Adolescents are a key group in the fight against HIV/AIDS. According to the data of China's HIV/AIDS Integrated Response Information Management System, from 2010 to 2019, Chinese mainland reported a total of 141557 cases of AIDS in the age group of 15~24 years, and the number of newly diagnosed patients increased year by year from 2010 to 2015 and remained stable from 2016 to 2019, but there are still about 3,000 cases of HIV infection among young students every year. In this context, it has become an important part of school health work to enhance the awareness of HIV/AIDS prevention and treatment among adolescents, especially to strengthen the behavioral intervention of key groups among students, and promote the integration of knowledge and action.
At the recent symposium on adolescent AIDS prevention and treatment at the 9th National Conference on AIDS Studies, a number of experts in the field of AIDS prevention and treatment exchanged experiences on the above issues.
Drive behavioural remodeling
In view of the current trend of HIV/AIDS transmission, a number of experts at the meeting pointed out that the separation of knowledge and action is a major difficulty in the prevention and control of HIV/AIDS among adolescents.
A 2019 survey of some young students in Beijing and Tianjin showed that 92.3% of them had received education on HIV/AIDS prevention, and 95.5% had passed the standard of HIV-related knowledge. However, the pass rate of these students was only 56.31% for attitude and 27.03% for behavior.
"If you want to change students' behavior, it's not enough to start with the knowledge dimension. Ma Yinghua, a professor at Peking University's Institute of Child and Adolescent Health, said that at present, the design of AIDS prevention education in mainland China is mostly based on reproductive health and STD prevention knowledge, hoping to cultivate students' positive health attitudes, thereby influencing students' behavior. However, the transformation of knowledge is not a simple process, and the lack of preparedness and experience can lead to high-risk behaviors. Therefore, HIV prevention education based on behaviour building and change is crucial.
Ma Yinghua introduced that the China Association for the Prevention and Treatment of STDs and AIDS and the Institute of Child and Adolescent Health of Peking University jointly compiled and released the "Training Manual for Young Students to Prevent AIDS Behavior Change", which is to solve the above problems. The handbook integrates psychological theories such as the Fogg Behavior Model and the "Elephant and the Elephant Rider" into practical training to promote the reshaping of healthy behaviors of young students, and designs a variety of scenario simulations, which opens up new ideas for teachers and peer educators to design AIDS prevention education programs.
"The serious separation of students' knowledge and action is also reflected in the weak awareness of active testing among key groups. Jiang Feng, who has worked in the hospital of Zhengzhou University for many years, has a very good understanding of the situation of the students. As the deputy chief physician of the Department of Disease Control and Prevention, Jiang Feng faces considerable challenges in promoting the prevention of HIV/AIDS on campus. He said frankly: "The large scale of the school, the large number of students and the scattered campuses have made the prevention and control of HIV/AIDS on campus difficult and complicated. ”
In order to promote the transformation of students from "knowledge" to "action", Zhengzhou University Hospital, the School of Public Health, the Academy of Fine Arts and other departments have set up a number of campus HIV/AIDS prevention clubs, and trained student volunteers to carry out testing promotion for key groups on campus through the establishment of an "Internet +" testing promotion mechanism, so as to improve and optimize campus testing methods. "Let young people approach young people, let young people influence young people. Through the implementation of this innovative work model based on peer education, Jiang Feng found that the active HIV antibody testing rate of students in schools will increase significantly in 2023.
Student volunteer teams play an important role in the prevention of HIV/AIDS in colleges and universities. Qu Meixia, director of the second project department of the China Association for the Prevention and Treatment of STDs and AIDS, said that in the pilot project of AIDS prevention education and comprehensive intervention in schools in the new era carried out by the association, more than 50 student intervention teams have been established, covering more than 1,200 volunteers from 50 pilot colleges and universities in 10 provinces.
"We have made innovative use of the method of 'narrowing the encirclement' to understand the general distribution of key populations through anonymous risk assessment questionnaires in classes and dormitories, and on this basis, we have given full play to the advantages of student volunteers to carry out targeted publicity and intervention activities, effectively improving the accessibility of key student populations to HIV prevention and treatment services, so as to promote their behavior change. Qu Meixia said.
Strengthen targeted prevention and control
After years of research and exploration, the focus of adolescent HIV prevention and control has been continuously subdivided, laying the foundation for precise policy.
"According to the survey, compared with high school students, students in secondary vocational schools have a lower awareness rate of HIV prevention and control. Liu Hui, director of the Policy Coordination Department of the National AIDS Office of the Chinese Center for Disease Control and Prevention, is concerned that the education received by secondary vocational students is more professional, and the proportion of students living in schools is relatively high, and they are less constrained by their elders, so they receive HIV/AIDS prevention education and sex education are even more insufficient.
In order to gain a deeper understanding of the needs of secondary vocational students for sex education, Liu Hui and her team conducted interviews with 256 students, teachers, relevant persons in charge and personnel from local disease control agencies in five secondary vocational schools in Guangzhou, Guangdong Province, Chengdu City, Sichuan Province, and Jinan City, Shandong Province. The survey found that all parties believe that it is necessary for secondary vocational schools to carry out sex education, and there is a good environment for sex education, but there is a lack of professional teachers and authoritative teaching materials.
"At present, most schools use subject-integrated curriculum for sex education, such as embedding sex education into thematic class meetings, mental health lectures, etc. We hope that policy-making authorities will further clarify the measurement criteria for sexuality education teaching in subject-inclusive curriculum, as well as the content and scope of sexuality education, and provide teaching materials and guidelines. In addition, Liu Hui suggested that secondary vocational schools should strengthen teacher training, increase exchanges between relevant teachers and professionals, and explore the establishment of a long-term mechanism for cooperation in sex education.
In addition to school students, out-of-school youth groups are also being watched. According to a study of HIV cases conducted by the Chinese Center for Disease Control and Prevention, in 2020, 77.8% of newly reported HIV infections aged 15~24 in mainland China were adolescents outside of school. According to Liu Hui, compared with the MSM population in school (men who have sex with men), the MSM population outside of school has a higher risk of HIV infection. A survey of 1407 16~24-year-old adolescents aged 16~24 with MSM in 7 cities in mainland China (Tianjin, Shenyang City, Liaoning Province, Fuzhou City, Fujian Province, Qingdao City, Shandong Province, Changsha City, Hunan Province, Shenzhen City, Guangdong Province, and Haikou City, Hainan Province) showed that the HIV infection rate in this group was relatively high (4.4%), and the proportion of people who did not know their own infection status was high.
"This suggests that the coverage of HIV/AIDS prevention and treatment services needs to be expanded, and we need to further think about whether the prevention and treatment services should follow the group or the place, increase the attention to the MSM population of adolescents outside the school, find suitable starting points, carry out more targeted education and intervention work, and make the testing work wider and deeper, so as to reduce the spread of AIDS. Xu Peng, director of the Planning and Supervision Department of the National AIDS Office of the Chinese Center for Disease Control and Prevention, said.
Text: Health News reporter Liu Jiyue Editor: Li Shiyao Proofreader: Yang Zhenyu Review: Qin Mingrui Xu Bingnan