Thursday, October 23, 2008

Post-Quake HIV/AIDS Prevention Planning

May 12 caught the Chinese off-guard. Much like September 11 in the United States. Many in China still refer to the earthquake by its date. Others refer to the catastrophe as the “Wenchuan Earthquake” (pinyin: Wènchuān dà dìzhèn) after the earthquake’s epicenter in Wenchuan County, Sichuan province.

The hard work of rescuing and treating the injured is over. Tents have been struck for those who lost their homes. Schools have been re-opened, if only for the purpose of giving the children an opportunity to step back into a routine that is familiar to them.

Others, including doctors who aided in the rescue work, hospital directors, community leaders, representatives of civic organization, researchers and health experts from several global agencies, including UNAIDS gathered for two days this past weekend to revisit their disaster relief efforts and to provide input to newly drafted guidelines for HIV/AIDS interventions in emergency settings. Many who spoke of their experience added that they wished such guidelines had been in place when the disaster struck. I was invited to attend. One of the students in my Global Health Challenges offered to serve as my interpreter.

China is still considered a country with a low infection rate. Many people still presume that the problem is confined to intravenous drug users. Still, a recently published UNAIDS report indicates that more cases of HIV/AIDS are identified in heterosexual populations each year.

As a result, professionals at the Conference remain concerned for careful monitoring at the earthquake site for possible new infections. The earthquake not only toppled poorly built school buildings, but also collapsed hospitals and clinics. When the upper floors collapsed, the weight of the cement also crushed sterilization equipment and other laboratory supplies. For several days there was not running water. One surgeon described his worry that their work may possibly have spread the disease. The need was so great – the resources so few. The surgeons worked 12 and 15 hour shifts; moving from patient to patient, having doused their hands in disinfectant and changing their surgical gloves.

The earthquake also left behind broken families and shattered relationships. The social chaos in the first days and weeks was unimaginable. Within a short time, the thousands who had lost their homes were housed in tenements of bright blue tents. The hospital director attending the Conference commented on the observed but quite unexpected sexual activity in the closely spaced tents. “Unexpected,” commented the hospital director, because the tents were placed so close together that there was little to no privacy.

The lack of guidelines for HIV/AIDS interventions in emergency settings meant that little thought had been given to the most basic means of prevention. The draft guidelines which address issues ranging from coordination and to shelter and site planning to health, education and behavioral communication change, are meant to remedy this oversight. No one had planned ahead for the earthquake, just as no one anticipated the events of 9/11. The Wenchuan EQ was a wake up call for health professionals in western China. The Guidelines, when published in January 2009, will set standards for HIV/AIDS preparedness for China and countries around the world. I was honored to have been included as a participant at this important global review.

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