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Ye R, Lai Y, Gu J. New sexually transmitted HIV infections from 2016 to 2050 in Guangdong Province, China: a study based on a dynamic compartmental model. BMC Public Health 2024; 24:1307. [PMID: 38745217 PMCID: PMC11092022 DOI: 10.1186/s12889-024-18735-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/29/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND In Guangdong Province, China, there is lack of information on the HIV epidemic among high-risk groups and the general population, particularly in relation to sexual transmission, which is a predominant route. The new HIV infections each year is also uncertain owing to HIV transmission from men who have sex with men (MSM) to women, as a substantial proportion of MSM also have female sexual partnerships to comply with social demands in China. METHODS A deterministic compartmental model was developed to predict new HIV infections in four risk groups, including heterosexual men and women and low- and high-risk MSM, in Guangdong Province from 2016 to 2050, considering HIV transmission from MSM to women. The new HIV infections and its 95% credible interval (CrI) were predicted. An adaptive sequential Monte Carlo method for approximate Bayesian computation (ABC-SMC) was used to estimate the unknown parameter, a mixing index. We calibrated our results based on new HIV diagnoses and proportions of late diagnoses. The Morris and Sobol methods were applied in the sensitivity analysis. RESULTS New HIV infections increased during and 2 years after the COVID-19 pandemic, then declined until 2050. New infections rose from 8,828 [95% credible interval (CrI): 6,435-10,451] in 2016 to 9,652 (95% CrI: 7,027-11,434) in 2019, peaking at 11,152 (95% CrI: 8,337-13,062) in 2024 before declining to 7,084 (95% CrI: 5,165-8,385) in 2035 and 4,849 (95% CrI: 3,524-5,747) in 2050. Women accounted for approximately 25.0% of new HIV infections, MSM accounted for 40.0% (approximately 55.0% of men), and high-risk MSM accounted for approximately 25.0% of the total. The ABC-SMC mixing index was 0.504 (95% CrI: 0.239-0.894). CONCLUSIONS Given that new HIV infections and the proportion of women were relatively high in our calibrated model, to some extent, the HIV epidemic in Guangdong Province remains serious, and services for HIV prevention and control are urgently needed to return to the levels before the COVID-19 epidemic, especially in promoting condom-based safe sex and increasing awareness of HIV prevention to general population.
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Affiliation(s)
- Rong Ye
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, No. 74 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Yingsi Lai
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, No. 74 Zhongshan 2nd Road, Guangzhou, 510080, China
- Sun Yat-sen Global Health institute, Sun Yat-sen University, Guangzhou, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, No. 74 Zhongshan 2nd Road, Guangzhou, 510080, China.
- Sun Yat-sen Global Health institute, Sun Yat-sen University, Guangzhou, China.
- Research Center of Health Informatics, Sun Yat-sen University, Guangzhou, China.
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Jin X, Wang Z, Zhang Z, Wu H, Ruan Y, Zhang C, Kang R, Xing H, Lou J. The transmission of drug-resistant strains of HIV in heterosexual populations based on genetic sequences. PLoS One 2021; 16:e0259023. [PMID: 34851959 PMCID: PMC8635345 DOI: 10.1371/journal.pone.0259023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/11/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND China's National Free Antiretroviral Treatment Program (NFATP) has substantially reduced morbidity and HIV/AIDS incidence since 2003. However, HIV resistance to antiretroviral drugs (ARVs) has been a major challenge for the current treatment of HIV/AIDS in China. METHODS In the current study, we established a nested dynamic model to predict the multi-drug resistance dynamics of HIV among the heterosexual population and evaluated the impact of intervention measures on the transmission of drug resistance. We obtained an effective reproductive number [Formula: see text] from each sub-model held at different stages of the dynamic model. Meanwhile, we applied Bayesian phylogenetic methods to infer the weighted average effective reproductive number [Formula: see text] from four HIV subtypes that sampled from 912 HIV-positive patients in China. It is an original and innovative method by fitting [Formula: see text] to [Formula: see text] by Markov Chain Monte Carlo (MCMC) to generate unknown parameters in [Formula: see text]. RESULTS By analyzing the HIV gene sequences, we inferred that the most recent common ancestor of CRF01AE, CRF07BC, CRF08BC, and CRFBC dated from 1994, 1990, 1993 and 1990, respectively. The weighted average effective reproductive number [Formula: see text] dropped from 1.95 in 1994 to 1.73 in 2018. Considering different interventions, we used a macro dynamic model to predict the trend of HIV resistance. The results show that the number of new infections and total drug resistance under the baseline parameter (S1) are 253,422 and 213,250 in 2025, respectively. Comparing with the numbers under the target treatment rate (S2), they were 219,717 and 236,890, respectively. However, under the ideal treatment target (S3, the treatment rate reaches 90% and the treatment success rate reaches 90%), the number of new infections shows a declining trend and will decrease to 46,559 by 2025. Compared with S1 and S2, the total number of resistance also decreased to 160,899 in 2025. CONCLUSION With the promotion of NFATP in China, HIV resistance to ARVs is inevitable. The strategy of increasing the treatment rate would not only ineffectively curb the epidemic, but also deteriorate drug resistance issue. Whereas, a combination of intervention strategies (the treatment rate reaches 90% and the treatment success rate reaches 90%) can greatly reduce both infection and drug resistance rate than applying one strategy alone.
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Affiliation(s)
- Xin Jin
- Department of Mathematics, Shanghai University, Shanghai, China
| | - Zhen Wang
- Department of Mathematics, Shanghai University, Shanghai, China
| | - Zhiyuan Zhang
- Department of Statistics, Columbia University, New York, NY, United States of America
| | - Hui Wu
- Department of Mathematics, Shanghai University, Shanghai, China
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases and National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chen Zhang
- School of Nursing, University of Rochester, Rochester, NY, United States of America
| | - Ruihua Kang
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases and National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Disease Prevention and Control, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Hui Xing
- State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases and National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jie Lou
- Department of Mathematics, Shanghai University, Shanghai, China
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3
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Jin F, Dore GJ, Matthews G, Luhmann N, Macdonald V, Bajis S, Baggaley R, Mathers B, Verster A, Grulich AE. Prevalence and incidence of hepatitis C virus infection in men who have sex with men: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 6:39-56. [PMID: 33217341 DOI: 10.1016/s2468-1253(20)30303-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND WHO has set targets for hepatitis C virus (HCV) elimination by 2030. We did a global systematic review of HCV prevalence and incidence in men who have sex with men (MSM) to provide updated estimates that can guide community education and public health policy. METHODS We did a systematic review and meta-analysis of studies published and listed on MEDLINE or Embase between Jan 1, 2000, and Oct 31, 2019, including conference proceedings. Studies were eligible if they reported measures of HCV prevalence or HCV incidence (or both) among MSM. Studies that relied on participants' self-reported HCV status with no laboratory confirmation were excluded. Pooled HCV estimates in MSM were stratified by HIV status and by injecting drug use, then by WHO region and by income level. Random-effects meta-analysis was done to account for between-study heterogeneity and examined using the I2 statistic. Pooled HCV prevalence was also compared with HCV estimates in the general population and presented as prevalence ratios (PRs). In HIV-negative MSM, incidence estimates were stratified by use of HIV pre-exposure prophylaxis (PrEP). The systematic review was registered with PROSPERO, number CRD42020156262. FINDINGS Of 1221 publications identified, 194 were deemed to be eligible and included in the systematic review and meta-analysis. Overall, the pooled HCV prevalence in MSM was 3·4% (95% CI 2·8-4·0; I2=98·0%) and was highest in Africa (5·8%, 2·5-10·4) and South-East Asia (5·0%, 0·0-16·6). Globally, HCV prevalence was 1·5% (1·0-2·1) in HIV-negative MSM and 6·3% (5·3-7·5) in HIV-positive MSM. Compared with the general population, HCV prevalence was slightly higher in HIV-negative MSM (PR 1·58, 95% CI 1·14-2·01) and markedly higher (6·22, 5·14-7·29) in HIV-positive MSM. Pooled HCV prevalence was substantially higher in MSM who had ever injected drugs (30·2%, 22·0-39·0) or currently injected drugs (45·6%, 21·6-70·7) than in those who never injected drugs (2·7%, 2·0-3·6). In HIV-negative MSM, the pooled HCV incidence was 0·12 per 1000 person-years (95% CI 0·00-0·72) in individuals not on PrEP and 14·80 per 1000 person-years (9·65-20·95) in individuals on PrEP. HCV incidence in HIV-positive MSM was 8·46 per 1000 person-years (6·78-10·32). INTERPRETATION HIV-positive MSM are at substantially increased risk of HCV. Overall, HIV-negative MSM had a slightly higher prevalence of HCV than the general population but had a lower prevalence than HIV-positive MSM. High HCV incidence in more recent PrEP studies suggests that as PrEP use increases, greater HCV transmission might occur. HCV burden in MSM varies considerably by region, which is likely to be associated with variation in the prevalence of injecting drug use and HIV. FUNDING World Health Organization.
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Affiliation(s)
- Fengyi Jin
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Gail Matthews
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Niklas Luhmann
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Virginia Macdonald
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Sahar Bajis
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Rachel Baggaley
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Bradley Mathers
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Annette Verster
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Cao W, Wong HM, Chang C, Agudile EP, Ekström AM. Coping strategies and needs among women married to men who have sex with men living with HIV in China. PSYCHOL HEALTH MED 2020; 26:711-723. [PMID: 32338057 DOI: 10.1080/13548506.2020.1758733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Stigma towards men who have sex with men (MSM) is prevalent, and many MSM are married to women. This study aims to provide acomprehensive understanding of coping strategies and the need for support among women in serodiscordant relationships with MSM living with HIV. We conducted 19 qualitative in-depth interviews with these women living in Sichuan, China. Semi-structured interviews were recorded and transcribed. Qualitative data were transcribed verbatim and analyzed using content analysis. We found that these women utilized multiple coping strategies both within the family and externally. Coping strategies within the family included keeping husbands' HIV diagnosis confidential, integrating husband's HIV treatment management into family routines, restoring spousal relationship, protecting themselves from HIV infection, denying, self-blaming, and persuading the husbands to see the psychiatrist due to homosexual behaviors. Coping strategies outside the family included seeking information from multiple sources, peer support, and online support. Participants expressed needs for more information, psychological support, stigma reduction, and special counseling on how to handle their husband's homosexual identity and/or behavior. Women married to MSM living with HIV develop both adaptive and maladaptive coping strategies, and the majority of these women's needs are unmet under the current service system in China.
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Affiliation(s)
- Wangnan Cao
- Paediatric Dentistry & Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.,Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, RI, USA
| | - Hai Ming Wong
- Paediatric Dentistry & Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Emeka Pascal Agudile
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Anna Mia Ekström
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
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Dong MJ, Peng B, Liu ZF, Ye QN, Liu H, Lu XL, Zhang B, Chen JJ. The prevalence of HIV among MSM in China: a large-scale systematic analysis. BMC Infect Dis 2019; 19:1000. [PMID: 31775654 PMCID: PMC6880607 DOI: 10.1186/s12879-019-4559-1] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 10/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of HIV among men who have sex with men (MSM) has become a significant public health challenge. The aim was to comprehensively estimate the national prevalence of HIV among MSM and its time trends through a large-scale systematic analysis. METHODS Systematic search of Cochrane Library, PubMed, EMBASE, CNKI, VIP, and Wanfang Data databases without language restriction for studies on the prevalence of HIV among MSM published before Dec.31, 2018. Studies were eligible for inclusion if they were published in the peer-reviewed literature and used validated assessment methods to assess the prevalence of HIV among MSM. Estimates were pooled using random-effects analysis. RESULTS Data were extracted from 355 cross-sectional studies (571,328 individuals) covered 59 cities from 30 provinces and municipalities of China. The overall national prevalence of HIV among MSM from 2001 to 2018 was estimated to be 5.7% (95% CI: 5.4-6.1%), with high between-study heterogeneity (I2 = 98.0%, P < 0.001). Our study showed an increased tendency in the HIV prevalence as time progressed by meta-regression analysis (I2 = 95.9%, P < 0.0001). HIV prevalence was the highest in those aged 50 years and older with HIV prevalence of 19.3% (95%CI: 13.1-27.4%, N = 13). HIV was more prevalent in the illiterate population (16.8%), than in those who had received an education. Although the internet was a major venue for Chinese MSM seeking male sex partners (35.6, 95%CI: 32.3-39.9%, N = 101), seeking MSM in bathhouses/saunas had the highest associated prevalence of HIV (13.4, 95%CI: 10.3-17.1%, N = 22). The HIV prevalence among MSM varied by location: compared with other regions in China, HIV was highly prevalent among MSM in the southwest (10.7, 95%CI: 9.3-12.2%, N = 91). Compared to participants who sometimes or always used condoms, participants who had never used a condom in the past 6 months had a higher risk of HIV infection, with odds ratios of 0.1 (95%CI: 0.08-0.14). CONCLUSIONS Our analysis provided reliable estimates of China's HIV burden among MSM, which appears to present an increasing national public health challenge. Effective government responses are needed to address this challenge and include the implementation of HIV prevention.
