(Department of Disease Control of MOH, June 2001)
In recent years, as a result of the implementation of the Medium and Long Term Plan for AIDS Prevention and Control in China (State Council Doc. No. 38, 1998 hereinafter referred to as the "Plan"), as well as development of health education and behavior intervention programs in all regions by relevant departments, certain progress has been made in AIDS and STD (Sexually Transferred Diseases) prevention work throughout the country. Currently, however, AIDS and STD prevention work still faces severe situation: AIDS and STD have been spreading at rapidly growing speed; the number of patients has been increasing rather rapidly; the drastic rise in the cases of AIDS virus transfer by way of intravenous drug use has not been contained; channels for AIDS virus transfer through blood collection and donation have not been blocked; illegal blood collection by manual ways and illegal collection of plasma continue to occur despite repeated effort to stop such activities; and the supervision and administration of blood products still need improvement; due to the insufficient understanding by some local government leaders to the potential danger of large scale eruption of AIDS in our country and its harm to social and economic development of the country, the implementation of the Plan is uneven in different regions, and coordination for comprehensive measures in AIDS prevention is inadequate. In order to thoroughly solve these problems, ensure the timely fulfillment of tasks and meeting of objectives of the Plan, the Action Plan of China for AIDS Prevention and Containment (2001 - 2005) (hereinafter referred to as the Action Plan) is hereby developed.
Chapter 1: Implementation Principles
1. government taking charge, striving for stronger inter-agency cooperation and social participation and acting in concerted effort;
2. giving priority to prevention, stepping up effort on education and propaganda, removing root causes as well as the symptoms, adopting comprehensive measures;
3. concentrating on focal points, strengthening health education and behavior intervention, emphasizing result-orientation;
4. providing classified guidance, strengthening supervision and guidance, strictly enforcing the law, adopting comprehensive evaluation methods.
Chapter 2: Objective and Work Targets
Adopting active and effective measures to contain the momentum of rapid growth of AIDS and STD and to lower the rate of AIDS and STD development. By the end of 2005, the annual growth rate of AIDS and STD patients should be contained within 10%; the average level of AIDS virus transfer through clinical blood transfusion be controlled under 1/100,000, and in regions of AIDS high occurrence under 1/10,000 to 1/50,000.
2. Work Targets
Work targets to be completed by the end of 2002
(1) Resolutely removing all illegal collections points of blood or raw material plasma; adopting AIDS virus screening procedures for all clinical use of bloods; 85% of the clinical use of blood should be provided by the legitimate blood collection agencies, the rest of the blood should be provided through self-collection for self-use by the approved medical institutions; all raw material plasma used in producing blood products be provided by legitimate agencies specializing in collection of plasma by mechanized means.
(2) Completing training for all medical staff on AIDS and STDs. 70% of the comprehensive hospitals above the county (municipal) level, specialized hospitals for contagious diseases, TCM hospitals and other medical institutions shall provide standard diagnostics, treatment, consulting as well as prevention services to AIDS virus carriers and AIDS patients; 85% of all medical institutions above county (municipal) level shall provide standard diagnostic, treatment, consulting as well as prevention services to STD patients; 50% of all township clinical units shall provide consulting and prevention services to AIDS virus carriers and AIDS and STD patients.
(3) At least 50% of all AIDS virus carriers and AIDS patients should be able to obtain medical and daily care at community living facilities and at home.
(4) Completing the establishment of national wide AIDS and STD information network as well as national comprehensive monitor, laboratory test network system above prefecture (municipal) level.
(5) Developing relevant policies for reducing dangerous activities among population groups; establishing an insurance mechanism for blood transfusion risk and infection from occupational accidents for AIDS prevention personnel; providing medical and social assistance to AIDS virus carriers and patients.
Work targets to be reached by the end of 2005
(1) Public knowledge at national level on AIDS and STD prevention and free blood donation reaching above 75% in urban population, and 45% among rural population; above 80% among the high risk population groups; above 95% among detainees, prisoners or recipient of education in drug abuse correction centers, prisons, as well as labor remolding and education institutions.
