United Nations Development Programme Chinese Center for Disease Control and Prevention

1. Socio-economic impact of HIV at the household levels in China: the results from a five-province study United Nations Development Programme Chinese Center for Disease Control and Prevention National Center for AIDS/STD Control and Prevention And Beijing Institute of Information and Control July 2010

2. Team Leaders: • Liu Kangmai Yuan Jianhua Edmund Settle Research Team Members: Xu Xiyang Jiang Siyu Jiang Tao Deng Yuchen, Xia Zhiyong Wang Qiang Lin Dan Mao Tian, Pu Hongbo Gao Yuhua Jiang Xiaopeng Technical Support: Dr. Basanta K. Pradhan G. Pramod Kumar

3. Outline Background Introduction Main findings Recommendations

4. Background • Reported cases by end of 2009: 326,000, mostly in rural areas • Estimated PLHIV: 740,000 (by end of 2009) • Overall prevalence low, but severe concentrated epidemics among MARPs and in certain pockets • Started to spread from MARPs to the general population • Need for strategic information for policies and programmes on impact mitigation

5. Field survey in five provinces(1) Introduction • Objective: Assess SE impact of HIV at individual and household levels and advise impact mitigation steps • Study period: Feb. 2008 to Jan. 2010 • Locations: Five high HIV prevalence provinces - Yunnan, Guangxi, Sichuan. Hubei and Shanxi. • Partners: Office of HIV/AIDS Prevention and Treatment of Yunnan province; Centers for Disease Control of Guangxi, Sichuan, Hubei and Shanxi provinces; Red Ribbon Home (Yunnan); Liuanhuaming Group (Sichuan); Libaqiang Group (Shanxi) • Methodology : Quantitative and Qualitative - questionnaire surveys, FGDs, in-depth interviews, case studies

6. Sampling & limitations Sampling: multi-stage and systematic Selection of the control group: households in the neighbourhood of PLHIV-respondents with similar socio-economic background Sample size: 931 HIV households (1027 PLHIV, 654 males and 373 females) and 995 non-HIV households (472 males and 523 females) Limitations: MARPs not included, hence impact on them not assessed; study not longitudinal, hence impact over time unable to capture; mitigation by existing Govt/NGO assistance reduces the apparent impact; possible recall errors

7. Impact on income and employment

8. Impact on income and employment

9. Impact on consumption

10. Stigma and discrimination

11. Impact on education

12. Impact on education

13. Impact on women time use pattern

14. Gender and health-seeking behavior

15. Coping mechanisms

16. Social security Percentage of households who received support Average amount of support

17. Recommendations • The expansion of anti-discrimination education and its integration into all IEC activities should be a high • SE impact mitigation of PLHIV-households should be part of the national AIDS strategy • Combine various efforts to provide day-to-day support to PLHIV- households, especially those with single parents, widows and elderly. • Initiate targeted measures to reduce vulnerability of women to HIV and the impact on women living with HIV.

18. The social safety net for PLHIV and their families should be integrated into broader and well funded national safety net programs. It will not only help PLHIV, hut also will allow the government achieve greater impact and equity. Specifically; • Efforts to improve medical care for PLHIV should focus on integrating their needs into new social insurance initiatives ; the RCMS in rural areas; and basic medical insurance and others in urban areas. • Life support for PLHIV should be incorporated into broader existing government support programs by advising the MLSA to cover PLHIV. • Income generation activities for PLHIV should be combined with broader anti-poverty and development programs, in order to advance HIV households’ own abilities to cope with the burdens of the disease themselves.

19. Thanks!