鼓励、帮助媒体客观正面的报道同志生活及同志人群艾滋病防治工作的现状。为社会大众了解同志创造条件。2、在高等院校中寻找合作伙伴，推进同志人群艾滋病防治研究课题的开展，促进在条件适宜的院校开设相关课程。3、积极促进同志人群与家庭、社会的沟通，学习国外及港台地区同志人群与家庭、社会沟通的成功经验，开展相应活动，为同志人群创造良好的生活环境，从而促进人群远离高危行为。（四）加强健康教育，普及艾滋病性病防治知识1、加强同伴教育。扩大同伴教育教员数量和同伴教育人员覆盖范围，使同伴教育者能覆盖到各亚人群。加强对同伴教育者的培训，提高同伴教育者的工作能力，促进同伴教育干预人数和质量的提高。2、开发更多更适应同志需要的宣传资料，如小册子；同时开发更多更为有效的宣传途径，如夹报，网站等，开展健康教育工作。3、大力发展健康的同志社区文化。开展积极健康的社区文化和交流活动；继续寻求支持，编印社区读物同心，从同志亚文化特征出发，促进人群对艾滋病危险的认识，加强艾滋病知识的普及与宣传。4、通过同伴教育、健康宣传，在同志人群中大力开展反毒教育。预防同志人群静脉注射毒品，及吸食新型毒品。（五）推广安全性行为，减少人群的高危行为1、充分利用同伴教育网络、社区文化、交流活动，推广安全性行为，发放安全套，改变社区亚文化环境，促进安全套使用意识的增加和使用习惯的形成。2、加强重点高危人群的干预工作。加强针对青少年同志人群的宣传教育工作，通过培养青少年同志中的骨干志愿者、支持青少同志社团的发展、大力开展青少年同志中的同伴教育、组织青少同志活动等形式，在这一人群中持续开展干预工作。在男性性工作者中开展以同伴教育、安全套派发和营销、性病服务、性消费者干预相结合的综合干预工作，降低艾滋病对这一群体的危害。加强对互联网活动同志群体的干预，探索通过互联网开展艾滋病干预工作的有效方法。大力在流动人口中的男男性接触者、同志人群中低收入低文化水平群体开展干预工作，通过同伴教育、安全套推广、性病服务等形式，提高该群体艾滋病知识知晓率，安全套使用率。3、推行安全套社会营销方法，健全市场服务网络，通过在同志活动场所设立销售点，利用同伴教育网络开展安全套直销等方式，促进安全套的可及性，提人群安全套的使用率。（六）改善针对同志的性病服务1、积极寻找合作伙伴，帮助合作伙伴开展医务人员培训，促进性病诊疗点数量增加和服务质量的提高。2、与合作伙伴共同开展社区性病服务宣传和外展服务活动。促进同志对性病预防和正确就医意识的建立。在同志酒吧中的健康宣传栏，定期发布医院相关信息和性病正确就诊知识；在同志网站发布促进性病正确就诊和性病定点医院的宣传广告。3、通过同伴教育、外展、热线咨询、文化活动等途径，为社区同志提供友好、方便的性病诊疗转介服务。（七）与CDC合作建立自愿、友好、可及的检测体系，促进同志人群中检测覆盖面的扩大1、与CDC合作，利用已设立的VC点为同志提供检测咨询和采血服务。完善社区VCT流程，提高服务质量。2、在同志活动场所增加流动咨询检测点，积极开展转介服务，为同志人群提供更加方便、友好、可及的检测服务。3、积极在志愿者中发展咨询员，开展检测前后的咨询和转介服务，定期对咨询员进行专业知识和技能的培训、再培训，并定期进行评估，提高服务质量。4、建立并逐步完善人群检测资料库，即时向政府和相关部门反映人群中艾滋病流行状况；并充分利用资料库，为后期定期跟踪检测、检测提醒、关怀治疗等健康服务提供依据。（八）积极开展艾滋病医疗辅助工作，进一步加强对艾滋病病毒感染者、艾滋病病人及其家庭的关怀救助力度。1、大力开展宣传教育活动，消除歧视，创造无歧视的社区环境。2、为艾滋病毒感染者及其家庭提供专业、友好的信息咨询和心理支持，建立健全社区随访机制，做好转诊、陪护、定期检查提醒等服务。3、与医疗、防疫机构建立畅通、高效的沟通机制，帮助艾滋病人及时、便利的获得抗病毒治疗。4、积极争取资源，帮助艾滋病人获得机会性感染的预防和治疗。为生活困难的艾滋病人争取减免抗机会性感染治疗费用，积极帮助筹集部分治疗费用。5、成立社区关怀中心，开展对艾滋病毒感染者和病人的关怀护理和救助工作。支持感染者建立互助小组，帮助艾滋病病毒感染者开展生产自救，为有需求的感染者提供职业培训、职业中介等服务。（九）推广干预经验，建立全省同志人群干预网络1、收集、整理工作资料，分析、总结已有的工作经验，形成可推广的同志社区艾滋病干预模式。并编制干预技术材料，供其他社区开展干预工作学习借鉴。2、在成都周边有基础的市县，发现和发动当地志愿者。为其提供培训和干预资料、材料，使其开展起干预工作。3、选择合适的中小型城市（从23个起），组织当地志愿者建立志愿者小组，学习成都已有的干预经验，结合当地实际，逐步开展综合干预工作。在中小型城市工作组有一定工作经验的前提下，帮助其自己制定干预计划、争取干预资源，自主开展干预工作。4、在全省有35个成熟的工作小组正常运作前提下，形成全省同志人群干预网络，通过几个中心城市向周边辐射，最终使干预工作覆盖全省同志人群。（十）争取政府稳定的财政投入，多渠道筹集资金，统筹管理和使用。1、争取政府对同志人群艾滋病防治给予稳定的财政投入，使干预工作可以持续、深入的开展。2、积极争取国际资金的支持。通过向国际社会宣传，与相应机构沟通，积极争取有意愿帮助中国艾滋病防治的国际机构，向同志社区艾滋病防治工作投入资源。3、积极发动企业和个人向艾滋病防治事业的捐赠。4、通过发展针对同志人群的消费产业，走可持续发展的道路，自我造血，为艾滋病防治工作创造更广泛的资金来源。5、建立健全公开、透明的财务系统，统筹管理、合理安排各渠道筹集的资金，专款专用，提高工作效率，使有限的资金发挥最大的效益。七、督导与评估为了确保按时高质实施计划目标，总结并推广成功经验，发现存在的问题并及时调整项目目标与活动，成都同乐健康咨询服务中心将会同有关部门对计划实施开展督导评估。督导评估指标紧扣计划的目标和活动，坚持多部门参与，目标人群参与的原则，加强社区非政府组织督导评估的能力建设，强调将督导评估的结果用于决策、计划以及活动和预算的调整。由成都同乐健康咨询服务中心邀请四川省、成都市卫生行政机关、疾控专业机构和社区代表组建督导评估专家组，编制评估方案，制定评估指标。根据评估方案，分阶段进行督导评估：2008年中、2009年底进行行动计划的中期、终期评估。并配合日常督导。督导内容针对项目实施过程与结果开展：包括计划的进度与管理、工作人员的培训与能力建设、社区非政府组织建设、合作伙伴的参与情况、干预工作的开展与效果等。督导方法包括：现场督导评估、非现场督导评估。现场督导评估：利用定性方法：召开座谈会、小组访谈、个人访谈、查阅有关档案资料（文件、记录、照片、报表等）、现场考察/观察和定量方法：专题抽样调查，收集现场督导评估相关的信息非现场督导评估：按季度和年度，成都同乐健康咨询服务中心向督导评估专家组报送季度与年度工作报表与报告。另外，在常规工作中通过电话、电子邮件等联系方式进行督导评估，及时发现并解决问题。督导评估小组现场反馈督导评估的初步结果并提供技术支持，通过讨论，整理督导意见，撰写督导评估报告：包括优点与经验、存在的问题与不足、建议与解决的方法等。将督导评估结果报告以书面的形式正式反馈到成都同乐健康咨询服务中心及合作伙伴单位。成都同乐健康咨询服务中心及合作伙伴单位根据专家提出的建议和解决的方法在规定时限内（如1个月之内）改进。并充分利用督导评估的数据，将督导评估数据用于决策、制定计划，根据督导评估结果调整今后的目标、措施与活动。