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Prevalence of HIV and syphilis and their co-infection among men having sex with men in Asia: A systematic review and meta-analysis. Heliyon 2023; 9:e13947. [PMID: 36895383 PMCID: PMC9988516 DOI: 10.1016/j.heliyon.2023.e13947] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023] Open
Abstract
Background Studies found that the group of men who have sex with men (MSM) is at a very high level of risk of HIV and sexually transmitted infections (STIs) in Asian regions due to multiple reasons. Although the prevalence of HIV among general people in Asia is considered low, the prevalence of HIV and Syphilis among MSM in this region was found very high and usually, it goes unnoticed. This study aimed to inspect the prevalence of and trends in HIV, Syphilis, and their co-infection among MSM in Asia. Methods A systematic search was performed on January 5, 2021, in PubMed, Web of Science, and Google Scholar databases. To evaluate the heterogeneity, Q-tests, and I 2 were used. To explore the publication bias, Eggers' test and funnel plot were used. The random-effect model and subgroup analysis were performed due to the significant heterogeneity. Results A total of 2872 articles were identified, and 66 articles were included in the final analysis. The overall prevalence of HIV and Syphilis among MSM was estimated considering 69 estimates from 66 studies whereas 19 estimates of co-infection were found in 17 studies. The pooled HIV prevalence was 8.48% (CI: 7.01-9.95) and the pooled Syphilis prevalence was 9.86% (CI: 8.30-11.41) with significant heterogeneity and publication bias. The pooled prevalence of HIV and Syphilis co-infection was 2.99% (CI: 1.70-4.27) with significant heterogeneity and no publication bias. The HIV, Syphilis, and HIV-Syphilis co-infection prevalence estimates exhibited an upward trend during 2002-2017. Conclusions HIV, Syphilis, and their co-infection are quite prevalent among MSM in the Asia-Pacific region. Integrated and intensified intervention strategies, HIV testing, and improved access to antiretroviral treatment as well as increased awareness are needed to reduce HIV, Syphilis, and their co-infection among the discussed vulnerable group.
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Li X, Li Y, Liu H, Trovão NS, Foley BT. The Emergence and Transmission Dynamics of HIV-1 CRF07_BC in Mainland China. Virus Evol 2022; 8:veac014. [PMID: 35350472 PMCID: PMC8946679 DOI: 10.1093/ve/veac014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 02/03/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022] Open
Abstract
A total of 1155 partial pol gene sequences of human immunodeficiency virus (HIV)-1 CRF07_BC were sampled between 1997 and 2015, spanning 13 provinces in Mainland China and risk groups [heterosexual, injecting drug users (IDU), and men who have sex with men (MSM)] to investigate the evolution, adaptation, spatiotemporal and risk group dynamics, migration patterns, and protein structure of HIV-1 CRF07_BC. Due to the unequal distribution of sequences across time, location, and risk group in the complete dataset (‘full1155’), subsampling methods were used. Maximum-likelihood and Bayesian phylogenetic analysis as well as discrete trait analysis of geographical location and risk group were carried out. To study mutations of a cluster of HIV-1 CRF07_BC (CRF07-1), we performed a comparative analysis of this cluster to the other CRF07_BC sequences (‘backbone_295’) and mapped the mutations observed in the respective protein structure. Our findings showed that HIV-1 CRF07_BC most likely originated among IDU in Yunnan Province between October 1992 to July 1993 [95 per cent hightest posterior density (HPD): May 1989–August 1995] and that IDU in Yunnan Province and MSM in Guangdong Province likely served as the viral sources during the early and more recent spread in Mainland China. We also revealed that HIV-1 CRF07-1 has been spreading for roughly 20 years and continues to cause local transmission in Mainland China and worldwide. Overall, our study sheds light on the dynamics of HIV-1 CRF07_BC distribution patterns in Mainland China. Our research may also be useful in formulating public health policies aimed at controlling acquired immune deficiency syndrome in Mainland China and globally.
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Affiliation(s)
- Xingguang Li
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, 315010, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315000, China
| | - Yanping Li
- College of Chemistry Biology and Environment, Yuxi Normal University, Yuxi, 653100, China
| | - Haizhou Liu
- National Virus Resource Center, Wuhan Institute of Virology, University of Chinese Academy of Sciences, Wuhan, 430071, China
| | - Nídia S Trovão
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Brian T Foley
- HIV Databases, Theoretical Biology and Biophysics Group, Los Alamos National Laboratory, Los Alamos, New Mexico, 87545, USA
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Huang L, Wu H, Yan H, Liang Y, Li Q, Shui J, Han Z, Tang S. Syphilis Testing as a Proxy Marker for a Subgroup of Men Who Have Sex With Men With a Central Role in HIV-1 Transmission in Guangzhou, China. Front Med (Lausanne) 2021; 8:662689. [PMID: 34307399 PMCID: PMC8293274 DOI: 10.3389/fmed.2021.662689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/26/2021] [Indexed: 12/09/2022] Open
Abstract
Objectives: The objectives of this study were to distinguish the role of men who have sex with men (MSM) with or without syphilis testing in HIV-1 transmission and to provide molecular evidence of syphilis testing as a proxy marker for identifying the subgroup of MSM. Methods: HIV-1 transmission clusters were constructed by HIV-TRACE and Cluster Picker using HIV-1 pol sequences from 729 newly diagnosed HIV-infected MSM from 2008 to 2012 in Guangzhou, China. The role of MSM in HIV-1 transmission networks was determined by a node influence measurement and centrality analysis. The association between syphilis testing and factors related to HIV-1 transmission and antiretroviral treatment (ART) were analyzed by the Cox regression model. Results: Among HIV-infected MSM, 56.7% did not test for syphilis at the time of HIV-1 diagnosis. MSM without syphilis testing was a specific subgroup of MSM with a larger closeness centrality and clustering coefficient than the recipients of syphilis testing (P < 0.001), indicating their central position in the HIV-1 transmission networks. The median degree and radiality within HIV-1 transmission networks as well as the median K-shell scores were also greater for MSM without syphilis testing (P < 0.001), suggesting their relatively greater contribution in transmitting HIV-1 than the receipts of syphilis testing. MSM with syphilis testing usually did not disclose their occupation or were more likely to be unemployed or to take non-skilled jobs, to have a history of sexually transmitted infections (STIs), and to be AIDS patients when diagnosed with HIV-1 infection (P < 0.05). Multivariable Cox regression analysis indicated that syphilis testing per se did not promote the engagement of ART (P = 0.233) or affect the speed of CD4+ T cell count recovery after treatment (P = 0.256). Conclusions: Our study identifies syphilis testing as a proxy marker of a specific subgroup of HIV-infected MSM who refuse syphilis testing during HIV-1 diagnosis with an important role in HIV-1 transmission. Specific prevention and intervention targeting MSM without syphilis testing during HIV-1 care are urgently needed.
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Affiliation(s)
- Liping Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Hao Wu
- Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Huanchang Yan
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yuanhao Liang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Qingmei Li
- Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Jingwei Shui
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Zhigang Han
- Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China.,Institute of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Shixing Tang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China.,Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, China
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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: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [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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Cheng W, Xu H, Tang W, Zhong F, Meng G, Han Z, Zhao J. Online HIV prevention intervention on condomless sex among men who have sex with men: a web-based randomized controlled trial. BMC Infect Dis 2019; 19:644. [PMID: 31324233 PMCID: PMC6642590 DOI: 10.1186/s12879-019-4251-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 07/03/2019] [Indexed: 11/13/2022] Open
Abstract
Background Given the widespread use of the Internet among men who have sex with men (MSM) and high risk of Internet-facilitated sexual behaviors, Internet-based interventions to reduce sexual risk are urgently needed. Methods We recruited 1,100 participants from online and randomly assigned to two groups. One group received online HIV intervention services. Online HIV intervention was developed through mix-method formative research, measures included scenarios experiencing intervention and HIV information dissemination. Self-reported condomless anal sex with a male in the past three months was measured to evaluate the intervention effect. Result Of the 1,100 participants, the majority were aged between 21 and 30 years old (62%), had a college degree or higher (80%), were single (88%), and self-identified as homosexual (78%). The estimated risk difference of condomless sex with a male in the past three months between groups was 9.3% (95% confidence interval (CI): 1.1, 17.5%). Using multiple imputations intention-to-treat, the estimated risk difference was 8.9% (95%CI: 1.2, 16.6%). Modification effects were found between intervention and characteristics including: educational attainment (p = 0.012), marital status (p = 0.005) and awareness of AIDS-related knowledge (p = 0.010). Conclusion Internet appears to be a promising approach to disseminate HIV prevention amongst MSM. Interactive online intervention appeals to MSM and poses a great potential for reducing HIV risky behavior. Trial registration ChiCTR1800014260 (retrospectively registered 2 Jan, 2018). Electronic supplementary material The online version of this article (10.1186/s12879-019-4251-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Weibin Cheng
- Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Baiyun District, Guangzhou, 510440, Guangdong, China. .,Dermatology Hospital of Southern Medical University, No.2 Lujing Road, Yuexiu District, Guangzhou, 510095, Guangdong, China.
| | - Huifang Xu
- Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Baiyun District, Guangzhou, 510440, Guangdong, China.
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, No.2 Lujing Road, Yuexiu District, Guangzhou, 510095, Guangdong, China.,University of North Carolina Project-China, No.2 Lujing Road, Yuexiu District, Guangzhou, 510095, Guangdong, China
| | - Fei Zhong
- Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Baiyun District, Guangzhou, 510440, Guangdong, China
| | - Gang Meng
- Lingnan Partners Community Support Center A2-Tianwenyuan, Tiyuxi road, Guangzhou, 510000, Guangdong, China
| | - Zhigang Han
- Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Baiyun District, Guangzhou, 510440, Guangdong, China
| | - Jinkou Zhao
- The Global Fund to fight AIDS, Tuberculosis and Malaria, Chemin de Blandonnet 8
- 1214 Vernier, Geneva, Switzerland
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Secular trends in HIV/AIDS mortality in China from 1990 to 2016: Gender disparities. PLoS One 2019; 14:e0219689. [PMID: 31318900 PMCID: PMC6638923 DOI: 10.1371/journal.pone.0219689] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 06/29/2019] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES HIV/AIDS has become the leading cause of death by infectious disease in China since 2009. However, the trend of gender disparities in HIV/AIDS has not been reported in China since 1990. Our study aimed to explore the secular trend of HIV/AIDS mortality in China from 1990 to 2016 and to identify its gender disparities over the past 27 years. METHOD The mortality data of HIV/AIDS were obtained from the Global Burden of Disease Study 2016 (GBD 2016). Logistic regression was used to estimate the prevalence odds ratio (POR) of gender for HIV/AIDS mortality in different surveys. RESULTS The standardized mortality of HIV/AIDS in China rose dramatically from 0.33 per 100,000 people in 1990 to 2.50 per 100,000 people in 2016. The rate of HIV/AIDS mortality increased more quickly in men than in women, and the sex gap of mortality of HIV/AIDS widened. By 2016, the HIV/AIDS mortality in men was 3 times that in women and was 5.74 times that in women within the 75- to 79-year-old age group. CONCLUSIONS The mortality of HIV/AIDS in China is increasing, with a widening gender disparity. It is critical for policymakers to develop policies to eliminate these disparities and to ensure that everyone can live a long life in full health.