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Affiliation(s)
- Meng-Jie Dong
- The Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, 310003 People’s Republic of China
| | - Bin Peng
- Department of Medical Statistics, Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Zhen-Feng Liu
- The Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, 310003 People’s Republic of China
| | - Qian-ni Ye
- The Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, 310003 People’s Republic of China
| | - Hao Liu
- The Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, 310003 People’s Republic of China
| | - Xi-Li Lu
- The Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, 310003 People’s Republic of China
| | - Bo Zhang
- The Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, 310003 People’s Republic of China
| | - Jia-Jia Chen
- Infectious Disease Department, College of Medicine, Zhejiang University, Zhejiang, 310003 People’s Republic of China
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6
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Characteristics of HIV-1 Molecular Epidemiology in Suzhou, China, from 2009 to 2014. Virol Sin 2018; 33:209-212. [PMID: 29549651 DOI: 10.1007/s12250-018-0022-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/12/2018] [Indexed: 10/17/2022] Open
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7
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Liu Y, Qian HZ, Amico KR, Liu H, Yin L, Ruan Y, Shao Y, Zhang C, Vermund SH. Subsequent Sexual Risks Among Men Who Have Sex with Men May Differ by Sex of First Partner and Age at Sexual Debut: A Cross-Sectional Study in Beijing, China. AIDS Behav 2017; 21:2913-2923. [PMID: 28110474 DOI: 10.1007/s10461-017-1677-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sexual debut experience may influence HIV/sexual risks among men who have sex with men (MSM). We assessed associations between age of sexual debut and sex of debut partner with recent (past-3-month) sexual/HIV/syphilis risks among 3588 community-based Chinese MSM. Sexual debut with women was associated with more recent (condomless) insertive anal sex with men, more recent (condomless) vaginal sex, and more lifetime female partners. Sexual debut with men was associated with more recent (condomless) receptive anal sex with men and more lifetime male partners. All associations were strongest among those having first sex ≤18 years in both groups. Earlier sexual debut was associated with higher HIV/syphilis risk; HIV risk was higher with first sex with a man, but syphilis was higher with first sex with a woman. Earlier age of sexual debut is associated with greater HIV/syphilis and sexual risks, but MSM risk differs with first sex with women versus men.
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Affiliation(s)
- Yu Liu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Suite 750, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Suite 750, 2525 West End Avenue, Nashville, TN, 37203, USA
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - K Rivet Amico
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
| | - Hongjie Liu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | - Lu Yin
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Suite 750, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chen Zhang
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Suite 750, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Suite 750, 2525 West End Avenue, Nashville, TN, 37203, USA.
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
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8
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Unpacking the Influence of Sexual Stigma on HIV Risk: Results From a Prospective Study of Men Who Have Sex With Men in Beijing, China. J Acquir Immune Defic Syndr 2017; 74:e38-e44. [PMID: 27787344 DOI: 10.1097/qai.0000000000001217] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We examined the mediating roles of coping, depression, anxiety, and encountering difficult sexual situations in explaining the association between stigma against men who have sex with men (MSM) and HIV risk. METHODS We conducted path analyses using longitudinal data collected from 493 Chinese MSM in Beijing at baseline, 6 months, and 12 months from 2011 to 2013. RESULTS MSM stigma, specifically anticipations of stigma, had a marginally significant, protective total effect on unprotected anal intercourse at 12 months. This overall association, however, was the byproduct of 5 significant, indirect associations (3 risk enhancing, 2 protective) that routed through coping, anxiety, and difficult sexual situations. Of note, heavier use of avoidant coping principally had a protective effect on risk behavior by decreasing difficult sexual situations. CONCLUSIONS Interventions to reduce avoidant coping would be an important tool for improving the emotional well-being of Chinese MSM. Such interventions, however, must be paired with biomedical or behavioral HIV prevention strategies to ensure that their benefit is not undermined by unintended increased HIV transmission risk in response to reduced social isolation among MSM.
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Xian Y, Zhu B, Zhang X, Ma P, Wei Y, Xia H, Jiang W, Yang C, Meng X, Peng P, Yang Y, Jiang L, Chu M, Zhuang X. Risk factors associated with sexually transmitted infections among HIV infected men who have sex with men. PLoS One 2017; 12:e0170635. [PMID: 28158317 PMCID: PMC5291509 DOI: 10.1371/journal.pone.0170635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/06/2017] [Indexed: 12/25/2022] Open
Abstract
To investigate the factors associated with sexually transmitted infection and Human Immunodeficiency Virus (STI-HIV) co-infection among men who have sex with men (MSM). A total of 357 HIV-infected participants (84 STI-HIV co-infection and 273 HIV infections only) were recruited from Jiangsu, China. Logistic regression analyses were used to estimate the related factors associated with STI-HIV co-infection. Marginal structural models were adopted to estimate the effect of transmission drug resistance (TDR) on STI-HIV co-infection. For all participants, logistic regression analyses revealed that those who diagnosed with HIV-1 for longer duration (≥1.8 years) were significantly associated with reduced STI-HIV co-infection risk (OR = 0.55, 95%CI: 0.32–0.96, P = 0.036). In further stratification analysis by antiretroviral therapy (ART), individuals with longer duration showed consistent significant associations with STI-HIV co-infection risk (OR = 0.46, 95%CI: 0.26–0.83, P = 0.010) among MSM with ART-naïve status. In addition, significant reduced risk for STI-HIV co-infection (OR = 0.98, 95%CI: 0.96–0.99, P = 0.010) were observed in younger (under the average age of 31.03) MSM of the same group. Interestingly, we also found TDR was significantly associated with an increased risk of STI-HIV co-infection risk (OR = 3.84, 95%CI: 1.05–14.03, P = 0.042) in ART-naïve group. Our study highlights a pattern of STI-HIV co-infection among MSM in China and indicates that targeted interventions aimed at encouraging TDR monitoring in MSM with early HIV infection are warranted.
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Affiliation(s)
- Yun Xian
- Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, Nantong City, Jiangsu Province, China
| | - Bowen Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, Nantong City, Jiangsu Province, China
| | - Xuan Zhang
- Wuxi Centre for Disease Control and Prevention, Wuxi City, Jiangsu Province, China
| | - Ping Ma
- Nantong Centre for Disease Control and Prevention, Nantong City, Jiangsu Province, China
| | - Ye Wei
- Nantong Centre for Disease Control and Prevention, Nantong City, Jiangsu Province, China
| | - Hongli Xia
- Nantong Centre for Disease Control and Prevention, Nantong City, Jiangsu Province, China
| | - Wenjie Jiang
- Department of Management Studies, University of Bath, Bath City, United Kingdom
| | - Changqing Yang
- Yancheng Centre for Disease Control and Prevention, Yancheng City, Jiangsu Province, China
| | - Xiaojun Meng
- Wuxi Centre for Disease Control and Prevention, Wuxi City, Jiangsu Province, China
| | - Peng Peng
- Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, Nantong City, Jiangsu Province, China
| | - Yue Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, Nantong City, Jiangsu Province, China
| | - Liying Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, Nantong City, Jiangsu Province, China
| | - Minjie Chu
- Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, Nantong City, Jiangsu Province, China
| | - Xun Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, Nantong City, Jiangsu Province, China
- * E-mail:
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10
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Choi KH, Steward WT, Miège P, Hudes E, Gregorich SE. Sexual Stigma, Coping Styles, and Psychological Distress: A Longitudinal Study of Men Who Have Sex With Men in Beijing, China. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1483-1491. [PMID: 26679303 PMCID: PMC4912467 DOI: 10.1007/s10508-015-0640-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 09/04/2015] [Accepted: 09/30/2015] [Indexed: 06/01/2023]
Abstract
The direct link between stigma against sexual minorities and psychological distress is well established. However, few studies have examined the potential mediating roles of avoidant and social support coping in the relationships between internalized and anticipated stigma associated with homosexuality and depressive symptoms and anxiety among Chinese men who have sex with men (MSM). We recruited a longitudinal sample of 493 MSM in Beijing, China from 2011 to 2012. Participants completed computer-based questionnaires at baseline, 6, and 12 months. We found significant indirect effects of anticipated MSM stigma on symptoms of both depression and anxiety via avoidant coping: anticipated MSM stigma at baseline was significantly associated with avoidant coping (B = 0.523, p < 0.001) at 6 months and, conditional on anticipated MSM stigma, avoidant coping had a significant positive effect on depressive symptoms and anxiety at 12 months (B = 0.069, p = 0.001 and B = 0.071, p = 0.014). In contrast, no significant indirect effects of anticipated MSM stigma on either psychological distress outcome via social support coping were found. No significant indirect effects of internalized MSM stigma via either avoidant or social support coping were found. These results underscore the need for interventions that address anticipations of stigma and the use of avoidant coping techniques to manage such anticipations.
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Affiliation(s)
- Kyung-Hee Choi
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, 550 16th Street, Floor 3, Box 0886, San Francisco, CA, 94143, USA.
| | - Wayne T Steward
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, 550 16th Street, Floor 3, Box 0886, San Francisco, CA, 94143, USA
| | - Pierre Miège
- Institute of Social Development and Public Policy, Beijing Normal University, Beijing, People's Republic of China
| | - Esther Hudes
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, 550 16th Street, Floor 3, Box 0886, San Francisco, CA, 94143, USA
| | - Steven E Gregorich
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, 550 16th Street, Floor 3, Box 0886, San Francisco, CA, 94143, USA
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Wu J, Wu H, Li P, Lu C. HIV/STIs risks between migrant MSM and local MSM: a cross-sectional comparison study in China. PeerJ 2016; 4:e2169. [PMID: 27478695 PMCID: PMC4950534 DOI: 10.7717/peerj.2169] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/02/2016] [Indexed: 11/30/2022] Open
Abstract
Background. Internal migration plays a significant role in China’s HIV epidemic. However, few studies have directly compared migrant men who have sex with men (MSM) with local MSM with regard to HIV/sexually transmitted infections (STIs) risks. Methods. We conducted a study in Guangzhou, China, with the aim of understanding the differences in HIV/STIs risks between migrant MSM and local MSM. A cross-sectional study was conducted among 273 migrant MSM and 249 local MSM in Guangzhou, China. Their behavioral and serologic data on HIV/syphilis were collected and compared between the two groups. A multivariate logistic regression was used to estimate the associations between HIV/STIs risks and migratory status. Results. Migrant MSM, compared to local MSM, have higher odds of reporting unprotected anal intercourse (UAI) (OR = 1.4; 95% CI [0.9–2.0]) and having multiple homosexual partners (OR = 1.2; 95% CI [0.8–1.8]). A lower rate of condom use at homosexual debut was reported in migrant MSM than in local MSM (OR = 0.7; 95% CI [0.5–0.9]). Migrant MSM have less odds of reporting HIV/STIs testing in the previous 6 months relative to local MSM (OR = 0.5; 95% CI [0.4–0.8]). In addition, migrant MSM demonstrated a lower level of HIV knowledge than local MSM (OR = 0.4; 95% CI [0.2–0.8]). Conclusion. Migrant MSM are more likely to engage in sexual risk behaviors, report a lower level of HIV knowledge and have less access to HIV/STIs testing. Further comprehensive interventions targeting migrant MSM are urged.
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Affiliation(s)
- Jie Wu
- Department of Medical Statistics and Epidemiology, Sun Yat-Sen University, Guangzhou, China
| | - Hong Wu
- Department of Medical Statistics and Epidemiology, Sun Yat-Sen University, Guangzhou, China
| | - Pengsheng Li
- Department of Medical Statistics and Epidemiology, Sun Yat-Sen University, Guangzhou, China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, Sun Yat-Sen University, Guangzhou, China
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12
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Liu Y, Li D, Vermund SH, Zhang C, Ruan Y, Yin L, Liu H, Amico KR, Shao Y, Qian HZ. Associations of current marital status and living arrangements with HIV and syphilis risk: findings from a community-based sample of men who have sex with men in China. AIDS Care 2016; 28:1461-6. [PMID: 27236988 DOI: 10.1080/09540121.2016.1189502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chinese men who have sex with men (MSM) are disproportionally affected by HIV and sexually transmitted infections (STIs), but little is known about the role of current marital status and living arrangements in shaping their HIV/syphilis risk. A cross-sectional study was conducted among MSM in Beijing, China to assess their sociodemographic/behavioral characteristics between married and single MSM, and test the hypothesis that currently married MSM have a lower odds of being HIV- and/or syphilis-infected. Participants were recruited via short message services, peer referral, internet, and community outreach. Data collection was based on a questionnaire survey and self-report. Infection status was lab-confirmed. Multivariable logistic regression modeling was used to assess the association of marital status and living arrangement with HIV/syphilis risk. Of the 3588 MSM, infection prevalence was high (HIV = 12.7%; syphilis = 7.5%). Compared to single MSM living with their boyfriends or male sex partners, single/alone MSM and married MSM living with wives were less likely to practice condomless insertive (CIAI) or receptive (CRAI) anal intercourse with men; while married MSM living with boyfriends or male sex partner were more likely to practice CIAI and CRAI, and married MSM were more likely to practice condomless vaginal sex. Compared to men living with boyfriends/sexual partners, significantly reduced odds of being HIV-positive were seen among married MSM who were living alone (aOR: 0.52; 95%CI: 0.28, 0.94) or living with their wives (aOR: 0.53; 95%CI: 0.31, 0.89). Similarly, single MSM living alone (aOR: 0.67; 95%CI: 0.48, 0.95) and married MSM living with their wives were comparatively less likely to be syphilis-infected (aOR: 0.43; 95%CI: 0.23, 0.79). Future efforts should consider characteristics of marital status and living arrangements for designing subgroup-specific risk reduction strategies among Chinese MSM.