(2) Percentage of condom use among the high risk population groups reaching above 50%.
(3) 90% of county (municipal) level comprehensive hospitals, specialized hospitals for contagious diseases, TCM hospitals and other institutions, 50% of the central health care centers in the AIDS high occurrence regions providing standard diagnostic, treatment, consulting as well as prevention services to AIDS virus carriers and AIDS patients; 75% of the township healthcare units, 50% of the pre-marriage medical check institutions providing consulting and prevention services to AIDS virus carriers and AIDS patients.
(4) Coverage of pre-occupational training to professional personnel in AIDS prevention, clinical medical care, diagnostics and laboratory testing, blood collection and supply reaching 100%.
(5) In conjunction with the construction of the national health information system network, perfecting the national AIDS and STD Information Network at county (municipal) level.
Chapter 3: Action Measures
1. Ensuring safety of blood and blood products and eliminating AIDS spread through blood collection and supply process
Strengthening construction of blood collection and supply institutions in accordance with law, improving blood supply institution networks; saving blood resources and striving for reasonable and scientific use. Establishing and perfecting provincial level blood centers. By the end of 2002, necessary modification should be made to central blood banks at prefecture (municipal) level that are not up to construction standards; central blood banks must be established in the prefectures (cities) which do not have blood collection and supply institutions. By the end of 2005, grass root level blood stations or central blood stations shall be established in counties that are not covered by central blood stations. By the end of 2001, introducing AIDS virus screening and testing procedures to all clinical use of blood by instant diagnostic reagents for AIDS virus in the grass root medical units that rely on self-collection for self-use in the remote regions. By the end of 2002, introducing examination system to all technical and relevant testing personnel at all blood stations throughout the country, and introducing a licensing and certification system to the blood collection and supply personnel.
In accordance with the Standards for Single Plasma Collection Station, Methods for Administration of Single Plasma Collection Stations, efforts should be made to consolidate the current single plasma collection stations. In 2001, the Ministry of Health (MOH) shall organize a licensing check on all the single collection plasma stations, those that fail to meet standards shall be removed.
Control shall be imposed on the total number of blood product manufacturing enterprises to strengthen supervision and administration. From 2001, no new manufacturing enterprise of blood products shall be approved. The Provisions for Blood Product Administration shall be applied to al blood product manufacturing enterprises. The State Drug Administration (SDA) shall conduct timely inspection on the procurement of mechanically collected plasma by the single plasma collection stations with License for Single Plasma Collection and quality responsibility letters. Those that fail to comply with requirements shall be ordered to mend themselves within a specific period of time.
An annual review and reporting system for the raw material plasma collection and blood product manufacturing enterprises shall be introduced. Health administration departments of each province (autonomous region, and Municipal City) shall submit annual reports to MOH on collection of raw material plasma by the single plasma collection stations within each respective province (autonomous region, or Municipal City). All blood product-manufacturing enterprises shall periodically report to SDA on the output of blood products and the sources and quantity of plasma. All the manufacturing enterprises of plasma disposable products shall provide sales information to MOH on relevant disposable. MOH and SDA shall periodically conduct corresponding reviews on the quantity of plasma supply, quantity of disposable use and sales, as well as the quantity of blood product manufacturing. Penalty shall be imposed on individuals and institutions who violate the Provisions for Administration of Blood Products and relevant regulations.
Supervision and administration on the manufacturing, circulation, clinical use as well as the after-use treatment of sterile medical devices such as disposable transfusion sets (blood transfusion and injection). There shall be a crackdown on illegitimate activities of manufacturing and recycling, of disposable sterile medical devices. MOH and SDA shall conduct law enforcement check campaigns at appropriate times.
Further efforts shall be made to improve regulatory system and technical standards. Quality control over blood and related products, diagnostic reagents as well as anti-AIDS drugs shall be strengthened, and testing and monitoring capacity and technology skills should be enhanced to ensure safety in blood use. All manufacturing enterprises must establish the system of Quarantine Period for raw material plasma before use. Two step virus elimination or inactivation measures shall be adopted for blood products such as coagulation factors. By the end of 2001, a pre-market national system for batch approval shall be introduced for blood products; by the end of 2002, nucleic acid sample inspection shall be introduced to the raw material plasma after it has been mixed.