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Cheng W, Xu H, Zhong F, Pan S, Tucker JD, Weir S, Zhao J, Tang W. Can HIV service data be used for surveillance purposes?: a case study in Guangzhou, China. BMC Public Health 2018; 18:1268. [PMID: 30453934 PMCID: PMC6245699 DOI: 10.1186/s12889-018-6128-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timely monitoring HIV epidemic among key populations is a formidable challenge. This study aimed to evaluate the agreement between data collected from an enhanced HIV sentinel surveillance (HSS+) and an HIV service, and to discuss whether testing service data can be used for surveillance purposes. METHODS The HSS+ data were collected from HIV sentinel surveillance conducted annually among men who have sex with men (MSM) between 2009 and 2013 in Guangzhou, China. The HIV service data were obtained from the China-Bill & Melinda Gates Foundation Cooperation Program on HIV Prevention and Care (China-Gates HIV Program) in Guangzhou during the same period. The China-Gates HIV Program aimed to increase HIV counseling and testing among MSM. We compared demographic characteristics, condom use, HIV testing history, and the HIV status among individuals in these two datasets. The Armitage-trend test was used to evaluate the HIV epidemic and behaviors of the participants in the two datasets over the study period. RESULTS Overall, a total of 2224 and 5311 MSM were included in the surveillance and service datasets, respectively. The majority of participants in the two datasets were between 20 and 29 years old, at least attended college, and had never been married. However, socio-demographic characteristics varied slightly between the two datasets. Similar trends were observed for the HIV epidemic in these two datasets. The surveillance dataset indicated that HIV prevalence increased from 3.9% in 2009 to 11.4% in 2013 (P-value for trend < 0.001), while data from the HIV service dataset indicated that MSM HIV prevalence during this same period increased from 6.2 to 8.9% (P-value for trend = 0.025). The rates of condom use were similar between the two datasets and remained consistent throughout the study period. CONCLUSION HIV service data can complement existing HIV surveillance systems for MSM in China, though it may underestimate the HIV prevalence (HSS+ data contains people whose status is already know, while service data contains people who were initially negative or people of unknown status). HIV service data can be used for surveillance purposes, when prerequisite variables are collected from a large number people, if the quality assessment is conducted.
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Affiliation(s)
- Weibin Cheng
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Huifang Xu
- Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Fei Zhong
- Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Stephen Pan
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, China
| | - Joseph D Tucker
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, China
| | - Sharon Weir
- School of Medicine of University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jinkou Zhao
- Technical Advice and Partnership Department, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Chemin de Blandonnet 8, CH 1214, Geneva, Switzerland.
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China. .,University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, China.
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8
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Wang X, Wang Z, Jiang X, Li R, Wang Y, Xu G, Zou H, Cai Y. A cross-sectional study of the relationship between sexual compulsivity and unprotected anal intercourse among men who have sex with men in shanghai, China. BMC Infect Dis 2018; 18:465. [PMID: 30219033 PMCID: PMC6139151 DOI: 10.1186/s12879-018-3360-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 08/23/2018] [Indexed: 11/13/2022] Open
Abstract
Background HIV prevalence among men who have sex with men (MSM) in China is rising rapidly, and unprotected anal intercourse (UAI) is associated with HIV transmission. Recent research has shown that associations between UAI and other factors can differ according to the type of sex partners, including regular partners and casual partners. This study aimed to explore the relationship between sexual compulsivity and UAI according to partner type among MSM in Shanghai, China. Methods A cross-sectional study was conducted among 547 MSM from four districts in Shanghai, China. All participants were recruited using snowball sampling. The Sexual Compulsivity Scale was used to evaluate participants’ sexual compulsivity. Multivariable logistic regression was used to identify factors associated with sexual compulsivity and UAI. The mediation effects of substance use before sex on the relationship between sexual compulsivity and UAI were tested through mediation analyses. Results After adjusting for sociodemographic variables, sexual compulsivity was associated with overall UAI (adjusted odds ratios [AOR] = 1.039, 95% confidence intervals [CI] = 1.004–1.075), UAI with non-regular sex partners (AOR = 1.089, 95% CI = 1.033–1.148) and UAI with commercial sex partners (AOR = 1.185, 95% CI = 1.042–1.349). No significant association was found between sexual compulsivity and UAI with regular sex partners (AOR = 1.029, 95% CI = 0.984–1.077). Mediation analyses indicated that the relationship between sexual compulsivity and UAI was not mediated by either alcohol use before sex or drug use before sex. Conclusions The association between sexual compulsivity and UAI varies depending on the type of UAI partner. Therefore, individuals may engage in different types of UAI for different reasons, and tailored HIV cognitive–behavioral intervention programs are needed.
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Affiliation(s)
- Xin Wang
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Zezhou Wang
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Xueqin Jiang
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Rui Li
- Department of Public Health Science, School of Medicine and Dentistry, University of Rochester, New York, USA
| | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China
| | - Gang Xu
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China.
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China. .,School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China. .,Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, People's Republic of China.
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Bias Adjustment Techniques Are Underutilized in HIV Sexual Risk Estimation: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081696. [PMID: 30096874 PMCID: PMC6121670 DOI: 10.3390/ijerph15081696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/17/2018] [Accepted: 08/07/2018] [Indexed: 01/26/2023]
Abstract
Background: Valid measurement of determinants of HIV infection among men who have sex with men (MSM) is critical for intervention planning and resource allocation. However, sexual minority research concerning HIV risk often relies on proxy exposures of sexual behaviors such as sexual orientation and partner gender. Inferring high risk sexual behaviors (i.e., condomless anal intercourse) from these proxies inaccurately captures HIV risk, but few studies have attempted to correct for this bias. Methods: We performed a systematic review of methodological practices for estimating risk of HIV infection among MSM. Results: We identified 32 studies in which high risk sexual behavior was assessed: 82% (n = 26) measured and used sexual risk behaviors (e.g., condomless anal intercourse or sexual positioning) to assess risk of HIV infection; 9% (n = 3) used proxy measures; and 9% (n = 3) used both behavior and proxy variables. Various treatments of misclassification reported by investigators included the following: 82% (n = 26) discussed misclassification of sexual behavior as a potential limitation; however, among these studies, no attempts were made to correct misclassification; 12% (n = 4) did not report exposure misclassification, and 6% (n = 2) explicitly considered this information bias and conducted a Bayesian approach to correct for misclassification. Conclusions: Our systematic review indicates that a majority of studies engaging in collecting primary data have taken additional steps to acquire detailed information regarding sexual risk behaviors. However, reliance on population-based surveys may still lead to potentially biased estimates. Thus, bias analytic techniques are potential tools to control for any suspected biases.
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Guanghua L, Yi C, Shuai T, Zhiyong S, Zhenzhu T, Yuhua R, Yousuf MA, Wensheng F. HIV, syphilis and behavioral risk factors among men who have sex with men in a drug-using area of southwestern China: Results of 3 cross-sectional surveys from 2013 to 2015. Medicine (Baltimore) 2018; 97:e0404. [PMID: 29668597 PMCID: PMC5916656 DOI: 10.1097/md.0000000000010404] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To assess human immunodeficiency virus (HIV), syphilis, and behavioral risk factors among men who have sex with men (MSM) in southwestern China, where HIV started as a drug-driven epidemic, and shifted to mainly heterosexual transmission.These cross-sectional studies were conducted yearly in 2013, 2014, and 2015 in Guangxi, China. A total of 1,996, 1,965, and 1,697 participants were recruited in 2013, 2014, and 2015, respectively. The data included demographic and sexual behavioral variables. Other variables included individuals who used illegal drugs, and who received HIV counseling, testing, and free condoms, and peer education. Participants were tested for HIV, syphilis, and hepatitis C virus (HCV) with whole blood specimens. Questionnaires and laboratory testing data were double entered, and validated with EpiData software. The data were then transferred into SPSS software (SPSS Inc, Chicago, IL) and Chi-square test performed.The prevalence of HIV was 6.6% in 2013, 8.4% in 2014, and 11.2% in 2015. The prevalence of syphilis was 9.3% in 2013, 9.8% in 2014, and 6.1% in 2015. And HCV prevalence was 0.5% in 2013 and remained stable at 0.4% in 2014, and 2015. HIV infection, and associated factors among MSM in these 3 annual cross-sectional survey showed that HIV-infected MSM were significantly, more likely, to perform unprotected anal intercourse with any commercial male partners in the past 6 months (adjusted odds ratio [AOR] = 1.81, 95% CI: 1.50-2.20), had sex with any female partners in the past 6 months (AOR = 1.31, 95% CI: 1.01-1.71), used drugs in the past (AOR = 2.73, 95% CI: 1.30-5.71), and are syphilis infected (AOR = 3.53, 95% CI: 2.77-4.49).There is an urgent need for intervention strategies like condom distribution, HIV counseling, free testing, and education regarding safe sex, HIV, and other sex-related diseases in Guangxi to curb, and prevent HIV among MSM.
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Affiliation(s)
- Lan Guanghua
- Guangxi Center for Disease Control and Prevention, Nanning
| | - Chen Yi
- Guangxi Center for Disease Control and Prevention, Nanning
| | - Tang Shuai
- Guangxi Center for Disease Control and Prevention, Nanning
| | - Shen Zhiyong
- Guangxi Center for Disease Control and Prevention, Nanning
| | - Tang Zhenzhu
- Guangxi Center for Disease Control and Prevention, Nanning
| | - Ruan Yuhua
- State Key Laboratory for Infectious Disease Prevention and Control (SKLID), Chinese Center for Disease Control and Prevention (China CDC), Beijing
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | | | - Fan Wensheng
- Department of Health Services Administration, Florida International University, Miami, FL
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11
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Zhou N, Bauermeister J, Guo W, Yu M, Yang J, Zheng M, Guo Y, Gong H, Gao Y, Jiang G. Condomless Anal Intercourse by Partner Type Among Chinese Men Who Have Sex With Men in Tianjin. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:63-71. [PMID: 29481303 DOI: 10.1521/aeap.2018.30.1.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
HIV prevalence and incidence is high among men who have sex with men (MSM) in China, underscoring the need to support and optimize HIV risk reduction strategies for this population. We sought to estimate the prevalence of condomless anal sex among MSM living in Tianjin, China. We recruited 595 HIV-negative MSM living in Tianjin to participate in a HIV study between 2013 and 2014. Data were collected after a voluntary counseling and testing session through a face-to-face survey. We used multivariable logistic regressions to examine the association between sociodemographic characteristics and HIV risk correlates and MSM's likelihood of engaging in condomless anal intercourse with main and casual partners in the prior 6 months. Results are presented. HIV risk reduction efforts should be developed to be sensitive and responsive to the unique experiences of Chinese MSM. We discuss opportunities for future work, including the development HIV risk reduction interventions.
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Affiliation(s)
- Ning Zhou
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | | | - Wei Guo
- National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Maohe Yu
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Jie Yang
- Tianjin Dark Blue Working Group, Tianjin, China
| | - Minna Zheng
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Yan Guo
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Hui Gong
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Yongjun Gao
- Tianjin Hongqiao District Center for Disease Control and Prevention, Tianjin, China
| | - Gueohong Jiang
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
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12
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Qin Q, Tang W, Ge L, Li D, Mahapatra T, Wang L, Guo W, Cui Y, Sun J. Changing trend of HIV, Syphilis and Hepatitis C among Men Who Have Sex with Men in China. Sci Rep 2016; 6:31081. [PMID: 27535092 PMCID: PMC4989164 DOI: 10.1038/srep31081] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 07/13/2016] [Indexed: 11/21/2022] Open
Abstract
Dearth of information regarding the trend and correlates of HIV, syphilis and Hepatitis C (HCV) in a country-wide sample of understudied though high-risk Chinese men who have sex with men (MSM) called for a comprehensive serial cross-sectional study. Using a multistage mixed-method strategy, 171,311 MSM from 107 selected cities/counties in 30 provinces of mainland China, were interviewed and tested. Descriptive, bivariate, multivariate and Cochran-Armitage trend analyses were conducted using SAS 9.2. During 2009-13, recent (71.5% to 78.6%, p < 0.001) and consistent (40.4% to 48.8%, p < 0.001) condom use as well as condom use during commercial anal sex (46.5% to 55.0%, p < 0.001) were increasing. In contrast, commercial anal sex with male (11.9% to 7.1%, p < 0.001) and drug use (1.9% to 0.8%, p < 0.001) were decreasing over time. HIV prevalence increased gradually (5.5% to 7.3%, p < 0.001), while syphilis (9.0% to 6.3%, p < 0.001) and HCV prevalence (1.5% to 0.7%, p < 0.001) decreased over time. A positive correlation was observed between HIV and syphilis prevalence (r = 0.38). HIV infection was associated with HIV-related knowledge, services and injecting drug use. An increasing trend of HIV prevalence was observed during 2009–13 among MSM in China. While gradual reduction of risk behaviors along with syphilis and HCV prevalence supported expansion of testing and prevention services, increasing HIV burden called for deeper thematic investigations.
