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Cao Z, Chen J, Lin B, Zhang C, Zhong X. Factors Influencing Intention on Condom Use During Sexual Intercourse With Regular Female Partners Among Men Who Have Sex With Men in Western China: A Structural Equation Modeling Analysis. Sex Transm Dis 2023; 50:782-788. [PMID: 37944160 PMCID: PMC10662588 DOI: 10.1097/olq.0000000000001876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/06/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Given the rapid rise in HIV infection among men who have sex with men (MSM) in China, they may be a potential bridge for HIV transmission to the general female population, and increasing condom use is an important protective measure. This study aimed to explore factors that influence the intention of condom use during sexual intercourse with regular female partners among MSM in Western China, based on the Health Action Process Approach model. METHODS This study used a baseline sample from a cohort study of the National Science and Technology Major Project. A nonprobability sampling method was adopted to recruit MSM from western China. Information on sociodemographic characteristics, HIV-related characteristics, sexual behavior, and constructs of the Health Action Process Approach model was collected through structured questionnaires, and the data were analyzed using a structural equation model. RESULTS Among 232 participants, 62.9% (146 of 232) intended to use condoms every time they had sex with their regular female partners during the following 3 months. The results of the structural equation model showed that self-efficacy had the greatest influence on behavioral intention (β = 0.398, P < 0.001), followed by negative outcome expectancy (β = -0.303, P < 0.05). In addition, risk perception (β = 0.206, P < 0.05) and positive outcome expectancy (β = 0.270, P < 0.01) had indirect effects on intention, whereas self-efficacy played a mediating role in these indirect influencing factors. CONCLUSIONS Risk perception, outcome expectancy, and self-efficacy are predictors of condom use intention, with self-efficacy in particular serving as a significant medium for future interventions. These findings could provide a reference for future targeted interventions to reduce the likelihood of HIV transmission from MSM to the female population.
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The Prevalence of HIV Infection in Minority Indigenous Populations of the South-East Asia and Western Pacific Regions: A Systematic Review and Meta-analysis. AIDS Behav 2022; 27:2226-2242. [PMID: 36543946 PMCID: PMC9771782 DOI: 10.1007/s10461-022-03954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
A random effects meta-analysis was used to estimate the pooled prevalence of HIV infection within minority indigenous populations of the South-East Asia (SEAR) and Western Pacific Regions (WPR). Sub-group analyses were conducted, and the sources of heterogeneity explored through meta-regression. The majority of studies were undertaken in high HIV risk subpopulations. There was a paucity of data for many countries with data from China representing 70% of the comparative studies. Within minority indigenous populations the pooled prevalence of HIV infection was 13.7% (95% CI 8.9, 19) and 8.4% (95% CI 6.3, 10.7) among other populations. The prevalence differential between populations was significant in the WPR (adjusted odds ratio 1.1, 95% CI 1.0, 1.2). Across both regions, in contrast to other populations, minority indigenous did not experience any significant reduction in HIV prevalence over the years of data collection. There was large heterogeneity in the prevalence of HIV across studies.
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Wang Y, Chen X, Ye M, Pang W, Zhang C, Xiong SD, Zheng YT. Consistency of spatial dynamics of HIV-1 and HCV among HIV-1/HCV coinfected drug users in China. BMC Infect Dis 2021; 21:1001. [PMID: 34563139 PMCID: PMC8465760 DOI: 10.1186/s12879-021-06711-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As the transmission routes of human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) are similar, previous studies based on separate research on HIV-1 and HCV assumed a similar transmission pattern. However, few studies have focused on the possible correlation of the spatial dynamics of HIV-1 and HCV among HIV-1/HCV coinfected patients. METHODS A total of 310 HIV-1/HCV coinfected drug users were recruited in Yingjiang and Kaiyuan prefectures, Yunnan Province, China. HIV-1 env, p17, pol and HCV C/E2, NS5B fragments were amplified and sequenced from serum samples. The genetic characteristics and spatial dynamics of HIV-1 and HCV were explored by phylogenetic, bootscanning, and phylogeographic analyses. RESULTS Among HIV-1/HCV coinfected drug users, eight HCV subtypes (1a, 1b, 3a, 3b, 6a, 6n, 6v, and 6u) and two HIV-1 subtypes (subtype B and subtype C), three HIV-1 circulating recombinant forms (CRF01_AE, CRF07_BC and CRF08_BC), and four unique recombinant forms (URF_BC, URF_01B, URF_01C and URF_01BC) were identified. HCV subtype 3b was the most predominant subtype in both Yingjiang and Kaiyuan prefectures. The dominant circulating HIV-1 subtypes for drug users among the two areas were CRF08_BC and URF_BC. Maximum clade credibility trees revealed that both HIV-1 and HCV were transmitted from Yingjiang to Kaiyuan. CONCLUSIONS The spatial dynamics of HIV-1 and HCV among HIV-1/HCV coinfected drug users seem to have high consistency, providing theoretical evidence for the prevention of HIV-1 and HCV simultaneously.
