Breaking The Great Silence
AIDS Prevention With Yunnan Church Leaders
Katrin Fiedler
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Shao En (L) and He Congpei (M) from Amity's Medical and Health Division in action |
"Breaking the silence is sometimes also called 'breaking the ice'," He Congpei starts the two-day training programme for AIDS prevention in Luquan County. "Have all of you seen ice before?" In subtropical Yunnan , this is not natural, but most of the dark peasant faces nod. Yes, they have seen ice before - but what is this 'ai-zibing' ["AIDS-illness"] they were summoned here for?
A quick survey at the beginning of the class reveals that of the dozens of church leaders present, some had not heard of AIDS before being invited to the training programme, and those who do know a little bit more describe it as a "sexually transmitted disease." Nobody can pinpoint symptoms or describe safe forms of contact with HIV-infected persons.
Amity runs a number of AIDS prevention programmes in Yunnan Province, addressing typical risk groups as well as the general population. Supported by German development service EED, Amity has already spent 5 million RMB [US$ 625,000 approx.] on AIDS prevention in four of Yunnan 's counties, and in the big cities, about 80% of the population now know about AIDS. However, much remains to do in the countryside, and this is where "training of trainers" programmes, such as this workshop for church leaders, come in.
Protect yourself, care for others
"And now we come to a topic not mentioned on our schedule," smiles He, "condoms." Some nervous shuffling and coughing ensues. It slowly emerges that there are some in the group who have heard of condoms, but never seen one. Although He and his colleague Shao En have gone to lengths to approach the topic in a careful and sensitive way (this being day two of the workshop), some of the women are palpably embarrassed. In general, however, women prove to be the more daring of participants over these two days, learning fast and volunteering answers.
Apart from giving basic information enabling participants to protect themselves, the programme emphasizes the need to care for AIDS patients rather than stigmatizing them. Sooner or later some of these church leaders or their congregations will come in touch with HIV infected persons. Apart from practical aspects regarding safe contact with patients, suggestions for counselling are given, such as "be prepared for hard work," "keep on learning about AIDS," "express sympathy to the patient to open the way for conversation," "listen well," and "have total respect for the confidential nature of the counselling situation."
The possibility of prolonging patients' lives with retroviral drugs is only briefly mentioned. After all, the 30,000 RMB [US$ 3,750] required per year of treatment are an "astronomical figure" in the Chinese countryside, as one participant put it. For those who fall ill with AIDS, simple care seeking to relieve the symptoms is all they can hope for. But even this very basic care can make a huge difference. On my previous visit to Yunnan , I had met a group of HIV-infected young men, one of whom already looked quite frail and was so depressed that he hardly talked at all. "How is he doing?" I ask, fearing to hear that he is bedridden and weak. "Oh, he is much better," I am told. "He has cheered up tremendously and has started to talk more."
The training programme takes place only shortly after the SARS outbreak, and it is interesting to see how many people bring it up in private conversations. About one quarter of the students have heard of this illness. It becomes clear: There are channels to relay important health information to the grassroots, but how to achieve the same for AIDS?
As a popular tourism destination, Yunnan has got its share of prostitution. Drug consumption is also rampant in the province. They may or may not have seen snow and ice before, but most of the group nod when He Congpei asks them whether they have seen people using drugs. In this southwestern Chinese province with its estimated 50,000 HIV infected people, even for those outside typical risk groups such as sex workers, drug users and homosexuals, the threat of HIV-transmission is very real. In many hospitals, especially small rural clinics, blood supplies and equipment such as needles may only be insufficiently screened or sterilized.
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Taking a poster break |
Snowball effect in the subtropics
With 100 students representing 65 churches, the class is much bigger than usual. "Normally, we strictly limit the number of participants to thirty, so that we can work more in small groups," explains Shao En from Amity's Medical and Health Division. Together with her colleague He Congpei, she has run similar training programmes in a number of locations. The advantage of a big class is, of course, that the prevention message will probably reach hundreds of people at the grassroots.
Students in the class range from 20-something girls, giggling somewhat embarrassedly when certain topics come up, to an 89-year-old preacher. All of them are actively involved in their congregations as leaders of choirs, women's groups, or evangelists, and they are expected to organize further training programmes on a smaller scale upon their return to their home churches. Most of those present can read and write a little, but even though presentations rely heavily on images and the spoken word, one respondent writes in his final evaluation: "Many of us here do not have much schooling. Please use more pictures in the next class." They all receive posters and videos to take back for their home audiences.
The students have come from villages and townships all over the county, some of them travelling half a day over bad mountain roads to participate in the training programme. Many of them belong to China 's minority nationalities, some of the women have even donned ethnic dress for this special occasion.
"How do you intend to spread the message to your congregation back home?" I ask Li Chaoxiu. The 35-year-old mother of two already has an idea: "I work in our women's group. I plan to organize some AIDS-related activity for our women."
Not everybody is optimistic that the information gained over the past two days will be easy to relay to their friends and neighbours in church back home. "Many people in our church are quite old. If I talk about things like sex, they will have prejudices," Zhang Yingguan says. Zhang leads the choir in his home village Jiuxi, a poor settlement with around 20% Christian population. "Besides, people in Jiuxi are so poor, they cannot even treat a common cold. How shall they ever think about prevention?" he adds, leaving it somewhat unclear whether he himself sees AIDS prevention as a real possibility or just one more nuisance in a life regularly threatened by poor health and malnutrition.
Similar prevention programmes have already been run in conjunction with other churches. Zhang Benmei, an Yi minority national and pastor from Kunming Christian Council, is very supportive: "[In other places] before the training, they used to think that AIDS didn't have anything to do with them. But after the class, they realize that there are also other ways of transmission than sex."
Checking back into my hotel in Kunming next to the " Green Lake " tourist hot spot, I get a call to my room, which is interrupted when the caller hears a female voice answering the phone. Presumably this was only the usual offer for "massage". I just hope the unknown girl out there has also got the message.