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Affiliation(s)
- Qianqian Qin
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Weiming Tang
- University of North Carolina at Chapel Hill, Project-China. No. 2 Lujing Road, Guangzhou, 510095, China.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, USA
| | - Lin Ge
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dongmin Li
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tanmay Mahapatra
- National Institute of Cholera and Enteric Diseases, Kolkata, 700010, India
| | - Liyan Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wei Guo
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan Cui
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiangping Sun
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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13
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Johnston LG, Hakim AJ, Dittrich S, Burnett J, Kim E, White RG. A Systematic Review of Published Respondent-Driven Sampling Surveys Collecting Behavioral and Biologic Data. AIDS Behav 2016; 20:1754-76. [PMID: 26992395 DOI: 10.1007/s10461-016-1346-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Reporting key details of respondent-driven sampling (RDS) survey implementation and analysis is essential for assessing the quality of RDS surveys. RDS is both a recruitment and analytic method and, as such, it is important to adequately describe both aspects in publications. We extracted data from peer-reviewed literature published through September, 2013 that reported collected biological specimens using RDS. We identified 151 eligible peer-reviewed articles describing 222 surveys conducted in seven regions throughout the world. Most published surveys reported basic implementation information such as survey city, country, year, population sampled, interview method, and final sample size. However, many surveys did not report essential methodological and analytical information for assessing RDS survey quality, including number of recruitment sites, seeds at start and end, maximum number of waves, and whether data were adjusted for network size. Understanding the quality of data collection and analysis in RDS is useful for effectively planning public health service delivery and funding priorities.
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Affiliation(s)
- Lisa G Johnston
- University of California, San Francisco, Global Health Sciences, San Francisco, CA, USA.
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
| | - Avi J Hakim
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Samantha Dittrich
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janet Burnett
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Evelyn Kim
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Richard G White
- CMMID and Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
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14
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Fu X, Qi J, Hu Y, Pan X, Li Y, Liu H, Wu D, Yin W, Zhao Y, Shan D, Zhang NN, Zhang D, Sun J. Partner notification in cooperation with community-based organizations among HIV-positive men who have sex with men in two Chinese cities. Int J STD AIDS 2016; 27:821-31. [PMID: 27140946 PMCID: PMC5004245 DOI: 10.1177/0956462416648827] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/22/2016] [Indexed: 11/17/2022]
Abstract
The epidemic of HIV/AIDS among Chinese men who have sex with men (MSM) is rapidly escalating. We implemented partner notification among HIV-infected MSM, cooperating with MSM-serving community-based organizations (CBOs) in two Chinese cities from June 2014 to May 2015. CBOs participated in identifying new HIV-positive MSM utilizing rapid HIV tests and partner notification among index cases. 253 index cases were recruited and 275 sexual partners were notified and tested with 10.5% screened positive. Compared with previously identified index cases, the proportion of contactable sexual partners of newly identified index cases was higher, but the testing rate was lower (p < 0.001). Overall, 83.7% of sexual partners were casual with a contactable rate of 24.9% and a HIV testing rate of 71.1%. Having no contact information for sexual partners and fear of disclosure of HIV status are the main reasons for declining partner notification. It is feasible and effective to perform partner notification in cooperation with CBOs serving Chinese MSM.
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Affiliation(s)
- Xiaojing Fu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China Graduate School of Chinese Center for Disease Control and Prevention, China
| | - Jinlei Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Yifei Hu
- Department of Child, Adolescent Health and Maternal Health, Capital Medical University, China
| | - Xiaohong Pan
- Department of HIV/AIDS Prevention and Control, Zhejiang Provincial Center for Diseases Control and Prevention, China
| | - Youfang Li
- Department of HIV/AIDS Prevention and Control, Yunnan Provincial Center for Diseases Control and Prevention, China
| | - Hui Liu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Di Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Wenyuan Yin
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Yuan Zhao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Duo Shan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Nanci Nanyi Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Dapeng Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Jiangping Sun
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
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15
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Risky sexual networks and concentrated HIV epidemics among men who have sex with men in Wenzhou, China: a respondent-driven sampling study. BMC Public Health 2015; 15:1246. [PMID: 26673429 PMCID: PMC4682249 DOI: 10.1186/s12889-015-2591-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 12/09/2015] [Indexed: 11/21/2022] Open
Abstract
Background The high and continually increasing prevalence of human immunodeficiency virus (HIV) and other sexually transmitted diseases among men who have sex with men (MSM) in China underscores the critical importance of examining the exact sexual networks that result in HIV transmission, as well as HIV infection, using powerful sampling methods, such as respondent-driven sampling (RDS), to improve the sexual health of this population. Methods Using RDS, a cross-sectional study was conducted among MSM in Wenzhou, Zhejiang province, China from December 2013 to June 2014. The type of sex, numbers of anal sex partners, male oral sex partners and vaginal sex partners, condom use during each type of sex over the previous 6 months, prevention behaviors, risk perception, and the burdens of HIV and syphilis were investigated and analyzed. Results Of 424 MSM, a great number of them did anal sex, male oral sex, and vaginal sex during the previous 6 months, and weighted estimates for the prevalence that MSM did not conduct these sexual behaviors were 11.2 % (95 % confidence interval [CI] =6.7–16.50 %), 20.3 % (95 % CI = 15.2–27.1 %), and 58.9 % (95 % CI = 52.1–65.8 %), respectively. Multiple sexual partners, engaging in regular, casual and commercial sex, and lack of condom use during all types of sex were common among MSM. The estimated HIV and syphilis prevalences were 22.8 % (95 % CI = 16.9–28.5 %) and 9.7 % (95 % CI = 6.4–13.6 %), respectively. Of the participants, 53.5 % (95 % CI = 45.3–60.2 %) received HIV-related interventions during the previous year, 48.1 % (95 % CI = 39.7–55.1 %) had never been tested for HIV, and only 14.1 % (95 % CI =10.1–19.2 %) perceived a risk of contracting HIV. Multiple logistic regression analysis revealed that age over 44 years (adjusted odds ratio [AOR] = 3.60, 95 % CI = 1.34–9.64), a monthly income of 3001–4000 yuan (approximately 470–630 US$) (AOR = 1.96, 95 % CI = 1.67–3.60), multiple anal sex partners (AOR = 1.93, 95 % CI = 1.15–3.24), awareness of the possibility of contracting HIV (AOR = 3.18, 95 % CI = 1.56–6.48), and current syphilis infection (AOR = 3.01, 95 % CI = 1.44–6.29) were predictors of HIV infection. Conclusions HIV transmission has become highly prevalent and will likely become more prevalent among MSM and their female partners if these risky sexual networks persist. Our findings call for urgent and effective interventions to prevent the rapid transmission of HIV among MSM in Wenzhou. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2591-7) contains supplementary material, which is available to authorized users.
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16
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Huang SW, Wang SF, Cowó ÁE, Chen M, Lin YT, Hung CP, Chen YH, Yang JY, Tang HJ, Chen YMA. Molecular Epidemiology of HIV-1 Infection among Men who Have Sex with Men in Taiwan in 2012. PLoS One 2015; 10:e0128266. [PMID: 26039757 PMCID: PMC4454672 DOI: 10.1371/journal.pone.0128266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 04/23/2015] [Indexed: 11/19/2022] Open
Abstract
The number of men who have sex with men (MSM) infected with HIV-1 in Taiwan has increased rapidly in the past few years. The goal of this study was to conduct a molecular epidemiological study of HIV-1 infection among MSM in Taiwan to identify risk factors for intervention. Voluntary counseling program and anonymous testing were provided to patrons at 1 gay bar, 7 night clubs and 3 gay saunas in Taipei and New Taipei Cities in 2012. HIV-1 subtypes were determined using gag subtype-specific PCR and phylogenetic analysis by env sequences. Recent HIV-1 infection was determined using LAg-Avidity EIA. In-depth interviews and questionnaires were used to identify risk factors. The prevalence and incidence of HIV-1 among MSM in Taiwan were 4.38% (53/1,208) and 3.29 per 100 person-years, respectively. Of 49 cases genotyped, 48 (97.9%) were infected with subtype B and 1 with CRF01_AE (2%). Phylogenetic analysis of 46 HIV-1 strains showed that 25 (54.4%) subtype B strains formed 9 clusters with each other or with other local strains. The CRF01_AE case clustered with a reference strain from a Thai blood donor with bootstrap value of 99. Multivariate logistic regression analysis showed that risk factors associated with HIV-1 infection included use of oil-based solution as lubricant (vs. saliva or water-based lubricants, OR= 4.23; p <0.001); exclusively receptive role (vs. insertive role, OR= 9.69; p <0.001); versatile role (vs. insertive role, OR= 6.45; p= 0.003); oral sex (vs. insertive role, OR= 11.93; p= 0.044); times of sexual contact per week (2-3 vs. zero per week, OR= 3.41; p= 0.021); illegal drug use (OR= 4.12; p <0.001); and history of sexually transmitted diseases (OR= 3.65; p= 0.002). In conclusion, there was no new HIV-1 subtype or circulating recombinant form responsible for the increase of HIV-1 among MSM in Taiwan in 2012. Misuse of oil-based solution as lubricant is a new risk factor identified among MSM in Taiwan. The Taiwan's Centers for Disease Control has created a video (www.youtube.com/watch?v=BinExvvOTMM&feature=iv&src_vid=BW81-PfmY3E&annotation_id=annotation_2436493705) to correct such misconception in its AIDS prevention campaign.
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Affiliation(s)
- Szu-Wei Huang
- Institute of Microbiology and Immunology, National Yang Ming University, Taipei 11221, Taiwan
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Sheng-Fan Wang
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Ángel E. Cowó
- International Health Program, National Yang Ming University, Taipei 11221, Taiwan
| | - Marcelo Chen
- Department of Urology, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing and Management, Taipei 25245, Taiwan
- School of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan
| | - Yu-Ting Lin
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chun-Po Hung
- Rainbow Queer Health and Culture Center, Living with Hope Organization, Taiwan Society of Preventive Medicine, Taipei 10084, Taiwan
| | - Yi-Hsien Chen
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | | | - Hung-Jen Tang
- Department of Medicine, Chi Mei Medical Center, Tainan 71067, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan
| | - Yi-Ming Arthur Chen
- Institute of Microbiology and Immunology, National Yang Ming University, Taipei 11221, Taiwan
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Microbiology and Immunology, Institute of Medical Research and Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- * E-mail:
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17
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Meng X, Zou H, Fan S, Zheng B, Zhang L, Dai X, Deng M, Zhang X, Lu B. Relative Risk for HIV Infection Among Men Who Have Sex with Men Engaging in Different Roles in Anal Sex: A Systematic Review and Meta-analysis on Global Data. AIDS Behav 2015; 19:882-9. [PMID: 25319954 DOI: 10.1007/s10461-014-0921-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We systematically reviewed and meta-analyzed global data on the relative risk for HIV infection among men who have sex with men (MSM) engaging in different roles in anal sex. MSM engaging in receptive anal sex only (MRAI) and MSM engaging in both insertive and receptive anal sex (MIRAI) were 6.9 (95 % CI 5.5-8.6) and 4.3 (95 % CI 3.6-5.3) times more likely to have prevalent HIV compared to MSM engaging in insertive anal sex only (MIAI) in 1981-1985. These figures were 1.8 (95 % CI 1.6-2.0) and 2.2 (95 % CI 2.0-2.4) in 1986-2010. Overall, MRAI and MIRAI were 6.2 (95 % CI 3.3-11.8) and 6.6 (95 % CI 3.8-11.7) times more likely to develop incident HIV infection compared to MIAI. MRAI are at higher risk for HIV infection compared to MIAI. HIV prevalence among men engaging in all roles in anal sex is high enough that all MSM should be aware of potential risk.
