CHINA: Providing AIDS care and helping street children

In May 2003, MSF opened a free clinic in Xiangfan city as part of a project which targets an estimated 45,000 people living with HIV/AIDS in Hubei province. Most of those who are HIV-positive in this part of central China were infected after selling blood to illegal blood banks. Many are rural subsistence farmers with no access to the local, fee-based healthcare system.

MSF teams are training local staff at medical centers, including a tuberculosis hospital, infectious disease hospital, and maternal/child health and sexually transmitted disease units. In cooperation with the Xiangfan Centre for Disease Control, MSF is providing training in safe blood and body fluid handling and disposal techniques (universal precautions), and in providing comprehensive care to those living with HIV/AIDS, including treatment. Medical expertise in life-extending antiretroviral (ARV) medications is minimal in China.

The MSF project in Xiangfan is considered a model pilot project and is complementary to the government's "China Comprehensive AIDS Response" program better know as "China Cares" which aims to offer treatment to people living in rural areas.

Other activities include voluntary counseling and testing, treatment for opportunistic infections, home-based and palliative care and ARV therapy. As of January 2004, 42 people were receiving ARVs in Xiangfan, including several children, and more than 100 patients were accessing care through the clinic, which has a capacity of 500. Future project plans include decentralizing treatment of opportunistic infections and side effects management as many patients now travel long distances to reach the clinic.

A particular challenge in this part of China is accessing patients who are in "no-go" zones where foreigners are not permitted; 50 percent of the patients at the MSF clinic in Xiangfan are from these areas.

On December 1, 2003, MSF began a second HIV/AIDS project in Nanning, Guangxi autonomous region, the fourth most affected by AIDS region in China. In collaboration with the Guangxi provincial Ministry of Health and provincial center for disease control, MSF has set up a common clinic with the capacity to provide care and ARV treatment for 10-20 new patients a month.

As of March 2004, 108 patients were accessing care at the clinic. Of these, 67 were on World Health Organization-recommended ARV treatment, including four children.

The goal is to include, with MSF's Chinese medical colleagues, 250 patients on ARVs before the end of the year. MSF is also creating patient support groups, part of the fledgling network of HIV-positive people in this part of China. A special effort on adherence has been implemented as well as management of opportunistic infections.

Tuberculosis (TB) is another concern as 25 percent of the clinic's patients are co-infected with HIV/TB. The team is trying to import fixed-dose combination TB drugs. The program is also focusing on the availability of generic ARVs and fixed-dose combinations of ARVs in order to promote affordable drugs, adherence and decrease the risk of resistance.

MSF continues to provide psychosocial support to marginalized children in Baoji city, Shaanxi province. In China, homeless children living on the street are becoming a growing problem. Having escaped from or having been rejected by their families, these children have often been exposed to physical and psychological trauma, neglect, abuse, hunger and social rejection.

The Baoji Children Centre aims at assisting those who agree to leave the streets. In cooperation with the Ministry of Civil Affairs in Baoji, MSF has been running a children's center since March 2001. The MSF team and civil affairs educators work with the children to provide temporary accommodation, medical and psychological care, food, schooling (on site or externally), and access to their rights.

The full team has also started outreach activity on the streets of Baoji. Because the center is not a solution, but only an alternative period in the children's lives, the team takes action throughout the children's stay to help them re-establish their links with Chinese society and their families.

MSF officially closed a water and sanitation project in Kashgar province of Xinjiang autonomous region in October 2003. The population in this region of western China is predominantly comprised of Muslim minority communities. In the townships of Yarkand and Yengisar, teams worked in cooperation with local authorities to bring clean drinking water to 8,500 people in the area.

Integration, sustainability and quality were the strategic focus of the project, which expanded to include a sanitation component during its final year. Local villagers participated in the project's decision-making process through community mapping exercises. In addition to the installment of 58 water points (each providing water for an average 125 people), MSF staff conducted hygiene promotion in local communities. Activities included promoting hygiene and training caretakers in the maintenance of hand-pumps. The project began in March 2000.

Building on existing relationships in the region, negotiations are now underway for a TB project in Kashgar. TB is the main public health problem in this part of China, and MSF has carried out an initial assessment confirming the need for intervention. Discussions with local authorities are ongoing. MSF hopes to begin the project in the near future.