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Affiliation(s)
- Yu Wang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, Kunming Institute of Zoology, Chinese Academy of Sciences, 32 Jiaochang Donglu, Kunming, 650223, China.,KIZ-SU Joint Laboratory of Animal Models and Drug Development, College of Pharmaceutical Sciences, Soochow University, 199 Renai Road, Wuzhong District, Suzhou, 215000, China
| | - Xin Chen
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, Kunming Institute of Zoology, Chinese Academy of Sciences, 32 Jiaochang Donglu, Kunming, 650223, China.,Department of Pathogenic Biology, School of Basic Medical Sciences, Gannan Medical University, Ganzhou, China
| | - Mei Ye
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, Kunming Institute of Zoology, Chinese Academy of Sciences, 32 Jiaochang Donglu, Kunming, 650223, China.,Kunming College of Life Science, University of Chinese Academy of Sciences, Kunming, Yunnan, China
| | - Wei Pang
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, Kunming Institute of Zoology, Chinese Academy of Sciences, 32 Jiaochang Donglu, Kunming, 650223, China
| | - Chiyu Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Si-Dong Xiong
- KIZ-SU Joint Laboratory of Animal Models and Drug Development, College of Pharmaceutical Sciences, Soochow University, 199 Renai Road, Wuzhong District, Suzhou, 215000, China. .,Jiangsu Key Laboratory of Infection and Immunity, Institutes of Biology and Medical Sciences, Soochow University, Suzhou, China.
| | - Yong-Tang Zheng
- Key Laboratory of Animal Models and Human Disease Mechanisms of the Chinese Academy of Sciences, Kunming Institute of Zoology, Chinese Academy of Sciences, 32 Jiaochang Donglu, Kunming, 650223, China. .,KIZ-SU Joint Laboratory of Animal Models and Drug Development, College of Pharmaceutical Sciences, Soochow University, 199 Renai Road, Wuzhong District, Suzhou, 215000, China.
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4
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Raya NAJ, Krisnawati KMS, Pramitaresthi IGA. Sexual behavior experience of former injecting drug users infected with HIV in Bali, Indonesia. ENFERMERIA CLINICA 2021. [PMID: 33357807 DOI: 10.1016/j.enfcli.2020.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Injecting Drug Users (IDUs) have become a serious concern in public health due to their potential in HIV transmission. This study aims to describe the sexual behavior experience of former IDUs infected with HIV in Bali, Indonesia. A qualitative study with a phenomenology approach was conducted using purposive sampling. Five former IDUs infected with HIV were selected and analyzed using a thematic analysis. The finding showed two themes; (1) knowledge related to drugs and HIV/AIDS, and (2) risky sexual behavior which consisted of sex with many close friends and using local prostitutes, sex after a drug party or after using drugs, preference for vaginal sex, engaging in sex despite having a known HIV positive status, and not using condoms frequently. This finding can be used to recommend that nurses and other health care providers work collaboratively and comprehensively in preventing the new cases of HIV caused by the risky sexual behavior of the IDUs.
