Following the principles of "understanding the HIV/AIDS situation, recognizing the trend of the epidemic, providing care and support to PLHA, implementing HIV/AIDS control measures, and containing the spread of HIV", a comprehensive HIV/AIDS response system has been developed and improved under the leadership of the CDC in Henan Province to strengthen the disease prevention and control system, develope scientific HIV/AIDS strategies, and implement HIV/AIDS control measures. This system integrates HIV surveillance, laboratory testing, counseling service, epidemic management, prevention of HIV transmission and behavioral intervention in high-risk populations, and is playing a key role in response to HIV/AIDS in Henan Province in achieving good results and laying a solid foundation for future scale-up of HIV/AIDS response.

First, a provincial HIV surveillance network has been established. Using the web-based HIV case reporting system and advanced computer management techniques, a ongoing active HIV surveillance has been conducted among the general population and high-risk sub-populations in several scientific ways, including routine surveillance, sentinel surveillance and special survey, to understand the situation and trend of the HIV/AIDS epidemic in Henan Province.

Second, the HIV testing network has been improved. The construction of HIV screening laboratories and confirmatory laboratories has been strengthened. Currently, there are 35 confirmatory laboratories and 494 screening laboratories in Henan to undertake HIV test, CD4 test and viral load test across the province. The 35 confirmatory laboratories are located in 18 provincial cities and 13 key counties/cities/districts heavily affected by the epidemic, providing timely service for confirmatory HIV testing.

Third, a provincial VCT network has been established. Currently, there are 480 VCT clinics in Henan Province, covering 159 counties/districts in 18 provincial cities. Free VCT services are provided to all clients seeking voluntary counseling and testing, in order to detect and manage HIV infected persons as early as possible. In addition, psychological support and technical guidance are provided to reduce high risk behaviors and reduce the spread of HIV.

Fourth, mechanisms have been established to prevent marital sexual transmission and mother-to-child transmission of HIV. A target responsibility system featuring "one-on-one supervision" has been implemented. Target responsibility documents need to be signed at the village, township and county levels to strengthen the management by objectives. Regular follow-up and test are provided to PLHA, as well as health education and technical guidance. The management of serodiscordant couples and the prevention of mother-to-child transmission have played an important role in preventing secondary transmission and reducing family tragedies.

Fifth, the IEC campaign has been strengthened to raise public awareness of HIV/AIDS prevention and self-protection. HIV/AIDS health education is widely conducted across the province to promote healthy behaviors and mobilize social support for HIV/AIDS responses. TV, websites, IEC leaflets, posters, brochures and picture posters are used to disseminate HIV/AIDS knowledge among different target population through different strategies and intervention methods.

Sixth, effective high-risk behavior interventions have been conducted to prevent the spread of HIV from high-risk populations to the general population. A variety of interventions, including methadone maintenance treatment, behavioral intervention and owner training in entertainment establishments, condom use promotion, "face-to-face" dissemination of STI/HIV/AIDS knowledge as well as training, have been conducted among different high-risk populations (e.g. DUs, FSWs and their clients, MSM, spouses of PLHA and migrant workers) integrating with other HIV/AIDS control measures in the last few years..

Seventh, the implementation of China CARES Program has been strengthened to develop a comprehensive HIV/AIDS response system focusing on care and support, and establish a health care service network at the village level. These efforts have increased access of PLHA and their families to medical care and life relief in China CARES sites, improved their living conditions and quality of life, protected their legal rights and interests, and contained the further spread of the epidemic.

Eighth, a cohort study have been conducted to detect new HIV/AIDS cases in a timely manner, explore the disease course of HIV/AIDS and provide evidence for the development of HIV/AIDS strategies. Cohort study sites have been set up in 16 villages of 14 counties/districts in 6 provincial cities, with two professional databases created for each site (i.e. basic profile database and HIV test record database). The baseline survey and regular follow-up provide valuable firsthand data for better understanding of the demographic characteristics, behavioral information and serologic indicators of participants as well as the influencing factors for new HIV infections and changes during the course of HIV/AIDS.

Ninth, international cooperation has been promoted to learn from successful experiences in other countries/regions in response to HIV/AIDS. The USCDC Global AIDS Program (GAP) has been launched in Henan Province and made many efforts in care and support for PLHA as well as surveillance and management of high-risk populations.

In summary, Henan Province has achieved considerable progress in response to HIV/AIDS after  hard work in the past two decades based on the provincial disease prevention and control system, and developed normative models for the national HIV/AIDS response. However, it is still a long way for the province to address existing challenges. The provincial disease prevention and control system will continue to implement scientific and effective HIV/AIDS measures, enhance HIV surveillance and contain the spread of HIV under the leadership of the Provincial Party Committee and the Provincial Government, contributing to the provincial economic development and social stability.

(Zhu Qian, Li Ning,  Henan CDC)