中國(guó)艾滋病流行現(xiàn)狀和防治策略

1、中國(guó)艾滋病流行現(xiàn)狀和防治策略,Shen JieChinese Center for Disease Control and Prevention,HIV/AIDS Epidemic and Response Strategy in China,沈 潔中國(guó)疾病預(yù)防控制中心,一 流行概況A. Overview of HIV/AIDS二 防治工作B. Response三 國(guó)際合作項(xiàng)目進(jìn)展C. Int. Cooper

2、ation project progress,一. 流行概況A. HIV/AIDS Epidemic in China,中國(guó)艾滋病疫情情況(1995-2003.6)AIDS Situation in China by the end of June, 2003,截止到2003年6月底，全國(guó)累計(jì)報(bào)告艾滋病病毒感染者45,092例其中艾滋病病人3,532例，死亡1,800人。 The end of June,2003, na

3、tional cumulative statistics report that HIV positive cases number 45,092. Among which cumulative cases of AIDS number 3,532. Deaths number 1,800.,中國(guó)艾滋病疫情情況(1995-2003.6)AIDS Situation in China by the end of June, 2003,據(jù)

4、專家估計(jì)到2003年6月底：現(xiàn)有艾滋病病毒感染者約為84萬(wàn),其中AIDS患者估計(jì)數(shù)約8萬(wàn).According to expert statistics, by the end of June,2003, the number of persons Living with HIV is 840 thousand in China, hereinto AIDS about 80 thousand,1985－2003年6月底中國(guó)艾滋病流行狀

5、況HIV /AIDS Epidemic Trends in China 1985-2003.6,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,0,10000,20000,30000,40000,50000,,,,,,年份,,,,,,,,,,,,,,,,,,,,,,,,,,AIDS,1,1,

6、3,3,3,5,8,13,36,65,117,155,281,417,647,880,1594,2639,3532,,,HIV(+),5,6,15,22,193,492,708,969,1243,1774,3341,5990,9333,1263,1731,2251,3073,4056,4509,1985,1986,1987,1988,1989,1990,1991,1992,1993,1994,1995,1996,1997,1998,19

7、99,2000,2001,2002,2003,中國(guó)累計(jì)報(bào)告HIV感染者地區(qū)分布（1995－2003.6）Geographic Distribution of Cumulative HIV Infections in China (1985-2003.6),中國(guó)累積報(bào)告HIV感染者感染途徑 (1985-2003.6) Risk Factors for Cumulative HIV Infections in China, 1985 ~

8、2003.6,中國(guó)艾滋病流行特征概括（一）Summary of HIV/AIDS Epidemic in China,感染范圍廣，全國(guó)低流行，局部高流行Transmit in extensive scope,low transmission nationwide, high transmission endemic全國(guó)AIDS 疫情、發(fā)病和死亡都呈現(xiàn)明顯上升趨勢(shì)The nationwide AIDS transmission,

9、 symptom, and death have witnessed an distinct ascending trend傳播模式暨途徑發(fā)生變化，疫情由高危人群向一般人群擴(kuò)散Transmission pattern and method changed, the epidemic transfers from the high-risk population mass to the normal mass,A1. 注射吸毒傳

10、播流行A1. Epidemics driven by injecting drug use,HIV Infection Rate in IDUs, 1995-2000,1995 1996 1997 1998 1999 2000 0.02 1.7 6.6 10.8 12.1 10.0,1995-2000年哨點(diǎn)監(jiān)測(cè)全國(guó)注射吸毒者平均艾滋病感染率,

11、五年期間增長(zhǎng)約500倍Increased some 500 folds over 5 year period,1995-2001年 注射與共用注射器比例Proportion of IDU and Needle Sharing, Surveillance Program in China, 1995 ~ 2001,,注射吸毒者艾滋病流行小結(jié)Summary of Epidemics in injecting drug use,在未來(lái)

12、的數(shù)年里，經(jīng)注射吸毒方式傳播仍將是中國(guó)艾滋病流行的主要傳播方式Epidemics caused by injecting drug use will continue to be major transmission mode of HIV infection in next a few years.,A2. 單采漿傳播流行A2. Epidemic in former plasma donors,某縣既往獻(xiàn)血員艾滋病病毒感染

