Aibai-HHS: Serving People Living With HIV/AIDS

1. Aibai-HHS: Serving People Living With HIV/AIDS Challenges in HIV Intervention among Gay Men in China in the Age of the InternetHua Jiang, MBBS, PhDHealth and HIV ServiceAibai Culture and Education CenterChengdu & Beijing

2. Topics

3. Annual HIV Positive Rate of Sentinel Surveillance for Gay Men in Chengdu, China: a Predictive Model Actual Predicted Jiang H, et al. A Study on Gay Men HIV Positive Prediction. Supported By Sichuan Provincial Department of Health

4. Current HIV Prevention Strategies • HIV Knowledge Training/Activities • Out reach and Condom Distribution • Bars and Bath house • Peer Education

5. Challenge on Behavioral Intervention/Education

6. “Peer Education”? • Deng B, Jiang H, et al. Modern Preventive Medicine. 2010, 37(8): 1543-1546

7. Knowledge ＝ Behavioral Change？ • 90%：Know enough about HIV/STD and know condom could protect them from HIV • 30％：Use condom in every sex behavior • Deng B, Jiang H, et al. Modern Preventive Medicine. 2010, 37(8): 1543

8. Self-identity - Mental Health • The underlying impetus for low condom use among gay men: • Associated with deep-seated and often untreated psychological problems related to their status as sexual minorities • Some individuals have a reduced self-worth because of their sexual minority status and engage in unsafe sexual behavior because they either do not care about the results or do not care enough about themselves to use protection

9. Culture attitudes: Dynamics

10. Culturomic Tool: analysis tool for culture attitude trends

11. Culturomic analysis: Trends on HIV/STD issues in past 10 years • Gay and Lesbian Q/A column on www.aibai.org • Accumulated more than 30,000 records in past 10 years AIDS STD

12. Culturomic Analysis: Self-identity Homosexuality Come Out

13. Culturomic Analysis: Mental Health Depression Suicide

14. Analysis • Little behavioral change even with knowledge • For young gay men, Internet is the first and most-trusted source on HIV/STD issues • There is a change in priorities: HIV is replaced by self-identity or mental health issues as the top subject

15. MSM – an Abused Concept Problem is, socially, psychologically and culturally, the MSM population is actually made of several distinctively different groups Jiang H，J Prev Med Inf. 2009, 25(7): 499-503 Wei W, Society.2007(1):67

16. MSM – an Abused Concept Wei W.Society.2007(1):67 Gosine A. IDS Bulletin; 2006;37 (5) : 27-33

17. MSM – an Abused Concept • Gay men • Facing discrimination, self-identity crisis and social/familial pressures, sometimes lead to promiscuity • Some resent being labeled only by a sexual behavior • Married Men Who Engaging with Same Sex • Highly secretive sexual behavior, risk infecting wives and children • Rarely attend education or outreach activities • Migrant Workers • Not gay and resent being labeled MSM because it implies “gay”

19. Gay Men’s Self-identity and Mental Health in China: A Serious Challenge JAMA. 1998, 279:1529-1536 www.aibai.org, Gay and Lesbian Q/A Column, 1999-2012

20. Solutions • Stop using MSM in public campaigns • Develop subgroup specific strategies • Provide concise, updated and easy-to-take home information • Innovative and high quality training kits, including outcome measures • Emphasize mental health support for sexual minorities • Multidisciplinary studies that integrating behavioral sciences, anthropology and sociology

21. Stop using MSM inappropriately • Address the subgroups as they are, i.e. gay men, married gay men, bisexual men, and migrant workers • Face the issue of sexual minorities openly and honestly • Develop specific campaigns for each subgroup with appropriate content and delivery mechanism

22. Providing concise, updated and easy-to-take home information • Actionable and non-ambiguous messages: • Aside from tested long term partners, treat everyone as if infected • Be tested every 6 months or so for those sexually active

23. Sexual Minority Friendly Environment at Schools, Workplaces and Homes

24. Living with HIVChallenges after Infection

25. Major Challenges facing PLWHAs in China • Employment discrimination • Discrimination from health providers (e.g. unable to receive surgical treatment) • ART is free, but lacking resources to address other important issues, e.g.. OIs, malnutrition, side effects • Adherence programs exist but are inadequate • Rampant myths and misunderstandings on living with HIV/AIDS, because of lack of adequate support and counseling: • “You will be died in 2-3 years” • “Early treatment, early death” • “herbal medicine works better than ART pills”

26. Health and HIV Service, Aibai

27. Comprehensive Solution: an Attempt by Aibai • Creating a good service network with case management • Peking Union Medical College Hospital • Sichuan Provincial People’s Hospital • West China Hospital • Chengdu TransmittedDisease Hospital • Sichuan and Chengdu CDCs • Innovative Services: • Nutritional counseling and medical nutrition therapy (MNT) • Mental health support • Adherence, ARV education, long-term follow up • Educational Materials: Books, Training Kits, and APP R&D • Multidisciplinary, clients-oriented research

28. “This is just what this book aims to do, informing people living with HIV of the do’s and don’ts in their daily lives, and empowering them to seek information and support that they need in order to live a life of dignity, quality and responsibility.“ Abhimanyu Singh Director & Representative UNESCO Beijing Office

29. Acknowledgement • Sichuan Provincial CDC and National CDC of China • Chengdu Transmitted Disease Hospital • Sichuan Academy of Medical Sciences • Peking Union Medical College Hospital • Consulate General Chengdu & State Department, United States • Los Angeles Gay and Lesbian Center, U.S • Global Funds • United Nations (through UNESCO, UNDP & UNAIDS) • World Bank • Barry and Martin’s Trust, UK and U.S

30. Thank You