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Affiliation(s)
- Yu Liu
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Dongliang Li
- b Chaoyang Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Sten H Vermund
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , TN , USA.,c Division of Epidemiology, Department of Medicine , Vanderbilt University School of Medicine , Nashville , TN , USA.,d Department of Pediatrics , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Chen Zhang
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Yuhua Ruan
- e State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Lu Yin
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Hongjie Liu
- f Department of Epidemiology and Biostatistics, School of Public Health , University of Maryland , College Park , MD , USA
| | - K Rivet Amico
- g Department of Health Behavior and Health Education , University of Michigan , Ann Arbor , MI , USA
| | - Yiming Shao
- e State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Han-Zhu Qian
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , TN , USA.,c Division of Epidemiology, Department of Medicine , Vanderbilt University School of Medicine , Nashville , TN , USA
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Liu Y, Ruan Y, Vermund SH, Osborn CY, Wu P, Jia Y, Shao Y, Qian HZ. Predictors of antiretroviral therapy initiation: a cross-sectional study among Chinese HIV-infected men who have sex with men. BMC Infect Dis 2015; 15:570. [PMID: 26714889 PMCID: PMC4696158 DOI: 10.1186/s12879-015-1309-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 12/03/2015] [Indexed: 11/16/2022] Open
Abstract
Background Early antiretroviral therapy (ART) initiation is crucial to achieve HIV viral suppression and reduce transmission. HIV-infected Chinese men who have sex with men (MSM) were less likely to initiate ART than other HIV-infected individuals. We assessed predictors of ART initiation among Chinese MSM. Methods In 2010–2011, a cross-sectional study was conducted among MSM in Beijing, China. We examined ART initiation within the subgroup who were diagnosed with HIV infection prior to participation in the survey. Logistic regression models were fitted to evaluate socio-demographic and behavioral factors associated with ART initiation. The eligibility criterion in the 2010/2011 national HIV treatment guidelines was CD4 cell count <350 cells/μL or World Health Organization (WHO) clinical stage III/IV. Results Of 238 eligible HIV-infected participants, the median duration of HIV infection was 15 months (range: 31 days-12 years); 62 (26.1 %) had initiated ART. Among 103 men with CD4 counts <350 cells/μL, 38 (36.9 %) initiated ART. Being married to a woman (adjusted odd ratios [aOR]: 2.50; 95 % confidence interval [CI]: 1.07-5.87), longer duration of HIV infection (aOR: 10.71; 95 % CI: 3.66-31.32), and syphilis co-infection (aOR: 2.58; 95 % CI: 1.04-6.37) were associated with a higher likelihood of ART initiation. Of 135 men with CD4 count ≥350 cells/μL, 24 (18 %) initiated ART. Being married to a woman (aOR: 4.21; 95 % CI: 1.60-11.06), longer duration of HIV infection (aOR: 22.4; 95 % CI: 2.79-180), older age (aOR: 1.26; 95 % CI: 1.1-1.44), Beijing Hukou (aOR: 4.93; 95 % CI: 1.25-19.33), presence of AIDS-like clinical symptoms (aOR: 3.97; 95 % CI: 1.32-14.0), and history of sexually transmitted infections (aOR: 4.93; 95 % CI: 1.25-19.43) were associated with ART initiation. Compared with men who did not initiated ART, those with ART were more likely to receive counseling on benefits of ART (96.8 % vs. 66.4 %, P = 0 < 0.01), HIV stigma coping strategy (75.8 % vs. 65.9 %, P = 0.04), mental health (66.1 % vs. 52.9 %, P = 0.02), and substance use (46.7 % vs. 36.6 %, P = 0.04). Conclusions We documented low rates of ART initiation among Chinese MSM. Policy changes for expanding ART eligibility and interventions to improve the continuum of HIV care are in progress in China. Impact evaluations can help assess continuing barriers to ART initiation among MSM.
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Affiliation(s)
- Yu Liu
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China.
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. .,Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Chandra Y Osborn
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. .,Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Pingsheng Wu
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. .,Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Yujiang Jia
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China.
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. .,Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
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Pan X, Wu M, Ma Q, Wang H, Ma W, Zeng S, Chen J, Zhang Y, Miao D, Zhou X, Jiang T, He L, Xia Y, Peng Z, Xia S. High prevalence of HIV among men who have sex with men in Zhejiang, China: a respondent-driven sampling survey. BMJ Open 2015; 5:e008466. [PMID: 26656982 PMCID: PMC4679937 DOI: 10.1136/bmjopen-2015-008466] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To examine the prevalence of HIV and risk behaviours among men who have sex with men (MSM) and to explore the feasibility of using respondent-driven sampling in this population in order to conduct customised interventions among MSM in the future. DESIGN Cross-sectional study. SETTING Zhejiang, China. PARTICIPANTS 1316 MSM. PRIMARY AND SECONDARY OUTCOME MEASURES HIV prevalence rates and factors associated with HIV infection; sociodemographic and behavioural information of participants, syphilis prevalence rates. RESULTS The adjusted prevalence of HIV and syphilis were 13.8% and 11.4%, respectively. Multivariate analysis showed that higher educational level, support treatment of HIV, negative syphilis are protective factors of HIV infection. MSM who had heterosexual behaviour before and whose primary sexual partner was HIV-positive were less likely to be infected with HIV compared with their counterparts, while frequency of sexual behaviour with primary sexual partner was positively associated with HIV infection. CONCLUSIONS This survey confirmed a high HIV prevalence among MSM in Zhejiang province. MSM are extremely vulnerable to HIV infection and comprehensive interventions are urgently needed to slow the spread of HIV among MSM.
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Affiliation(s)
- Xiaohong Pan
- Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Minni Wu
- Department of Epidemiology & Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qiaoqin Ma
- Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Hui Wang
- Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Wenzhe Ma
- Department of Epidemiology & Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shidian Zeng
- Wenzhou Center for Disease Control and Prevention, Wenzhou, Zhejiang, China
| | - Junfang Chen
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Yan Zhang
- Ningbo Center for Disease Control and Prevention, Ningbo, Zhejiang, China
| | - Dandan Miao
- Department of Epidemiology & Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xin Zhou
- Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Tingting Jiang
- Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Lin He
- Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yan Xia
- Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zhihang Peng
- Department of Epidemiology & Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shichang Xia
- Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, Zhejiang, China
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Sexual Risk Behaviors and HIV Infection among Men Who Have Sex with Men and Women in China: Evidence from a Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:850132. [PMID: 26779538 PMCID: PMC4686633 DOI: 10.1155/2015/850132] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 06/07/2015] [Accepted: 06/16/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To understand the current risk of HIV infection and transmission and further elucidate the underlying risk factors among men who have sex with men and women (MSMW) in China. METHODS Following PRISMA guidelines, we conducted a systematic review and meta-analysis of searching through Chinese and English available literature databases between January 2000 and June 2014 to identify articles. RESULTS Thirty-six articles (including 19,730 MSMW and 53,536 MSMO) met the selection criteria and the aggregated results found that MSMW have significantly higher HIV prevalence than MSMO (6.6% versus 5.4%, OR = 1.27, 95% CI = 1.01-1.58). A higher proportion of MSMW had commercial male partners in the past 6 months (18.3% versus 12.2%, OR = 1.56, 95% CI = 1.01-2.42). Additionally, substance use in the past 6 months was significantly more frequent among MSMW than MSMO (alcohol use: 27.1% versus 13.1%, OR = 2.53, 95% CI = 2.14-2.99; illicit drug use: 5.3% versus 2.5%, OR = 2.09, 95% CI = 1.48-2.95). CONCLUSION A higher proportion of commercial sex and substance use among MSMW may be a potentially indicative factor for significantly higher HIV prevalence compared to MSMO. Targeted interventions should aim at increasing the frequency of HIV/STIs screening and preventing high risk commercial sex and substance use among MSMW to decrease their HIV transmission to the general population.
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16
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Liao M, Wang M, Shen X, Huang P, Yang X, Hao L, Cox C, Wu P, Tao X, Kang D, Jia Y. Bisexual Behaviors, HIV Knowledge, and Stigmatizing/Discriminatory Attitudes among Men Who Have Sex with Men. PLoS One 2015; 10:e0130866. [PMID: 26121250 PMCID: PMC4485898 DOI: 10.1371/journal.pone.0130866] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 05/26/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the correlates for bisexual behaviors, HIV knowledge, and HIV/AIDS-related stigmatizing/discriminatory attitudes among men who have sex with men (MSM). METHODS A cross-sectional survey among MSM was conducted in 2011 to provide demographics, sexual behaviors, HIV knowledge, HIV/AIDS-related stigmatizing/discriminatory attitudes, and services in Jinan, Qingdao, and Yantai of Shandong Province of China. RESULTS Of 1230 participants, 82.8% were single, 85.7% aged <35 years, and 47.2% received college or higher education. There were 28.6% MSM who reported to be married or cohabitating or ever had sex with woman in the past 6 months (P6M). 74.5% had ≥6 HIV-related knowledge score. The average total score of stigmatizing/discriminatory attitude was 37.4±4.4(standard deviation). Bisexual behavior was independently associated with higher levels of HIV/AIDS-related stigma/discrimination(AOR = 1.1, 95% CI:1.0-1.1), older age(AOR = 1.2, 95%CI:1.1-1.2), and lower HIV-related knowledge score(AOR = 1.6, 95%CI:1.2-2.2). HIV knowledge score ≥6 was independently associated with lower levels of HIV/AIDS-related stigma/discrimination(AOR = 1.3, 95%CI:1.2-1.3), less bisexual behaviors(AOR = 0.6, 95%CI:0.5-0.9), ever received a test for HIV in the past 12 months (P12M)(AOR = 3.2, 95%CI:2.3-4.5), college or higher level education(AOR = 1.9, 95%CI:1.4-2.6), consistent condom use with men in P6M(AOR=6.9, 95%CI:4.6-10.6), recruited from internet or HIV testing sites(AOR = 11.2, 95%CI:8.0-16.1) and bars, night clubs, or tea houses(AOR = 2.5, 95%CI:1.7-4.8). Expressing higher levels of HIV/AIDS-related stigmatizing/discriminatory attitudes was independently associated with bisexual behaviors(Aβ = 0.9, 95%CI:0.4-1.4), lower HIV-related knowledge score(Aβ = 3.6, 95%CI:3.0-4.1), the number of male sex partners in the past week ≥2(Aβ = 1.4, 95%CI:1.0-1.9), unprotected male anal sex in P6M(Aβ = 1.0, 95%CI:0.5-1.6), and inversely associated with ever received HIV test(Aβ = 1.4, 95%CI:0.8-2.0) and peer education in P12M(Aβ = 1.4, 95%CI:0.9-1.9). CONCLUSION HIV/AIDS-related stigmatizing/discriminatory attitudes were associated with bisexual behaviors, low HIV testing rate, lower HIV-related knowledge and risk behaviors. This study called for innovative programs that would reduce HIV/AIDS-related stigmatizing/discriminatory attitudes and bisexual behaviors and improve the uptake of prevention service among MSM.