13、HIV Infection Among Former Plasma Donors (FPD) in X County,獻(xiàn)血員,其他,合計(jì),艾滋病病毒感染率與單采漿頻率的關(guān)系Relation of HIV Infection and Frequency of Plasma donation in B County,Frequency of donation/per month,HIV rate,,既往獻(xiàn)血員艾滋病流行小結(jié)Summary

14、 of Epidemics in former plasma donors,經(jīng)采供血造成艾滋病傳播基本控制，對(duì)進(jìn)一步的傳播流行不會(huì)構(gòu)成很大威脅。目前的主要任務(wù)是對(duì)已經(jīng)感染的人提供醫(yī)療服務(wù)和社會(huì)支持。Epidemics in former plasma donors has been controlled and will not threat to further epidemics. The major task will be

15、 care and support to those who already infected.,A3. 異性性接觸傳播流行A3. Epidemics driven by hetero-sexual contact,經(jīng)性途徑傳播威脅很大Threat of Epidemic by Heterosexuals,性亂行為增長(zhǎng)Sex work expanded widely in China賣淫以多種形式存在Diverse le

16、vel of sex workers賣淫婦女中很高比例從事高危行為，特別是低層賣淫婦女High proportion of sex workers engaged in high-risky behaviors, particularly low class賣淫婦女中艾滋病病毒感染增加Increased HIV infection,賣淫婦女中安全套使用率Condom Use Rate Among Prostitutes,

17、Surveillance Program in China, 1995-2001,Use every time,Never use,HIV Infection Rate Sex Workers, 1995-2000,1995 1996 1997 1998 1999 2000 0.02 0.02 0.3 0.4 0.8 1.32,1995-2000年哨

18、點(diǎn)監(jiān)測(cè)全國(guó)賣淫婦女平均艾滋病感染率,五年期間增長(zhǎng) 66倍Increased some 66 folds over 5 year period,1988,1989,1990,1991,1992,1993,1994,1995,1996,1997,1998,1999,2000,Year,Cases,1985-2000 年全國(guó)報(bào)告性病病例數(shù)Annual Reported STDs in China，1985-2000,HIV Infect

19、ion Rate in STD Patients, 1995-2000,1995 1996 1997 1998 1999 2000 0.02 0.01 0.26 0.35 0.76 1.1,1995-2000年哨點(diǎn)監(jiān)測(cè)全國(guó)性病就診者平均艾滋病感染率,五年期間增長(zhǎng) 55 倍Increased some 55 folds over 5 year perio

20、d,,經(jīng)異性性接觸艾滋病流行小結(jié)Summary of Epidemics by heterosexual contact,在未來(lái)的數(shù)年里，經(jīng)異性性接觸將會(huì)持續(xù)上升，將逐步成為我國(guó)艾滋病流行的主要傳播方式.Epidemics caused by heterosexual contact will continue to increase will become major transmission mode of HIV infe

21、ction in future.,A4 同性/雙性戀傳播流行A4 Epidemics driven by homo-/bi-sexual contact,據(jù)專家估計(jì)，涉及同性戀的人員數(shù)量很大The number of man involved are presumed large by expert;有限的數(shù)據(jù)表明，艾滋病已經(jīng)進(jìn)入這一人群，個(gè)別調(diào)查顯示，感染率高達(dá)1%-5%Limited information showed

22、 HIV already got into this group, some with infection rate is 1%-5% ;絕大多數(shù)男性同性/雙性戀實(shí)際上是以同女性組成婚姻家庭的形式存在，對(duì)女性構(gòu)成威脅。Most homosexuals or bi-sexually exist in marriage with a woman, put women at risk of HIV infection.我們需要更多地

23、關(guān)注同性戀艾滋病問題Need more attention,A5 母嬰傳播流行A5 Epidemics by mother-to-child mode,有關(guān)母嬰傳播的數(shù)據(jù)有限，但這并不說(shuō)明問題不嚴(yán)重Limited information is available about epidemic in mother-to-child transmission. This does not mean it is not a probl

24、em隨著經(jīng)性途徑感染的人增多，女性感染者將增加，母嬰傳播將會(huì)增加。Accompany with increased infection caused by heterosexual contact, there will be more women being infected, therefore the mother-to-childe transmission will increase in future.目前，母嬰傳