HIV/AIDS Prevention and Control Action Plan in Chengdu Gay Community (2007-2009) Chengdu Gay Care Organization2006.61. BackgroundAt present, AIDS epidemic in China has got into the rapid-spreading period. According to 2005 China AIDS epidemic and the progress of prevention by Chinas Ministry of Health, Men who have sex with men (MSM, including homosexual and heterosexual men who have had sex with men) accounts for 7.3% (47,000) of estimated number of HIV infected people in China (650,000). Surveillance data in several large and medium-size cities showed that HIV infection had been occurred among MSM throughout the country with a much higher infection rate than in normal population. Since the first HIV-infected person in Sichuan was found in 1991, the number of HIV infection has been increasing rapidly. At present, the reported number of HIV infection in Sichuan ranked the sixth in China. In the past years, measures have been carried out to prevent the disease from spreading, especially among the gay community. While little has been done in other areas in China, we started intervention projects from 2002 in Chengdu, Leshan, Nanchong by mobilizing the target population to participate in the intervention activities and developing NGO to carry out the HIV intervention in the community. Chengdu is one of the most important cities in the southwest China with well-known relaxed and harmonious culture and atmosphere which turned out to be good support for AIDS prevention and control. From 2002 to 2006, with the help of the provincial and the city level government, health department and NGO in the community, we established a comprehensive intervention program performed by gay people themselves in the community to conduct environment creation, capacity building, intervention, surveillance, care and treatment work. At the same time, we founded an extensive team with about 20 core members and over 150 volunteers from various fields and social classes.We have covered nearly 10000 persons in 4 years intervention work; trained 50 peer education workers who educated about 30,000 persons; launched the Condom Promotion Project in about 20 places and distributed more than 70,000 condoms and 50,000 IEC materials; opened the fixed STD clinic for gays which have already provided service for almost 500 persons; set up a blood-taking and counseling spot where 619 persons received VCT with the support of CDC.As a result, the rate of people who insist on using condom increased from 3.3% in 2002 to 44.02% in 2005, and the participation of target population is more active. We also form a new MSM intervention mode with 4 principles: self-domination by target population, platform of community NGO, homosexual sub-culture characters and “Empowerment theory”. Meanwhile, we meet some problems in our work: The intervention workers are mobile, and not qualified enough: As community NGO has not acquired a legal status, it is impossible to form a stable team with fulltime workers. Therefore some capable volunteers are lost and the capacity of the whole team will be greatly affected. The coverage is limited: According to our estimate, the scale of MSM population in Chengdu is from 70,000 to 100,000 at present, and we just covered nearly 10% of the population after 4 years work, which reduces the effect of HIV/AIDS prevention and control work. The depth is restricted: The intervention group is not professional and stable enough, so we have encountered some problems when exploring more intervention methods towards various classes and sub-groups in the community. The resource is instable: Because the government has no stable finance input for the intervention work in gay community, our intervention depends mostly on international projects, which is always short-term and instable. Care work to HIV-victims is at the beginning, and lots of problems need to be resolved especially resource and technical problems.Therefore the AIDS situation in Chengdu gay community is still tough. The surveillance sentinel result shows that HIV