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Wilson A, Wang YY, Chen R, Cen P, Wang Y, Yao X, Wang T, Li S, Yan H. A thematic analysis of experiences of HIV risks among female sex workers in the Yunnan-Vietnam Chinese border region. BMC WOMENS HEALTH 2021; 21:7. [PMID: 33407384 PMCID: PMC7789185 DOI: 10.1186/s12905-020-01143-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/07/2020] [Indexed: 12/29/2022]
Abstract
Background The Yunnan province is located near the “Golden Triangle” border region between China, Myanmar and Thailand, which has the highest HIV/AIDS prevalence in China. Female sex workers (FSWs) in the Yunnan province are highly vulnerable to HIV infection. The objective of this study was to examine the experiences of FSWs in the Yunnan to better understand the risk of infection and the potential for transmission of HIV. Methods Semi-structured interviews were conducted between May 2018 and June 2018 with 20 FSWs recruited in Hekou County, Yunnan Province, China. Thematic analysis was conducted to identify themes that highlighted increased exposure of FSWs to the risk of HIV infection and transmission. Results The findings showed that FSWs’ primary source for HIV information was gynecologists, with few visiting the local HIV charity Red Ribbon. FSWs reported infrequent visits for check-ups with some seeing a gynecologist once a year. FSWs felt that the onus was on them to prevent STI/HIV infection by using a condom during sex, regardless of their ability to negotiate use. FSWs were also reluctant to see a gynecologists for treatment. Instead, they resorted to douching as a way of preventing HIV/STIs and treating vaginal health problems, such as leucorrhea. Most FSWs worked without the influence of alcohol and drugs. A small number of FSWs reported heroin addiction and injecting drug use. Conclusion The findings suggest a need for innovative HIV prevention strategies among FSWs and their clients in the Chinese border region. Governmental agencies should continue to implement practical strategies in terms of HIV prevention education and condom use through tailored interventions that are localized. Such strategies should include localized tailored interventions that dispel myths about douching as a method of HIV/STI prevention and incorporate a mobile outreach approach, similar to the ‘roadside restaurant’ outreach that has been successful in rural China.
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Affiliation(s)
- Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Yuan Yuan Wang
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Runsen Chen
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ping Cen
- Center for Disease Control and Prevention of Nanning, Nanning, China
| | - Yuehui Wang
- School of Health Sciences, Wuhan University, Wuhan, China.,Center for Disease Control and Prevention of Yuzhong District of Chongqing, Chongqing, China
| | - Xing Yao
- Center for Disease Control and Prevention of Wuhan, Wuhan, China
| | - Tang Wang
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Shiyue Li
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Hong Yan
- School of Health Sciences, Wuhan University, Wuhan, China.
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6
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Liu C, Ma YL, Liu XH, Duan YR, Liu PL, Wang X, Yin P. Sociodemographic Factors Associated With HIV/HCV High-Risk Behaviors Among People Who Use Drugs on Methadone Maintenance Treatment: A 10-Year Observational Study. Front Psychiatry 2021; 12:707257. [PMID: 34594250 PMCID: PMC8477022 DOI: 10.3389/fpsyt.2021.707257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Sociodemographic factors have an impact worldwide on the behavior of people who use drugs (PWUD). This study attempts to clarify the sociodemographic factors related to HIV/HCV high-risk behaviors (injection drug use, syringe sharing, and multiple sex partners) among PWUD on methadone maintenance treatment (MMT) in the long term. Methods: The 13,300 PWUD recruited into the MMT program were followed during 2006-2015. Generalized estimating equations were used to examine the relationship between sociodemographic characteristics and HIV/HCV high-risk behaviors. Results: We found that male (vs. female), living alone (vs. living with family or relatives), temporary income, financial support from family/friends, and financial support from social welfare (vs. regular salary) were positively associated with injection drug use. Age of initial drug use was negatively associated with injection drug use and syringe sharing. For both genders, being unmarried (vs. married or in cohabitation), living with friends, living alone (vs. living with family or relatives), temporary income, financial supports from family/friends (vs. regular salary), being employed (vs. unemployed/between jobs) was positively associated. In contrast, age at baseline was negatively associated with having multiple sexual partners for both genders. Ethnic of non-Han (vs. Han) was positively associated with having multiple sexual partners simply for males. Being divorced or widowed (vs. married or cohabitated) was positively associated with having multiple sexual partners merely for females. Conclusion: HIV/HCV high-risk behaviors correlated with certain sociodemographic factors of PWUD receiving MMT. There is a need for improving the well-being, employment, and housing status of PWUD on MMT to reduce their HIV/HCV risk behaviors.