25、播主要發(fā)生在流行發(fā)生早、嚴(yán)重的地區(qū).Mother-to-child transmission mainly occurred in epidemic center.,二 防治工作B. Response,中國(guó)國(guó)家主席胡錦濤明確指出：“艾滋病是關(guān)系我中華民族素質(zhì)和國(guó)家興亡的大事，各級(jí)領(lǐng)導(dǎo)需提高認(rèn)識(shí)，動(dòng)員全社會(huì)，從教育入手，立足預(yù)防，堅(jiān)決遏制其蔓延勢(shì)頭?！盩he Chinese President Hu Jintao once sta

26、ted explicitly,”HIV/AIDS prevention, care and treatment is a major issue pertinent to the quality and prosperity of the Chinese nation. The party and government leaders at all levels need to deepen their understanding of

27、 the issue and motivate the whole society to deal with it. Starting with education and focusing on prevention, we should be determined to contain the spread of HIV/ADIS.”,國(guó)務(wù)院總理溫家寶也非常關(guān)注艾滋病問題，多次指示有關(guān)部門加強(qiáng)和做好艾滋病防治工作，“把這件關(guān)系民族根

28、本利益的大事抓緊抓好。Mr. Wen Jiabao, Premier of the State Council, is also very concerned about the HIV/AIDS issue and has repeatedly given instructions to departments concerned to improve HIV/AIDS prevention and treatment,”…deal

29、ing with HIV/AIDS as an urgent and major issue, which is related to the fundamental interests of the whole Chinese nation”.,政府在艾滋病防治的領(lǐng)導(dǎo)作用Government Leadership in AIDS Control,隨著艾滋病疫情的變化，艾滋病防治工作的領(lǐng)導(dǎo)也發(fā)生了變化As the HIV/AIDS

30、epidemic has changed in China, so has prevention leadership:從單一的衛(wèi)生部門到多部門合作A health sector problem has become a multi-sectored collaboration國(guó)務(wù)院牽頭直接領(lǐng)導(dǎo)艾滋病防治工作HIV/AIDS is now addressed at the State Council level,,政府在艾滋病防

31、治中的領(lǐng)導(dǎo)作用(續(xù))Government Leadership in AIDS Control (cont.),1996年國(guó)務(wù)院建立防治艾滋病性病協(xié)調(diào)會(huì)議制度1996: State Council Coordinating Committee for HIV/AIDS/STD Control and Prevention 確定國(guó)家各有關(guān)部委在艾滋病防治工作中的職責(zé)和任務(wù)Responsibilities allocated to

32、 different government ministries and/or commissions for AIDS control動(dòng)員、組織社會(huì)各種資源和力量開展艾滋病防治工作Mobilization of Chinese society for HIV/AIDS prevention and control,,組長(zhǎng)：國(guó)務(wù)院副總理副組長(zhǎng)：衛(wèi)生部部長(zhǎng)/國(guó)務(wù)院副秘書長(zhǎng)成員：34個(gè)部委負(fù)責(zé)人Chairman:Vi

33、ce PremierVice Chairman:Minister of Health / Vice Secretary General of State CouncilMembers: Ministers of 34 departments,國(guó)務(wù)院防治艾滋病性病協(xié)調(diào)會(huì)議領(lǐng)導(dǎo)成員The State Council Coordinating Committee for HIV/AIDS/STD Prevention and

34、 Control,,中國(guó)預(yù)防與控制艾滋病中長(zhǎng)期規(guī)劃 (1998-2010)China’s medium- & long-term strategy for HIV/AIDS prevention and control (1998-2010)中國(guó)遏制與防治艾滋病行動(dòng)計(jì)劃 (2001~ 2005年) China's Action Plan for Reducing and Preventing the Spread

35、 of HIV/AIDS (2001 - 2005),制定了兩個(gè)重要國(guó)家規(guī)劃和計(jì)劃Two National Plans,,中國(guó)預(yù)防與控制艾滋病中長(zhǎng)期規(guī)劃 (1998-2010)China’s medium- & long-term strategy for HIV/AIDS prevention and control (1998-2010),工作目標(biāo)Working objectives(一) 建立健全領(lǐng)導(dǎo)管理機(jī)制T

