PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Subdivisions of Program Areas, these track general higher level sub-classifications of expenditure.
Subdivisions of Major categories, these are the most detailed expenditure data.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008
New/Continuing Activity: New Activity
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $21,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Education $21,000
Program Budget Code: 04 - HMBL Biomedical Prevention: Blood Safety
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Drug use is an important driver of the HIV/AIDS epidemic in China. It remains the major transmission mode in China's
southwestern provinces and Xinjiang in the northwest. According to the 2006 China Report on Narcotics Control, there were 1.16
million registered drug users in China by the end of 2005. The estimated number of drug users is about 2-3 times higher than the
registered number, and 85% inject heroin. In Guangxi, there are approximately 55,000 drug users. In Yunnan, there is an
estimated 52,000 drug users (including both registered and estimated non-registered users). Guangxi and Yunnan are among
seven provinces where the number of persons living with HIV infected through IDU is over 10,000. While HIV prevalence among
IDU nationally averages around 7.54%, 2006 sentinel surveillance found an IDU HIV prevalence of 34% in Guangxi, 25% in
Yunnan, 20.4% in Xinjiang, and 8% in Guizhou.
Based on a joint assessment of HIV/AIDS prevention, treatment, and care conducted by State Council AIDS Working Committee
Office (SCAWCO) and the UN Theme Group on AIDS, the cumulative number of reported HIV cases in China as of October 2007
was 223,501, 38.5% of whom were infected via IDU. IDU transmission accounted for 42% of the 50,000 estimated new HIV
infections in 2007. In Gejiu, one of four USG-supported MPS sites in Yunnan, IDU make up 65% of all HIV/AIDS cases.
Behavioral survey data show that 38% of IDU reported sharing needles prior to entering detoxification centers. In addition to
needle and syringe sharing among IDU, a key determinant in assessing potential HIV transmission is the extent of sexual mixing
between IDU and non IDU. Sexual transmission plays an increasingly important role in HIV infection among IDU and their sexual
partners. In Yunnan, 21% of female IDU said they had sold sex for money or drugs in the previous month. FSW may also inject
drugs, thereby transmitting the virus to other IDU, regular partners, and clients. In Sichuan, 2.5% of FSW reported injecting drugs;
among street- based sex workers the proportion who reported injecting was twice as high. The HIV infection rate among IDU FSW
is 18.3% in Geiju and 14.5% in Kaiyuan, two MPS sites in Yunnan province. A recent behavioral study in Yunnan and adjoining
provinces showed that male IDU often buy sex, potentially infecting FSW. In Sichuan, 22% of male IDU reported buying sex and
only a minority reported condom use at last commercial sex. Male IDU may also have male to male sex.
China has made great strides in addressing the issue of HIV transmission via IDU. It is one of the first countries in the world to
make methadone maintenance treatment (MMT) a national priority in its response to HIV/AIDS and drug use issues. The MMT
program initiated its pilot phase during 2004-2005. Since 2006, MMT has been a formal national program, co-managed by MoH,
the Ministry of Public Security (MoPS), and the State Food & Drug Administration. By May 2008, a total of 507 MMT clinics had
been set up in 23 of 31 provinces. The government has set a target of 1,000 MMT clinics to be operational by the end of 2008. As
of May 2008, there were 133,002 clients enrolled in the national MMT program with 74,892 clients still on treatment. The average
number of clients per clinic was 148, and the annual retention rate was 69%.
While MMT and other interventions aimed at IDU are being scaled-up, coverage of IDU remains hampered by continual police
crack downs and regular incarceration in "rehabilitation centers." Recent developments suggest that the need to prevent HIV/AIDS
is moving China's policy environment to take small but significant steps towards a less retributive response to drug users. First, a
new "anti-drug" law, which came into effect on June 1, 2008, introduces the concept of "community-based drug rehabilitation,"
which can be delivered through neighborhood committees and designated grassroots organizations. This concept paves the way
for a broader social response to drug use that does not simply treat it as a crime. Second, the latest version of the government
guidelines for implementing the MMT program dispense with the eligibility requirement of two failed detoxification center
detentions (for registered IDU) and allow for non-registered IDU (i.e., drug users who have never been arrested) to enroll directly
into the program through the clinics without referral from the Public Security Bureau (PSB). Both of these changes create an
opportunity to further develop existing services and implement new ones that push for improved access to drug treatment. There
is a strong political concern in China about adherence rates within the country's MMT program. This has led to a greater
willingness to explore new interventions to reduce program drop-out rates. Together, these four factors - the need to act quickly
to halt the HIV/AIDS epidemic among IDU, a new more tolerant anti-drug law, a loosening of the entry requirements for the MMT
program, and a strong concern about the MMT program's outcomes - create an opportunity for service improvement.