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Affiliation(s)
- Cong Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Wuhan Centers for Disease Control and Prevention, Wuhan, China
| | - Yi-Lei Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xue-Han Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan-Ran Duan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pu-Lin Liu
- Wuhan Centers for Disease Control and Prevention, Wuhan, China
| | - Xia Wang
- Wuhan Centers for Disease Control and Prevention, Wuhan, China
| | - Ping Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Zhu J, Hu D, Yin Y, Zhu Z, Wang N, Wang B. HIV prevalence and correlated factors among male clients of female sex workers in a border region of China. PLoS One 2019; 14:e0225072. [PMID: 31697754 PMCID: PMC6837524 DOI: 10.1371/journal.pone.0225072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/27/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives To assess the prevalence of human immunodeficiency virus (HIV) infection and the correlated risk factors among male clients of female sex workers (FSWs) in a Chinese–Vietnamese border region in Yunnan Province, China. Methods A cross-sectional survey was conducted between 2014 and 2015 in Hekou County, Yunnan Province, China. Convenience sampling and snowball sampling methods were used to recruit male clients for a questionnaire survey to collect information on demographics, sexual behavior, and drug use. Blood and urine samples were collected for testing of HIV/sexually transmitted infections (STIs) and drug use. Multivariate logistic regression was used to examine factors correlated with HIV infection. Results Of 776 respondents who participated in the study, 721 (92.91%) were Chinese and 55 (7.09%) were Vietnamese. Overall HIV prevalence in male clients of FSWs was 2.06%, 128 (16.49%) were infected with HSV-2, and five (0.64%) tested syphilis-positive. Two-thirds (68.81%) of respondents reported always using condoms with FSWs, and 89.05% reported condom use in the last episode of commercial sex. Male clients from Vietnam were significantly more likely to take morphine (9.09%) compared with Chinese male clients of FSWs. Age ≥50 years (OR: 8.11, 95%CI: 1.26–52.16) and morphine positivity (OR: 7.35, 95%CI: 1.42–38.06) were associated with HIV infection in the multivariate logistic regression model. Conclusion The relatively high proportion of male clients of FSWs who have numerous sexual partners and use condoms less frequently make them serve as important bridges for HIV transmission from FSWs to the low-risk general population. The positive association between morphine positivity and HIV infection confirmed illegal drug use as another important route for acquiring HIV infection in addition to sexual transmission, indicating that innovative interventions addressing both drug use and risky sexual behaviors are greatly required for male clients. Respondents aged ≥50 years have a higher risk of HIV infection, which emphasizes that older male clients of FSWs should be focused in future HIV prevention interventions in the border regions of China.
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Affiliation(s)
- Jing Zhu
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu, P.R. China
| | - Dan Hu
- Department of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Yueqi Yin
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu, P.R. China
| | - Zhibin Zhu
- Hekou Center for Disease Control and Prevention, Hekou, Yunnan, P.R. China
| | - Ning Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Bei Wang
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu, P.R. China
- * E-mail:
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8
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Shava E, Lipira LE, Beauchamp GG, Donnell DJ, Lockman S, Ruan Y, Shao Y. Risky Sexual Behavior Among Individuals Receiving Buprenorphine/Naloxone Opiate Dependency Treatment: HIV Prevention Trials Network (HPTN) 058. J Acquir Immune Defic Syndr 2019; 78:300-307. [PMID: 29557855 PMCID: PMC5997518 DOI: 10.1097/qai.0000000000001683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Understanding the role of opiate dependency treatment in risky sexual behavior could help optimize interventions for people who inject drugs (PWID). OBJECTIVES We evaluated whether long-term medication-assisted treatment (LT-MAT) of opiate dependency with buprenorphine/naloxone influenced risky sexual behavior among HIV-uninfected PWID and identified predictors of risky sexual behavior. METHODS We used data from HPTN 058, a randomized controlled trial of LT-MAT vs. short-term medication-assisted treatment among PWID in China and Thailand. We evaluated associations between randomized opiate dependency treatment group and self-reported risky sexual behaviors within the past month: condomless sex with primary partner, condomless sex with nonprimary partner, multiple partners, and more than 3 sexual acts. We used generalized estimating equations to conduct intention-to-treat, as-treated, and exploratory analyses of these associations. RESULTS Of 1250 participants included in the analysis, 92% were male, with median age of 34 years (interquartile range 28-39). At baseline, referring to the past month, 36% of participants reported condomless sex with primary partner, 4% reported condomless sex with nonprimary partner, 6% reported multiple sex partners, and 30% reported more than 3 sexual acts. Risky sexual behaviors did not differ significantly between treatment groups at any point. Significant predictors (P < 0.05) of condomless sex with nonprimary partner were history of incarceration and noninjection drug use. Number of needle-sharing partners, noninjection drug use, and higher income were predictors for multiple sexual partners. CONCLUSIONS LT-MAT did not significantly modify risky sexual behavior among HIV-uninfected PWID. Interventions that reduce sexual risk should target PWID with history of incarceration, alcohol use, and needle sharing.
