AIDS Care China—Model Partnership Provides Red Ribbon AIDS Care

October 2009—In mid-2007, the five HIV/AIDS specialists at China's Longtan Hospital were treating nearly 1,000 HIV patients, many of whom had difficulty coming in for follow-up visits or to pick up medications. Overwhelmed by the demands of providing medical care, doctors and nurses found themselves unable to closely track their patients' adherence to treatment or ensure that they received counseling and social support.

During the past two years, however, Longtan Hospital has seen a decrease in the number of patients lost to follow-up and a significant improvement in patient health—thanks in large part to the work of AIDS Care China, a TREAT Asia-supported organization whose Red Ribbon Centers are now functioning at 28 hospitals and clinics in south and central China.

A patient counseling session at the Xiangfan Red Ribbon Center. (Photo: Karl Grobl)

Founded in 2001 by HIV-positive advocate Thomas Cai, AIDS Care China is considered a model for community-based HIV care in the region. "AIDS Care China promotes the concept that people living with HIV/AIDS should not isolate themselves in a small circle of fear to be pitied," said Cai.

The Red Ribbon Centers provide support services for people living with HIV including counseling and education on antiretroviral treatment (ART) and opportunistic infections, social support, and financial assistance for transportation and other expenses. They also help doctors and nurses focus exclusively on medical care by taking on essential administrative tasks such as patient appointments and follow-up, maintaining confidential patient information, and ensuring that patients have consistent and adequate supplies of medication.

"The biggest benefit of having the Red Ribbon Center here is having people who help us monitor the patients, and ensure that they come to pick up their medicines," said Dr. Meng Zhihao, inpatient director at Longtan Hospital.

TREAT Asia has supported AIDS Care China since 2005, providing funding for the establishment of four Red Ribbon Centers and technical assistance in training staff and developing treatment literacy materials. To evaluate the centers' impact on patients' treatment adherence, overall health, and well-being, TREAT Asia recently developed a case study of three of the centers, including the one at Longtan Hospital. The results showed that in addition to improved adherence, all three centers reported increases in patient CD4 levels that persisted over time. At the Xiangfan and Nanzhang hospitals, where viral load testing is available, the number of patients with no detectable viral load increased markedly, with more than 90 percent of clients at the Xiangfan center achieving an undetectable viral load. And patients reported that the social support they received at the centers gave them a sense of hope for the future.

The key to the Red Ribbon Centers' success has been their integration into local government healthcare systems, creating a platform for collaboration between medical personnel, government officials, and people living with HIV. Staff at the centers have worked to develop close relationships with doctors and nurses—who in turn have grown to rely on the centers as key sources of patient-care support. These collaborations have also led to changes in local and provincial government policies.

"We work very closely with the Red Ribbon Center staff," said Ye Hengbo, deputy director of the health bureau in the city of Xiangfan. "As soon as the patients pick up their medicine, they must go to the Red Ribbon Center to receive information and counseling."

A personalized approach to counseling and education has helped keep Red Ribbon Centers connected to the communities they serve; many of their trained counselors are themselves HIV positive. Patients attend one-on-one counseling sessions before and after medical visits and receive treatment education in small group discussions.

"HIV patients really need more care and support, and communication and counseling, than other patients," said Dr. Lee Rong, director of the outpatient department at Longtan Hospital. "Our time as doctors is limited, and when we are off work, the Red Ribbon Center is still here, providing support.

To help rural patients with the cost of traveling to cities for appointments and medications, AIDS Care China has set up a transportation fund. The Red Ribbon Centers also operate a short-term shelter service.

One patient from Longtan described her experience at a Red Ribbon Center shelter when she and her 18-month-old son were first diagnosed. "The staff at the shelter really helped a lot. They constantly explained to me about the situation and why I should get my son on treatment. There was another positive child there—a nine-year-old orphan—and one of the staff there was positive and had a daughter who was positive. So I felt my son could survive. I decided to take him for treatment, and now he is doing very well."