The road for preventing AIDS at border villages in Yunnan Province

by Zhang Yuehan (Reporter from Southern Weekly)

Reporter Zhang Yuehan gives an in depth story after an exposure tour to Amity's itegrated community development and AIDS prevention programmes in Yunnan

The Dai ethnic village doctor Daguang guards a secret that rarely any people know – that is, who are the HIV positives? "I even won’t tell my daughter." Daguang said. This secret was previously known only to the county Center for disease control and prevention (CDC). Since 2012, Menglian County of Yunnan Province has cooperated with Amity Foundation for an attempt on community-based AIDS prevention: through medical training for the village doctors, to move HIV positives down to the management of village doctors. It seems to be a simple change, but difficult to proceed. The root cause is the “social discrimination” that cannot be ignored in the local areas. Eliminating discrimination is a long way to go. But as the project progresses, some ethnic minority villages in the border counties are undergoing some unprecedented changes.

HIV positives in village doctors’ eyes

Village doctors taking blood test of villagers

Every morning at around 7:00 am, the health center in Laopan Village welcomed villagers who wanted to see the doctor. Usually, the villagers are busy with farming. They mostly come to the health center early in the morning or after 8:00 pm in the evening. During these two periods, Daguang, the village doctor, always stays in the center. Daguang is a village doctor in Laopan Village. He has been working for nearly 30 years and is well known by local people. Laopan Village, located in Menglian County, Yunnan Province, is a small town bordering Myanmar's Wa State. Here, nearly 90% of the population are ethnic minorities, mainly Dai, Lahu and Yi, with a total of 3,208 people. The health center where Daguang is located serves these villagers, and also, 11 HIV-positives. "Over 20 villagers visits the health center per day, seven days a week,” said Daguang. “There is no special rest day for me." Daguang told us that, during daytime, he usually visited villagers for follow-up check, and it was also his job to provide public health services. There are 18 services, including mainly the management of health records of residents and the promotion of healthcare, to encourage villagers to participate in physical examinations, including rapid AIDS detection. In the local area, there are only three village doctors like Daguang. Due to large numbers of population flow on the China-Myanmar border, local HIV infections in Menglian are high. There are many HIV-positives in the village, but no one knows who they are, except the village doctor.

Support instead of discrimination

“It’s their privacy,” Daguang is very cautious. “In the training provided by the county CDC on village doctors, we were required to sign a confidentiality agreement. 'confidentiality is the most crucial part’ for AIDS management.” People are afraid of HIV-positives and HIVpositives are also afraid of others knowing their status. Only confidentiality can build basic trust, and only by this trust can Daguang communicate with HIV-positives. At the end of October 2018, when reporter of Southern Weekly accompanied Daguang to visit patients in Laopan Village, Daguang said, "The key of the work is to care for their emotions and for their families." In addition to the distribution of basic medicines and follow-up observation, Daguang has another important job, that is to educate. He educates family members to give support to patients instead of discrimination which was common among villagers. Also, he teaches villagers how to protect themselves and regularly takes kids to the county for testing. There are lots of similar work. Though trivial, these work need patience. Subsidies for village doctors are meager. For example, when making rapid HIV detection, the village doctor will only receive RMB 2 for each person that is found infected. Lin Jianmei, Project Director of the Yunnan Foundation for Poverty Alleviation, told reporter of Southern Weekly: ”Village doctors are also worried about their own safety. Some people don’t want to be discovered. When the village doctor come to visit, they are worried that they are exposed. That’s why they may hurt the doctor." How to promote AIDS prevention work by village doctors? Ye Xiaoxiang, Chair of the Yunnan Foundation for Poverty Alleviation, thinks highly of training, "This project needs all levels of training and mobilization." Ye Xiaoxiang believes that capacity building of village doctors should be the trend for AIDS prevention.

Villagers receive information about HIV/AIDS and receive training how to improve their livelihood

Solve the power shortage problem

Ye Xiaoxiang remembers that this AIDS prevention and treatment project in cooperation with Amity Foundation can be traced back to 1992. In that year, Ye Xiaoxiang was the Deputy Director for the Yunnan Provincial CPPCC Poverty Alleviation Project Office. The funds were far from enough to work in poverty-stricken areas. Ye Xiaoxiang, who wanted to do something, raised funds and looked for support everywhere. Also in that year, Ye Xiaoxiang met with Amity. The first project was to solve the power shortage problem for poverty-stricken mountainous areas in Wuding County. During the two years, in order to establish power supply facilities, Ye Xiaoxiang and his colleagues went to the village dozens of times. Amity provided a total of RMB 170,000. After the project ended, Amity, Poverty Alleviation Office and villagers were all satisfied with the project, so they started long-term cooperation. Ye Xiaoxiang became a project specialist for Yunnan Projects of Amity Foundation. In 1996, Amity cooperated with Yunnan Provincial AIDS Prevention Office to launch a three-year AIDS Prevention Education Program in Longchuan, Fengqing and Lincang, the three most drug-affected counties in Yunnan. In 1999, Ye Xiaoxiang participated in Amity’s integrated community development projects focusing on AIDS prevention.