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Affiliation(s)
- Xiaojun Meng
- Wuxi Center for Disease Control and Prevention, Wuxi, Jiangsu, People's Republic of China
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18
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Muessig KE, Bien CH, Wei C, Lo EJ, Yang M, Tucker JD, Yang L, Meng G, Hightow-Weidman LB. A mixed-methods study on the acceptability of using eHealth for HIV prevention and sexual health care among men who have sex with men in China. J Med Internet Res 2015; 17:e100. [PMID: 25900881 PMCID: PMC4420841 DOI: 10.2196/jmir.3370] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 12/19/2014] [Accepted: 02/05/2015] [Indexed: 01/16/2023] Open
Abstract
Background Human immunodeficiency virus (HIV) infection disproportionately affects men who have sex with men (MSM). Over half of all HIV-positive MSM in China may not know their HIV status. Mobile phones and Web interventions (eHealth) are underutilized resources that show promise for supporting HIV education, testing, and linkage to care. Objective This mixed-methods study among MSM in China assessed technology utilization and eHealth acceptability for sexual health care. Methods We conducted in-depth interviews and an online survey. Qualitative analyses informed the development of the Internet survey, which was administered through two popular MSM websites. Bivariate and multivariate analysis assessed characteristics of MSM interested in eHealth for sexual health care. Results The qualitative sample included MSM across a range of ages, education, marital status, sexuality, and HIV testing experience. Qualitative findings included the importance of the Internet as the primary source of information about sexual health, HIV and other sexually transmitted diseases (STDs), use of the Internet to enable HIV testing opportunities by facilitating connections with both the gay community and health care providers, and mixed perceptions regarding the confidentiality of eHealth tools for sexual health. Among the Internet sample (N=1342), the average age was 30.6 years old, 82.81% (1098/1342) were single, and 53.42% (711/1331) had completed college. In the past 3 months, 38.66% (382/988) had condomless sex and 60.53% (805/1330) self-reported having ever tested for HIV. The majority of men owned computers (94.14%, 1220/1296) and mobile phones (92.32%, 1239/1342), which many had used to search for HIV/STD information and testing sites. In multivariate analysis, interest in using computers or mobile phones to support their sexual health care was associated with being a student, prior use of computers or mobile phones to search for general health information, prior use of computers or mobile phones to search for HIV/STD information, and confidentiality concerns. Conclusions MSM in this sample had high utilization of technology and interest in eHealth despite confidentiality concerns. Future eHealth interventions can thoughtfully and creatively address these concerns as a priority for successful implementation.
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Affiliation(s)
- Kathryn E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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Bien CH, Muessig KE, Lee R, Lo EJ, Yang LG, Yang B, Peeling RW, Tucker JD. HIV and syphilis testing preferences among men who have sex with men in South China: a qualitative analysis to inform sexual health services. PLoS One 2015; 10:e0124161. [PMID: 25875336 PMCID: PMC4395264 DOI: 10.1371/journal.pone.0124161] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 03/13/2015] [Indexed: 11/23/2022] Open
Abstract
Background Health services for men who have sex with men (MSM) are inadequate in many areas around the world. HIV and syphilis test uptake remain suboptimal among MSM in China and many other regions. To inform the development of more comprehensive sexually transmitted disease (STD) testing programs among MSM, we collected descriptive data on MSM testing practices and preferences. Methods MSM in two large urban Chinese cities were recruited through community-based organizations and clinics to participate in semi-structured interviews. We purposively sampled MSM across a range of sociodemographic characteristics and testing history, and assessed preferences for HIV and syphilis testing in the context of facilitators and barriers to testing and previous testing experiences. Each interview transcript was coded and thematically analyzed using Atlas.ti 7.0. Results 35 MSM were interviewed. Confidentiality and privacy were the most important factors influencing participants’ decisions about whether and where to get tested. Men preferred rapid testing (results available within 30 minutes) compared to conventional tests where results take several hours or days to return. Participants described concerns about quality and accuracy of rapid tests offered in non-clinical settings such as community-based organizations. Men preferred testing service providers who were MSM-friendly, non-discriminatory, and medically trained. Preferred service center environments included: convenient but discrete location, MSM-friendly atmosphere, and clean/standard medical facilities. Conclusion Our data highlight the need for HIV/syphilis testing services that are confidential and inclusive of MSM. Rapid testing in decentralized (i.e. peripheral health facilities and community-level, non-clinical venues) settings provides an opportunity to reach individuals who have not been tested before, but must be accompanied by quality assurance systems and technical competence. Implementation research could further evaluate HIV/syphilis testing programs responsive to MSM preferences. Short Summary A qualitative study of MSM in South China found that men preferred rapid STD testing at MSM-focused test centers, but were concerned about test quality assurance and confidentiality.
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Affiliation(s)
- Cedric H. Bien
- University of North Carolina-Project China, Guangzhou, China
- Mount Sinai School of Medicine, New York, United States of America
| | - Kathryn E. Muessig
- University of North Carolina-Project China, Guangzhou, China
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States of America
| | - Ramon Lee
- Harvard Medical School, Boston, United States of America
| | - Elaine J. Lo
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States of America
| | - Li Gang Yang
- Guangdong Provincial STD Control Center, Guangzhou, China
| | - Bin Yang
- Guangdong Provincial STD Control Center, Guangzhou, China
| | | | - Joseph D. Tucker
- University of North Carolina-Project China, Guangzhou, China
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Medicine, University of North Carolina, Chapel Hill, United States of America
- * E-mail:
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20
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Fu GF, Jiang N, Hu HY, Mahapatra T, Yin YP, Mahapatra S, Wang XL, Chen XS, Babu GR, Xu XQ, Ding P, Qiu T, Liu XY, Guo H, Huan XP, Tang W. The epidemic of HIV, syphilis, chlamydia and gonorrhea and the correlates of sexual transmitted infections among men who have sex with men in Jiangsu, China, 2009. PLoS One 2015; 10:e0118863. [PMID: 25775451 PMCID: PMC4361608 DOI: 10.1371/journal.pone.0118863] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 01/07/2015] [Indexed: 12/18/2022] Open
Abstract
Background In China, the HIV/AIDS epidemic is expanding among men who have sex with men (MSM). As independent risk factors of HIV infection, the epidemics of Chlamydia (CT) and Gonorrhea (NG) in MSM were not well studied, particular for the risk factors of these infectious. The objectives of current reported study were to understand the dynamics of HIV and other sexual transmitted infections (STIs) among MSM in Jiangsu, China, and to measure factors that correlated with STIs. Methods In order to gain more participants, a multisite cross-sectional study design was used in our study, by using convenience-sampling to recruit MSM in two Changzhou and Yangzhou, Jiangsu, China, between the July and October of 2009. Results In this comprehensive survey involving MSM in two cities of Jiangsu province of China, the prevalence of STIs of CT (6.54%), NG (3.63%), syphilis (20.34%) and HIV (11.62%) were measured. Overall, the STIs prevalence (CT, NG or syphilis) for the participants in our study was 26.39%, meanwhile, 3.4% (14 out of the 413) participants had at least two kinds of STIs. Meeting casual partners at parks, public restrooms or other public areas, having had anal sex with men in the past six months, having had STI symptoms in the past year were positively correlated with STIs positive, with adjusted ORs of 4.61(95%CI 1.03–20.75), 1.91(95%CI 1.14–3.21) and 2.36(95%CI 1.07,5.24). Conclusion Our study findings reiterate the fact that Chinese MSM are highly susceptible to acquiring syphilis, CT, NG and HIV, and there is an urgent need for intervention targeted towards this population. Behavioral measures should constitute an important part of the targeted intervention. Furthermore, the already implemented preventive and diagnostic services for HIV should be expanded to include syphilis CT and NG, too.
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Affiliation(s)
- Geng-Feng Fu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Ning Jiang
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Hai-Yang Hu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Tanmay Mahapatra
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Yue-Ping Yin
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Sanchita Mahapatra
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Xiao-Liang Wang
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Xiang-Sheng Chen
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Giridhar R. Babu
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Xiao-Qin Xu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Ping Ding
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Tao Qiu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Xiao-Yan Liu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Hongxiong Guo
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Xi-Ping Huan
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
- * E-mail: (XPH); (WT)
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
- * E-mail: (XPH); (WT)
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Zhang SH, Liu SJ, Hu LL, Li JF, Liu LH, Wei N. The prevalence and correlates of syphilis and HIV among homosexual and bisexual men in Shijiazhuang, China. Int J STD AIDS 2015; 27:127-32. [PMID: 25725492 DOI: 10.1177/0956462415575619] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 02/01/2015] [Indexed: 11/17/2022]
Abstract
Bisexual men (men who have sex with men and women) are potential epidemiological bridges responsible for the spread of HIV and other sexually transmitted infections from men who have sex with men only to the heterosexual population. We aimed to estimate the prevalence of syphilis and HIV and the factors associated with syphilis infection among men who have sex with men and women and men who have sex with men only from Shijiazhuang, China. In 2011-2013, a cross-sectional cohort of 427 men who have sex with men was recruited by a snowball sampling method and tested for syphilis and HIV. Chi square and logistic regression were performed to identify syphilis risk factors. Among the 427 men who have sex with men, 71 (16.6%) cases were syphilis-positive and 16 cases (3.7%) were HIV-positive. The proportions of men who have sex with men and women and men who have sex with men only in the total sample were 31.4% and 68.6%, respectively. Men who have sex with men and women exhibited double the syphilis prevalence of men who have sex with men only and were more likely to practice insertive anal sex. Higher education level, being married, having more male partners, and both receptive and insertive anal sex roles were associated with syphilis among men who have sex with men and women. Residing in suburban areas, being married, being HIV positive, and an absence of desire to change sexual orientation were associated with syphilis among men who have sex with men only. Therefore, men who have sex with men and women represent an important sub-group in the syphilis epidemic and further interventions should be developed to reduce risk among different sub-sets of men who have sex with men.