A reporting system shall be established to strengthen efforts on cracking down on illegal blood collection activities. MOH and SDA shall take concerted effort with the public security agencies to severely crack down on illegal activities of collection, procurement and sales of manually collected plasma. Institutions which engage in manual collection of plasma shall have their License for Single Plasma Collection revoked; enterprises which procure plasma collected manually shall be treated the same as those manufacturing or selling counterfeit or inferior quality drugs, i.e. their permit for production shall be revoked. Chief responsible persons and other responsible persons shall be Criminally liable for violations. MOH and SDA shall organize checks on the single plasma collection stations and blood product manufacturing enterprises every year. MOH and Ministry of Public Security (MPS) shall take actions to crack down on illegal collection and supply of blood or raw material plasma. Illegal blood collection and supply organizations shall be removed. Efforts shall be made to severely crack down on "blood heads" and "blood chiefs" who organize illegal collection and supply of blood. Violators shall be criminally liable. SDA shall impose punitive measures on biological product manufacturers who engage in procurement of manually collected raw plasma material.
2. Strengthening health education to improve public knowledge of AIDS and STD prevention as well as free blood donation
Propaganda departments and public media shall undertake extensive public health education programs to improve public knowledge on AIDS and STD prevention and free blood donation. The central and provincial levels of TV and broadcasting stations should feature advertisements or relevant programs for the public benefit at least once a week in its prime program times on AIDS or STD prevention and promotion of free blood donation. Major newspapers at central and provincial (autonomous region, municipal) levels shall publish AIDS and STD prevention, free blood donation reports or advertisement for public good at least once a week. Relevant periodicals at central and local levels which have a relatively large influence shall also publish relevant articles or advertisements for the public good.
Relevant departments and groups including trade unions, youth leagues, Red Cross, etc. shall take responsibility for AIDS and STD prevention and free blood donation education in their respective staff and relevant groups. Township and street committees shall incorporate health education on AIDS and STD prevention as well as free blood donation into the program of creating civilized communities. Grass root level population schools shall universally undertake AIDS and STD prevention education to improve reproductive health. Special attention shall be paid to the universal education of puberty and sex health, AIDS and STD knowledge, knowledge on free blood donation as well as knowledge on drug abuse control among juveniles. AIDS and STD prevention health education documents, promotional materials (products) and special topic seminars shall be provided to newly enrolled students in universities and colleges, mid level vocational schools, and high schools; elementary schools shall incorporate the above-mentioned knowledge into health education curriculum.
Propaganda display windows shall be erected and issuance of promotional materials (products) shall be conducted in public transportation areas such as airports, train and bus stations, ports, as well medical care institutions where there are large groups of people. At entertainment business sites, AIDS and STD prevention knowledge education, free blood donation promotion shall be conducted. AIDS and STD prevention education and relevant consulting services shall be provided at borders for those leaving or entering for work, business and tour.
3. Conducting behavior interventions on high-risk groups to reduce risk behaviors among population groups
Strong efforts shall be made to enhance socialist spiritual civilization construction. Illegal activities of prostitution, and drug abuse and smuggling shall be cracked down on in accordance with the law. Large efforts shall be made to promote education on knowledge of drug abuse prohibition in connection with the Drug Free Community construction, to actively promote and advocate healthy life style and behaviors for the purpose of reducing harm and decreasing high-risk behaviors.
Social marketing approaches shall be introduced and market services networks shall be perfected. Vending machines for sales of condoms shall be set up in public areas. Proper use of condoms shall be promoted by taking advantage of family planning services and networks as well as the preventive medicine health networks. Injection and needle marketing should be conducted actively to promote use of clean needles and injectors in a bid to reduce the hazard of AIDS transfer through needle sharing.
Trial projects shall be carried out on the treatment of drug abusers with pharmaceuticals therapy in community medical institutions. Pilot work shall be carried out in a cautious and safe manner and strict control shall be exercised. Specialized work plan and management methods should be developed and implementation shall be undertaken upon the approval of MOH and MPS.