Difficulties

“When we went to Menglian in 2012, we were very experienced as we had been doing the same for over 10 years.” In 1999, Dehong was a place with a large number of HIV positives. It was also a place that AIDS prevention work was hard to proceed. “We didn't dare to go to public places,” said Ye Xiaoxiang. “Yet dare we go inside one’s home. But we have to talk to them and they must have the knowledge. So we usually chose some remote spots to talk alone.” This kind of one-on-one talks last for years. "You go slowly… go slowly from knowledge to their families and into their lives," said Ye Xiaoxiang. "Whoever got infected would collapse." Until the end of the project, some HIV-positives dared to stand out and become volunteers. They took the lead in organizing care teams for others and Amity provided funding and resources for these care teams. At the same time, Amity continued to hold various training courses locally, big and small, from county to village. "For example training for families - how to face reality and do not discriminate; or trainings for the public – everybody should have basic knowledge about HIV/AIDS". Moreover, industry trainings were also provided to help HIV positives to rebuild their lives. In Ye Xiaoxiang's eyes, Amity Foundation's AIDS prevention work has a clear goal. "We hope that they (positives) come out of miserableness, face reality, protect their bodies, become productive and normalize their lives." But this simple goal is not easy to achieve. "It takes a long time to find out the ways." The unremitting efforts gradually achieved results. With over ten years’ of project experience Dehong and Longchuan, Ye Xiaoxiang told the reporter that “the outcomes are very good and we are on the right track. Now we hand it over to the local government.”

A delegation from the German church visits a local AIDS/HIV support group

CDC weakness

In 2012, when Menglian launched the project, Amity and the Yunnan Foundation for Poverty Alleviation first cooperated with the local Health Bureau and CDC through government coordination. Still, everything started from basic training. At the Menglian County Center for Disease Control, there are currently only two doctors responsible for STD/AIDS prevention and treatment. Qi Dezhong and Chen Yahong, Yi and Lahu ethnic minorities respectively, participated in Amity projects since 2012. With financial support, they first tested drug users, and then trained village doctors. Village doctors received training several times. In this way, they realized rapid detection and achieved comprehensive testing of the general population. After large-scale testing, the number of HIV-positives in Menglian County underwent a continuous increase in 2013 and 2014. However, in the eyes of Qi Dezhong, it was a good news. “Through the tests, we reach a peak period and later slowly controled the situation.” According to Qi Dezhong, HIV-positives in Menglian County were scattered in several towns. “If you rely on the two doctors in the CDC, you can never do it.” In recent years, the government was fully implementing targeted poverty alleviation. Qi Dezhong had to stay in local villages for 10 days every month. "I have no holidays and no leaves, but overtime work every day." Greater pressure comes from the AIDS prevention work itself. "AIDS is a disease that faces discrimination by society." Qi Dezhong was very careful when visiting HIV-positives. "If other people see CDC doctors visiting someone, suspicions will come up." Later, even when the person being visited went to a friend's home, he was under pressure to be misunderstood as an HIV-positive.

Village doctors are trusted

"But, if you are a village doctor, people will see it normal for you to visit someone." Qi Dezhong believes that village doctors have unique advantages. "Some HIV-positives get heavy mental burdens after they are confirmed positive. Some are ethnic minorities, language is different, and it is difficult to communicate or manage treatment. But village doctors are easily trusted and also keep abreast of the patient's medication and condition." In the first few years, the CDC and Amity Project Office did a lot of training work. They selected village doctors with better knowledge for continuous training. HIV-positives and village doctors established WeChat groups to communicate, and organized visits to build trust. Many of the village doctors have participated in the “Amity Village Doctor Training Program”, in which Amity funded their learning and living expense for a two year study at a local health school. Daguang received two trainings in 1999 and 2002 respectively. These village doctors are familiar with Amity’s projects. They have trust on Amity and are more active and take the initiative. Now, Menglian County has set up demonstration sites in Laopan Village. According to the data provided by the Amity Project Office, a total of 60 HIV-positives are on the list of follow-up visits, a total of 720 visits have been completed and there have been 360 cases of CD4 cells, which support the immune system, sent by the village doctors. Village doctors conducted HIV tests for 60 people who have HIV-positive spouses. 30 people were referred to the antiviral treatment point. Daguang has done more than 900 cases of rapid HIV testing, and has found no positives so far..

