Acknowledgement: Keats Research Fund (KRF), Newcastle University, Australia.

1. Innovative cultural approach for reduction to vulnerabilities among ethnic Qiang women and children affected by HIV in the earthquake disaster areas Sichuan, China Shuguang Wang1,2, 3 XVIII International AIDS Conference Vienna, Austria, 2010 (abstract number: MOAD0302) 1. School of Psychology, the University of Newcastle, Australia 2. Institute of Sociology, Sichuan Academy of Social Sciences, China 3. Unicef, Beijing, PRC

2. Acknowledgement: • Keats Research Fund (KRF), Newcastle University, Australia. • Unicef funds for these women and children affected by HIV in earthquake disaster areas, Sichuan. • Volunteers and participants from all project sites in 9 disaster counties, Sichuan, PRC. Enquires: shuguang.wang@newcastle.edu.au

3. Indigenous cultural response to vulnerability Background • The HIV/AIDS epidemic in the Chinese ethnic minorities is at a critical stage requiring urgent, focused innovated strategies to prevent further expansion. • The disastrous earthquake of 12 May, 2008 had its greatest impact on these population affected by HIV in ethnic communities in Sichuan disaster areas. • The vulnerability to HIV was increased significantly among these women and children affected by HIV in ethnic Qiang and Tibetan communities living in the poorest and most socially disadvantaged remote mountainous of Sichuan in post-disaster settings at the earthquake’s epicentre.

4. Indigenous cultural response to vulnerability Background • International AIDS organizations have mainly taken the form of projects to support the development of national and local community level prevention packages, but there has been limited progress to tackle the crisis in the region as a whole (Gould, 2005; Wang, 2009). • Evidences have also shown that employing traditional official-led model at public health agenda from a non-indigenous and outside community perspective is a very limited effect in reducing vulnerabilities for these ethnic women and children affected in post-disaster challenged settings (Wang et al., 2010). • key factor is the failure to use the simple BCC/IEC model deriving from individualistic perspective, with traditional official-led oriented , message giving oriented, centre-cultural oriented, and CDC oriented in local/indigenous cultures and community, which has not reached people effectively enough to reduction of vulnerability to HIV in ethnic community.

5. Indigenous cultural response to vulnerability Background • Furthermore, the biggest challenge for the projects in the ethnic community is the difficulty of reaching various audiences in diverse indigenous ethnic/tribe cultures with diverse history, gender system, faiths, and uncounted local languages. • Developing a comprehensible, sustainable and culturally appropriate responsive program as acceptable approach has been a significant demand in locals. • Program was curried out in 12 project sites from 9 disaster counties, Sichuan, PRC combining two programs – Keats funds and Unicef.Data presented in the study as a demonstrative model is from 3 project sites of all 9 disaster counties in Wen Chuan, Mao Xiang, and Li Xiang, which are traditional Qiang resident areas.

6. Indigenous cultural response to vulnerability Aim & question • The aim of the study is to develop a integrated socio-cultural approach to reduction of vulnerability to HIV among these women and children affected by HIV in ethnic Qiang community of earthquake disaster areas of Wen Chuan and Miao Xian, China. • The immediate aim is to adapt the methods used in previous successful research in cross-cultural studies of minority ethnic Yi and Tibet communities (Keats & Wang, 2004; Wang & Keats, 1999; 2005, 2007), combining the approaches of comprehensive cultural model to reduce the vulnerability to HIV/AIDS in disaster background. • A further aim will be to move to a national approach to dealing with the increase of vulnerability to epidemics in a broad range of minority ethnic communities in various  challenged settings of China. • The major research question in the study is to examine whether the adoption of a comprehensive cultural model will be significant in leading to reduction of vulnerability for these women and children affected.

7. Methodology: Focuses & Vision • 1. Needs-oriented focus - Program must be tailored to meet the needs from target groups in cultural and disaster settings. • 2. Effectiveness-oriented focus - Program of activities is designed to enhance self-esteem, and foster psychological and cultural well being. • 3. Collective oriented focus - Group-based participatory approach rather than one that is based on treating problems of individuals. • 4. Context-oriented focus - Cultural context-based facilitates advices. • 5. Theoretico-empirical agenda - The activities will be linked to theoretical bases drawn from a number of sources.