4. Perfecting health service system and enhancing the quality of preventive and medical care services to AIDS virus carriers ad AIDS patients
AIDS prevention and medical service networks shall be perfected, and TCM therapy and combined Chinese-Western therapy shall be adopted in treatment of AIDS. Preventive medicine health institutions and medical institutions at provincial level, and in case of AIDS high occurrence zones prefecture (municipal) levels shall provide prevention, clinical diagnostic and treatment services to AIDS virus carriers and AIDS patients. By the end of 2001, cities above prefecture (city) level, and in AIDS high occurrence regions counties (cities) shall designate a qualified medical institution or department in an institution to accept AIDS virus carriers and patients for treatment.
A community-based system of AIDS prevention, treatment and care shall be established. Community backbone professional taskforces or volunteer groups shall be established to create favorable and comfortable living environment for AIDS virus carriers and AIDS patients. Medical treatment and care shall be adopted and management shall be strengthened to reduce flow of AIDS patients.
Drug or other intervention means as well as cesarean delivery and artificial feeding of babies shall be adopted for pregnant women carriers of AIDS virus in order to control the transfer of AIDS virus through mother to baby. STD diagnostic and treatment service market shall be rectified. Anonymous patient care, standard STD patient diagnostic and treatment services shall be promoted to enhance service quality.
Medical service capacity to AIDS virus carriers and patients should be enhanced, and care should be provided for their treatment. AIDS virus carriers and AIDS patients who have participated in the urban worker's basic medical insurance shall be entitled to basic medical care treatment. Expenses covered under the basic medical care regulations shall be included in the reimbursable items to be paid out of basic medical insurance fund in accordance with regulations. Commercial insurance and social assistance shall be encouraged. AIDS social assistance funds may be established by trade unions, youth leagues, women's federations, Red Crosses and other groups and charity organizations.
5. Establishing and perfecting a monitoring system, information system and evaluation system on AIDS and STD
AIDS and STD comprehensive monitoring network shall be established to conduct biological, population science, behavioral science and sociological monitors. Laboratory testing network and quality control system shall be established to conduct testing on AIDS virus for quality guarantee of blood and blood products. The AIDS and STD information network shall be incorporated into the health information network construction to gradually establish and perfect a information high way which is comprehensive, quick and responsive to enhance the contingency response and treatment capacity.
Forces from multiple departments and disciplines shall be encouraged and motivated to participate in the development of the system of targets for evaluation of AIDS and STD. By end of 2002, a scientific and reasonable category evaluation targets system should be established for AIDS and STD prevention; a multi department and discipline evaluation organization system should be gradually established and perfected to conduct comprehensive evaluation on policies, prevention methods and measures on a periodic basis; an evaluation feedback mechanism shall be established to make timely amendments and improvement to relevant policies to constantly readjust prevention strategies and technical measures.
6. Strengthening training on AIDS and STD prevention knowledge and skills
Relevant experts should be organized to develop training outlines for different categories of medical and healthcare personnel and various types of training textbooks. Full member training on AIDS and STD prevention knowledge to medical and health care personnel as well as professional training to personnel involved in AIDS and STD prevention, health education, clinical nursing, testing and inspection, management of the blood collection and supply processes, etc. by taking advantage of school education for medical students, post training, post graduate education and continued medical education.
AIDS and STD prevention and control strategies and approaches shall be incorporated into the training curriculum of the party schools and administration colleges at central and local levels. Administration departments should conduct study on policy development and evaluation methods in conjunction with post training.