Establishing a Women's Health Center

The fate of Xiaohong has two turning points. One, as he was tested positive in 2005, and the other was becoming a volunteer in Amity's project. In 2005, after a free medical examination in the village, Xiaohong received a call from the county CDC. "Can you come over to take another blood sample?" That year, Menglian County was still unable to treat people living with HIV virus. Under the help of Dr. Song from the CDC, Xiaohong did all kinds of examinations for three months and later was treated for one year in Simao City (now the Pu'er City). Xiaohong is grateful and trustful to the doctors at the CDC. “I can attend training in the Province and in Pu’er. I can learn a lot  and I have subsidies for my travel expense.” Knowing much, Xiaohong began to have the courage to stand out and share her story. Care events organized by volunteers serve as one of the effective ways for Amity’s AIDS prevention work. As Xiaohong is older than most of other members, Xiaohong often persuade them in the WeChat group to “take medicine in time” and to “go to the hospital”. This kind of communication is actually very important for HIV-positives. Otherwise, it will make them "feel very lonely and don't know who to talk to”, and “can only talk to the doctor, who sometimes I don't fully trust." In 2016, with the support of the CDC, Xiaohong established a Women's Health Center, which gives safety advice to some high-risk groups such as prostitutes, and suggest them to apply for health certificates.

Villagers receive health knowledge training during Amity's AIDS prevention program

AIDS prevention is a social issue

Womens' organizations and common activities

strenghen the community resilience

However, Xiaohong hasn’t told her son what disease she has. Her son often saw her taking medicine and knew his family is "poor because of illness". But when he asked mom, "Mom, what disease do you have?" Xiaohong couldn't tell him. In Ye Xiaoxiang’s eyes, AIDS prevention and treatment is not only a medical problem, but also a social issue. It is related to local culture, human feelings and customs. Therefore, the first step should be changing serious discrimination. The work should be based on the community for integrated development. In the early years, Amity scattered its projects in Yunnan, including village doctor training, disaster management, AIDS prevention, industrial development, water and power supply and so on. Later, Ye Xiaoxiang discussed with Qiu Zhonghui, Chair of the Board of Amity Foundation that "why don't we focus on several villages, and put all projects in as an integrated program? After a few years the whole village will change." This is what Amity is doing in Menglian. Starting from community training and capacity building, Amity built roads, improved sanitary conditions, developed the economy, provided health knowledge, improved education environment, fostered farmers' development associations in the community, and encouraged inheritance of traditional culture. On the basis of this integrated development, Amity set up a “AIDS Management System” in Menglian, focusing on HIV positives, based on families' support, relying on communities, connecting villages and guiding medical institutions.

Advantages of social organizations

Amity's AIDS/HIV projects are supported by overseas partner organizations

Xiao Li, a villager in Laopan Village, is a local “online star”. He spent more time on WeChat than other villagers and has a series of updates on the Old Yongqian Village in his WeChat Moments. On October 24, 2018, Xiao Li told the Southern Weekly reporter, "We spent five years before making the change." The old situation here was poor and backward. Only ten years ago, TV became a household appliance in this village. Five years ago, the road to the county was still a mud road. Villagers who needed to go to town had to take a tractor and spend three hours on the way. In the past seven years, the first thing Amity Foundation did was road construction. The mud road towards the outside world was turned into a gravel road, which is five kilometers long. A water project was carried out in the same period to improve the quality of drinking water for the villagers. In the past, in order to get drinking water, people in Laopan Village had to go to a mountain 800 meters away. Generally women fetched the water and one woman could only carry three to four gourds. It took them long time to go a long way to fetch little water. After the project was completed, it released the daily difficulty of local women. Moreover, Amity implemented rural buisness development and low-yield fields and ditches transformation to assist the development of the villages. For example, after changing the field crop from sugar cane and corn to coffee, income for villagers could increase almost RMB 10,000 per year.

Select suitable projects to set models for others

Compared to facilities construction, Amity emphasized more on the “internal strength” of communities. The performance team of the Old Yongqian Village was established in 2013. In the previous researches, Lin Jianmei found that there were many young people in this stockade village and the village was featured ethnic minority culture of Hani people. After consent from the villagers, they invited professional from the county to train their performance. After doing good in the communities, in 2017, Amity Project Office implemented a “Menglian County Rural Medical Plan”, which helped build 5 village clinics and provided 10 sets of medical facilities in 8 villages. Amity Foundation, Yunnan Foundation for Poverty Alleviation and the local government cooperated with each other. Amity was responsible for fundraising, research, testing and assessment. Yunnan Foundation for Poverty Alleviation was responsible for coordination and tests, and the local government was responsible for establishing Amity Office for County to implement projects. For every project, “local participation, public participation, and experts participation” were adopted. Ye Xiaoxiang believes that a non-profit organization had limited funds and capabilities and the key was to select suitable projects to set models for others. "In this way, you can achieve enough effects with limited expenses." Now, AIDS prevention and treatment work in Menglian has made much achievements. After Amity’s projects ended this year, the government provided RMB 280,000 to the CDC to continue promoting the system. “The government also hopes that HIV-positives could be managed by village doctors. However, at present only the two towns where Amity has participation did it.” Ye Xiaoxiang told the Southern Weekly reporter that from this end, “Social organizations show their advantages. Their processes are very detailed and they have proven concepts for implementation”. But in terms of AIDS prevention,“it needs at least ten years” before seeing the positive outcomes.

(This article were originally published by Southern Weekly on Nov 22, 2018)

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