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Affiliation(s)
- Meizhen Liao
- Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China
| | - Mei Wang
- Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China
| | - Xingjie Shen
- Jinan Central Hospital Affiliated Shandong University, Jinan, Shandong Province 250014, P. R. China
| | - Pengxiang Huang
- Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China
| | - Xingguang Yang
- Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China
| | - Lianzheng Hao
- Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China
| | - Catherine Cox
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD 20742, United States of America
| | - Pingsheng Wu
- Department of Biostatistics, Vanderbilt University, Nashville, TN 37232, United States of America
| | - Xiaorun Tao
- Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China
| | - Dianmin Kang
- Institution for AIDS/STD Control and Prevention & Shandong Key Laboratory for Epidemic Disease Control and Prevention, Shandong CDC, Jinan, Shandong Province 250014, P. R. China
| | - Yujiang Jia
- Department of Health Policy, Vanderbilt University, Nashville, TN 37232, United States of America
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Lin H, Ding Y, Liu X, Wu Q, Shen W, He N. High Prevalence of HIV Infection and Bisexual Networks among a Sample of Men Who Have Sex with Men in Eastern China. PLoS One 2015; 10:e0129300. [PMID: 26053179 PMCID: PMC4459882 DOI: 10.1371/journal.pone.0129300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 05/08/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine homosexual and heterosexual behaviors, behavioral networks and HIV infection among men who have sex with men (MSM) in Eastern China. METHODS A cross-sectional survey was conducted among MSM in 2013 in a rural prefecture of Zhejiang province. Participants were interviewed for their sexual behaviors and sexual networks and were tested for HIV infection. RESULTS A total of 620 MSM from gay bath houses and bars participated in the survey. Of them, 58.2% aged 18 to 39 years and 49.5% were currently married with a female. The age of first homosexual contact was 26.7 years on average, ranging from 12 to 66 years. 91.0% had multiple male sex partners and 86.1% also had female sex partners in lifetime. 70 (11.3%) of the participants were tested HIV-positive. A total of 620 independent egocentric sexual networks involving 620 study participants and 1,971 reported sexual partners in the past 12 months were constructed, including 70 networks for the 70 HIV-positive participants with their 221 sexual partners and 550 networks for the 550 HIV-negative participants with their 1,750 sexual partners. The median network degree was 3 (IQR 2-4) overall and was not different between HIV-positive participants (Median: 3; IQR: 2-4) and HIV-negative participants (Median: 3; IQR: 2-4) (Mann-Whitney test, Z=-0.015, P=0.998). The proportion of networks with a multiple male sexual partnership was 63.7% overall, 62.8% for HIV-positive participants and 63.8% for HIV-negative participants (χ2=0.025, P=0.875). The proportion of networks with both male and female sexual partners was 44.8% overall, 47.1% for HIV-positive participants and 44.5% for HIV-negative participants (χ2=0.169, P=0.681). Consistent condom use and knowledge of HIV infection status were rare within the network partners. CONCLUSIONS The currently high HIV prevalence and complicated bisexual networks among MSM in the study area provides enhanced evidence for developing tailored prevention strategies for HIV transmission among and beyond the MSM population.
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Affiliation(s)
- Haijiang Lin
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
- Taizhou City Center for Disease Control and Prevention, Taizhou city of Zhejiang Province, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Xing Liu
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Qionghai Wu
- Taizhou City Center for Disease Control and Prevention, Taizhou city of Zhejiang Province, China
| | - Weiwei Shen
- Taizhou City Center for Disease Control and Prevention, Taizhou city of Zhejiang Province, China
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- * E-mail:
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Wang S, Song D, Huang W, He H, Wang M, Manning D, Zaller N, Zhang H, Operario D. Heterosexual Partnerships and the Need for HIV Prevention and Testing for Men Who Have Sex With Men and Women in China: A Qualitative Study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2015; 27:126-138. [PMID: 25915698 PMCID: PMC4893787 DOI: 10.1521/aeap.2015.27.2.126] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Previous studies have reported that approximately 30% of men who have sex with men (MSM) in China have concurrent female partners. Men who have sex with men and women (MSMW) might "bridge" HIV transmission to their female sex partners. This study aimed to explore (a) motivations for why MSMW in China engage in relationships and sexual behaviors with female partners; (b) patterns of sexual behaviors and condom use between MSMW and their female partners; and (c) barriers to and strategies for encouraging MSMW and their female partners to undergo HIV testing. The authors conducted in-depth interviews with 30 MSMW in two urban cities in China, Guangzhou and Chengdu, and used thematic analysis methods to code and interpret the data. MSMW described family, social, and workplace pressures to have a female partner, and expressed futility about their ability to form stable same-sex relationships. Although participants reported concern about the risk of personally acquiring and transmitting HIV or other sexually transmitted infections (STIs) to their female partners, they described the challenges to using condoms with female partners. HIV-positive participants described how stigma restricted their ability to disclose their HIV status to female partners, and HIV-negative participants displayed less immediate concern about the need for female partners to undergo HIV testing. Participants described a range of possible strategies to encourage HIV testing among female partners. These findings highlight the urgent need for HIV risk reduction and testing interventions for Chinese MSMW in the context of heterosexual partnerships, and they also underscore the additional need for privacy and cultural sensitivity when designing future studies.
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Wang LH, Yan J, Yang GL, Long S, Yu Y, Wu XL. Prevalence of consistent condom use with various types of sex partners and associated factors among money boys in Changsha, China. J Sex Med 2015; 12:936-45. [PMID: 25615688 DOI: 10.1111/jsm.12821] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Money boys with inconsistent condom use (less than 100% of the time) are at high risk of infection by human immunodeficiency virus (HIV) or sexually transmitted infection (STI), but relatively little research has examined their risk behaviors. AIM We investigated the prevalence of consistent condom use (100% of the time) and associated factors among money boys. METHODS A cross-sectional study using a structured questionnaire was conducted among money boys in Changsha, China, between July 2012 and January 2013. MAIN OUTCOME MEASURE Independent variables included socio-demographic data, substance abuse history, work characteristics, and self-reported HIV and STI history. Dependent variables included the consistent condom use with different types of sex partners. RESULTS Among the participants, 82.4% used condoms consistently with male clients, 80.2% with male sex partners, and 77.1% with female sex partners in the past 3 months. A multiple stepwise logistic regression model identified four statistically significant factors associated with lower likelihoods of consistent condom use with male clients: age group, substance abuse, lack of an "employment" arrangement, and having no HIV test within the prior 6 months. In a similar model, only one factor associated significantly with lower likelihoods of consistent condom use with male sex partners was identified in multiple stepwise logistic regression analyses: having no HIV test within the prior six months. As for female sex partners, two significant variables were statistically significant in the multiple stepwise logistic regression analysis: having no HIV test within the prior 6 months and having STI history. CONCLUSIONS Interventions which are linked with more realistic and acceptable HIV prevention methods are greatly warranted and should increase risk awareness and the behavior of consistent condom use in both commercial and personal relationship.
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Affiliation(s)
- Lian-Hong Wang
- Nursing School of Central South University, Changsha, China; Nursing School of ZunYi Medical College, ZunYi, China
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Wang Y, Huang Y, Chen H, Li L, Xu J, Li Z, Zhang G, Fan J, Zhao X, Jia S. Incidence and correlates of HIV and syphilis in a prospective cohort of men who have sex with men in Mianyang, China, over a 36-month period. Sex Health 2015; 12:546-55. [PMID: 26318795 DOI: 10.1071/sh14243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 06/09/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background Estimates for the HIV/AIDS epidemic from the China Ministry of Health show that the epidemic is spreading rapidly among men who have sex with men (MSM). METHODS Respondent-driven sampling (RDS) was adapted in 2009 and snowball sampling was adapted to supplement the number of participants in 2010 and 2011. Interviewer-administered questionnaires and blood tests were conducted to confirm enrolment eligibility of participants. RESULTS A total of 725 HIV-negative participants were included into the cohort study. The cohort had a HIV incidence density of 5.6 (95% CI: 3.9-7.3)/100 person-years (PY) and a syphilis incidence density of 5.6 (95% CI:3.7-7.6)/100 PY. Age ≤20 years (21-25 years, hazard ratio (HR)=0.32, 95%CI: 0.11-0.95/≥26 years, HR=0.17, 95%CI: 0.05-0.66), having not participated in peer education in the past year (HR=2.96, 95%CI: 1.19-7.35), seeking male sexual partners in a public washroom/park (HR=3.61, 95%CI: 1.03-12.47), being currently infected with syphilis (HR=3.21, 95%CI: 1.31-7.91), having sex partners aged ≥30 years (HR=3.40, 95%CI: 1.11-10.39) and having more than four male sexual partners within the past 6 months (HR=3.34, 95%CI: 1.24-9.04) were found to be risk factors for HIV seroconversion (each P<0.05). Being married (HR=2.38, 95%CI: 1.04-5.46), having not participated in peer education in the past year (HR=2.28, 95%CI: 1.08-4.82), having limited HIV/AIDS knowledge (HR=4.28, 95%CI: 1.94-9.43) and having a sexually transmitted disease infection in the past 6 months (HR=4.74, 95%CI: 1.83-12.30) were identified as factors for syphilis infection (each P<0.05). CONCLUSION The incidence rates of HIV and syphilis in Mianyang City reamained high in the cohort of MSM for 36 months. Increased attention should be given to this serious epidemic, and appropriate interventions should be implemented to address MSM-specific issues in order to prevent HIV and syphilis infection in China.
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Affiliation(s)
- Yi Wang
- Mianyang Centre for Disease Control and Prevention, Mianyang 621000, Sichuan, China
| | - Yuling Huang
- Pi'xian Centre for Disease Control and Prevention, Chengdu 610000, Sichuan, China
| | - Huailiang Chen
- Department of Infectious Diseases Prevention and Healthcare, People's Hospital of Chengdu Tianfu new area, upper Zhengbei Street 97#, Huayang, Tianfu new area, Chengdu 610000, Sichuan Province, China
| | - Liulin Li
- Mianyang Centre for Disease Control and Prevention, Mianyang 621000, Sichuan, China
| | - Jie Xu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Zhijun Li
- China office of Global AIDS Program, the United States Centers for Disease Control and Prevention, Beijing 100050, China
| | - Guanggui Zhang
- Mianyang Bureau of Health, Mianyang 621000, Sichuan, China
| | - Jing Fan
- Mianyang MSM care group, Mianyang 621000, Sichuan, China
| | - Xihe Zhao
- Mianyang Centre for Disease Control and Prevention, Mianyang 621000, Sichuan, China
| | - Shuguang Jia
- Mianyang Centre for Disease Control and Prevention, Mianyang 621000, Sichuan, China
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Abstract
BACKGROUND This study explores patterns of drug use and related correlates among a sample of men who have sex with men (MSM) and men who sell sex to other men (aka "money boys") in China. OBJECTIVES Data were collected from MSM and money boys (MBs) in Shanghai, China using a Community Popular Opinion Leader (CPOL) research design with a self-administered cross-sectional survey to: (1) describe drug use and drug use correlates and (2) examine relationships between drug use and sexual behaviors in general MSM and MBs. METHODS The sample consisted of 402 MSM (203 MBs) who live in Shanghai, China. Descriptive statistics and regression analyses were used to explore associations between drug use and sexual behaviors and make comparisons between MBs and general MSM. RESULTS MBs reported using more drugs in the last week, 3 months and ever; sex after using drugs, and unprotected sex after using drugs more frequently than general MSM. Additionally, many MBs reported receiving free drugs from their clients and those who did receive free drugs were very likely to report having unprotected sex. CONCLUSIONS It is crucial to increase research and include Chinese MSM and their drug use in the Chinese policy conversation. These data suggest that drug use and sexual behaviors after drug use among Chinese MSM differ widely based upon selling sex and separate intervention strategies may be appropriate.
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Affiliation(s)
- Eric J Nehl
- 1Department of Behavioral Sciences & Health Education, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
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Li YZ, Xu JJ, Qian HZ, You BX, Zhang J, Zhang JM, Hu QH, Chu ZX, Liu SY, Jiang YJ, Geng WQ, Shang H. High prevalence of HIV infection and unprotected anal intercourse among older men who have sex with men in China: a systematic review and meta-analysis. BMC Infect Dis 2014; 14:531. [PMID: 25287717 PMCID: PMC4287343 DOI: 10.1186/1471-2334-14-531] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 09/16/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND China has the largest number of the elderly in the world. As the proportion of elderly is rapidly increasing among national reported HIV/AIDS cases, it is a concern about HIV epidemic among older MSM in China. However, studies on HIV prevalence and unprotected anal intercourse (UAI) among Chinese older MSM were relatively few or generally had small sample sizes. METHODS English and Chinese articles published in peer-reviewed journals were identified by systematically searching 5 electronic databases including PubMed and through cross-referencing. Summary prevalence rates of HIV infection and UAI with male sexual partners were calculated, and analyses were performed using the software Comprehensive Meta-Analysis V2.0 and SPSS V17.0. Subgroup analyses were performed separately by sample size, study year, study location, recruitment settings and sampling method. RESULTS Twenty eligible cross-sectional studies (3 in English and 17 in Chinese), published between 2005 and 2013, with a total of 2812 older MSM participants, were identified. Our meta-analyses showed that the prevalence of HIV, syphilis and UAI in the last 6 months were 11.6% (95% confidence interval [CI]: 8.0%-16.6%), 23.0% (95% CI: 15.8%-32.3%) and 79.5% (95% CI: 72.7%-84.9%), respectively. HIV prevalence increased over the study period (6.3% in 2003-2007; 8.6% in 2008-2009, and 11.5% in 2010-2011, trend test Chi-square = 7.02, p = 0.008). The pooled prevalence of HIV (11.6% vs. 5.2%, Chi-square value = 36.2, p < 0.001) and UAI (79.5% vs. 52.6%, Chi-square value = 440.04, p < 0.001) among older MSM were both significantly higher than among younger age group (age < 50 years). CONCLUSIONS Older Chinese MSM have high prevalence of HIV and syphilis. Unprotected anal sex is common and further puts them at high risks of acquiring and transmitting HIV, which was one of reasons for the rapid increasing of national reported older male HIV/AIDS cases. Prevention intervention programs should be specially tailored for this high risk MSM subgroup.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China.