infection rate increases year by year from 0.64% in 2003 to 1% in 2004 to 2.18% to 2005.In short, it is our focus in the next period that comprehensively plan the AIDS intervention and prevention work in gay community and execute it step by step.2. Work PrinciplesI. Guided by the government, leaded by gay community, reduce the harm of AIDS with the participation of gays and people from other groups.II. Cooperate with government departments, professional organizations, international organizations and NGOs in different levels and fields.III. Based on the reality of Chengdu gay community, conduct intervention and prevention work scientifically and practically.IV. Insist on principles of “Equality, Non-discrimination & Non-judgment” to eliminate discriminations in the society and among gay community and advocate forgiveness and harmony.V. Guided by self-decision principle, provide information, service and analysis and respect individual idea.VI. Insist on confidential principle and respect privacy.3. General GoalMobilize people in community to participate in the AIDS prevention and control work; build a sound AIDS prevention and control system leaded by the government, with cooperation of multi-departments and participation of the whole society; coordinate with the government and related departments to prevent AIDS spreading.4. Performance indicatorsTo the end of 2009:i. Complete the registration and institutional building of NGO. Provide information and data about AIDS epidemic characters and regulations in gay community to the government, and cooperate with the government to do HIV/AIDS prevention and control work, in order to put HIV/AIDS prevention work in gay community into the government budget.ii. Develop peer education workers to 100 and all of them have been trained systematically.iii. Establish sound volunteer management system. Increase volunteers to 300 and provide AIDS prevention and relevant sociology knowledge to at least 80% of them.iv. Enlarge the coverage of intervention to 20,000 persons.v. Enlarge the coverage of VCT: increase people who take VCT by 30% per year, and reach 500 in the end of 2009.vi. Promote the usage of professional STD service and try to make the STD clinic known by half of people in gay community.vii. Raise the condom using rate in gay people who have received intervention to 80%. Among them, raise the condom using rate of Male Sex Workers to 90% and of floating population and low-income &low-literacy groups in gay community by 20% from the base number. viii. Provide care service to 50% HIV-victims in Chengdu gay community.ix. Make AIDS/STD knowledge known by 90% persons in Chengdu gay community.x. Promote the mode of AIDS prevention and control in Chengdu Gay Community and build a working-network with about 3-5 cities in Sichuan.5. Action1) Strengthen Communication and Cooperation with Government Departments and Professional Organizations to Create a Better Policy EnvironmentI. Invite officials from government departments and professional organizations to inspect our work regularly for better understanding to gay community.II. Transfer information about HIV/AIDS epidemic and prevention situation to the government through various channels to help them make policies.III. Cooperating with professional organizations, start investigation and research work in gay community under their strong technical support.IV. Coordinating with national plan, conduct specific HIV/AIDS prevention work in gay community by community NGOs influence.V. Cooperating with government departments, complete community NGO registration