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Affiliation(s)
- Emily Shava
- Botswana Harvard AIDS Institute Partnership, Harvard T.H. Chan School of Public Health, Gaborone, Botswana
| | - Lauren E Lipira
- HIV Prevention Trials Network, Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA.,Department of Health Services, University of Washington, Seattle, WA
| | - Geetha G Beauchamp
- HIV Prevention Trials Network, Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Vaccine and Infectious Disease Division (VIDD), Seattle, WA
| | - Deborah J Donnell
- HIV Prevention Trials Network, Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Shahin Lockman
- Botswana Harvard AIDS Initiative Partnership, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Gaborone, Botswana
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
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9
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Chen M, Ma Y, Chen H, Dai J, Luo H, Yang C, Dong L, Jin X, Yang M, Yang L, Song L, Song Z, Jia M. Spatial clusters of HIV-1 genotypes in a recently infected population in Yunnan, China. BMC Infect Dis 2019; 19:669. [PMID: 31357947 PMCID: PMC6664787 DOI: 10.1186/s12879-019-4276-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/10/2019] [Indexed: 12/04/2022] Open
Abstract
Background As a gateway for HIV-1 in China, Yunnan has experienced dramatic changes in HIV-1 epidemics, during which HIV-1 genotypes have become complex. To track dynamic changes in HIV-1 genotypes, an HIV-1 molecular epidemiological study was implemented in the recently infected population in Yunnan. Methods From 6,357 HIV-1-positive samples diagnosed during the first half of 2015 in Yunnan, 586 samples were identified as recent infections with BED-capture enzyme immunoassay (CEIA) and were subjected to phylogenetic analyses. Spatial scanning analyses for the main HIV-1 genotypes were also performed. Results Among the 439 specimens successfully genotyped, more than ten genotypes were detected, including CRF08_BC (45.3%), CRF07_BC (19.4%), unique recombinant forms (URFs) (18.2%), CRF01_AE (11.4%), subtype C (2.1%), CRF85_BC (1.1%), CRF55_01B (0.9%), subtype B (0.5%), CRF64_BC (0.5%), CRF59_01B (0.2%), CRF83_cpx (0.2%) and CRF87_cpx (0.2%). Females, Chinese, heterosexual contact and intravenous drug injection were significantly associated with CRF08_BC infection; homosexual contact was significantly associated with CRF01_AE and CRF07_BC infection; males and non-Chinese had a higher risk of URF infection than females. Among all HIV-1 genotypes, the geographic coverage of CRF08_BC was the largest. For CRF08_BC, CRF07_BC, URFs and CRF01_AE, spatial clusters were detected. The two CRF08_BC clusters and one URF cluster were associated with heterosexual transmission, and two of CRF01_AE clusters were associated with homosexual transmission. Transmitted drug resistance (TDR)-associated mutations were detected in 2.4% of individuals. Conclusions The diversity of HIV-1 genotypes increased in recent infections because of a long-term HIV-1 epidemic in Yunnan. The predominant HIV-1 strains showed distinct demographic characteristics and formed spatial clusters. These findings improved our understanding of the evolution of HIV-1 in Yunnan and provided information for further HIV-1 control and prevention. Electronic supplementary material The online version of this article (10.1186/s12879-019-4276-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Min Chen
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No. 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Yanling Ma
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No. 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Huichao Chen
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No. 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Jie Dai
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No. 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Hongbing Luo
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No. 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Chaojun Yang
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No. 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Lijuan Dong
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No. 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Xiaomei Jin
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No. 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Min Yang
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No. 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Li Yang
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No. 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Lijun Song
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No. 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Zhizhong Song
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No. 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China
| | - Manhong Jia
- Institute for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, No. 158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China.