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Wu J, Hu Y, Jia Y, Su Y, Cui H, Liu H, Wang N. Prevalence of unprotected anal intercourse among men who have sex with men in China: an updated meta-analysis. PLoS One 2014; 9:e98366. [PMID: 24874882 PMCID: PMC4038612 DOI: 10.1371/journal.pone.0098366] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 05/01/2014] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The purpose of this review was to assess the prevalence of unprotected anal intercourse (UAI) among men who have sex with men (MSM) in China. METHODS A comprehensive search was conducted including online databases like "Wanfang", Chinese National Knowledge Infrastructure, PubMed and manual searches. Analyses using random-effects models were performed to estimate the prevalence of UAI among MSM in China. RESULTS Sixty-two articles reporting eighty-two studies were selected. The pooled prevalence rates of UAI with any male partner, with regular male partners, with non-regular male partners, with casual male partners, and with commercial male partners among MSM were 53%(95%CI: 51-56%), 45%(95%CI: 39-51%), 34%(95%CI: 24-45%), 33%(95%CI: 30-36%), 12% (95%CI: 5-26%), respectively. A cumulative meta-analysis found that the pooled UAI prevalence decreased over time. CONCLUSIONS Although the prevalence of UAI with male partners among MSM in China presents a decreasing trend over the past decade, the concomitant rise in HIV prevalence and incidence indicates that current prevention intervention efforts are insufficient to effectively contain the spread of HIV. Therefore, the persistently high prevalence of risky sexual behaviors underscores the need for innovative and effective prevention strategies among MSM.
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Affiliation(s)
- Jing Wu
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Yifei Hu
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Yujiang Jia
- Department of Preventive Medicine, School of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Yingying Su
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Huixia Cui
- College of Nursing, Liaoning Medical University, Jinzhou, Liaoning, China
| | - Huixin Liu
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Ning Wang
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
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HIV prevalence trends, risky behaviours, and governmental and community responses to the epidemic among men who have sex with men in China. BIOMED RESEARCH INTERNATIONAL 2014; 2014:607261. [PMID: 24822214 PMCID: PMC4005141 DOI: 10.1155/2014/607261] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/06/2013] [Accepted: 01/03/2014] [Indexed: 11/18/2022]
Abstract
Purpose of Review. Numerous studies reported the rapid spread of HIV/AIDS epidemic among men who have sex with men (MSM) in China. This paper aims to investigate the overall epidemic trend and associated high-risk behaviours among Chinese MSM and to explore the governmental and community responses to the epidemic. Recent Findings. HIV prevalence among Chinese MSM increased rapidly in all Chinese regions in the past decade and disproportionally affected the Southwest China. In addition to the high-risk homosexual behaviours, overlapping bisexual, commercial, and drug use behaviours are commonly observed among Chinese MSM. The Chinese government has significantly expanded the surveillance efforts among MSM over the past decade. Community responses against HIV have been substantially strengthened with the support of international aid. However, lack of enabling legal and financial environment undermines the role of community-based organisations (CBOs) in HIV surveillance and prevention. Conclusion. HIV continues to spread rapidly among MSM in China. The hidden nature of MSM and the overlapping homosexual, bisexual, and commercial behaviours remain a challenge for HIV prevention among MSM. Strong collaboration between the government and CBOs and innovative intervention approaches are essential for effective HIV surveillance and prevention among MSM in China.
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Alcohol use, stigmatizing/discriminatory attitudes, and HIV high-risk sexual behaviors among men who have sex with men in China. BIOMED RESEARCH INTERNATIONAL 2014; 2014:143738. [PMID: 24795879 PMCID: PMC3985170 DOI: 10.1155/2014/143738] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 02/22/2014] [Indexed: 11/20/2022]
Abstract
Objective. This research was conducted to assess the correlates of alcohol consumption and HIV/AIDS-related stigmatizing and discriminatory attitudes among men who have sex with men (MSM) in Shandong province, China. Methods. A cross-sectional survey provided demographics, sexual behaviors, illicit drug use, alcohol consumptions, and service utilization. Results. Of 1,230 participants, 82.8% were single, 85.7% aged <35 years, 47.2% had college or higher education, and 11.7% drank alcohol >3 times per week in the past six months. The average total score of stigmatizing and discriminatory attitude was 37.4 ± 4.4. More frequent episodes of alcohol use were independently associated with higher levels of HIV/AIDS-related stigma and discrimination, unprotected anal sex, bisexual identity, multiple male sex partners, drug use, and lower levels of education. Expressing higher levels of HIV/AIDS-related stigmatizing and discriminatory attitudes was independently associated with alcohol use, unprotected male anal sex, bisexuals, more male sex partners, commercial sex with men, and non-receipt of peer education in the past year. Conclusion. HIV/AIDS-related stigmatizing and discriminatory attitudes are common and associated with alcohol use and unprotected sex among MSM. The finding highlights the needs to develop programs that would reduce HIV/AIDS-related stigmatizing and discriminatory attitudes and strengthen alcohol use prevention and risk reduction initiatives among MSM.
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Kasatpibal N, Viseskul N, Srikantha W, Fongkaew W, Surapagdee N, Grimes RM. Effects of Internet-based instruction on HIV-prevention knowledge and practices among men who have sex with men. Nurs Health Sci 2014; 16:514-20. [PMID: 24645824 DOI: 10.1111/nhs.12135] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 01/17/2014] [Accepted: 01/20/2014] [Indexed: 11/30/2022]
Abstract
HIV infection is increasing among men who have sex with men. In this study, the effects of Internet-based instruction on HIV-prevention knowledge were evaluated. The sample consisted of 162 men-who-have-sex-with-men volunteers in Thailand. The research instruments included a demographic data questionnaire, a knowledge test, and an HIV preventive practice questionnaire. The participants completed these instruments upon entry to the study and four months later. After entry to the study, the participants were given access to a previously-developed Internet-based instruction on HIV risk behaviors. Data were analyzed using descriptive statistics and paired t-test. After accessing the Internet-based instruction, the average score of HIV-prevention knowledge among the sample increased significantly, from 11.17 to 15.09 (maximum score of 20 points). The average score of practicing HIV prevention among the sample increased significantly, from 62.94 to 76.51 (maximum score of 99 points). This study demonstrated that Internet-based instruction was effective in improving HIV-prevention knowledge and practices among men who have sex with men. This suggests that Internet-based instruction could be developed for use in other countries and evaluated in a similar way.
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Affiliation(s)
- Nongyao Kasatpibal
- Division of Nursing Science, Chiang Mai University, Chiang Mai, Thailand
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27
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Disparities and risks of sexually transmissible infections among men who have sex with men in China: a meta-analysis and data synthesis. PLoS One 2014; 9:e89959. [PMID: 24587152 PMCID: PMC3933676 DOI: 10.1371/journal.pone.0089959] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/24/2014] [Indexed: 01/04/2023] Open
Abstract
Background Sexually transmitted infections (STIs), including Hepatitis B and C virus, are emerging public health risks in China, especially among men who have sex with men (MSM). This study aims to assess the magnitude and risks of STIs among Chinese MSM. Methods Chinese and English peer-reviewed articles were searched in five electronic databases from January 2000 to February 2013. Pooled prevalence estimates for each STI infection were calculated using meta-analysis. Infection risks of STIs in MSM, HIV-positive MSM and male sex workers (MSW) were obtained. This review followed the PRISMA guidelines and was registered in PROSPERO. Results Eighty-eight articles (11 in English and 77 in Chinese) investigating 35,203 MSM in 28 provinces were included in this review. The prevalence levels of STIs among MSM were 6.3% (95% CI: 3.5–11.0%) for chlamydia, 1.5% (0.7–2.9%) for genital wart, 1.9% (1.3–2.7%) for gonorrhoea, 8.9% (7.8–10.2%) for hepatitis B (HBV), 1.2% (1.0–1.6%) for hepatitis C (HCV), 66.3% (57.4–74.1%) for human papillomavirus (HPV), 10.6% (6.2–17.6%) for herpes simplex virus (HSV-2) and 4.3% (3.2–5.8%) for Ureaplasma urealyticum. HIV-positive MSM have consistently higher odds of all these infections than the broader MSM population. As a subgroup of MSM, MSW were 2.5 (1.4–4.7), 5.7 (2.7–12.3), and 2.2 (1.4–3.7) times more likely to be infected with chlamydia, gonorrhoea and HCV than the broader MSM population, respectively. Conclusion Prevalence levels of STIs among MSW were significantly higher than the broader MSM population. Co-infection of HIV and STIs were prevalent among Chinese MSM. Integration of HIV and STIs healthcare and surveillance systems is essential in providing effective HIV/STIs preventive measures and treatments. Trial Registration PROSPERO No: CRD42013003721
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28
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Fan EL. HIV testing as prevention among MSM in China: The business of scaling-up. Glob Public Health 2014; 9:85-97. [DOI: 10.1080/17441692.2014.881520] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Changing the landscape of the HIV epidemic among MSM in China: results from three consecutive respondent-driven sampling surveys from 2009 to 2011. BIOMED RESEARCH INTERNATIONAL 2014; 2014:563517. [PMID: 24575408 PMCID: PMC3918367 DOI: 10.1155/2014/563517] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 12/27/2013] [Indexed: 11/17/2022]
Abstract
This study assessed the changes of HIV incidence and its predictors among Beijing's men who have sex with men (MSM). Three consecutive cross-sectional surveys were carried out using a consistent respondent-driven sampling (RDS) approach in 2009, 2010, and 2011, respectively. Structured-questionnaire based interviews were completed with computer-assisted self-administration. Incident infection was examined with BED capture enzyme immunoassay (BED-CEIA). The overall rate of HIV prevalence was 8.0% in the three years (95% confidence interval [CI]: 4.9%-11.2%). The overall rate of BED-CEIA incidence was 7.8/100 person years (PY) (95% CI: 5.5-10.1) with 6.8/100PY (95% CI: 3.4-10.2) in 2009, 11.2/100PY (95% CI: 6.2-16.3) in 2010, and 5.8/100PY (95% CI: 2.4-9.3) in 2011, respectively. Multivariable logistic regression analysis revealed that, compared with HIV-negative MSM, recently infected MSM were more likely to be bisexual (adjusted odds ratio [AOR] = 2.1, 95% CI: 1.1-4.1), live in Beijing ≤3 years (AOR = 2.1, 95% CI: 1.2-4.0), and have a negative attitude towards safe sex (AOR = 1.1 per scale point, 95% CI: 1.0-1.1). This study demonstrated a disturbing rise of HIV infections among Beijing's MSM. These findings underscored the urgency of scaling up effective and better-targeted intervention services to stop the rapid spread of the virus.
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Chow EPF, Jing J, Feng Y, Min D, Zhang J, Wilson DP, Zhang X, Zhang L. Pattern of HIV testing and multiple sexual partnerships among men who have sex with men in China. BMC Infect Dis 2013; 13:549. [PMID: 24238403 PMCID: PMC3840637 DOI: 10.1186/1471-2334-13-549] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 11/07/2013] [Indexed: 11/28/2022] Open
Abstract
Background Men who have sex with men (MSM) are a hidden but emerging population susceptible to HIV infection against a background of rapidly increasing HIV prevalence in China. Low HIV testing levels and multiple partnerships among MSM are two major contributing factors to HIV transmission. Methods We conducted a cross-sectional survey among 447 Chinese MSM in Changsha and Tianjin cities from November to December 2011 using an anonymous questionnaire. We aim to investigate (1) the trend of HIV testing rates among Chinese MSM during 2009 to 2011; and (2) the patterns of multiple sexual relationships with male, female and commercial partners. Results The self-reported past-12-months HIV testing level among Chinese MSM increased from 16.6% in 2009 to 46.3% in 2010 and 58.6% in 2011 (χ2 = 173.49, p < 0.001). Compared with men who have tested for HIV, the never-tested MSM were generally younger, never married, students, and more likely to have unprotected anal intercourse with non-commercial male partners. Furthermore, 21.3% (56/263) MSM reported having multiple regular male and female sexual partnerships and 6.2% (16/257) reported having commercial male partners in the past six months. However, individuals who were never-tested for HIV are consistently less likely to engage in multiple sexual relationships. Conclusions HIV testing rates have increased substantially among Chinese MSM in the period 2009–2011, although significant barriers to testing remain. Multiple sexual partnerships, and especially bisexual behaviours, are common among Chinese MSM.