and organization system building as well as community and social supervision system.2) Improve Capacity Building to Work GroupI. Provide trainings of planning, management, implementation, supervision and assessment to some social workers in order to make them professional enough to organize and manage intervention work independently.II. Encourage the participation of volunteers from different social classes, fields, ages and sub-groups. Train and arrange them properly.III. Provide regular, short-term or special training to social workers and volunteers to improve work ability.IV. Conduct supervision and assessment to social workers and volunteers and adjust their work according to the result.V. Enhance the partnership with professional organizations and try to get their technical support to improve our working ability in AIDS intervention and achieve better outcomes.3) Create a Positive Image of Gays and Make Better Social Environment for AIDS Prevention and Control Work by Public EducationI. Develop cooperation with the media. Encourage and help the media to give positive and objective report about gays lives and AIDS prevention and control work in the community for the publics better understanding of gays. II. Establish relationships with universities. Promote research topics about AIDS prevention and control work as research topics and open related courses in suitable university.III. Encourage gays to communicate with their family and the society learning the experience in foreign countries, Hong Kong and Taiwan. Develop activities to create a nice social environment for gays to help them stay away from high-risk behaviors.4) Strengthen Health Education and Popularize the Knowledge of AIDS Prevention and ControlI. Strengthen peer education. Increase the members of peer education workers and coverage and improve their work capacity through various trainings.II. Make more IEC materials which meet the need of gays, find more effective publicizing channels and stress health education work. III. Develop healthy gay community culture. Organize community culture and communication activities to make people aware of the danger of AIDS, and seek for the support for publishing the first gay community magazine in China HOMOHEART.IV. Launch anti-drug education in gay community to prevent gays from injection and new drugs by ways of peer education and health education.5) Advocate Safe Sex and Reduce High-risk BehaviorsI. Utilize peer education network, community culture and communication activities to promote condom and safe sex, to change the sub-culture environment in community and to form a habit of using condom.II. Stress intervention to major high-risk people1) Stress education in young gays by training core volunteers, supporting the foundation of young gay groups and producing peer education among youth in gay community. 2) Strengthen intervention work among money boys, including peer education, free condoms, STD service and intervention to customers. 3) Enhance intervention on the internet and explore an efficient online intervention method.4) Stress intervention work in MSM of floating population and low-income and low-literacy people in gay community by means of peer education, condom promotion and STD service to make them be access to HIV/AIDS knowledge and safe sex.III. Advocate condom marketing methods, set up sales spots in gay sites and sale condoms directly through peer education network.6) Improve STD Service to Gaysi. Provide trainings to doctors and nurses to improve the quality of service and find more partners in order to increa