Double-mobilization: Transnational Advocacy Networks for China's Environment and Public Health

This dissertation investigates the nature of transnational advocacy networks and the impact of domestic structures on the development and political relations of such networks. Drawing upon the theoretical frameworks built by Margaret Keck, Katherine Sikkink and Sanjeev Khagram, I, though, challenge the conceptual bias embedded in this body of literature emphasizing contentious political relations between advocacy actors and targeted governments. I use the method of in-depth comparative case studies, and focus on two transnational advocacy networks in nature conservation and HIV/AIDS prevention in China to illustrate my three-fold argument: First, it is necessary to relax the theoretical bias in existing transnational advocacy literature, and recognize that the triangular relationship among the state, local society and international NSAs varies both over time and across issue areas. The two cases studied reveals a what I call the "double-mobilization" character of such networks. This Double-mobilization pattern emphasizes that international advocacy actors endeavor to engage, collaborate with, and advocate around the state, even as they establish connections and solidarity with local societal groups. I propose this double-mobilization concept to capture the gradual, consensual, and sustainable aspect of transnational activism. Second, it is not sufficient to use political regime type as the main causal variable to examine the emergence and evolvement of transnational activism and advocacy networks. Evidence from China has shown that the politics generated by international NSAs in a non-democratic country is complex, and despite strict macro-structures, transnational advocacy networks are emerging. Third, I argue that two domestic micro-level structures--decentralization within the state, and interconnections within existing civil society groups--strongly influence the political relations of transnational activism and networks. With decentralized environmental governance, and a strong and connected local environmentalist community, international NGOs have been able to generate, expand, and consolidate their mobilization networks in both governmental and societal domains in nature conservation. While transnational NGO linkages and networks are surfacing in HIV/AIDS preventions in China, both the scope and level of deepening of such networks are still limited

Contrôle gradué : l’évolution des relations entre gouvernement et Organisations non gouvernementales

En dépit de certains changements politiques, la surveillance et le contrôle des ONG de base en Chine restent, dans une large mesure, très répandus et bien réels. La mise en œuvre du contrôle des ONG est compliquée par trois facteurs : premièrement, ce processus n’est pas centralisé et plusieurs agences sont responsables en même temps du contrôle des ONG ; deuxièmement, les interactions entre le gouvernement et les ONG varient beaucoup d’un cas à l’autre et dépendent énormément du contexte politique local ; enfin, dans la mesure où les ONG ont des histoires très différentes, leurs réponses aux différents types de contrôle gouvernemental différent beaucoup, ce qui rend la situation encore plus complexe. Les résultats de cette recherche s’appuient sur des entretiens avec 60 employés d’ONG et avec des responsables des Affaires civiles de 17 provinces entre janvier 2011 et mai 2012

Contrôle gradué : l’évolution des relations entre gouvernement et Organisations non gouvernementales

En dépit de certains changements politiques, la surveillance et le contrôle des ONG de base en Chine restent, dans une large mesure, très répandus et bien réels. La mise en œuvre du contrôle des ONG est compliquée par trois facteurs : premièrement, ce processus n’est pas centralisé et plusieurs agences sont responsables en même temps du contrôle des ONG ; deuxièmement, les interactions entre le gouvernement et les ONG varient beaucoup d’un cas à l’autre et dépendent énormément du contexte politique local ; enfin, dans la mesure où les ONG ont des histoires très différentes, leurs réponses aux différents types de contrôle gouvernemental différent beaucoup, ce qui rend la situation encore plus complexe. Les résultats de cette recherche s’appuient sur des entretiens avec 60 employés d’ONG et avec des responsables des Affaires civiles de 17 provinces entre janvier 2011 et mai 2012

Graduated Control and Beyond: The Evolving Government-NGO Relations

Despite recent policy changes, governmental monitoring and control of grassroots NGOs remain pervasive and effective to a large extent in China. The enforcement of control over NGOs is complicated by at least three layers of factors: First, multiple agencies are involved in NGO control without a centralised norm. Second, government-NGO interactions vary across cases and are deeply rooted in local political contexts. Last, but not least, since the NGO community at its origin is highly diverse, NGOs’ responses to various types of governmental control differ, which in turn triggers further complications. The main findings of this research are based on interviews with 60 NGO staff, as well as with civil affairs officials in Shanghai and Shenzhen from January 2011 to May 2012

Summarizing methods for estimating population size for key populations: a global scoping review for human immunodeficiency virus research.