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Affiliation(s)
| | | | | | | | | | | | - Xiaohu Zhang
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
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Zhang L, Chow EPF, Jing J, Zhuang X, Li X, He M, Sun H, Li X, Gorgens M, Wilson D, Wang L, Guo W, Li D, Cui Y, Wang L, Wang N, Wu Z, Wilson DP. HIV prevalence in China: integration of surveillance data and a systematic review. THE LANCET. INFECTIOUS DISEASES 2013; 13:955-63. [PMID: 24107261 DOI: 10.1016/s1473-3099(13)70245-7] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Asian HIV epidemics are concentrated among particular behavioural groups, but large variations exist in epidemic types, timing, and geographical spread between countries and within countries, especially in China. We aimed to understand the complexity of HIV epidemics in China by systematically analysing prevalence trends by data source, region, population group, and time period. METHODS We collected HIV prevalence data from official national sentinel surveillance sites at the provincial level from Jan 1, 1995, to Dec 31, 2010. We also searched PubMed, VIP Chinese Journal Database (VIP), China National Knowledge Infrastructure, and Wanfang Data from Jan 1, 1990, to Dec 31, 2012, for independent studies of HIV prevalence. We integrated both sets of data, and used an intraclass correlation coefficient test to assess the similarity of geographical pattern of HIV disease burden across 31 Chinese provinces in 2010. We investigated prevalence trends (and 95% CIs) to infer corresponding incidence by region, population group, and year. FINDINGS Of 6850 articles identified by the search strategy, 821 studies (384,583 drug users, 52,356 injecting drug users, 186,288 female sex workers, and 87,834 men who have sex with men) met the inclusion criteria. Official surveillance data and findings from independent studies showed a very similar geographical distribution and magnitude of HIV epidemics across China. We noted that HIV epidemics among injecting drug users are decreasing in all regions outside southwest China and have stabilised at a high level in northwest China. Compared with injecting drug users, HIV prevalence in female sex workers is much lower and has stabilised at low levels in all regions except in the southwest. In 2010, national HIV prevalence was 9·08% (95% CI 8·04-10·52) in injecting drug users and 0·36% (0·12-0·71) in female sex workers, whereas incidence in both populations stabilised at rates of 0·57 (0·43-0·72) and 0·02 (0·01-0·04) per 100 person-years, respectively. By comparison, HIV prevalence in men who have sex with men increased from 1·77% (1·26-2·57) in 2000, to 5·98% (4·43-8·18) in 2010, with a national incidence of 0·98 (0·70-1·25) per 100 person-years in 2010. We recorded strong associations between HIV prevalence among at-risk populations in each province, supporting the existence of overlap in risk behaviours and mixing among these populations. INTERPRETATION HIV epidemics in China remain concentrated in injecting drug users, female sex workers, and men who have sex with men. HIV prevalence is especially high in southwest China. Sex between men has clearly become the main route of HIV transmission.
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Affiliation(s)
- Lei Zhang
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Comprehensive AIDS Research Center, Tsinghua University, Beijing, China.
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Tao J, Ruan Y, Yin L, Vermund SH, Shepherd BE, Shao Y, Qian HZ. Sex with women among men who have sex with men in China: prevalence and sexual practices. AIDS Patient Care STDS 2013; 27:524-8. [PMID: 23931683 DOI: 10.1089/apc.2013.0161] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Men who have sex with men and women (MSMW) are a potential bridge population for transmitting HIV to heterosexual women. This study assessed key characteristics of this subgroup of men who have sex with men (MSM) in China. Of 1141 eligible MSM, 45.6% reported bisexual behaviors. Besides marriage as a strong predictor (odds ratio: 23.90, 95% confidence interval: 14.29-39.98), older age (1.12, 1.10-1.15) and lower education (or no college education) (1.98, 1.52-2.59) were also independently associated with having ever had sex with women. MSMW reported higher proportions of alcohol drinking, heterosexual/bisexual orientation, and preference for an insertive role in anal sex than men who had sex with men only; but there was no statistically significant difference between two groups in prevalence of HIV and syphilis infections and in history of sexually transmitted infections. HIV prevention intervention programs should break the bridging role of HIV transmission in MSMW population.
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Affiliation(s)
- Jun Tao
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Lu Yin
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
| | - Sten H. Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Bryan E. Shepherd
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Yiming Shao
- State Key Laboratory for Infectious Disease Prevention and Control and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
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Li Y, Xu J, Reilly KH, Zhang J, Wei H, Jiang Y, Geng W, Tang W, Shang H. Prevalence of HIV and syphilis infection among high school and college student MSM in China: a systematic review and meta-analysis. PLoS One 2013; 8:e69137. [PMID: 23874891 PMCID: PMC3712943 DOI: 10.1371/journal.pone.0069137] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 06/04/2013] [Indexed: 11/19/2022] Open
Abstract
Objectives The aim of this study is to systematically review the published studies and summarize the estimates of HIV and syphilis prevalences among high school and college student MSM in China in order to provide information for conducting targeted interventions. Methods Pubmed, Chinese National Knowledge Infrastructure, Wanfang and Google Scholar databases were searched in January 2013 to identify relevant articles. Data of eligible citations were extracted by two reviewers. All analyses were performed using Comprehensive Meta-Analysis V2.0 and SPSS V17.0. Results Twenty-four eligible studies (6 in English and 18 in Chinese), published between 2006 and 2012, with a total of 3083 student MSM participants, were included. The meta-analyses showed that the prevalences of HIV and syphilis among studied student MSM were 4.4% (95% CI: 3.0%, 6.4%) and 5.7% (95% CI: 4.8%, 6.7%), respectively. HIV prevalence increased over the study period (3.0% in 2003–2006; 4.5% in 2007–2008, and 6.8% in 2009–2010, trend test chi-square = 11.3, p = 0.001). Conclusions Student MSM have become high-risk populations for HIV infection in China. The high prevalence of syphilis and the increasing HIV prevalence trend indicate the potential for a more severe HIV epidemic. Comprehensive intervention strategies that address condom promotion, syphilis detection and treatment, and health education need to be tailored to this vulnerable population to prevent HIV and syphilis infections.
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Affiliation(s)
- Yongze Li
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Junjie Xu
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Kathleen H. Reilly
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianming Zhang
- Department of Clinical Epidemiology and Evidence-based Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongyi Wei
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yongjun Jiang
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wenqing Geng
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Weiming Tang
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Hong Shang
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
- * E-mail:
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Human immunodeficiency virus prevalence is increasing among men who have sex with men in China: findings from a review and meta-analysis. Sex Transm Dis 2013; 38:845-57. [PMID: 21844741 DOI: 10.1097/olq.0b013e31821a4f43] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND METHOD Multiple studies reported a fast-spreading human immunodeficiency virus (HIV) epidemic among men who have sex with men (MSM) in China. This study aimed to estimate the magnitude and time trends of HIV prevalence among MSM in different geographical regions of China through a systemic review and meta-analysis. RESULTS A total of 94 articles were identified (25 in English and 69 in Chinese) and analyzed. National HIV prevalence among Chinese MSM has increased over this period, from 1.4% (95% confidence interval [CI]: 0.8%-2.4%) in 2001 to 5.3% (95% CI: 4.8%-5.8%) in 2009. MSM in Southwest China have the highest HIV prevalence, of 11.4% (95% CI: 9.6%-13.5%) in comparison with other regions, which range 3.5% to 4.8%. CONCLUSION Significant increases in HIV prevalence among MSM were consistently observed across all Chinese regions. There is an urgent need for implementation of effective public health interventions to curb the spread of HIV infection among MSM across China, especially in the Southwest.
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35
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Yasin F, Delegchoimbol A, Jamiyanjamts N, Sovd T, Mason K, Baral S. A cross-sectional evaluation of correlates of HIV testing practices among men who have sex with men (MSM) in Mongolia. AIDS Behav 2013; 17:1378-85. [PMID: 23354852 DOI: 10.1007/s10461-013-0412-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study analyzed patterns and associations of HIV testing including sexual practices, HIV related knowledge, and human rights contexts among MSM in Mongolia. 313 participants were accrued using respondent-driven sampling and administered a structured questionnaire. Descriptive statistics are presented with crude and adjusted-point estimates with confidence intervals (95 % CI); and logistic regression models were used to identify factors associated with HIV testing in the last 12 months. RDS-adjustment demonstrated that 48.9 % (95 % CI = 36.7-58.3) of MSM had an HIV test in the past 12 months. Logistic regression revealed that experience of a human rights violation, enacted (OR = 0.50, 95 % CI = 0.26-0.97) or perceived (OR = 0.56, 95 % CI = 0.26-0.97), was inversely associated with a recent HIV test. Higher level of education (OR = 1.84, 95 % CI = 1.14-2.99), knowledge that anal sex is highest risk for HIV infection (OR = 4.54, 95 % CI = 2.41-8.56), and having 5 or more male sexual partners (OR = 1.82, 95 % CI = 1.00-3.30), were positively associated with a recent HIV test. MSM in Mongolia are at high risk for HIV infection and coverage of HIV testing is suboptimal. Understanding the variable sexual risk practices and barriers to HIV testing are vital to designing effective and relevant HIV-status dependent HIV intervention services.
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36
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Liu J, Qu B, Ezeakile MC, Zhang Y. Factors associated with unprotected anal intercourse among men who have sex with men in Liaoning Province, China. PLoS One 2012; 7:e50493. [PMID: 23209757 PMCID: PMC3507786 DOI: 10.1371/journal.pone.0050493] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 10/25/2012] [Indexed: 12/04/2022] Open
Abstract
Background HIV prevalence among men who have sex with men (MSM) has increased rapidly. MSM may play a bridging role in the spread of HIV and other STDs from the high-risk population to the general population. Interventions to reduce high-risk behavior are the key to controlling the spreading of HIV in the MSM population and the primary strategy for reducing the spread of AIDS in China. The purpose of the study was to examine the demographic characteristics of MSM, evaluate the HIV-related knowledge of MSM, and identify factors associated with unprotected anal intercourse (UAI) among MSM to make recommendations for future research. Methodology/Principal Finding A cross-sectional survey was conducted among 293 MSM in Fushun and Huludao City, China. A total of 91 participants (34.0%) reported engagement in UAI with a male partner during the previous six months. The results of univariate analysis showed that UAI was associated with older age, lower levels of education, less knowledge about HIV, and not receiving condoms, lubricant, peer education, AIDS counseling, STD checks, and informational materials (p<0.05). In a multivariate logistic regression model, awareness of the major HIV transmission routes (OR = 2.191; 95% CI: 0.869 to 5.524), receiving condoms (OR = 2.164; 95% CI: 1.149 to 4.076), receiving peer education (OR = 2.632; 95% CI: 1.566 to 4.426), and AIDS counseling (OR = 2.347; 95% CI: 1.260 to 4.372) were independently associated with a lower risk of UAI. Conclusions/Significance The study suggested that UAI could be decreased by improving education about AIDS, increasing the promotion of voluntary counseling and testing (VCT), and improving the accessibility and convenience of service.
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Affiliation(s)
- Jie Liu
- Faculty of Health Statistics, School of Public Health, China Medical University, Shenyang, China
| | - Bo Qu
- Faculty of Health Statistics, School of Public Health, China Medical University, Shenyang, China
- * E-mail:
| | - Moses C. Ezeakile
- Faculty of Health Statistics, School of Public Health, China Medical University, Shenyang, China
| | - Yang Zhang
- Faculty of Health Statistics, School of Public Health, China Medical University, Shenyang, China
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37
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Zou H, Hu N, Xin Q, Beck J. HIV testing among men who have sex with men in China: a systematic review and meta-analysis. AIDS Behav 2012; 16:1717-28. [PMID: 22677975 DOI: 10.1007/s10461-012-0225-y] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
HIV testing among men who have sex with men (MSM) in China has not been well studied. We systematically reviewed studies addressing HIV testing among MSM in China and conducted a meta-analysis on testing indicators before and after the adoption of China's National Plan for HIV/AIDS Prevention and Control among MSM in 2007. Rate of lifetime HIV testing (24 % [period 1-before adoption] vs. 47 % [period 2-after adoption]) and testing in the past 12 months (21 vs. 38 %) were both significantly higher in period 2. Rate of lifetime pre-test counseling showed a significant increase from period 1 to period 2 (72 vs. 90 %), while the figure for the past 12 months pre-test counseling did not change (51 vs. 50 %). More efforts are needed to promote frequent HIV testing among MSM.