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10
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Zhu J, Yuan R, Hu D, Zhu Z, Wang N, Wang B. HIV prevalence and correlated factors of female sex workers and male clients in a border region of Yunnan Province, China. Int J STD AIDS 2017; 29:424-434. [PMID: 28901213 DOI: 10.1177/0956462417730258] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Female sex workers (FSWs) and their male clients are vulnerable to HIV infection and serve as a bridge in HIV transmission from the high-risk population to the general, low-risk population. To examine the factors of FSWs and male clients that correlate with the prevalence of HIV infection in the Chinese-Vietnamese border region, a cross-sectional survey was conducted in 2014 in the Hekou county of the Yunnan province of China. We performed a questionnaire survey to collect data on demographics, sexual behavior, and drug use. Blood and urine samples were collected for testing of HIV/sexually transmitted infections and drug use. We found that the prevalence of HIV infection among FSWs was 2.74%, and 15 male clients (2.62%) were HIV-positive. Multivariate logistic regression analysis revealed that herpes simplex virus type 2 infection was a risk factor for HIV infection in FSWs and male clients, suggesting the increased role of sexual transmission in the HIV epidemic in the Chinese-Vietnamese border region. Positive urinalysis result for amphetamine-type stimulants was observed in FSWs with HIV infection. History of drug use was correlated with HIV infection, which increased the HIV infection risk of male clients, confirming that drug use is an important target in future interventions for HIV prevention.
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Affiliation(s)
- Jing Zhu
- 1 Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, 12579 Southeast University , Nanjing City, China
| | - Rui Yuan
- 1 Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, 12579 Southeast University , Nanjing City, China
| | - Dan Hu
- 2 Department of Health Policy and Management, 12461 Nanjing Medical University , Nanjing City, China
| | - Zhibin Zhu
- 3 Hekou Center for Disease Control and Prevention, Hekou, China
| | - Ning Wang
- 4 National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing City, China
| | - Bei Wang
- 1 Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, 12579 Southeast University , Nanjing City, China
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11
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Duan S, Jin Z, Liu X, Yang Y, Ye R, Tang R, Gao M, Ding Y, He N. Tobacco and alcohol use among drug users receiving methadone maintenance treatment: a cross-sectional study in a rural prefecture of Yunnan Province, Southwest China. BMJ Open 2017; 7:e014643. [PMID: 28363929 PMCID: PMC5387941 DOI: 10.1136/bmjopen-2016-014643] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of ever, current and heavy tobacco and alcohol use and their correlates among patients undergoing methadone maintenance treatment (MMT). DESIGN Cross-sectional study. SETTING The study was conducted in all of the 5 MMT clinics in Dehong Prefecture, China. PARTICIPANTS 2121 (81.6%) eligible MMT participants were included in the study population. ANALYSIS Ordinal logistic regression was used to estimate the ORs and their 95% CIs. RESULTS The overall prevalence of ever, current and heavy smoking was 98.6%, 97.8% and 66.3%, respectively; while that of ever, current and hazardous alcohol drinking was 86.6%, 58.6% and 16.6%, respectively. Among HIV-infected participants, the proportions of those experiencing harmful effects of tobacco and alcohol on AIDS were 53.6% and 72.5%, respectively, and 16.9% and 49.3% had ever tried to quit after diagnosis with HIV. After adjusting for potential confounders, heavier smokers and more hazardous drinkers were more likely to be men, older and less educated. Ethnic minorities were less likely to heavily smoke, but more likely to engage in hazardous drinking. In addition, hazardous drinking was negatively associated with longer years of MMT and HIV infection. Moreover, heavier smoking (OR≥2=2.08, 95% CI 1.16 to 3.73) and more hazardous drinking (OR≥2=2.46, 95% CI 1.53 to 3.97) were positively associated with having multiple sexual partners, and both were positively associated with each other. CONCLUSIONS The prevalence of tobacco and alcohol consumption was extraordinarily high among MMT participants in China, suggesting the urgent need of enhancing MMT patients' awareness of the harmful effects of tobacco and alcohol consumption and implementing comprehensive education and effective intervention programmes.