BACKGROUND: Estimating the population sizes of key populations(people who inject drugs, men who have sex with men, transgender persons, and commercial sex workers) is critical for understanding the overall Human Immunodeficiency Virus burden. This scoping review aims to synthesize existing methods for population size estimation among key populations, and provide recommendations for future application of the existing methods. METHODS: Relevant studies published from 1st January 2000 to 4th August 2020 and related to key population size estimation were retrieved and 120 of 688 studies were assessed. After reading the full texts, 81 studies were further excluded. Therefore, 39 studies were included in this scoping review. Estimation methods included five digital methods, one in-person method, and four hybrid methods. FINDING: We summarized and organized the methods for population size estimateion into the following five categories: methods based on independent samples (including capture-recapture method and multiplier method), methods based on population counting (including Delphi method and mapping method), methods based on the official report (including workbook method), methods based on social network (including respondent-driven sampling method and network scale-up method) and methods based on data-driven technologies (Bayesian estimation method, Stochastic simulation method, and Laska, Meisner, and Siegel estimation method). Thirty-six (92%) articles were published after 2010 and 23 (59%) used multiple methods. Among the articles published after 2010, 11 in high-income countries and 28 in low-income countries. A total of 10 estimated the size of commercial sex workers, 14 focused on men who have sex with men, and 10 focused on people who inject drugs. CONCLUSIONS: There was no gold standard for population size estimation. Among 120 studies that were related to population size estimation of key populations, the most commonly used population estimation method is the multiplier method (26/120 studies). Every method has its strengths and biases. In recent years, novel methods based on data-driven technologies such as Bayesian estimation have been developed and applied in many surveys

Modelling the geographical spread of HIV among MSM in Guangdong, China: a metapopulation model considering the impact of pre-exposure prophylaxis

Men who have sex with men (MSM) make up the majority of new human immunodeficiency virus (HIV) diagnoses among young people in China. Understanding HIV transmission dynamics among the MSM population is, therefore, crucial for the control and prevention of HIV infections, especially for some newly reported genotypes of HIV. This study presents a metapopulation model considering the impact of pre-exposure prophylaxis (PrEP) to investigate the geographical spread of a hypothetically new genotype of HIV among MSM in Guangdong, China. We use multiple data sources to construct this model to characterize the behavioural dynamics underlying the spread of HIV within and between 21 prefecture-level cities (i.e. Guangzhou, Shenzhen, Foshan, etc.) in Guangdong province: the online social network via a gay social networking app, the offline human mobility network via the Baidu mobility website, and self-reported sexual behaviours among MSM. Results show that PrEP initiation exponentially delays the occurrence of the virus for the rest of the cities transmitted from the initial outbreak city; hubs on the movement network, such as Guangzhou, Shenzhen, and Foshan are at a higher risk of 'earliest' exposure to the new HIV genotype; most cities acquire the virus directly from the initial outbreak city while others acquire the virus from cities that are not initial outbreak locations and have relatively high betweenness centralities, such as Guangzhou, Shenzhen and Shantou. This study provides insights in predicting the geographical spread of a new genotype of HIV among an MSM population from different regions and assessing the importance of prefecture-level cities in the control and prevention of HIV in Guangdong province. This article is part of the theme issue 'Data science approach to infectious disease surveillance'

Effectiveness of sexual health influencers identified by an ensemble machine learning model in promoting secondary distribution of HIV self-testing among men who have sex with men in China: study protocol for a quasi-experimental trial

Background HIV self-testing (HIVST), especially the secondary distribution of HIVST (SD-HIVST) initiated by sexual health influencers (SHIs), has been recognized as an effective strategy in promoting HIV testing, especially among men who have sex with men (MSM). This quasi-experimental study aimed to evaluate whether SHIs identified through the ensemble machine learning approach can distribute more HIVST than those who identified by the empiricalscale. Methods We will recruit eligible adults (≥18 years old) who were assigned male gender at birth, and willing to participate in potential SD-HIVST online. Participants will be assigned randomly to two groups (scale group or machine learning group), followed by a separate process of SHI identification based on the group assignment. After identification, all index participants (defined as identified SHIs who are verbally consented to participate in SD-HIVST or who directly order HIVST kits) will follow the same procedure for SD-HIVST acquisition and distribution. Index participants can order HIVST online and distribute them to members within their social networks (defined as alters) in-person or virtually through a personalized peer referral link. Once a unique alter uploads a photographed test result to the platform, both the alter and the corresponding index participant will receive a fixed incentive of 3 USD. The index MSM can order up to five HIVST in the first three months and ten HIVST in the following three months. Each index participant will need to complete a baseline survey at the first-time ordering and one to two follow-upbased on the times of ordering,, three months after ordering. This trial will be comparing 1) the mean number of alters motivated by each index participant in each group and 2) the mean number of newly-tested alters motivated by each index participant in each group. Discussion In promoting the efficacy of identifying SHIs for SD-HIVST, our study has the potential to enhance testing coverage, particularly among marginalized individuals and those who are reluctant to for HIV and other sexually transmitted infections. Trial registration We registered the study on the Chinese Clinical Trial Registry website on 4th November 2021, with registration number ChiCTR2000039632

Monetary incentives and peer referral in promoting secondary distribution of HIV self-testing among men who have sex with men in China: A randomized controlled trial