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38
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Lim SH, Guadamuz TE, Wei C, Chan R, Koe S. Factors associated with unprotected receptive anal intercourse with internal ejaculation among men who have sex with men in a large Internet sample from Asia. AIDS Behav 2012; 16:1979-87. [PMID: 22714116 DOI: 10.1007/s10461-012-0233-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We examined socio-demographic and behavioral characteristics of men who have sex with men (MSM) residing in Asia and correlates of unprotected receptive intercourse with Internet ejaculation (URAIE). Asia Internet MSM Sex Survey, a behavioral survey of MSM in Asia was conducted from 1 January to 28 February 2010. Data analysis was limited to participants aged 18 or above, biological male, and had one regular or casual sex partner in the past 6 months (n = 10,413). Pearson's Chi-square test, t test and logistic regression were used to examine the correlates of URAIE in the past 6 months, the highest risk sexual behavior sampled. Of 7311 participants who had receptive anal intercourse, 47.5 % had URAIE, which was associated with the following attributes: less than high-school education and pre-college education compared to university (AOR = 1.53, 95 % CI: 1.28, 1.83; AOR = 1.22, CI: 1.08, 1.37), being in the heterosexual marriage (AOR = 1.35, CI: 1.18, 1.56), having regular partners or both regular and casual partners compared to having casual partners (AOR = 2.85, CI: 2.48, 3.27; AOR = 2.32, CI: 2.06, 2.62), HIV-positive compared to HIV-negative status (AOR = 1.39, 95 % CI: 1.08, 1.81), higher perception of HIV risk (AOR = 1.62, CI: 1.34, 1.95), use of recreational drug before sex (AOR = 1.30, CI: 1.14, 1.49), and use of the Internet as the main way to seek sex partners (AOR = 1.21, CI: 1.08, 1.36). MSM from certain Asian countries reported alarming rates of URAIE. The internet can be used as a platform for HIV surveillance and intervention.
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Kasatpibal N, Viseskul N, Srikantha W, Fongkaew W, Surapagdee N, Grimes RM. Developing a web site for human immunodeficiency virus prevention in a middle income country: a pilot study from Thailand. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2012; 15:560-3. [PMID: 23002987 DOI: 10.1089/cyber.2012.0101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The Internet has often been used to reach men who have sex with men (MSMs) in developed countries. However, its use has not been as widespread in middle income countries because of a perceived lack of access to the web by residents of these countries. However, over half of the Internet users in the world now live in middle income countries. This article describes the development of web-based human immunodeficiency virus (HIV) prevention program that can serve as a model for middle income countries. Thai nursing faculty worked with MSMs to create and evaluate a Web site that provided HIV prevention messages directed toward MSMs. The steps for creating the site are described. Forty-one MSMs used the site and provided feedback to the site developers. The group was young (median=19 years), low income (median income was ∼170 US$ per month). The users demonstrated that they had access to the Internet and that they could utilize the site. They also reported moderate-to-high levels of satisfaction with site design, content, ease of use, information obtained, and benefits obtained from using the site. A previous article in the Thai language also showed that they reduced risk behaviors. They also made many useful suggestions for improving the content of the site. In conclusion, the study showed that the combination of nurses and MSMs from a middle income country could develop a usable HIV prevention Web site that instructed and changed behavior.
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40
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Wang B, Li X, Stanton B, Liu Y, Jiang S. Socio-demographic and behavioral correlates for HIV and syphilis infections among migrant men who have sex with men in Beijing, China. AIDS Care 2012; 25:249-57. [PMID: 22788859 DOI: 10.1080/09540121.2012.701714] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Migrant men who have sex with men (MSM) may be particularly vulnerable to sexually transmitted infections (STIs) including HIV. This study examines the rates of HIV and syphilis infections and associated socio-demographic and behavioral factors among migrant MSM in China. Data from 307 migrant MSM were collected in Beijing, China. Blood specimens were collected to test for HIV and syphilis infections. HIV and syphilis rates were 5.9% and 20.2%, respectively. Multivariate logistic regression analyses showed that having ever been married, living a longer period in Beijing, having more sexual partners, and having a foreign MSM friend were significantly associated with HIV infection. Migrating from a rural area, experiencing one's sexual debut at an older age, having a male as first sexual partner, having more sexual partners, and being recruited from peer outreach and social network were associated with syphilis infection. Migrant MSM in China are at high risk for HIV and syphilis infections. HIV prevention programs targeting rural migrant MSM who have been married are needed.
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Affiliation(s)
- Bo Wang
- Pediatric Prevention Research Center, Wayne State University School of Medicine, Detroit, MI, USA.
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41
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Zhou F, Gao L, Li S, Li D, Zhang L, Fan W, Yang X, Yu M, Xiao D, Yan L, Zhang Z, Shi W, Luo F, Ruan Y, Jin Q. Willingness to accept HIV pre-exposure prophylaxis among Chinese men who have sex with men. PLoS One 2012; 7:e32329. [PMID: 22479320 PMCID: PMC3316531 DOI: 10.1371/journal.pone.0032329] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 01/25/2012] [Indexed: 11/19/2022] Open
Abstract
Objective We investigated the awareness and acceptability of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and potential predicting factors. Methods This study was conducted among MSM in Beijing, China. Study participants, randomly selected from an MSM cohort, completed a structured questionnaire, and provided their blood samples to test for HIV infection and syphilis. Univariate logistic regression analyses were performed to evaluate the factors associated with willingness to accept (WTA) PrEP. Factors independently associated with willingness to accept were identified by entering variables into stepwise logistic regression analysis. Results A total of 152 MSM completed the survey; 11.2% had ever heard of PrEP and 67.8% were willing to accept it. Univariate analysis showed that age, years of education, consistent condom use in the past 6 months, heterosexual behavior in the past 6 months, having ever heard of PrEP and the side effects of antiretroviral drugs, and worry about antiretroviral drugs cost were significantly associated with willingness to accept PrEP. In the multivariate logistic regression model, only consistent condom use in the past 6 months (odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.13–0.70) and having ever heard of the side effects of antiretroviral drugs (OR: 0.30; 95% CI: 0.14–0.67) were independently associated with willingness to accept PrEP. Conclusions The awareness of PrEP in the MSM population was low. Sexual behavioral characteristics and knowledge about ART drugs may have effects on willingness to accept PrEP. Comprehensive prevention strategies should be recommended in the MSM community.
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Affiliation(s)
- Feng Zhou
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lei Gao
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shuming Li
- Beijing Chaoyang Center for Disease Control and Prevention, Beijing, China
| | - Dongliang Li
- Beijing Chaoyang Center for Disease Control and Prevention, Beijing, China
| | - Lifen Zhang
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academic of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Wensheng Fan
- Department of Public Health, College of Health and Human Service, Western Kentucky University, Bowling Green, Kentucky, United States of America
| | - Xueying Yang
- Beijing Chaoyang Center for Disease Control and Prevention, Beijing, China
| | - Mingrun Yu
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dong Xiao
- Chaoyang Chinese AIDS Volunteer Group, Beijing, China
| | - Li Yan
- Beijing Jingcheng Skin Diseases Hospital, Beijing, China
| | - Zheng Zhang
- Beijing Chaoyang Center for Disease Control and Prevention, Beijing, China
| | - Wei Shi
- Beijing Chaoyang Health Bureau, Beijing, China
| | - Fengji Luo
- Beijing Chaoyang Center for Disease Control and Prevention, Beijing, China
- * E-mail: (FL); (YR)
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (FL); (YR)
| | - Qi Jin
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Chow EPF, Wilson DP, Zhang L. Estimating HIV incidence among female partners of bisexual men in China. Int J Infect Dis 2012; 16:e312-20. [PMID: 22440544 DOI: 10.1016/j.ijid.2012.01.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 01/21/2012] [Accepted: 01/24/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND HIV prevalence among men who have sex with men (MSM) in China is rapidly increasing. The majority of Chinese MSM engage in bisexual behaviors and their female partners may be at high risk of HIV infection. METHODS Through a comprehensive literature review and the utilization of a mathematical optimization approach, this study infers quantitative distributions of sexual behavioral practices between Chinese MSM and their female partners over the past decade, and consequently estimates the trends in HIV incidence rates among female partners of Chinese MSM. RESULTS The average Chinese MSM had approximately 0.89 (95% confidence interval (CI) 0.68-1.23) female sexual partners, with a mean number of total penetrative acts with the female partners of 0.57 (95% CI 0.52-0.62), in the past 6 months. Condom usage increased slightly from 23.57% (95% CI 14.20-32.93%) in 2002 to 27.33% (95% CI 19.88-34.78%) in 2010. Thus, the substantially increasing HIV prevalence among MSM has led to an increase in HIV incidence among partners of bisexual MSM of approximately 5.3-fold, from 0.18 per 1000 person-years in 2002 to 0.88 per 1000 person-years in 2010. CONCLUSIONS Bisexual Chinese MSM may be a bridge group to the general female population for HIV transmission. There has been a substantial HIV incidence increase among their female partners.
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Affiliation(s)
- Eric P F Chow
- The Kirby Institute, University of New South Wales, CFI Building, Corner West and Boundary Streets, Darlinghurst, Sydney, NSW 2010, Australia
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43
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Fan S, Lu H, Ma X, Sun Y, He X, Li C, Raymond H, McFarland W, Sun J, Ma W, Jia Y, Xiao Y, Shao Y, Ruan Y. Behavioral and serologic survey of men who have sex with men in Beijing, China: implication for HIV intervention. AIDS Patient Care STDS 2012; 26:148-55. [PMID: 22248333 DOI: 10.1089/apc.2011.0277] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We assessed HIV prevalence and associated behaviors and risk factors among men who have sex with men (MSM) in Beijing, China. Five hundred MSM were recruited for a biological and behavioral survey using respondent-driven sampling (RDS) in 2009. Serologic specimens were tested for markers of HIV and syphilis infection. A computer-assisted personal interview (CAPI) administered questionnaire gathered information including demographic characteristics, sexual behaviors, HIV testing, and social norms concerning condom use. The adjusted HIV prevalence was 8.0%, syphilis 22.0%. HIV testing and disclosure was low; only 39.3% had HIV tested in the past 12 months, 49.7% knew their own HIV status and 22.8% knew their last male partner's HIV status. HIV infection was associated with syphilis, ever having sex with a woman, not knowing the HIV status of the most recent male partner, and never buying condoms in the past 12 months. Stronger endorsement of positive social norms around condom use strongly and predicted lower prevalence of HIV infection. Compared to surveys of similar design in the recent past, HIV continues to spread rapidly among Beijing's MSM. Our results identify points of intervention that, if addressed in time, may still alter the course of the epidemic including the promotion of HIV testing and partner disclosure, syphilis control and particularly changing social norms around condom use.
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Affiliation(s)
- Song Fan
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, P. R. China
| | - Hongyan Lu
- Beijing Center for Disease Control and Prevention, Beijing, P. R. China
| | - Xiaoyan Ma
- Beijing Center for Disease Control and Prevention, Beijing, P. R. China
| | - Yanming Sun
- Beijing Center for Disease Control and Prevention, Beijing, P. R. China
| | - Xiong He
- Beijing Center for Disease Control and Prevention, Beijing, P. R. China
| | - Chunmei Li
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, P. R. China
| | - H.F. Raymond
- San Francisco Department of Public Health, San Francisco, California
| | - Willi McFarland
- San Francisco Department of Public Health, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Jiangping Sun
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, P. R. China
| | - Wei Ma
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, P. R. China
| | - Yujiang Jia
- Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Yan Xiao
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, P. R. China
| | - Yiming Shao
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, P. R. China
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, P. R. China
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Zheng J, Wu Z, Poundstone KE, Pang L, Rou K. HIV, syphilis infection, and risky sexual behaviors among male university students who have sex with men in Beijing, China: a cross-sectional study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2012; 24:78-88. [PMID: 22339147 DOI: 10.1521/aeap.2012.24.1.78] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Young male university students who have sex with men are at high risk of HIV and sexually transmitted infections (STIs). We conducted a cross-sectional survey to assess the prevalence of risky sexual behaviors, HIV, and syphilis among male university students who have sex with men in Beijing, China; and to identify risk factors for unprotected anal intercourse (UAI). Among 157 study participants, HIV and syphilis prevalence were 2.5% and 7.0%, respectively. We found a high prevalence of UAI in our study population. Multiple logistic regression analysis revealed two significant predictors of UAI: believing it is not necessary to use a condom with a regular sex partner and not feeling anxious about being gay. Not using a condom during first sexual experience with a man was a marginally significant predictor of UAI. Male university students who have sex with men are especially vulnerable to HIV and STIs. Intensified education and HIV testing programs are needed to reduce risk in this population.
