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CHINA :: Information, Education and Communication in China A room full of Chinese health workers each holding a beaker full of clear liquid in one hand and a syringe in the other. Using their syringe, each draws a small amount of the fluid from their own beaker and injects it into the beaker of a colleague. Their colleague does the same thing in return. Everyone solemnly stirs their glass, and peers at the contents. Then they move around the room, find a new colleague and repeat the process again. This mysterious activity is, in fact, part of Médecins Sans Frontières’ training session on HIV/AIDS. The health staff are participating in a workshop about the transmission of the disease and real and imagined risks to health staff working in hospitals, clinics and laboratories. The aim is to explain that everybody is at risk from HIV and to highlight how people living with HIV/AIDS are discriminated against by society. "We do this “fluid exchange” exercise to illustrate the transmission of the HIV virus, " explains the medical aid agency’s health educator Carola Koornneef. "Each time the participants exchange fluids with another person this represents an act of sexual intercourse. One unknown person starts with a beaker filled with a chemical rather than water. This chemical, which cannot be told apart from water by appearance, represents the HIV virus. Through exchanging fluids, some people become ‘infected’. At the end, we ask the participants whether they want to be tested for the ‘infection’. “ "Even though it’s just a game, people actually get very nervous about the test. The reaction of people who test positive can be very strong - they feel really ashamed. Tellingly, they often ask, ‘Who gave me the virus?’. They do not ask, ‘Who did I give the virus to?’ The exercise makes them realise the anxiety that people feel when they come for real HIV testing, and brings home the intense shame that people feel if they test HIV positive." It is not surprising that the Médecins Sans Frontières workshop often provokes strong emotions from the participants. There is a high level of stigmatisation against people with HIV/AIDS in China and much fear and misunderstanding about the disease amongst health workers. "When we talk to HIV positive patients about their experiences, they often cry when they remember how they were treated by hospital staff, " says Yuxin, part of the health education team. "HIV positive patients are frequently unable to get the hospital care they need because nobody wants to touch them. But health staff themselves can also be discriminated against if they work with people who are HIV positive. I was once on a train wearing an Medecins Sans Frontieres t-shirt with a logo about AIDS. People looked at me strangely, kept their distance and even asked me if I was HIV positive. I felt very stigmatised myself." One of the main causes of stigmatisation is that health workers, like the wider community, often have misconceptions of how the HIV virus can be transmitted. People think that you can catch HIV by shaking hands with someone or sharing a meal. Another element of the Medecins Sans Frontieres training is therefore a game that gets participants to understand what is and isn't risky behaviour. "The participants are pre-tested at the beginning of the session so that we can find out what they already know about HIV transmission routes," explains Carola. "We give each of them a red and a green card and ask them questions like: 'Can HIV be transmitted by mosquitoes? By sharing razor blades? By oral sex? During the medical examination of an out-patient? By touching the wound or blood of a patient? By an HIV mother breastfeeding her baby?" "For each question the participants have to hold up a green card for "yes" and a red card for "no". Then we go back through each question and talk about the level of risk that each type of behaviour. People are often surprised to find out that HIV cannot be transmitted by mosquitoes but can be transmitted through breastfeeding. At the end of the training, we test people again and they have a much better understanding of HIV transmission routes. We discuss some of the myths that surround caring for HIV patients and talk about the actual risks to health staff, for example the importance of disposing of syringes safely." The lack of knowledge and fear about HIV/AIDS amongst Chinese health workers is symptomatic of myths and misconceptions about the disease throughout Chinese society. As in many other countries, AIDS is seen as a 'dirty' disease, associated with drug taking and illicit sex. HIV/AIDS patients in Xiangfan, many of whom contracted the virus after donating their blood to a blood-banks, struggle daily to overcome stigmatisation by their communities and even their own families. "Médecins Sans Frontières also runs support groups for patients, in order to create a supportive environment between members and increase their understanding of the disease and how it can be transmitted," explains Carola. "We try and get their families to come along too, but sometimes they don't want to be seen with the patient. Like with the health staff training, we talk about the different ways in which HIV can be passed from one person to another. We also sometimes give specific training, for instance on nutrition. “As well as exchanging information, the patients share their experiences and give each other emotional support. For many, it is the first time that they are able to meet others suffering from HIV/AIDS and talk about it openly. One patient recently even asked us to come to his community and give an information session about HIV/AIDS. This had a big impact in terms of decreasing stigmatisation against the man, which was very positive. “ As patient support groups are a very new idea in China, the Medecins Sans Frontieres health education team in Xiangfan are constantly thinking about how training can be adapted to suit the specific needs and expectations of patients. One thing that is already clear is that Chinese HIV patients themselves can play a crucial role. Mr Wang, who found out he was HIV positive several years ago, has recently joined the project team. He spends much of his time in the waiting room at the Xiangfan HIV/AIDS clinic, welcoming patients, making them feel as comfortable as possible and answering their questions about the disease and treatment. Because he has first-hand experience of living with AIDS, being discriminated against and coping with treatment, he can make a very special connection with other patients. "Mr Wang is very good at helping us to get across information during the patient support groups," says Carola. "Much of the training we give involves playing games, but in fact most Chinese people are not used to getting information in this way, because they have been through a different style of education system. Mr Wang can translate the information we are giving into something more easily understandable to the group.” The team also recently started running a support group for the parents of HIV positive children. The idea is not only to give out information, but also to find out the special needs of parents. "Parents of HIV positive children have lots and lots of questions about how they should help their child cope with HIV/AIDS," Carola explains. "The most frequently asked question is ‘how and when do I tell my child about the disease?’ Choosing when to tell the child is extremely difficult, not only because they don't want to scare the child, but also because they have very real concerns that their child could be discriminated against. They worry that if they tell their child at a young age, and the child tells their friends, they could be excluded from school and stigmatised by other children and parents." Lucy Clayton
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