8. Methodology: Theories [1] Gao, M. (2005) Participatory Communication Research and HIV/AIDS Control: A Study among Gay Men and MSM in Chengdu, China. PhD thesis. University of Newcastle. [2] Wang, S. & Gao. M. (2007). Participatory Communication and HIV/AIDS Prevention in Chinese Marginalised (MSM) Population. AIDS Care, 19(6): 799_810 [3] Health Belief Model (HBM) (Janz & Becker, 1984; Sarantakos,1993) [4] Social Cognitive Theory (SCT) (Bandura, 1995) [5] The Theory of Reasoned Action (TRA) (Ajzen & Fishbein, 1994; Fishbein, 1995)

9. Indigenous cultural response to vulnerability Methods: Sample in study one – survey • A total number of 2234 female caregivers and 3059 children aged from 3 to 14 years in Qiang villages and towns of Wen Chuan and Mao Xian have been enrolled in this survey study. • To assess the extent of the impact of the earthquake on the women and their children affected by HIV in disaster area. • Insights from the findings in the study are used to tailor the evidence-based, culturally appropriate approach on the best use of integrated socio-cultural resources to facilitate the reduction of vulnerabilities. • Participants were recruited through community key stakeholders and volunteers of this project.

10. Indigenous cultural response to vulnerability Methods: Sample in study two - Interview • The interview sample from children affected were drawn from the responses to the survey in Wen Chuan. • Comprise 1200 children in three age groups of 3-5 years, 6-12 years and 13-14 years, with 100 in each age group in each of 4 categories: (A) children with a family member; B) children affected by HIV with a family member; C) children who are apparently not seriously affected and are in the care of parents or close relatives; D) children who are apparently not seriously affected and are in the care of parents or close relatives, but affected by HIV. • Interview schedule was prepared based on the content of the Survey • Drawing pictures were conducted in the interview for children to express their emotion and appeal in difficult background, affected by disaster and epidemics. • Participants were recruited through community key stakeholders and volunteers of this project.

11. Indigenous cultural response to vulnerability Methods: Sample in study three – evaluating effects of intervention • A cohort of 256 women affected by HIV/AIDS in the study were respectively drawn from the Wen Chuan (Hang-Qiang mix - 107), Mao Xian (mainly Qiang population - 84), and Li Xian (Qiang-Tibetan mix - 65). • With matched comparisons of two groups: Direct Training Group (DTG) and Indirect Diffusion Group (DTG). • To evaluating changes in the two groups from baseline to posttest after 5 months

12. Indigenous cultural response to vulnerability Methods: Intervention (key components) • Promoting involvement of faith-based cultural leader using their prestige and traditional power to advocate the development in attitudes on gender social equality, and to support diffusion of discourse on gender equality combating discrimination for these women and children affected by HIV in disaster areas though undertake initiatives. • Strengthening governance (Qiang village leaders, doctors, and CBOs) at grass-roots level to underpin village work for support of these women and children affected for their services to access VCT and health care, prevention and treatment (Anti-retrovirus therapy).

13. Indigenous cultural response to vulnerability Methods: Intervention (key components) • Developing linguistically diffusion model at peer level in using oral story telling communication approach which was based on the particular ethnic situation and experiences to HIV - indigenous and traditional systems, gender issues of tribal/ethnic society, myth and reality, language and migration processes to convey messages on HIV prevention, harm reduction, combating discrimination, compliance/dependence education for ART. • Building up dialogue, participation and empowerment through the development for these women and children affected as volunteers to work with their peers. • Working to increase sustainability through policy implications for local governances in sharing successful experiences across regions and cultures.

14. Indigenous cultural response to vulnerability Methods: evaluation The Behaviour Check List (BCL) for children progress • The Behaviour Check List (BCL) is used to record observations of the children’s behavior during each activity session. It will be completed by the Volunteers and Activity Leader. • BCL is not a diagnostic test. It has been designed in a simple form so that all the volunteer helpers can use it. The items have been drawn from the most frequent responses to the Survey and Interviews. • BCL is to be completed at the beginning of each activity program, and on each occasion the group meets.

15. Indigenous cultural response to vulnerability Methods: evaluation The pre-posttest interview with women to focuses on assessing: • Social engagement in cultural context. • Involving peer-based activities with supporting the reduction to vulnerability for these women effected and affected by HIV (combating discrimination and poverty, involving support of CD4 monitor in their families, and the education of compliance /dependence for Anti-retrovirus therapy and treatment). • Access health care at local CDC level. • Adopting prevention behavior • Involving community activity to prompt dialogue, participation and empowerment through sharing successful experiences to develop policy implications for local.