36、o establish mechanism for leadership and to improve management of AIDS prevention and control(二) 全面普及艾滋病、性病防治知識(shí)，減少重點(diǎn)人群中的相關(guān)危險(xiǎn)行為To disseminate information about STD/HIV/AIDS prevention and reduce high risk behaviors amo

37、ng vulnerable groups,,中國(guó)預(yù)防與控制艾滋病中長(zhǎng)期規(guī)劃 (1998-2010)China’s medium- & long-term strategy for HIV/AIDS prevention and control (1998-2010),工作目標(biāo)Working objectives(三）建立健全艾滋病、性病監(jiān)測(cè)系統(tǒng)，力爭(zhēng)做到及時(shí)準(zhǔn)確分析、預(yù)測(cè)疫情及流行趨勢(shì)。建立起艾滋病、性病防治的服務(wù)體系

38、To improve the capacity of medical and health care services. This includes enhancing the capacity of the STD/HIV/AIDS surveillance system to analyze data in a timely manner and predict epidemic trends accurately,,中國(guó)預(yù)防與控制

39、艾滋病中長(zhǎng)期規(guī)劃 (1998-2010)China’s medium- & long-term strategy for HIV/AIDS prevention and control (1998-2010),工作目標(biāo)Working objectives(四) 加速艾滋病的防治科研工作。包括監(jiān)測(cè)、治療流行病學(xué)、社會(huì)行為學(xué)及衛(wèi)生經(jīng)濟(jì)學(xué)方面的研究4. To accelerate applied research on

40、 surveillance,treatment, epidemiology, behaviors and economics related to the AIDS epidemic(五) 建立和完善艾滋病防治的有關(guān)法律、法規(guī)體系To develop and perfect laws and regulations related to AIDS control,,目標(biāo) (到2005年底)Overall Objectives (

41、end of 2005):(一) 將艾滋病病毒感染者和性病發(fā)病人數(shù)年增長(zhǎng)幅度控制在10%以內(nèi)Bring down the rate of increase in the number of people infected with HIV and STDs to ten percent or less. (二) 將艾滋病病毒經(jīng)臨床輸血傳播的平均水平降低到1/10萬(wàn)以下，其中，在艾滋病高發(fā)地區(qū)，控制在1/萬(wàn)～1/5萬(wàn)以下 2.

42、 The HIV infection rate due to clinical blood transfusions should be brought down to 1 per 100,000 or less and in regions with a high incidence of HIV down to 1 per 10,000, 1 per 50,000 or less.,五年行動(dòng)計(jì)劃 Five Year Act

43、ion Plan,,目標(biāo) (到2005年底)Overall Objectives (end of 2005):（三）加強(qiáng)健康教育，普及艾滋病性病防治知識(shí)和無(wú)償獻(xiàn)血知識(shí) ，城市知曉率達(dá)到75％，農(nóng)村45％，高危人群80％3. Strengthen Health Education, Make Widely Known Information About HIV/AIDS Prevention and Voluntary Bloo

44、d Donation. Basic knowledge of HIV/STDs prevention and voluntary blood donation among the general population should reach 75% in urban area, 45% among rural population, over 80% among high risk populations（四）全國(guó)至少有50％的艾滋

45、病病毒感染者和艾滋病患者能在社區(qū)和家庭獲得醫(yī)療和生活照顧。4. At least 50% of HIV/AIDS patients can acquire community and family based medical and life care,,五年行動(dòng)計(jì)劃 Five Year Action Plan,目標(biāo) (到2005年底)Overall Objectives (end of 2005):（五）針對(duì)高危行為

46、開展干預(yù)工作，減少人群的危險(xiǎn)行為，高危行為人群中安全套使用率達(dá)到50％5. High Risk Behavior Interventions to Reduce Risky Behavior of Some Groups . The rate of condom usage among high risk population should over 50%（六）完善衛(wèi)生服務(wù)體系，提高對(duì)艾滋病病毒感染者和艾滋病患者的預(yù)防保健和醫(yī)療