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Affiliation(s)
- Shao-Hui Zhang
- Experiment Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Shu-Jun Liu
- Department of STD and AIDS Prevention and Control, Shijiazhuang Central for Disease Control and Prevention, Shijiazhuang, Hebei, China
| | - Ling-Ling Hu
- Experiment Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jie-Fang Li
- Department of STD and AIDS Prevention and Control, Shijiazhuang Central for Disease Control and Prevention, Shijiazhuang, Hebei, China
| | - Li-Hua Liu
- Department of STD and AIDS Prevention and Control, Shijiazhuang Central for Disease Control and Prevention, Shijiazhuang, Hebei, China
| | - Ning Wei
- Experiment Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Suguimoto SP, Techasrivichien T, Musumari PM, El-saaidi C, Lukhele BW, Ono-Kihara M, Kihara M. Changing patterns of HIV epidemic in 30 years in East Asia. Curr HIV/AIDS Rep 2015; 11:134-45. [PMID: 24664878 DOI: 10.1007/s11904-014-0201-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The HIV epidemic in East Asia started relatively late compared to the rest of the world. All countries or areas, except for North Korea, had reported HIV and AIDS cases, with China being the major contributor to the epidemic. Though initially driven by injecting drug use in China, East Asia did not experience an explosive spread. Strong commitment in China and early harm reduction programs in Taiwan managed to reduce transmission substantially among injecting drug users. In contrast to China and Taiwan, injection drug use has accounted just a little, if not at all, for the spread of HIV in other East Asian counties. However, following a global trend, sexual contact has become a major route of infection across the region. While much progress has been achieved in this region, with the epidemic among other key populations relatively stable, the emerging epidemic through sex between men is a growing concern. Recent estimates suggest that HIV prevalence among men who have sex with men (MSM) has reached 6.3 % in China, 7.5 % in Mongolia, and ranges between 8.1 %-10.7 % in Taiwan and between 2.7 %- 6.5 % in South Korea. In Japan, 74 % of male HIV cases were among MSM in 2012, while Hong Kong has witnessed a sharp increase of HIV cases among MSM since 2004. There is urgent need to address issues of discrimination and stigma toward homosexuality, and to strengthen the strategies to reach and care for this population.
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Affiliation(s)
- S Pilar Suguimoto
- Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan,
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Cai R, Cai W, Zhao J, Chen L, Yang Z, Tan W, Zhang C, Gan Y, Zhang Y, Tan J, Richards JH, De Vlas SJ. Determinants of recent HIV testing among male sex workers and other men who have sex with men in Shenzhen, China: a cross-sectional study. Sex Health 2015; 12:565-7. [PMID: 26364154 DOI: 10.1071/sh15109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/30/2015] [Indexed: 11/23/2022]
Abstract
We recruited 510 male sex workers (also referred as 'money boys' (MBs) and 533 other men who have sex with men (MSM) to investigate determinants of recent (last year) HIV testing in Shenzhen, China. Overall, 43% of MBs and 48% of other MSM reported having been tested for HIV in the last year. The most important determinant of testing among MBs was having multiple anal sex partners; among other MSM, the most important determinants were having a homosexual orientation and having a history of sexually transmissible infection. For MBs, education programs are needed to increase their awareness of actual HIV risk. For other MSM, destigmatising programs are needed.
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Affiliation(s)
- Rui Cai
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wende Cai
- Shenzhen Center for Disease Control and Prevention, No. 8 Longyuan Road, Longzhu Avenue, Nanshan District, Shenzhen, 518055, China
| | - Jin Zhao
- Shenzhen Center for Disease Control and Prevention, No. 8 Longyuan Road, Longzhu Avenue, Nanshan District, Shenzhen, 518055, China
| | - Lin Chen
- Shenzhen Center for Disease Control and Prevention, No. 8 Longyuan Road, Longzhu Avenue, Nanshan District, Shenzhen, 518055, China
| | - Zhengrong Yang
- Shenzhen Center for Disease Control and Prevention, No. 8 Longyuan Road, Longzhu Avenue, Nanshan District, Shenzhen, 518055, China
| | - Wei Tan
- Shenzhen Center for Disease Control and Prevention, No. 8 Longyuan Road, Longzhu Avenue, Nanshan District, Shenzhen, 518055, China
| | - Chenli Zhang
- Shenzhen Center for Disease Control and Prevention, No. 8 Longyuan Road, Longzhu Avenue, Nanshan District, Shenzhen, 518055, China
| | - Yongxia Gan
- Shenzhen Center for Disease Control and Prevention, No. 8 Longyuan Road, Longzhu Avenue, Nanshan District, Shenzhen, 518055, China
| | - Yan Zhang
- Shenzhen Center for Disease Control and Prevention, No. 8 Longyuan Road, Longzhu Avenue, Nanshan District, Shenzhen, 518055, China
| | - Jingguang Tan
- Shenzhen Center for Disease Control and Prevention, No. 8 Longyuan Road, Longzhu Avenue, Nanshan District, Shenzhen, 518055, China
| | - Jan Hendrik Richards
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sake J De Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Cheng W, Tang W, Zhong F, Babu GR, Han Z, Qin F, Gao K, Mai H, Zhao Y, Liang C, Fan L, Wu H, Xu H, Wang M. Consistently high unprotected anal intercourse (UAI) and factors correlated with UAI among men who have sex with men: implication of a serial cross-sectional study in Guangzhou, China. BMC Infect Dis 2014; 14:696. [PMID: 25519034 PMCID: PMC4279965 DOI: 10.1186/s12879-014-0696-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 12/11/2014] [Indexed: 12/22/2022] Open
Abstract
Background China experiencing an increasing HIV epidemic among men who have sex with men (MSM), and unprotected anal intercourse (UAI) has played a key role in this process. The aims of this study were to examine the trend of UAI and to explore the factors correlated with UAI among MSM in Guangzhou, China. Methods Data from 2008 to 2013 were retrieved from the annual serological and behavioral surveys system. We collected information on demographic, HIV related sexual behavior with men and women, access to HIV prevention services, and symptoms of sexually transmitted infections. Chi-square test was used to examine the similarity of the participants during the study period. Univariate and multivariate logistic regression were conducted to test the factors associated with UAI. Trend test was used to check the change of UAI in different characteristic stratums during the study period. Results In total, 58.4% (range from 54.5% to 62.0%) of the participants reported that they engaged in UAI in the past six months. Participants who aged less than 20 [Adjusted Odds Ratio (AOR): 2.22, 95% Confidential Interval (CI): 1.07-4.61], only attended elementary school (or less) (AOR: 1.41, 95% CI: 1.04-1.90), cohabiting with male partner (AOR: 2.15, 95% CI: 1.66-2.79), divorced or widowed (AOR: 2.80, 95% CI: 1.54-5.07), did not test for HIV in the past year (AOR: 1.36, 95% CI: 1.12-1.65), and had 10 or more partners in the past six months (AOR: 1.85, 95% CI: 1.18-2.91) had higher odds of UAI. However, the proportions of UAI were stable in different stratums during the study period. Conclusions The proportion of MSM engaged in UAI was consistently high during the study period. Effective intervention strategies, which include but not limit to risk reduction counseling and testing services, are urgently needed to bring down the risk behaviors of the MSM in Guangzhou, in order to control HIV/STIs epidemic in this specific population.
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Affiliation(s)
- Weibin Cheng
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Weiming Tang
- University of North Carolina Project-China, No.2 Lujing Road, Yuexiu District, Guangzhou, Guangdong Province, 510095, China.
| | - Fei Zhong
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China. .,School of Public Health, Sun Yat-Sen University, No.74 2nd Yat-Sen Road, Yuexiu District, Guangzhou, Guangdong, Province, 510080, China.
| | - Giridhar R Babu
- Department of Epidemiology, Public Health Foundation of India, IIPH H, Bangalore Campus, SIHFW Premises, 1st cross, Magadi road, Bangalore, Karnataka, 560023, India.
| | - Zhigang Han
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Faju Qin
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Kai Gao
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Huixia Mai
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Yuteng Zhao
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Caiyun Liang
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Lirui Fan
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Hao Wu
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Huifang Xu
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Ming Wang
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
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Li X, Wu G, Lu R, Feng L, Fan W, Xiao Y, Sun Z, Zhang H, Xing H, Shao Y, Ruan Y. HIV-testing behavior and associated factors among MSM in Chongqing, China: results of 2 consecutive cross-sectional surveys from 2009 to 2010. Medicine (Baltimore) 2014; 93:e124. [PMID: 25501047 PMCID: PMC4602788 DOI: 10.1097/md.0000000000000124] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The high and climbing human immunodeficiency virus (HIV) rates among Chinese men who have sex with men (MSM) bring huge pressure and challenge to acquired immune deficiency syndrome response work in China. This study examined HIV-testing behavior and describes the characteristics of recently tested MSM in Chongqing to address targeting HIV prevention interventions. Two consecutive cross-sectional surveys were conducted among Chongqing MSM using respondent-driven sampling in 2009 and 2010. Information was collected regarding details on demographic characteristics, sexual practices with male and female partners, and HIV-testing experiences. Univariate and multivariate logistic regression analyses were performed to identify factors independently associated with recent HIV testing.The final sample size included in our analyses was 992. The overall HIV prevalence was 13.4%, and HIV prevalence increased significantly from 11.6% in 2009 to 15.4% in 2010 (P = 0.08). The overall rate of HIV testing in the past 12 months was 44.6%, and the self-reported rates decreased significantly from 47.8% in 2009 to 41.1% in 2010 (P = 0.03). Factors independently associated with recent HIV testing included living in Chongqing >1 year (adjusted odds ratio [AOR] 1.8, 95% confidence interval [CI] 1.1-2.9), the age of most recent male partner ≤ 25 (AOR 1.5, 95% CI 1.1-2.1), not having unprotected insertive anal sex with most recent male partner in the past 6 months (AOR 1.5, 95% CI 1.1-2.0), disclosing HIV status to most recent male partner (AOR 2.8, 95% CI 2.0-3.8), and holding lower level of HIV-related stigma (AOR 1.1 per scale point, 95% CI 1.0-1.1). The extremely high HIV prevalence and low annual testing level put MSM at high risk of HIV infection and transmission, and it is a priority to promote regular HIV testing among this group in order to control the spread of HIV in Chongqing, China.
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Affiliation(s)
- Xuefeng Li
- From the State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing (XL, YX, ZS, HZ, HX, YS, YR); Karamay Center for Disease Control and Prevention, Karamay (XL); Chongqing Center for Disease Control and Prevention, Chongqing, P.R. China (GW, RL, LF); and Department of Public Health, College of Health and Human Services, Western Kentucky University, Bowling Green, Kentucky (WF). Drs Xuefeng Li, Guohui Wu, and Rongrong Lu contributed equally to the writing of this article
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26
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Tucker JD, Muessig KE, Cui R, Bien CH, Lo EJ, Lee R, Wang K, Han L, Liu FY, Yang LG, Yang B, Larson H, Peeling RW. Organizational characteristics of HIV/syphilis testing services for men who have sex with men in South China: a social entrepreneurship analysis and implications for creating sustainable service models. BMC Infect Dis 2014; 14:601. [PMID: 25422065 PMCID: PMC4247875 DOI: 10.1186/s12879-014-0601-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 10/31/2014] [Indexed: 11/10/2022] Open
Abstract
Background UNAIDS has called for greater HIV/syphilis testing worldwide just as local HIV/syphilis testing programs are cut or altered. New models are needed to make HIV/syphilis testing services sustainable while retaining their essential public health function. Social entrepreneurship, using business principles to promote a social cause, provides a framework to pilot programs that sustainably expand testing. Drawing on fieldwork in two South Chinese cities, we examined organizational and financial characteristics of current HIV/syphilis testing systems for men who have sex with men (MSM) in addition to new pilot programs focused on revenue-generation for sustainability. Methods We undertook a qualitative study to explore organizational and financial characteristics of HIV/syphilis testing for MSM. Data were collected from men who have sex with men and policy stakeholders in Guangzhou and Hong Kong. Framework analysis was used to identify themes and then code the data. Results Our qualitative research study included MSM and policy stakeholders (n = 84). HIV/syphilis testing services were implemented at a wide range of organizations which we grouped broadly as independent community-based organizations (CBOs), independent clinics, and hybrid CBO-clinic sites. From an organizational perspective, hybrid CBO-clinic sites offered the inclusive environment of an MSM CBO linked to the technical capacity and trained staff of a clinic. From a financial perspective, stakeholders expressed concern about the sustainability and effectiveness of sexual health services reliant on external funding. We identified four hybrid CBO-clinic organizations that launched pilot testing programs in order to generate revenue while expanding HIV testing. Conclusion Many MSM CBOs are searching for new organizational models to account for decreased external support. Hybrid CBO-clinic organizations create a strong foundation to increase HIV/syphilis testing using social entrepreneurship models in China. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0601-5) contains supplementary material, which is available to authorized users.