7. Developing basic and application research on AIDS prevention
AIDS prevention shall be included on the list of key state scientific research projects in order to strengthen the basic and application research resulting in safe blood transfusion, clinical treatment, drug development, vaccine development, etc. In light of the national conditions, application of scientific prevention and treatment methods and approaches from China and overseas shall be promoted in a timely manner. Research organizations and drug inspection institutions shall be encouraged and assisted in development of AIDS diagnostic reagents and high standard reagent standard product to enhance the diagnostic levels for AIDS virus detection in blood; effort shall be made to explore for effective method for treatment of AIDS by TCM or combined TCM and western medicine approaches; development of new types of anti-AIDS virus drug shall be carried out; research and development of AIDS epidemic virus vaccines and population group applications should be stepped up; strong efforts shall be made on basic research work on the virus inactivation in blood components. The Ministry of Science and Technology (MST), MOH and SDA shall develop and implement national plans for research, production and introduction of anti-HIV drugs and vaccines.
Research capacity on epidemiology shall be improved. Epidemic analysis and prediction models for AIDS shall be established and gradually improved in order to timely and accurately analyze and predict the development trend for AIDS. Economic evaluation and application studies shall be developed focusing on AIDS prevention and treatment measures and approaches.
Chapter 4: Measures to Ensure Progress
1. Organizational leadership
The establishment and work of the State Council AIDS and STD office for its prevention coordination meeting system shall be strengthened. Specialized persons shall be designated to take charge of the coordination, supervision, examination of the implementation of the Plan and decisions of the coordination meeting. Meanwhile, an AIDS expert and advisor committee shall be established by drawing personnel from multiple departments and multiple disciplines to provide consulting and proposals to the national work on AIDS prevention and treatment as well as relevant laws and regulation development.
State Council AIDS and STD Coordination Meeting System Office shall be in charge of developing the implementation plans for the Action Plan, providing guidance, supervision and examination on the implementation of the Action Plan. Starting from 2001, an examination and supervision program shall be organized on the implementation of the Plan and the Action Plan once every year. A work meeting shall be organized on containing and preventing AIDS to share information, summarize and exchange experience and to encourage the implementation of the Action Plan. Relevant departments and units should perform their respective duties and make coordinated efforts to do a good job of AIDS and STD prevention and treatment in accordance with the Duties and Responsibilities of Relevant State Ministries, Commissions, Bureaus (Groups) in Works for Preventing and Controlling AIDS and STD.
Local people's governments at all levels shall be responsible for leadership for implementation of the Action Plan in their respective regions. Implementation plans for each region shall be developed on the basis of study with well-defined responsibility. Guidance and supervisory checks should be strengthened to ensure timely fulfillment of the objectives of the Action Plan.
2. Readjusting and improving relevant laws, regulations and developing relevant policies
Stronger efforts shall be made on study and research in order to develop relevant laws, regulations on AIDS and STD prevention and treatment to legally ensure the work of AIDS and STD prevention and treatment. Research and formulation of intervention policies and measures for high-risk population groups shall be accelerated. Relevant insurance system should be researched and developed with a sense of urgency to properly solve the problem of blood transfusion risk and accidental infection problems by AIDS prevention professionals. At the same time, current laws and regulation shall be streamlined and amendments shall be made to those that are not consistent with the prevention and treatment work on AIDS and STD.
International exchange and cooperation in the field of AIDS prevention and control should be expanded. We should actively participate in relevant international activities in this field so as to borrow and absorb useful international experiences. Active efforts shall be made to introduce anti-AIDS virus drugs from overseas. Tax exemption or reduction policies shall be applied to drugs donated by international organizations or other countries for AIDS and STD prevention and treatment.
3. Mainly relying on government funding and raising funds from multiple channels
A mechanism shall be established to mainly rely on government funding with multiple channels of financing. The central government shall make special appropriation for AIDS prevention and treatment as part of annual financial budget to be used by the relevant central government departments for development of AIDS prevention and treatment programs and subsidizing the poor regions. Local governments shall make necessary appropriations in light of the necessity of AIDS prevention and treatment as part of local government budgets. Appropriate adjustment shall be made in line with the growth of national financial strength and actual need of AIDS prevention and treatment. Strong efforts shall be made to obtain social donations and overseas assistance in order to raise funds through multiple channels. Supervision and administration of funds shall be strengthened to enhance the efficiency of the use of capital.
(Note: The "Action Plan" is not applicable to Hong Kong and Macau SARs and Taiwan Province).