Background Digital network–based methods may enhance peer distribution of HIV self-testing (HIVST) kits, but interventions that can optimize this approach are needed. We aimed to assess whether monetary incentives and peer referral could improve a secondary distribution program for HIVST among men who have sex with men (MSM) in China. Methods and findings Between October 21, 2019 and September 14, 2020, a 3-arm randomized controlled, single-blinded trial was conducted online among 309 individuals (defined as index participants) who were assigned male at birth, aged 18 years or older, ever had male-to-male sex, willing to order HIVST kits online, and consented to take surveys online. We randomly assigned index participants into one of the 3 arms: (1) standard secondary distribution (control) group (n = 102); (2) secondary distribution with monetary incentives (SD-M) group (n = 103); and (3) secondary distribution with monetary incentives plus peer referral (SD-M-PR) group (n = 104). Index participants in 3 groups were encouraged to order HIVST kits online and distribute to members within their social networks. Members who received kits directly from index participants or through peer referral links from index MSM were defined as alters. Index participants in the 2 intervention groups could receive a fixed incentive ($3 USD) online for the verified test result uploaded to the digital platform by each unique alter. Index participants in the SD-M-PR group could additionally have a personalized peer referral link for alters to order kits online. Both index participants and alters needed to pay a refundable deposit ($15 USD) for ordering a kit. All index participants were assigned an online 3-month follow-up survey after ordering kits. The primary outcomes were the mean number of alters motivated by index participants in each arm and the mean number of newly tested alters motivated by index participants in each arm. These were assessed using zero-inflated negative binomial regression to determine the group differences in the mean number of alters and the mean number of newly tested alters motivated by index participants. Analyses were performed on an intention-to-treat basis. We also conducted an economic evaluation using microcosting from a health provider perspective with a 3-month time horizon. The mean number of unique tested alters motivated by index participants was 0.57 ± 0.96 (mean ± standard deviation [SD]) in the control group, compared with 0.98 ± 1.38 in the SD-M group (mean difference [MD] = 0.41),and 1.78 ± 2.05 in the SD-M-PR group (MD = 1.21). The mean number of newly tested alters motivated by index participants was 0.16 ± 0.39 (mean ± SD) in the control group, compared with 0.41 ± 0.73 in the SD-M group (MD = 0.25) and 0.57 ± 0.91 in the SD-M-PR group (MD = 0.41), respectively. Results indicated that index participants in intervention arms were more likely to motivate unique tested alters (control versus SD-M: incidence rate ratio [IRR = 2.98, 95% CI = 1.82 to 4.89, p-value < 0.001; control versus SD-M-PR: IRR = 3.26, 95% CI = 2.29 to 4.63, p-value < 0.001) and newly tested alters (control versus SD-M: IRR = 4.22, 95% CI = 1.93 to 9.23, p-value < 0.001; control versus SD-M-PR: IRR = 3.49, 95% CI = 1.92 to 6.37, p-value < 0.001) to conduct HIVST. The proportion of newly tested testers among alters was 28% in the control group, 42% in the SD-M group, and 32% in the SD-M-PR group. A total of 18 testers (3 index participants and 15 alters) tested as HIV positive, and the HIV reactive rates for alters were similar between the 3 groups. The total costs were $19,485.97 for 794 testers, including 450 index participants and 344 alter testers. Overall, the average cost per tester was$24.54, and the average cost per alter tester was $56.65. Monetary incentives alone (SD-M group) were more cost-effective than monetary incentives with peer referral (SD-M-PR group) on average in terms of alters tested and newly tested alters, despite SD-M-PR having larger effects. Compared to the control group, the cost for one more alter tester in the SD-M group was$14.90 and $16.61 in the SD-M-PR group. For newly tested alters, the cost of one more alter in the SD-M group was$24.65 and $49.07 in the SD-M-PR group. No study-related adverse events were reported during the study. Limitations include the digital network approach might neglect individuals who lack internet access. Conclusions Monetary incentives alone and the combined intervention of monetary incentives and peer referral can promote the secondary distribution of HIVST among MSM. Monetary incentives can also expand HIV testing by encouraging first-time testing through secondary distribution by MSM. This social network–based digital approach can be expanded to other public health research, especially in the era of the Coronavirus Disease 2019 (COVID-19). Trial registration Chinese Clinical Trial Registry (ChiCTR) ChiCTR190002543

Having Peers and Becoming One: Collective Consciousness among Civil Society Actors in China

Based on a unique survey of non governmental organization (NGO) practitioners from diverse backgrounds, the article examines how these NGO practitioners view their peers and people alike, and the interconnectedness, unity and solidarity of the NGO sector. The research has found that mutual awareness and trust is strong at the interpersonal level among NGO practitioners, yet their views on the collective existence of an NGO and activism community remain divided. In addition, preliminary statistical analysis shows that particular work experiences such as connections with other NGOs and participation in policy advocacy are associated with the optimism of a shared community of social activism. More importantly, the more one has or feels one has having peers across organizations, the more favorably one thinks of the whole activism community. Therefore, the key to becoming a community for civil society in China lies in having peers for individual activists and NGO practitioners.Accepted versio