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Affiliation(s)
- Song Duan
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Ziyi Jin
- Department of Epidemiology at School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Xing Liu
- Department of Epidemiology at School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yuecheng Yang
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Runhua Ye
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Renhai Tang
- Dehong Prefecture Center for Disease Control and Prevention, Mangshi, Yunnan Province, China
| | - Meiyang Gao
- Department of Epidemiology at School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Yingying Ding
- Department of Epidemiology at School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Na He
- Department of Epidemiology at School of Public Health and The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
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12
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Huang J, Jiang J, Yang X, Liang B, Qin B, Upur H, Zhong C, Wang Q, Wang Q, Ruan Y, Deng W, Xie P, Liao Y, Xu N, Zou Y, Wei F, Ye L, Liang H. Assessment of Different Intervention Models of Male Circumcision and Their Preliminary Effectiveness in Reducing HIV Incidence Among Drug Users in Western China. AIDS Res Hum Retroviruses 2016; 32:972-980. [PMID: 27400784 DOI: 10.1089/aid.2016.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
World Health Organization (WHO) and Joint United Nations Program on AIDS (UNAIDS) recommend male circumcision (MC) as an additional HIV prevention measure. This study aimed to assess three models of promoting MC and their effects on preventing HIV infection among drug users in western China. We carried out a cohort study in three provinces of western China. HIV seronegative male drug users were recruited from methadone maintenance therapy clinics and cluster randomized into three intervention models. At baseline, 6, and 9 months of follow-up, changes in MC knowledge, the acceptability of MC, MC surgery uptake, and the costs of model implementation were analyzed. Of 1,304 male drug users who were screened, 1,218 were enrolled in the study. The participants' knowledge about MC was significantly increased after interventions by all three models. The one-stage model led to the highest increase in MC acceptability and the greatest increase in MC uptake. Multivariable Cox regression analysis showed that the one-stage model was also the most effective method to promote MC uptake, compared with the two-stage model [rate ratio (RR) = 0.602; 95% confidence interval (CI), 0.420-0.862] and three-stage model (RR = 0.555; 95% CI, 0.382-0.807). The HIV incidence rate in the MC group was lower than that in the non-MC group (RR = 0.234; 95% CI, 0.056-0.974). Moreover, the one-stage model required the lowest cost per circumcision. The one-stage model is the most effective and the most cost-effective intervention to increase MC uptake among male drug users in western China and could decrease the HIV incidence rate, based on a short follow-up investigation.