16. Fieldwork Photos: FGS

17. Fieldwork Photos: Tanning

18. Volunteers for survey and interview in Wen Chuan and Mao Xian

19. Survey for children’s mother

20. Interview for children

21. Interview with puppets

22. Children drawing pictures to express their apple appeal  in disaster situation 

23. Drawing pictures from 9 year old Children

24. Drawing pictures from 10 year old Children

25. Drawing pictures from 11-12 year old Children

26. Drawing pictures from 13-14 year old Children

27. The rites conducted by the Shi Bi (the cultural leader) in Mao Xian Qiang community are the core activity in advocating collective action for responding to disasters.

28. The rites conducted by the Shi Bi (the cultural leader) in Li xian Qiang community are the core activity in advocating collective action for responding to disasters.

29. Practices of children drama performance of Qiang historical story  in school

30. Practices of children drama performance of Qiang historical story in school

31. Practices of children drama performance of Qiang historical story in school

32. Traditional dances and songs

33. Results: Impact Level of how the child was affected by the earthquake • More than 42% of caregivers in this study reported that their children were strongly affected by earthquake, with the rest being: • those children who were affected generally (29.32%) • slightly (14.06%) • no significantly (9.89%) • Children in the Qiang villages of Wen Chuan were reported as more strongly affected compared with the children from Mao Xian (p = 0.004)

34. Results: Impact Psychological impact for children in survey

35. Results: Impact Psychological impact for female caregivers in survey

36. Results: Demands Main needs/appeal for Qiang women in post-disaster settings

37. Results: Evaluating counseller’s work for the Qiang children’s progress Female caregivers’ descriptions of effects of access to counselling on children affected by earthquake

38. Results: Evaluating counseller’s work for the Qiang women progress Female caregivers’ descriptions of effects of access to counselling for themselves  affected by earthquake

39. Results: culture concern Cultural/faith-based leaders are indentified by these children as an important role Qiang community in interview

40. Results: cultural representation Drawing pictures to express children’s appeal and impression on the disaster

41. Results: Change for children Changes for Qiang children affected by HIV in disaster area from baseline to posttest recorded twice per month in improving psycho-cultural rehabilitation)

42. Results: Change for children Socio-psychological changes in two Qiang children groups from baseline to posttest after 5 months recorded twice per month in improving psycho-cultural rehabilitation)

43. Results: Changes for women Situational changes for Qiang women affected by HIV in disaster area from baseline to posttest after 5 months

44. Results: Changes for women

45. Results: Changes for women

46. Results: Changes for women

47. Results: Changes for women

48. Indigenous cultural response to vulnerability Conclusion • Data in this research was first study to assess the socio-cultural and psychological impact of the earthquake on the children and women affected by HIV in ethnic Qiang community. • Findings indicted that the disaster has increased the vulnerability to epidemics among these Qiang women and children affected living socially disadvantaged remote mountainous in post-disaster settings of the earthquake’s epicentre. • The project is the first program to use an integrated socio-cultural approach which draws on both insights from situational analysis of this study and previous experiences using innovative indigenous responses to vulnerabilities to HIV/AIDS in collective agency of ethnic communities in earlier stages of China. • Evidence in this study clearly indicated that the integrated socio-cultural response to vulnerable reduction to HIV among ethnic Qiang women and children affected were successful in support of psycho-cultural rehabilitation with facilitating their socio-cultural situation in challenged settings.

49. Indigenous cultural response to vulnerability Lessons learned: • Nature disaster as an agent in promoting socio-psycho-cultural approach for response to epidemic and disaster in challenged settings as a new agenda for HIV-related action is well-understood in the program practice. • Success in effective reduction to vulnerabilities among these ethnic women and children affected in disaster earthquake in this project are largely attributable to: 1) Innovative use of integrated socio-cultural resources in collective context for women engaged in combating poverty and discrimination must go to beyond a simple public health with a individualism oriented approach. 2) Gender and children-focused indigenous strategies with the particular linking ethnic situation – traditional advocacy, empowering tribal/ethnic society to take their own initiatives in collectivist environment are stressed to support decision-making in sharing successful experiences on the best use of healthcare and cultural resources in post-disaster challenged settings cross-culturally.

50. Indigenous cultural response to vulnerability Thanks!