47、服務(wù)質(zhì)量，50％的艾滋病高發(fā)區(qū)的中心衛(wèi)生院能夠?yàn)榘滩〔《靖腥菊吆桶滩』颊咛峁┮?guī)范化診斷、治療、咨詢與預(yù)防保健服務(wù)。6. Improve the health services system and raise the quality of preventive health and medical services provided to HIV-infected people and to people suffering

48、from AIDS.50% medical institutes that provide premarital medical examinations should be able to provide HIV/AIDS/STDs counseling and preventive health service,,五年行動(dòng)計(jì)劃 Five Year Action Plan,在聯(lián)大艾滋病高級(jí)別會(huì)議上中國(guó)政府承諾The Chine

49、se Government Political Committed at the HIV/AIDS High-level Meeting of the UN General Assembly,增強(qiáng)政府責(zé)任。中國(guó)政府將艾滋病防治作為一項(xiàng)重要工作任務(wù)，明確目標(biāo)，落實(shí)責(zé)任，加強(qiáng)考核，監(jiān)督檢查。對(duì)因工作不力，造成艾滋病擴(kuò)散的，追究政府有關(guān)人員的責(zé)任。We will strengthen government efforts to fulfil

50、l the responsibility. The Chinese government has considered HIV/AIDS prevention and treatment an important task. We will further clarify the targets, identify the responsibilities and improve evaluation, supervision and

51、monitoring. Should there be any HIV/ADIS speed coursed by ineffective work, we will hold the person or department in charge accountable for the negligence.,在聯(lián)大艾滋病高級(jí)別會(huì)議上中國(guó)政府承諾The Chinese Government Political Committed at

52、 the HIV/AIDS High-level Meeting of the UN General Assembly,中國(guó)政府承諾對(duì)經(jīng)濟(jì)困難的艾滋病患者免費(fèi)提供治療藥物，在城市對(duì)艾滋病患者中的低收入者提供免費(fèi)治療藥物；在農(nóng)村國(guó)家免費(fèi)為農(nóng)民提供治療藥物。同時(shí)，中央和地方政府投資100多億元，加強(qiáng)傳染病醫(yī)療救助體系建設(shè)，建立艾滋病防治專業(yè)技術(shù)隊(duì)伍。Chinese government is committed to provide fr

53、ee treatment and medicines to HIV/AIDS patients who are in economic difficulties.This program will cover low-income HIV/AIDS patients in urban areas and all patients in rural areas. Moreover, the central and local govern

54、ments will invest more than 10million yuan to strengthen the medical assistance system to people suffering from infectious diseases and train people to conduct professional HIV/AIDS prevention and treatment,保護(hù)艾滋病患者的合法權(quán)益，

55、反對(duì)社會(huì)歧視。建立124個(gè)艾滋病綜合防治示范區(qū)，采取抗病毒治療、人文關(guān)懷、生活救助等綜合防治措施。政府對(duì)貧困的艾滋病病人給予經(jīng)濟(jì)救助，對(duì)其子女免收上學(xué)費(fèi)用。We will protect the legitimate rights of HIV/AIDS patients and oppose social discrimination against them. In all the 124 counties where the C

56、hinese “care”project will be established, integrated measures including antiretroviral treatment, care and life assistance will be adopted. The government will provide economic aid to HIV/AIDS patients living in poverty

57、and their children will be tuition-free students.,在聯(lián)大艾滋病高級(jí)別會(huì)議上中國(guó)政府承諾The Chinese Government Political Committed at the HIV/AIDS High-level Meeting of the UN General Assembly,在聯(lián)大艾滋病高級(jí)別會(huì)議上中國(guó)政府承諾The Chinese Government Poli

58、tical Committed at the HIV/AIDS High-level Meeting of the UN General Assembly,完善法律法規(guī)，加強(qiáng)對(duì)危險(xiǎn)行為的干預(yù)措施。We will improve the laws and regulations and intensify the intervention on dangerous behaviors積極開展國(guó)際合作We will be more a

59、ctive in international cooperation,合作機(jī)構(gòu) (Collaborative agencies)：國(guó)際多邊機(jī)構(gòu) (UN bilateral agencies): 聯(lián)合國(guó)艾滋病規(guī)劃署 (UNAIDS-PAF) 世界衛(wèi)生組織 (WHO) 聯(lián)合國(guó)兒童基金會(huì) (UNICEF) 聯(lián)合國(guó)開發(fā) 計(jì)劃署 (UNDP) 聯(lián)合國(guó)人口基金 (UNFPA) 世界銀行衛(wèi)九貸款 (World Bank),國(guó)際合作艾