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Burt RD, Thiede H. Assessing differences in groups randomized by recruitment chain in a respondent-driven sample of Seattle-area injection drug users. Ann Epidemiol 2014; 24:861-867.e14. [PMID: 25277505 PMCID: PMC4252737 DOI: 10.1016/j.annepidem.2014.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/29/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Respondent-driven sampling (RDS) is a form of peer-based study recruitment and analysis that incorporates features designed to limit and adjust for biases in traditional snowball sampling. It is being widely used in studies of hidden populations. We report an empirical evaluation of RDS's consistency and variability, comparing groups recruited contemporaneously, by identical methods and using identical survey instruments. METHODS We randomized recruitment chains from the RDS-based 2012 National HIV Behavioral Surveillance survey of injection drug users in the Seattle area into two groups and compared them in terms of sociodemographic characteristics, drug-associated risk behaviors, sexual risk behaviors, human immunodeficiency virus (HIV) status and HIV testing frequency. RESULTS The two groups differed in five of the 18 variables examined (P ≤ .001): race (e.g., 60% white vs. 47%), gender (52% male vs. 67%), area of residence (32% downtown Seattle vs. 44%), an HIV test in the previous 12 months (51% vs. 38%). The difference in serologic HIV status was particularly pronounced (4% positive vs. 18%). In four further randomizations, differences in one to five variables attained this level of significance, although the specific variables involved differed. CONCLUSIONS We found some material differences between the randomized groups. Although the variability of the present study was less than has been reported in serial RDS surveys, these findings indicate caution in the interpretation of RDS results.
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Affiliation(s)
- Richard D Burt
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA.
| | - Hanne Thiede
- HIV/STD Program, Public Health-Seattle & King County, Seattle, WA
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Abstract
OBJECTIVE The present study aimed to estimate the prevalence of syphilis among men who have sex with men (MSM) currently married with women in cities of China and examine the related factors for syphilis among them. METHODS "Snowballing" sampling was used to recruit participants in 4 cities from April 2008 to August 2009. Information of participants was collected anonymously and remained confidential. Blood samples were collected from all eligible participants for HIV and syphilis tests. RESULTS A total of 858 men participated in the study, and their average age was 38.3 years (ranged from 21 to 75 years). Fifty-three percent did not have residence cards, 37% accepted junior high school education or less, and 41% identified themselves as gay. The prevalence of HIV and syphilis was 8.0% and 17.9%, respectively. Older age, less education, homosexual orientation, the sex of the first sexual partner, residential places, and HIV infection were significantly associated with syphilis infection. Gay had higher proportions of some risk sexual behaviors than did non-gay-identified participants, including the first insert sex before 18 years (17.9% vs. 13.0%), the first male sex partner (49.0% vs. 34.3%) anal sex in the last 6 months (88.0% vs. 83.0%), noncondom use in the last anal sex (35.9% vs. 28.0%), and never use condom in anal sex in the last 6 months (14.8% vs. 9.1%). Non-gay-identified participants had a higher proportion of having opposite sex than did gay participants (70.8% vs. 43.0%). CONCLUSIONS Currently married MSM had a high prevalence of syphilis, and preventive interventions should be developed to control syphilis transmissions among currently married MSM via extromarital sex and intromarital opposite sex.
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Virtual versus physical spaces: which facilitates greater HIV risk taking among men who have sex with men in East and South-East Asia? AIDS Behav 2014; 18:1428-35. [PMID: 24077974 DOI: 10.1007/s10461-013-0628-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Increasing use of the Internet to seek sex partners is accompanied by rising HIV infections among men who have sex with men (MSM) in East and South-East Asia. We examined whether the Internet facilitates greater HIV risk taking among MSM in the region. A cross-sectional sample of 9,367 MSM was recruited via the Internet in 2010. We compared socio-demographic and HIV-related behavioral characteristics among MSM who met sex partners on the Internet only, who met sex partners offline only, and who met sex partners through both. Multinomial logistic regression was used to identify independent correlates that were associated with differences in where participants met their male sex partners. Compared to MSM who met partners offline only, those who met partners online only were less likely to have multiple male sex partners, have paid for sex, have consumed recreational drugs, and have used alcohol before sex. MSM who met partners both online and offline appeared to be the riskiest group that they were more likely to have multiple male sex partners, have engaged in UIAI, and have consumed alcohol before sex. These findings suggest that social networking websites alone do not facilitate greater HIV risk taking among MSM. Rather, they provide additional venues for MSM who already engage in HIV-related high risk behaviors to seek sex partners. The Internet offers incredible opportunities to reach large numbers of MSM in East and South-East Asia for HIV prevention and research. Web-based outreach and prevention activities are needed to reach these men. In addition, mobile and application-based interventions should also be developed and disseminated.
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Increasing HIV and decreasing syphilis prevalence in a context of persistently high unprotected anal intercourse, six consecutive annual surveys among men who have sex with men in Guangzhou, China, 2008 to 2013. PLoS One 2014; 9:e103136. [PMID: 25061936 PMCID: PMC4111575 DOI: 10.1371/journal.pone.0103136] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/13/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Previous studies have reported a possibly increasing HIV prevalence among men who have sex with men (MSM) in China. However there have been limited systematic analyses of existing surveillance data to learn the trend of HIV prevalence and factors driving the trend. The aims of this study were to examine the trend of HIV prevalence among MSM in Guangzhou and to explore the role of unprotected anal intercourse (UAI) in the trend. METHODS Snow-ball sampling was applied in the subject recruitment for the annual serological and behavioral surveys among MSM from 2008 to 2013. Data collected in the behavioral survey include demographic information, HIV related sexual behavior with men and women, access to HIV prevention services, and symptoms of sexually transmitted infections. Chi-square test was used to analyze the trend of HIV prevalence. Multivariate logistic regression was conducted to test the factors associated with HIV infection. RESULTS HIV prevalence increased significantly from 5.0% in 2008 to 11.4% in 2013 while syphilis prevalence decreased from 17.4% to 3.3% in the same period. UAI rates were high and stable in every single year, ranging from 54.5% to 62.0%. Those who were having UAI (OR = 1.80, 95% confidence interval (CI): 1.26-2.58), being migrants, having more than 10 partners, and infected with syphilis had higher risk for HIV infection. CONCLUSIONS HIV epidemic is expanding in Guangzhou. The persistently high UAI may have played a major role in the increasing trend of HIV prevalence. Targeted prevention program should be conducted among MSM who are migrants, low educational level, syphilis infected, or having multiple partners to encourage HIV test and change UAI behavior. The general high UAI calls for tailored intervention program to promote healthy culture and form a safe sex social norm in the MSM community.
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Abstract
Respondent-driven sampling (RDS) is an increasingly common sampling technique to recruit hidden populations. Statistical methods for RDS are not straightforward due to the correlation between individual outcomes and subject weighting; thus, analyses are typically limited to estimation of population proportions. This manuscript applies the method of variance estimates recovery (MOVER) to construct confidence intervals for effect measures such as risk difference (difference of proportions) or relative risk in studies using RDS. To illustrate the approach, MOVER is used to construct confidence intervals for differences in the prevalence of demographic characteristics between an RDS study and convenience study of injection drug users. MOVER is then applied to obtain a confidence interval for the relative risk between education levels and HIV seropositivity and current infection with syphilis, respectively. This approach provides a simple method to construct confidence intervals for effect measures in RDS studies. Since it only relies on a proportion and appropriate confidence limits, it can also be applied to previously published manuscripts.
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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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Lau JTF, Wang Z, Lau M, Lai CHY. Perceptions of HPV, genital warts, and penile/anal cancer and high-risk sexual behaviors among men who have sex with men in Hong Kong. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:789-800. [PMID: 23982568 DOI: 10.1007/s10508-013-0172-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 11/20/2012] [Accepted: 12/29/2012] [Indexed: 06/02/2023]
Abstract
The prevalence of HIV and HPV is high among men who have sex with men (MSM) in China. It is unclear whether cognitive and affective responses related to HPV and HPV-related diseases are negatively associated with HIV-related risk behaviors among MSM. This cross-sectional study interviewed 449 adult Chinese MSM in Hong Kong. The prevalence of unprotected anal intercourse (UAI) and having had anal sex with more than one man in the last 6 months (multiple male sex partnerships) was 39.0 and 71.3 %, respectively. After adjusting for four significant background variables (education level, cohabitation with a man, exposure to HIV prevention materials, and HIV voluntary counseling and testing), variables negatively associated with UAI and/or multiple male sex partnerships included (1) correct HPV-related knowledge (AOR = 0.48-0.66), (2) perceived susceptibility (AOR = 0.32-0.55) and perceived severity (AOR = 0.12-0.60) related to HPV and HPV-related diseases, and (3) fear towards contracting genital warts and penile/anal cancer (AOR = 0.40-0.55). Perceived high chance of contracting HPV was positively associated with multiple partnerships (AOR = 4.74). It is possible to reduce HIV-related risk behaviors by increasing levels of knowledge, cognitions, and fear related to HPV and related diseases. It is important to integrate prevention of HIV with prevention of sexually transmitted infections. Such interventions are warranted.
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Affiliation(s)
- Joseph T F Lau
- Centre for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong,
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Zhao J, Chen L, Cai WD, Tan JG, Tan W, Zheng CL, Cheng JQ, Yang ZR, He ML, Wang XR. HIV infection and sexual behaviors among non-commercial men who have sex with men at different venues. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:801-809. [PMID: 23982566 DOI: 10.1007/s10508-013-0167-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 05/01/2013] [Accepted: 05/12/2013] [Indexed: 06/02/2023]
Abstract
The prevalence of HIV infection among men who have sex with men (MSM) has increased rapidly in China. Previous studies suggested that some venue-specific characteristics could significantly affect MSM's sexual behaviors that were related to HIV transmission. Thus, to compare the HIV infection rates and related risky sexual behaviors among MSM at different venues, we conducted a cross-sectional study with time-location sampling in Shenzhen, China. Among the 801 MSM recruited in the study, 7.0 % (n = 56) were found to be HIV positive, with 0.9 % of MSM at bars (BMSM), 3.5 % of MSM at suburban recreational centers (RMSM), 8.1 % of MSM at saunas (SMSM), 9.3 % of MSM at parks (PMSM), and 10.1 % of MSM at dorm-based venues (DMSM). HIV infection was significantly more prevalent in MSM in dorm-based venues, parks, and saunas than in other venues. Compared to MSM in other venues, BMSM were more likely to be single, drug and alcohol users, but less likely to be HIV and syphilis positive. More PMSM reported having unprotected anal intercourse with other men while more SMSM reported having multiple male sex partners and more RMSM had a low level of HIV-related knowledge. The results indicated that MSM frequenting different venues were inconsistent with regards to demographic characteristics, HIV and syphilis infection rates, and risky sexual behaviors. Greater efforts are needed to develop intervention strategies that target specific venues and risky behaviors.