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Affiliation(s)
- Jiandong Zheng
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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45
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Chow EPF, Wilson DP, Zhang L. The rate of HIV testing is increasing among men who have sex with men in China. HIV Med 2012; 13:255-63. [PMID: 22252151 DOI: 10.1111/j.1468-1293.2011.00974.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES HIV infection is spreading relatively quickly among men who have sex with men (MSM) in China. Accurate knowledge of HIV status is of high importance for public health prevention. METHODS We conducted a systematic review of literature published in either English or Chinese to collate available HIV testing data among MSM in China. Linear regression and Spearman's rank correlation were used to study factors associated with HIV testing rates. RESULTS Fifty-five eligible articles were identified in this review. The proportion of MSM who had ever been tested for HIV has significantly increased, from 10.8% in 2002 to 51.2% in 2009. In comparison, reported rates of HIV testing in the past 12 months have also significantly increased, from 11.0% in 2003 to 43.7% in 2009. CONCLUSIONS Chinese MSM have relatively low HIV testing rates compared with MSM in other settings. It is important to continue to promote HIV testing among MSM in China.
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Affiliation(s)
- E P F Chow
- The Kirby Institute for Infection and Immunity in Society, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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46
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Liao M, Kang D, Jiang B, Tao X, Qian Y, Wang T, Bi Z, Xiao Y, Li C, Wu P, Vermund SH, Jia Y. Bisexual behavior and infection with HIV and syphilis among men who have sex with men along the east coast of China. AIDS Patient Care STDS 2011; 25:683-91. [PMID: 21923416 DOI: 10.1089/apc.2010.0371] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study examined the correlates of bisexual behavior and infection with HIV/syphilis among men who have sex with men only (MSM-only) and those who have sex with both men and women (MSMW) in Shandong, China. Cross-sectional surveys probed sociodemographic information, sexual and drug use behaviors, knowledge, and use of prevention services; blood samples were tested for HIV/syphilis status. Of 2996 participants, 39.5% acknowledged being MSMW; 60.5% being MSM-only; 2.5% were HIV-infected with similar rates for MSMW (2.5%) and MSM-only (2.6%); 5.5% syphilis-infected with comparable rates for MSMW (5.6%) and MSM-only (5.5%). In multivariable models, MSMW were more likely than MSM-only to be older, local residents, recruited from outdoor cruising area, drug users, and less likely to have used a condom during last anal sex with a male partner. HIV-infected MSMW were more likely to have syphilis and other sexually transmitted diseases (STDs) and less likely to have received peer education. HIV-infected MSM-only were more likely to be older, nonlocal residents, and have syphilis and other STDs. MSMW with syphilis were more likely to be recruited from Jinan, Qingdao, and Zibo (versus Yantai), infected with HIV, and less likely to have received lubricant promotion. MSM-only with syphilis were more likely to be recruited from Jinan and Qingdao (versus Yantai), drug users, infected with HIV, and have had sex with male partners in the past 6 months. High prevalence of bisexual behavior and HIV/other STDs with common unprotected sex and multiple sexual partners among Shandong's gay community revealed in this study highlighted the importance of bisexuals as a potential epidemiologic bridge. Further research is needed to investigate the impact of bisexual behaviors on population transmission.
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Affiliation(s)
- Meizhen Liao
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Dianming Kang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Baofa Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong Province, P.R. China
| | - Xiaorun Tao
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Yueshen Qian
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Tongzhan Wang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Zhenqiang Bi
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, P.R. China
| | - Yan Xiao
- National AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, P.R. China
| | - Chunmei Li
- National AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, P.R. China
| | - Pingsheng Wu
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Sten H. Vermund
- Department of Preventive Medicine, Vanderbilt University, Nashville, Tennessee
- Department of Institute for Global Health, Vanderbilt University, Nashville, Tennessee
| | - Yujiang Jia
- Department of Preventive Medicine, Vanderbilt University, Nashville, Tennessee
- Department of Institute for Global Health, Vanderbilt University, Nashville, Tennessee
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47
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Chow EPF, Wilson DP, Zhang L. What is the potential for bisexual men in China to act as a bridge of HIV transmission to the female population? Behavioural evidence from a systematic review and meta-analysis. BMC Infect Dis 2011; 11:242. [PMID: 21920042 PMCID: PMC3180676 DOI: 10.1186/1471-2334-11-242] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 09/15/2011] [Indexed: 11/26/2022] Open
Abstract
Background HIV prevalence among men who have sex with men (MSM) in China has rapidly increased in recent years. It is suggested that MSM could be a potential bridge of HIV transmission to the general female population. We investigated the bisexual behaviour of MSM in China through systematic review and meta-analysis. Methods We conducted a systematic review and meta-analyses on published peer-reviewed Chinese and English literature during 2001-2010 according to the PRISMA guidelines. Marital status and sexual behavioural indicators of MSM were presented graphically using forest plots. The pooled effect rates with 95% confidence intervals were also calculated. Meta-regression analyses were performed to examine the factors associated with high heterogeneities across the studies. Results Forty-three eligible articles (11 in English and 32 in Chinese) were identified. Our results showed that 17.0% (95% CI: 15.1-19.1%) of MSM in China are currently married to a woman and 26.3% (95% CI: 23.6-29.1%) of MSM had female sexual partners in the last six months. The pooled estimates for condom use rate between MSM and female sex partners was 41.4% (95% CI: 35.5-47.5%) at the last sex act; and 25.6% (95% CI: 23.0-28.4%) in the last six months. The consistent condom use rates with regular, non-commercial, casual and commercial female sex partners in the last six months were 23.3% (95% CI: 11.25-42.1%), 39.0% (95% CI: 28.8-50.3%) and 55.8% (95% CI: 41.4-69.4%), respectively. Conclusions A substantial proportion of Chinese MSM is currently married or had sexual relations with a female in the past six months. In addition, low condom usage was common between married MSM and their wives, hence posing a higher risk of transmitting HIV. Harm-reduction programs targeting married MSM and their female partners are necessary to curb the further spread of HIV infection to the general female population.
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Affiliation(s)
- Eric P F Chow
- The Kirby Institute for infection and immunity in society, University of New South Wales, Sydney, Australia
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48
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Chow EPF, Wilson DP, Zhang L. What is the potential for bisexual men in China to act as a bridge of HIV transmission to the female population? Behavioural evidence from a systematic review and meta-analysis. BMC Infect Dis 2011. [DOI: 10.1186/1471-2334-11-242 [pii] 1471-2334-11-242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
HIV prevalence among men who have sex with men (MSM) in China has rapidly increased in recent years. It is suggested that MSM could be a potential bridge of HIV transmission to the general female population. We investigated the bisexual behaviour of MSM in China through systematic review and meta-analysis.
Methods
We conducted a systematic review and meta-analyses on published peer-reviewed Chinese and English literature during 2001-2010 according to the PRISMA guidelines. Marital status and sexual behavioural indicators of MSM were presented graphically using forest plots. The pooled effect rates with 95% confidence intervals were also calculated. Meta-regression analyses were performed to examine the factors associated with high heterogeneities across the studies.
Results
Forty-three eligible articles (11 in English and 32 in Chinese) were identified. Our results showed that 17.0% (95% CI: 15.1-19.1%) of MSM in China are currently married to a woman and 26.3% (95% CI: 23.6-29.1%) of MSM had female sexual partners in the last six months. The pooled estimates for condom use rate between MSM and female sex partners was 41.4% (95% CI: 35.5-47.5%) at the last sex act; and 25.6% (95% CI: 23.0-28.4%) in the last six months. The consistent condom use rates with regular, non-commercial, casual and commercial female sex partners in the last six months were 23.3% (95% CI: 11.25-42.1%), 39.0% (95% CI: 28.8-50.3%) and 55.8% (95% CI: 41.4-69.4%), respectively.
Conclusions
A substantial proportion of Chinese MSM is currently married or had sexual relations with a female in the past six months. In addition, low condom usage was common between married MSM and their wives, hence posing a higher risk of transmitting HIV. Harm-reduction programs targeting married MSM and their female partners are necessary to curb the further spread of HIV infection to the general female population.
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49
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Li HM, Peng RR, Li J, Yin YP, Wang B, Cohen MS, Chen XS. HIV incidence among men who have sex with men in China: a meta-analysis of published studies. PLoS One 2011; 6:e23431. [PMID: 21887251 PMCID: PMC3162552 DOI: 10.1371/journal.pone.0023431] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 07/17/2011] [Indexed: 12/03/2022] Open
Abstract
Background Men who have sex with men (MSM) have now become one of the priority populations for prevention and control of HIV pandemic in China. Information of HIV incidence among MSM is important to describe the spreading of the infection and predict its trends in this population. We reviewed the published literature on the incidence of HIV infection among MSM in China. Methods We identified relevant studies by use of a comprehensive strategy including searches of Medline and two Chinese electronic publication databases from January 2005 to September 2010. Point estimate of random effects incidence with corresponding 95% confidence intervals (CI) of HIV infection was carried out using the Comprehensive Meta-Analysis software. Subgroup analyses were examined separately, stratified by study design and geographic location. Results Twelve studies were identified, including three cohort studies and nine cross-sectional studies. The subgroup analyses revealed that the sub-overall incidence estimates were 3.5% (95% CI, 1.7%–5.3%) and 6.7% (95% CI, 4.8%–8.6%) for cohort and cross-sectional studies, respectively (difference between the sub-overalls, Q = 5.54, p = 0.02); and 8.3% (95% CI, 6.9%–9.7%) and 4.6% (95% CI, 2.4%–6.9%) for studies in Chongqing and other areas, respectively (difference between the sub-overalls, Q = 7.58, p<0.01). Syphilis infection (RR = 3.33, p<0.001), multiple sex partnerships (RR = 2.81, p<0.001), and unprotected receptive anal intercourse in the past six months (RR = 3.88, p = 0.007) represented significant risk for HIV seroconversion. Conclusions Findings from this meta-analysis indicate that HIV incidence is substantial in MSM in China. High incidence of HIV infection and unique patterns of sexual risk behaviors in this population serve as a call for action that should be answered with the innovative social and public health intervention strategies, and development of biological prevention strategies.
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Affiliation(s)
- Hong-Min Li
- Chinese Academy of Medical Sciences Institute of Dermatology, Nanjing, China
| | - Rui-Rui Peng
- Chinese Academy of Medical Sciences Institute of Dermatology, Nanjing, China
| | - Jing Li
- Chinese Academy of Medical Sciences Institute of Dermatology, Nanjing, China
| | - Yue-Ping Yin
- Chinese Academy of Medical Sciences Institute of Dermatology, Nanjing, China
- China Center for Disease Control and Prevention, National Center for STD Control, Nanjing, China
| | - Baoxi Wang
- Chinese Academy of Medical Sciences Institute of Dermatology, Nanjing, China
- China Center for Disease Control and Prevention, National Center for STD Control, Nanjing, China
| | - Myron S. Cohen
- Center of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Xiang-Sheng Chen
- Chinese Academy of Medical Sciences Institute of Dermatology, Nanjing, China
- China Center for Disease Control and Prevention, National Center for STD Control, Nanjing, China
- * E-mail:
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50
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Lau JTF, Lin C, Hao C, Wu X, Gu J. Public health challenges of the emerging HIV epidemic among men who have sex with men in China. Public Health 2011; 125:260-5. [PMID: 21658537 DOI: 10.1016/j.puhe.2011.01.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
Abstract
A large-scale national survey was conducted in 2008 across 61 cities throughout China, covering over 18,000 men who have sex with men (MSM). The prevalence of human immunodeficiency virus (HIV) was 4.9% and incidence ranged from 2.6 to 5.4 per 100 person-years. The prevalence of sexually transmitted diseases ranged from 2.0% to 29.9% among MSM in different parts of China. Syphilis status, recruitment of sexual partners mainly from gay saunas, duration of MSM experience, and unprotected sex with regular male sex partners and multiple male sex partners predicted HIV seroconversion. The prevalence of consistent condom use was low during anal sex, ranging from 29.4% to 37.3%. Within this context, this paper considers the factors surrounding HIV prevention activity, and identifies a number of public health challenges which need to be considered if optimum outcomes are to be achieved. HIV prevention targeting MSM is a delayed response. The high risk associated with gay saunas and the need for steady condom supply at these venues needs urgent consideration. In addition, approximately one-third of MSM in China reported bisexual behavior, which may be attributed to sociocultural reasons and stigma against MSM. Female sex partners of MSM are seldom aware of their exposure to high risk of HIV transmission. Finally, the primitive nature of non-government organizations for HIV prevention and issues around their sustainability pose another serious challenge for the future of HIV prevention campaigns targeting MSM in China.
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Affiliation(s)
- J T F Lau
- Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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