In light of the rapid expansion of the national MMT program, a number of challenges need to be addressed, including the limited
capacity of the implementing staff, insufficient psychosocial support, and the lack of special care and support services for IDU,
resulting in low enrollment and retention of clients at MMT sites. Through its involvement in scaling-up of the national program,
USG supported the development of the Methadone Clinic-Based Comprehensive Prevention, Support, and Treatment Model to
assist GoC in addressing enrollment and lost-to- follow-up issues of MMT clinics, providing training to improve MMT staff capacity
in 15 provinces, and supporting the first mobile MMT clinic in Yunnan in 2006.
In FY 2009, USG will collaborate with GFATM Round 4 provinces in using peer educators and outreach workers to increase MMT
enrollment in the 15 USG-supported provinces; expanding referral mechanisms from drug detoxification centers to MMTs for IDU;
field testing the model by using PSB staff to conduct follow-up to improve IDU enrollment in MMT upon release from detoxification
centers; providing psychosocial support through peers and MMT staff to improve MMT retention rates; and preferentially recruiting
HIV-positive IDU to improve the prevention effectiveness of MMT. USG also will support piloting a smart card MMT management
system in Guizhou province, aimed at improving MMT data management and referral of clients from one MMT clinic to another.
The system will eventually be scaled up nationally by GoC. USG will provide support to GoC in assessing the national MMT
program to generate data for decision making.
In FY 2008, USG supported the development of a community-based MMT adherence support program. An assessment of the
program was conducted in 2008, by the Yunnan CDC and Yunnan Institute of Drug Abuse, and found adherence rates in China's
MMT program to be low and flagged the need for more psychosocial support services to promote adherence. The current system
concentrates mainly on dispensing methadone and fails to address the individual client's psychological process of giving up heroin
and adjusting to a new way of life. An intervention was rolled out in FY 2008 in which peers and family members provide the
missing psychosocial support component. In FY 2009, this intervention will have been operating for 9 months, so activities will
focus on refining the model, assessing its impact on MMT adherence rates, and supporting further development of the program
around two MMT clinics in Nanning, while exploring the possibility of having it replicated in other sites by local partners.
Given China's leadership in initiating and scaling up MMT, USG will support GoC in developing a technical assistance program
aimed at sharing China's MMT experience with other countries that have an IDU-driven epidemic, such as Vietnam, Ukraine,
Kazakhstan and other Central Asian countries. The program will consist of convening workshops, sending Chinese experts
abroad as consultants, and receiving study tours from other countries.
Over the past several years in Guangxi and Yunnan provinces, USG supported the development of a series of demonstration
projects focused on establishing replicable models for delivering high quality, targeted prevention interventions linked with care
and treatment services provided by local government and CBOs. The MPS model for IDU is being implemented in eight sites in
Guangxi (Luzhai, Nanning, Ningming, and Pingxiang) and Yunnan (Gejiu, Kaiyuan, Kunming, and Mengzi) provinces. The model
includes peer education, drop-in centers, targeted interpersonal community outreach activities, community events, VCT, support
groups, STI management, and health service referrals. BCC interventions for IDU aim to normalize and promote correct and
consistent condom use with all partners and decrease the sharing of needles.
As part of the MPS model, drop-in centers run by local partners allow IDU to meet and learn about HIV prevention as well as
receive peer support and encouragement to quit using drugs. These centers also act as a base of operations for outreach workers
and the project team. Outreach teams go out into the community to engage IDU where they socialize or engage in risky behavior.
On-site counseling services for IDU to learn their sero-status is provided at the drop-in-centers, while testing is done at local CDC
offices. GFATM and GoC's China Comprehensive AIDS Response (CARES) program provides funding for needle and syringe
programs (NSP). NSP are situated proximate to the drop-in centers, and linkages are made to local MMT clinics. No USG funding
is used to purchase needles and syringes per PEPFAR policy.