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Affiliation(s)
- Jin Zhao
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
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Prevalence of HIV and syphilis infection among men who have sex with men in China: a meta-analysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:620431. [PMID: 24868533 PMCID: PMC4017804 DOI: 10.1155/2014/620431] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 01/06/2014] [Indexed: 12/02/2022]
Abstract
Objectives. To figure out the most current prevalence of HIV and syphilis in MSM in China. Methods. A meta-analysis was conducted on the studies searched through PubMed, CNKI, and Wanfang published between 1 January 2009 and 11 April 2013. Results. Eighty-four eligible studies, either in Chinese or in English, were included in this review. The pooled prevalence of HIV and syphilis infection in MSM in China was 6.5% and 11.2%, respectively. The subgroup analyses indicated that the prevalence of HIV infection was higher in the economically less developed cities than that in the developed cities (7.5% versus 6.1%, P < 0.05). In contrast, the prevalence of syphilis infection was lower in less developed cities than in developed cities (8.6% versus 15.1%). Studies with a sample size smaller than 500 had a lower prevalence of HIV and syphilis infection than those with a sample size greater than 500 (5.9% versus 7.2% for HIV; 11.0% versus 11.5% for syphilis, respectively). Conclusions. HIV and syphilis infection are prevalent in MSM in China. The different prevalence of HIV and syphilis infection between developing and developed cities underscores the need to target prevention strategies based on economic conditions.
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Cai Y, Lau JTF. Multi-dimensional factors associated with unprotected anal intercourse with regular partners among Chinese men who have sex with men in Hong Kong: a respondent-driven sampling survey. BMC Infect Dis 2014; 14:205. [PMID: 24735186 PMCID: PMC3996134 DOI: 10.1186/1471-2334-14-205] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/10/2014] [Indexed: 11/14/2022] Open
Abstract
Background The HIV prevalence and incidence among men who have sex with men (MSM) are high. Unprotected anal intercourse (UAI) with male regular partners (RP) is an important but under-emphasized risk behavior. The current study aimed to describe the prevalence of UAI with regular partner and the associated multi-dimensional factors with UAI among MSM in Hong Kong, China. Methods Respondent Driven Sampling method was used to recruit participants. A total of 285 participants were recruited, of whom 211 (75.1%) had had anal sex with RP in the last six months and their data were analyzed in this report. Weighed data were presented and logistic regression methods were fit. Results Participants’ high risk behaviors in the last six months included high prevalence of having had UAI with RP (45.8%), having had non-regular male sex partners (NRP: 27.3%) and UAI with such partners (18.9%). Adjusted for socio-demographic variables, factors associated with UAI with RP included: 1) substances use prior to having anal sex (65.7% versus 43.8%; AOR =2.36; 95% CI =1.07-5.18), 2) worry that condom use symbolizes mistrust (67.9% versus 44.3%; AOR = 2.91; 95% CI =1.19-7.10), 3) a lower perceived degree of the RP’s acceptance of condom use (91.7% versus 38.3%; AOR = 22.70; 95% CI =6.20-83.10), and 4) a higher level of impulsivity (61.1% versus 35.0%; AOR =4.02; 95% CI = 1.62-9.97). Two of these four variables, substances use (ORm = 2.28, 95% CI = 1.01-5.16) and perceived lower level of RP’s acceptance of condom use (ORm = 17.22; 95% CI = 5.06-58.62) were selected by the forward stepwise logistic regression model. Conclusions MSM with RP in Hong Kong is subjected to high risk of HIV transmission. Risk factors of UAI are multi-dimensional and interventions need to take into account factors of structural, interpersonal and individual levels.
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Affiliation(s)
| | - Joseph T F Lau
- Centre for Health Behaviors Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, 5/F,, School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong 030000, PR 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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Dai J, Zhao L, Liang Y. Policy implementation of methadone maintenance treatment and HIV infection: evidence from Hubei province, China. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2013; 8:38. [PMID: 24188659 PMCID: PMC4176141 DOI: 10.1186/1747-597x-8-38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 10/12/2013] [Indexed: 12/01/2022]
Abstract
To view methadone maintenance treatment (MMT) globally, it is necessary to accumulate data on MMT policy implementation under different health service systems. The aim of the current study is to provide empirical evidence about policy implementation of MMT and HIV infection control, as well as recommendations for improvement of MMT in the future. Based on China’s national policy framework of MMT, policy implementation of MMT in Hubei province has two objectives: 1) to create linkages between health and public security, and 2) to provide integrated services for management of drug abusers. From 2007 to 2011, following the establishment of MMT clinics that provide methadone as well as HIV prevention services, the proportion of HIV infection among drug abusers decreased relatively quickly (12.12% → 5.77% → 5.19% → 2.39% → 2.04%). However, high drop-out rate and poor information management have been identified as particular problems which now need to be addressed. Furthermore, client drop-out from MMT programs may reflect social issues the clients encounter, and consequently, sustainable MMT development requires incorporation of social measures that help MMT clients return to society without discrimination, especially through family cooperation and employment opportunities.
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Affiliation(s)
| | | | - Yuan Liang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, China.
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Lau JTF, Zhao JK, Wu XB, Gu J, Hao C. Gay saunas and the risks of HIV and syphilis transmissions in China--results of a meta-analysis. J Sex Med 2013; 10:642-52. [PMID: 23458215 PMCID: PMC7105074 DOI: 10.1111/j.1743-6109.2012.02956.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction Previous studies suggest the risk of human immunodeficiency virus (HIV) transmission among men who have sex with men (MSM) is associated with characteristics of venues. However, very few studies have systematically compared HIV/sexually transmitted disease (STD) prevalence among MSM according to key venue type for sourcing sex partners. Aims The aim of this study was to investigate the associations between HIV/syphilis prevalence and the types of venues, namely saunas, parks, gay bars, and the Internet, which are mostly used for sourcing male sex partners by MSM in China. Methods Meta‐analyses using fixed‐effect and random‐effect methods were conducted. Secondary data were obtained from 10 concurrent surveys conducted in 10 cities basing on a common protocol. Pairwise comparisons (e.g., “saunas” vs. “parks”) were made. Main Outcomes Measures Odds ratios (OR) for HIV/syphilis infection in relations to venue type for partner sourcing. Results The distribution of the most commonly used source to recruit male sex partner was 59.32% (Internet), 18.47% (gay bars), 14.18% (gay saunas), and 8.02% (parks). The median prevalence of HIV/syphilis was 10.49% and 19.38% (gay saunas), 2.12% and 16.25% (parks), 6.06% and 15.45% (Internet), and 4.41% and 11.90% (gay bars). We found significant between‐group differences when comparing “sauna” against “Internet” (HIV: OR = 2.27, 95% confidence interval [CI] = 1.65–3.12; syphilis: OR = 1.61, 95% CI = 1.07–2.41), “sauna” against “bars” (HIV: OR = 1.65, 95% CI = 1.14–2.39; syphilis: OR = 1.35, 95% CI = 1.02–1.78), and “parks” against “Internet” (syphilis: OR = 1.55, 95% CI = 1.12–2.15) as the main source to recruit male sex partners. Other pairwise comparisons were not statistically significant. Conclusions The results of this study suggest that those sourcing partners mainly from gay saunas have higher prevalence of HIV/syphilis when compared with those doing so via the Internet or gay bars. Venue based (sauna‐based) interventions using socio‐ecological approaches are greatly warranted in order to reduce HIV and syphilis prevalence among MSM in China. Lau JTF, Zhao J‐K, Wu X‐B, Gu J, and Hao C. Gay saunas and the risks of HIV and syphilis transmissions in China—results of a meta‐analysis. J Sex Med 2013;10:642–652.
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Affiliation(s)
- Joseph T F Lau
- Centre for Health Behaviors Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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Solomon SS, Lucas GM, Celentano DD, Sifakis F, Mehta SH. Beyond surveillance: a role for respondent-driven sampling in implementation science. Am J Epidemiol 2013; 178:260-7. [PMID: 23801014 DOI: 10.1093/aje/kws432] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We are now in the fourth decade of the human immunodeficiency virus (HIV) pandemic. Several novel prevention tools have been identified, and prevalence and incidence have declined in many settings. A remaining challenge is the delivery of preventive interventions to hard-to-reach populations, including men who have sex with men and injection drug users. Leaders in the field of HIV have called for a new focus on implementation science, which requires a shift in thinking from individual randomized controlled trials to cluster-randomized trials. Multiple challenges need to be addressed in the conduct of cluster-randomized trials, including: 1) generalizability of the study population to the target population, 2) potential contamination through overlap/exchange of members of control and intervention clusters, and 3) evaluation of effectiveness at multiple levels of influence. To address these key challenges, we propose a novel application of respondent-driven sampling-a chain-referral strategy commonly used for surveillance-in the recruitment of participants for the evaluation of a cluster-randomized trial of a community intervention. We illustrate this application with an empirical example of a cluster-randomized trial that is currently under way to assess the effectiveness of men's wellness centers in improving utilization of HIV counseling and testing among men who have sex with men in India.
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Affiliation(s)
- Sunil S Solomon
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Zou H, Wu Z, Yu J, Li M, Ablimit M, Li F, Poundstone K. Internet-facilitated, voluntary counseling and testing (VCT) clinic-based HIV testing among men who have sex with men in China. PLoS One 2013; 8:e51919. [PMID: 23418417 PMCID: PMC3572127 DOI: 10.1371/journal.pone.0051919] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 11/12/2012] [Indexed: 12/02/2022] Open
Abstract
Objective To explore the feasibility of using Internet outreach to encourage men who have sex with men (MSM) to get tested for HIV at voluntary counseling and testing (VCT) clinics in Beijing and Urumqi, China. Methods From June to August 2007, two volunteers contacted MSM using instant messaging, online chat rooms, mobile phone, and e-mail (active recruitment). Banners with study information were put at the front pages of three major Chinese gay websites (passive recruitment). Those contacted were offered a modest financial incentive to seek HIV testing at existing VCT clinics. Those who subsequently sought HIV testing services at VCT clinics and provided informed consent completed a questionnaire and a blood draw to test for HIV and syphilis. Results A total of 3,332 MSM were contacted and 429 attended VCT clinics. One out of every 4 men that were recruited through instant messaging actually went for HIV testing, while the recruitment yields for online gay chat rooms, mobile phone contact, and email were 1∶6, 1∶10, and 1∶140, respectively. The majority of participants (80%, 317/399) reported being motivated to seek HIV testing out of concern for their health, and only 3% (11/399) reported being motivated by the financial incentive. Active recruitment tend to recruit MSM who are younger (X2 = 11.400, P = 0.001), never tested for HIV (X2 = 4.281, P = 0.039), tested less often (X2 = 5.638, P = 0.018). Conclusion Internet outreach is a promising way to encourage MSM to seek HIV testing at existing VCT clinics. Active recruitment can target MSM who are younger, never tested for HIV and tested less often.