60、滋病防治項(xiàng)目International Cooperation,國(guó)際雙邊機(jī)構(gòu) (International Bilateral Agencies):英國(guó)國(guó)際發(fā)展署 (DFID，UK)澳大利亞國(guó)際發(fā)展署 (AusAID)瑞典國(guó)際發(fā)展署 (SIDA) 挪威政府 (Norway)美國(guó)疾病預(yù)防控制中心全球艾滋病項(xiàng)目 (US-CDC/GAP)美國(guó)國(guó)立衛(wèi)生研究院資助的艾滋病綜合研究項(xiàng)目(NIH-CIPRA),國(guó)際合作艾

61、滋病防治項(xiàng)目International Cooperation,國(guó)際非政府機(jī)構(gòu) (International NGOs):英國(guó)兒童救助會(huì)(Save the children, UK)無(wú)國(guó)界醫(yī)生組織 (MSF-Belgium)瑪麗斯普特中國(guó)辦事處 (MSI)前景集團(tuán)(Future’s Group)福特基金 (Ford Foundation) 在中國(guó)新設(shè)立的國(guó)際NGOs辦事處：美國(guó)家庭國(guó)際健康 (FHI)PATH ……,

62、國(guó)際合作艾滋病防治項(xiàng)目International Cooperation,,International projects in China,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,TIBET,QINGHAI,GANSU,NEIM ?ENGGU,HEILONG ?JIANG,JI

63、LIN,LIAONING,GUIZHOU,GUANGXI,GUANGDONG,HAINAN,HUNAN,JIANGXI,FUJIAN,TAIWAN,ZHEJIANG,JIANGSU,SHANGHAI,SHANDONG,SHAANXI,SHANXI,NINGXIA,XINJIANG,SICHUAN,HUBEI,HENAN,ANHUI,YUNAN,HEBEI,BEIJING,,TIANJIN,HONG KONG,MACAO,QU’s Sli

64、de_Nas2001_2,QU’s Slide_Nas2001_2,QU’s Slide_Nas2001_2,QU’s Slide_Nas2001_2,,,WB DFID UNICEF▲ WHO● EU◆ CIPRA★ GFATM● AusAID▼ UNFPA ? UNDP? SIDA? Norway,?,,,?,,?,,,,,,▲ ?,▲,▲,★,★,★,★,★,★,◆,◆,●,●,●,?●,●,●,●,

65、●,● ▼ ▲,●,● ?,,,★,,▼,? ▼,▼,▼,?,?,●,合作領(lǐng)域 (Collaborative areas): 行為改變交流/大眾健康宣傳教育 (BCC/IEC) 安全套推廣項(xiàng)目(Condom promotion) 減低危害 (Harm reduction) 性病防治推廣 (STI prevention) 預(yù)防母嬰傳播 (PMTCT),國(guó)際合作艾滋病防治項(xiàng)目International Cooperati

66、on,合作領(lǐng)域 (Collaborative areas):關(guān)懷和治療 (Treatment, Care and support)孤兒關(guān)懷 (Orphan Care)艾滋病監(jiān)測(cè) (HIV/AIDS surveillance)培訓(xùn) (Training)宣傳倡導(dǎo) (Advocacy),國(guó)際合作艾滋病防治項(xiàng)目International Cooperation,全球抗艾滋病、結(jié)核病和瘧疾基金

67、The Global Fund to Fight AIDS, Tuberculosis and Malaria,名稱： 加強(qiáng)中國(guó)中部地區(qū)以社區(qū)為基礎(chǔ)的 艾滋病綜合治療、關(guān)懷和預(yù)防項(xiàng)目Title: 　 China CARES (China Comprehensive Aids RESponse) A Communit

68、y-Based HIV Treatment, Care and Prevention Program in Central China,項(xiàng)目周期 (Project periods) : 五年 ( 5 years )項(xiàng)目地區(qū) (Project areas)： 河南、河北、湖北、山西、陜西、山東、安徽 (Henan, Hebei, Hubei, Shanxi, Shaanxi, Shan