In 15 provinces, USG will support provincial MMTs and associated community groups to train outreach workers and female IDU
peer educators on condom promotion and behavior change among female IDU. For FSW who also inject drugs and are reached
through the MPS sites in Guangxi and Yunnan, USG will ensure that appropriate messages and behavior change interventions for
the dual risk of sex work and injecting drug use are included.
Part of USG's IDU program in Guangxi and Yunnan includes the provision of technical assistance to GFATM and AUSAid IDU
sites. In FY 2009, USG will support partner officials on a study tour of the Kunming drop-in center. The study tour will serve as
part of an advocacy effort to convince GFATM sites and others to adopt the successful IDU drop-in center MPS model. USG also
supports developing the capacity of its local partners as technical assistance providers. A local partner in Gejiu, the Jin Hudong
Community, is providing systematic technical assistance to Jianshui County (a GFATM site in Yunnan) on IDU outreach and the
creation of effective linkages among outreach, NSP, and MMT. USG will continue support of this systematic technical assistance
to selected GFATM sites in FY 2009.
In June 2008, USG partners were requested by the Yunnan PSB to assist with programmatic support in launching the newly
mandated Provincial IDU Community Outreach Program. This Program is a result of a new law instructing local authorities to no
longer forcibly take IDU to detoxification centers if urine tests prove they have been using drugs. The law allows for offenders to
remain within their communities, provided they regularly report to their designated community contact person. However, many
officials remain unclear about what exactly this law mandates or how it may be implemented. USG sees this as an opportunity to
ensure the operationalization of the law to the benefit of the rehabilitation approach to the drug problem. In FY 2009, USG
partners will work closely with the Yunnan PSB to ensure the successful development of this program, which has the potential to
influence the way the law is enacted not only in Yunnan but also throughout China.
In previous years, USG partners supported training peer educators in compulsory detoxification centers in 29 sites (17 under
Global Fund, eight under USG, and four under the Australian government), and this essential work will continue in FY 2009. Given
that at any one time many of the active IDU are incarcerated, this is an effective way to reach this otherwise hidden population
and establish links for subsequent follow-up upon their release. The peer education model in the detoxification centers will be
expanded in FY 2009 to operate in most MPS sites. The new Community Rehabilitation outreach efforts will be conducted in
collaboration with PSB and the local community unit via peer educators in Kunming and Mengzi, with the potential to replicate the
IDU Community model in other sites in FY 2009.
In FY 2009, USG will continue to support limited targeted media efforts including targeted billboard messages in "hot spots" in
Gejiu and Mengzi, as well as public events in MPS sites. In the MPS model sites, USG funds will be used to build the capacity of
local partners, including local CDCs and other grassroots IDU NGOs, in behavior change interventions, HIV prevention, and
working with MARPs. USG partners will work closely with sub-partners to build their expertise in IDU and FSW interventions and
ensure the quality of their programs. In all MPS sites, social marketing, HIV prevention, and condom training programs will be
supported as needed.
USG and its partners will continue strong collaboration with national and local government partners, GFATM, and the Australian
government-funded highly active antiretroviral therapy (HAARP) project to promote success in reducing the HIV epidemic. As part
of the MPS approach, USG will support efforts to encourage GFATM project sites to replicate successful models of targeted
prevention interventions. Specific models for replication include detoxification center peer education, community outreach for IDU,
IDU drop-in centers, and peer outreach for IDU.
Program Budget Code: 05 - HMIN Biomedical Prevention: Injection Safety
Total Planned Funding for Program Budget Code: $0
Program Budget Code: 06 - IDUP Biomedical Prevention: Injecting and non-Injecting Drug Use
Total Planned Funding for Program Budget Code: $1,488,958
Estimated amount of funding that is planned for Human Capacity Development $46,865
Estimated amount of funding that is planned for Education $78,109
Estimated amount of funding that is planned for Human Capacity Development $5,250
Estimated amount of funding that is planned for Education $1,750
Estimated amount of funding that is planned for Human Capacity Development $13,125
Estimated amount of funding that is planned for Education $1,313