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Affiliation(s)
- Huachun Zou
- Division of Health Education and Behavioral Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Sexual Health Unit, School of Population Health, University of Melbourne, Victoria, Australia
| | - Zunyou Wu
- Division of Health Education and Behavioral Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail:
| | - Jianping Yu
- Division of AIDS/STD, Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Min Li
- Division of AIDS/STD, Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Muhtar Ablimit
- Center for AIDS/STD Control and Prevention, Xingjiang Uyghur Autonomous Region Center for Disease Control and Prevention, Urumqi, China
| | - Fan Li
- Center for AIDS/STD Control and Prevention, Xingjiang Uyghur Autonomous Region Center for Disease Control and Prevention, Urumqi, China
| | - Katharine Poundstone
- Division of Health Education and Behavioral Intervention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Prevalence of HIV/STIs and Associated Factors Among Men Who Have Sex With Men in An Giang, Vietnam. Sex Transm Dis 2012; 39:799-806. [DOI: 10.1097/olq.0b013e318265b180] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Zhang L, Chow EPF, Zhang J, Jing J, Wilson DP. Describing the Chinese HIV surveillance system and the influences of political structures and social stigma. Open AIDS J 2012; 6:163-8. [PMID: 23049665 PMCID: PMC3462331 DOI: 10.2174/1874613601206010163] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 10/28/2011] [Accepted: 11/20/2011] [Indexed: 11/22/2022] Open
Abstract
China’s public health surveillance system for HIV was established in late 1980s and has evolved significantly
during the past three decades. With the gradually changing mode of HIV transmission from sharing of intravenous
injecting equipment to sexual exposure and the rapid spread of HIV infection among Chinese homosexual men in recent
years, an efficient and comprehensive population-level surveillance system for describing epidemics trends and risk
behaviours associated with HIV acquisition are essential for effective public health interventions for HIV. The current
review describes the overall strength of the Chinese HIV surveillance system and its structural weaknesses from a political
and social perspective. The HIV surveillance system in China has undergone substantial revamping leading to a
comprehensive, timely and efficient reporting system. However, large data gaps and lack of quality control and sharing of
information obstruct the full performance of the system. This is largely due to fragmented authoritarianism brought about
by the underlying political structure. Social stigma and discrimination in health institutes are also key barriers for further
improvements of HIV diagnosis and surveillance in China.
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Affiliation(s)
- Lei Zhang
- Kirby Institute, University of New South Wales, Sydney, Australia
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Lansky A, Drake A, Wejnert C, Pham H, Cribbin M, Heckathorn DD. Assessing the assumptions of respondent-driven sampling in the national HIV Behavioral Surveillance System among injecting drug users. Open AIDS J 2012; 6:77-82. [PMID: 23049656 PMCID: PMC3462332 DOI: 10.2174/1874613601206010077] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 07/25/2011] [Accepted: 09/27/2011] [Indexed: 11/22/2022] Open
Abstract
Several assumptions determine whether respondent-driven sampling (RDS) is an appropriate sampling method to use with a particular group, including the population being recruited must know one another as members of the group (i.e., injection drug users [IDUs] must know each other as IDUs) and be networked and that the sample size is small relative to the overall size of the group. To assess these three assumptions, we analyzed city-specific data collected using RDS through the US National HIV Behavioral Surveillance System among IDUs in 23 cities. Overall, 5% of non-seed participants reported that their recruiter was “a stranger.” 20 cities with multiple field sites had ≥1 cross-recruitment, a proxy for linked networks. Sample sizes were small in relation to the IDU population size (median = 2.3%; range: 0.6%- 8.0%). Researchers must evaluate whether these three assumptions were met to justify the basis for using RDS to sample specific populations.
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Affiliation(s)
- Amy Lansky
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, USA
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Holtz TH, Thienkrua W, McNicholl JM, Wimonsate W, Chaikummao S, Chonwattana W, Wasinrapee P, Varangrat A, Mock PA, Sirivongrangson P, van Griensven F. Prevalence of Treponema pallidum seropositivity and herpes simplex virus type 2 infection in a cohort of men who have sex with men, Bangkok, Thailand, 2006–2010. Int J STD AIDS 2012; 23:424-8. [DOI: 10.1258/ijsa.2011.011256] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report prevalence of Treponema pallidum (TP) seropositivity and herpes simplex virus type 2 (HSV-2) infection and risk factors associated with their prevalence in a cohort of men who have sex with men (MSM) in Bangkok, Thailand. Between April 2006 and March 2010 we enrolled Thai MSM into a cohort study based at the Silom Community Clinic, with baseline behavioural data and laboratory testing for sexually transmitted infections (STIs). Logistic regression was used to analyse risk factors associated with the prevalence of TP seropositivity and HSV-2 infection. From a total of 1544 enrolled men (mean age 26 years) TP, HSV-2 and HIV seropositive rates were 4.4%, 20.7% and 21.6%, respectively. After multivariable analysis, participating in group sex, reporting paying for sex, reporting sex with a casual partner in a park and being HSV-2 seropositive were associated with TP prevalence. Age ≥30 years, having less than a high school education, past use of recreational drugs, meeting casual sexual partners at a public venue (sauna) and TP seropositivity were associated with HSV-2 infection. The significant baseline prevalence of TP seropositivity and HSV-2 infection in this cohort demonstrates the need for screening and treatment of these STIs and targeted prevention interventions in Thai MSM in Bangkok.
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Affiliation(s)
- T H Holtz
- Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, DDC7 Building, 4th Floor, Ministry of Public Health Nonthaburi 11000, Thailand
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W Thienkrua
- Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, DDC7 Building, 4th Floor, Ministry of Public Health Nonthaburi 11000, Thailand
| | - J M McNicholl
- Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, DDC7 Building, 4th Floor, Ministry of Public Health Nonthaburi 11000, Thailand
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W Wimonsate
- Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, DDC7 Building, 4th Floor, Ministry of Public Health Nonthaburi 11000, Thailand
| | - S Chaikummao
- Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, DDC7 Building, 4th Floor, Ministry of Public Health Nonthaburi 11000, Thailand
| | - W Chonwattana
- Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, DDC7 Building, 4th Floor, Ministry of Public Health Nonthaburi 11000, Thailand
| | - P Wasinrapee
- Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, DDC7 Building, 4th Floor, Ministry of Public Health Nonthaburi 11000, Thailand
| | - A Varangrat
- Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, DDC7 Building, 4th Floor, Ministry of Public Health Nonthaburi 11000, Thailand
| | - P A Mock
- Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, DDC7 Building, 4th Floor, Ministry of Public Health Nonthaburi 11000, Thailand
| | - P Sirivongrangson
- Bureau of AIDS, Tuberculosis and STI, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - F van Griensven
- Thailand Ministry of Public Health – US Centers for Disease Control and Prevention Collaboration, DDC7 Building, 4th Floor, Ministry of Public Health Nonthaburi 11000, Thailand
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Zhang L, Ding X, Lu R, Feng L, Li X, Xiao Y, Ruan Y, Vermund SH, Shao Y, Qian HZ. Predictors of HIV and syphilis among men who have sex with men in a Chinese metropolitan city: comparison of risks among students and non-students. PLoS One 2012; 7:e37211. [PMID: 22623994 PMCID: PMC3356386 DOI: 10.1371/journal.pone.0037211] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 04/17/2012] [Indexed: 12/18/2022] Open
Abstract
Background Men who have sex with men (MSM) are at a substantial risk of HIV, given rising HIV prevalence in urban China. Adolescent and adult students often take HIV-related risk as part of sexual exploration. We compared the risks of HIV and syphilis infections and risky sexual behaviors between student and non-student among urban MSM. Methods Respondent driven sampling approach was used to recruit men who were self-identified as MSM in Chongqing Metropolitan City in southwestern China in 2009. Each participant completed a computer-assisted self-interview which collected demographic and behavioral data, and provided blood specimens for HIV and syphilis testing. Multivariable logistic regression analyses identified predictors for HIV and syphilis infections while comparing student and non-student MSM. Results Among 503 MSM participants, 36.4% were students, of whom 84.2% were in college. The adjusted prevalence of HIV infection was 5.5% (95% confidence interval [CI]: 2.1%–10.2%) in students and 20.9% (95% CI: 13.7%–27.5%) in non-students; the adjusted prevalence of syphilis was 4.4% (95% CI: 0.7%–9.0%) in students and 7.9% (95% CI: 3.6%–12.9%) in non-students (P = 0.12). Two groups had similar risky sexual behaviors such as number of sexual partners and exchanging sex for money. Multivariate analysis showed that students had lower HIV prevalence than non-students (adjusted odds ratio [AOR]: 0.3; 95% CI: 0.1–0.8) adjusting for age, ethnicity and other variables. Conclusion Student MSM have lower HIV and similar syphilis prevalence compared with non-student MSM. However, due to a shorter duration of sexual experience and high prevalence of at-risk sexual behaviors among student MSM, HIV risk might be quite high in students as in non-students.
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Affiliation(s)
- Lan Zhang
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | - Xianbin Ding
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Rongrong Lu
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Liangui Feng
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Xuefeng Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | - Yan Xiao
- China Office of the Joint United Nations Program on HIV/AIDS, Beijing, China
- * E-mail: (HZQ); (YX); (YR)
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control, Beijing, China
- * E-mail: (HZQ); (YX); (YR)
| | - Sten H. Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Yiming Shao
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- * E-mail: (HZQ); (YX); (YR)
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49
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Systematic differences in risk behaviors and syphilis prevalence across types of female sex workers: a preliminary study in Liuzhou, China. Sex Transm Dis 2012; 39:195-200. [PMID: 22337106 DOI: 10.1097/olq.0b013e31823d2e2a] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Female sex workers (FSWs) have become one of the key populations for HIV/STI control in China. Categorization of FSWs can help prioritize HIV/STI intervention efforts. We examined 2 possible categorizations of FSWs and the relationship with syphilis infection risk in Liuzhou City, China. METHODS From October 2009 to February 2010, a total of 583 FSWs recruited by respondent-driven sampling in a cross-sectional survey were tested for syphilis and interviewed to collect sociodemographic and behavioral information. Respondents were categorized based on transaction price for vaginal sex and type of sex work location. The relationship between the 2 categorizations and syphilis infection risk was assessed using univariate and multivariate logistic regression analysis. RESULTS The prevalence rates of lifetime and active syphilis infection were 8.6% and 4.1%, respectively. Lifetime and active syphilis prevalence was higher among FSWs in the lowest price category (52.7% and 25.4%, respectively) and those working in streets (69.7% and 39.8%, respectively) or through telephone (46.3% and 17.0%, respectively). Multivariate analysis showed that lifetime syphilis prevalence was significantly higher among street- (adjusted odds ratio [AOR]: 38.7, 95% confidence intervals [CI]: 10.7-139.9) and telephone-based FSWs (AOR: 10.8, 95% CI: 3.3-35.1), and that active syphilis prevalence was significantly higher among street-based FSWs (AOR: 15.2, 95% CI: 3.7-62.1) after adjusting for demographic and behavioral factors. CONCLUSIONS Categorization based on sex work location was more closely related to the risk of syphilis infection than the price classification. Street- and telephone-based FSWs had significantly higher risk of syphilis infection. Focused interventions among these particular high-risk FSWs subgroups are warranted.
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50
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Liu S, Zhao J, Rou K, Chen L, Cai W, Li L, Wu Z, Detels R. A survey of condom use behaviors and HIV/STI prevalence among venue-based money boys in Shenzhen, China. AIDS Behav 2012; 16:835-46. [PMID: 21800179 DOI: 10.1007/s10461-011-9978-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We examined an at-risk population in China, money boys (MBs), to evaluate their potential role for transmitting HIV and sexually transmitted infections (STIs). Data were collected from 418 MBs selected by time-location cluster sampling, using a self-administered computerized questionnaire and testing a small blood sample for HIV/STIs. One-third (32.1%) of participants self-identified as homosexual, 25.4% heterosexual, 33.5% bisexual, and 9.1% uncertain. Consistent condom use by participants was 70-80% with commercial sex partners, 43.9% with girlfriends, and 60-70% with other non-commercial partners. HIV prevalence was 3.3%; syphilis, 10.5%; and HSV-2, 11.0%; overall prevalence for any was 20.3%. Factors significantly associated with HIV/STIs included being minority (OR = 4.82), having only male partners (OR = 1.92), having more male casual partners in the last 6 months (OR = 1.28), being younger at sexual debut (OR = 1.14), and being older (OR = 1.11). This study emphasizes the importance of developing targeted interventions for MBs, particularly those who are homosexual or minority.
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Affiliation(s)
- Shusen Liu
- National Center for AIDS/STD Control and Prevention, Beijing, China
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