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Affiliation(s)
- Jiegang Huang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Junjun Jiang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaobo Yang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Bingyu Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Bo Qin
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Halmurat Upur
- School of Public Health, Xinjiang Medical University, Urumqi, China
| | - Chaohui Zhong
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qianqiu Wang
- National Center for STD Control, China Centers for Disease Control and Prevention, Nanjing, China
| | - Qian Wang
- School of Public Health, Xinjiang Medical University, Urumqi, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Wei Deng
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Peiyan Xie
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Yanyan Liao
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Na Xu
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Yunfeng Zou
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Fumei Wei
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Li Ye
- Guangxi Key Laboratory of AIDS Prevention and Treatment & School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment & Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
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13
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Tsui HY, Lau JTF, Wang Z, Gross DL, Wu AMS, Cao W, Gu J, Li S. Applying the pre-intentional phase of the Health Action Process Approach (HAPA) Model to investigate factors associated with intention on consistent condom use with various types of female sex partners among males who inject drugs in China. AIDS Care 2016; 28:1079-88. [DOI: 10.1080/09540121.2016.1146652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Vargas SE, Fava JL, Severy L, Rosen RK, Salomon L, Shulman L, Guthrie KM. Psychometric Properties and Validity of a Multi-dimensional Risk Perception Scale Developed in the Context of a Microbicide Acceptability Study. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:415-428. [PMID: 26621151 PMCID: PMC4707104 DOI: 10.1007/s10508-015-0619-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 08/31/2015] [Accepted: 09/03/2015] [Indexed: 06/05/2023]
Abstract
Currently available risk perception scales tend to focus on risk behaviors and overall risk (vs partner-specific risk). While these types of assessments may be useful in clinical contexts, they may be inadequate for understanding the relationship between sexual risk and motivations to engage in safer sex or one's willingness to use prevention products during a specific sexual encounter. We present the psychometric evaluation and validation of a scale that includes both general and specific dimensions of sexual risk perception. A one-time, audio computer-assisted self-interview was administered to 531 women aged 18-55 years. Items assessing sexual risk perceptions, both in general and in regards to a specific partner, were examined in the context of a larger study of willingness to use HIV/STD prevention products and preferences for specific product characteristics. Exploratory and confirmatory factor analyses yielded two subscales: general perceived risk and partner-specific perceived risk. Validity analyses demonstrated that the two subscales were related to many sociodemographic and relationship factors. We suggest that this risk perception scale may be useful in research settings where the outcomes of interest are related to motivations to use HIV and STD prevention products and/or product acceptability. Further, we provide specific guidance on how this risk perception scale might be utilized to understand such motivations with one or more specific partners.
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Affiliation(s)
- Sara E Vargas
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA.
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Lawrence Severy
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Rochelle K Rosen
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Liz Salomon
- The Fenway Institute, Fenway Community Health, Boston, MA, USA
| | | | - Kate Morrow Guthrie
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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15
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Chow EP, Gao L, Chen L, Jing J, Zhang L. Shifting Patterns of the HIV Epidemic in Southwest China: A Case Study Based on Sentinel Surveillance, 1995-2012. AIDS Patient Care STDS 2015; 29:314-20. [PMID: 25928866 DOI: 10.1089/apc.2014.0307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The HIV epidemic is experiencing a rapid shift in transmission profile in China. This study aims to examine the changes in magnitude, transmission pattern, and trend of the HIV epidemic in a typical Southwest Chinese prefecture over the period of 1995-2012. HIV surveillance data from the web-based reporting system were analyzed during this period. We investigated the temporal trends in the changing characteristics of HIV transmission, the HIV disease burden in key affected populations, and assessed the impacts on HIV disease progression due to scale-up of antiretroviral treatment. A total of 3556 HIV/AIDS cases were reported in Yuxi prefecture, Yunnan, over the study period. The number of HIV tests conducted has dramatically increased from 1041 in 1995 to 247,859 in 2012, resulting in a substantial increase in HIV diagnoses from 11 cases to 327 cases over the same period. Since 2005, cumulatively 1250 eligible people living with HIV (PLHIV) have received combination antiretroviral therapy which reduced AIDS disease progression from 9.0% (95% CI: 6.7-11.4%) in 1995 to 0.1% (0-0.3%) in 2012 (ptrend=0.0002). The primary mode of HIV transmission has been shifted from injection sharing (71.9% diagnoses in 1995-2004) to unsafe sexual contacts (82.6% diagnoses in 2012). Yuxi prefecture is experiencing a concentrated but shifting HIV epidemic. Scale-up of HIV testing is essential to effective sentinel surveillance and enhancing early diagnosis and treatment in PLHIV.
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Affiliation(s)
- Eric P.F. Chow
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- The Kirby Institute, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Liangmin Gao
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Liang Chen
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Jun Jing
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Lei Zhang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- The Kirby Institute, University of New South Wales Australia, Sydney, New South Wales, Australia
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16
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Wang B, Liang Y, Feng Y, Li Y, Wang Y, Zhang AM, Baloch Z, Liu L, Qin W, Xia X. Prevalence of human immunodeficiency virus 1 infection in the last decade among entry travelers in Yunnan Province, China. BMC Public Health 2015; 15:362. [PMID: 25886406 PMCID: PMC4415269 DOI: 10.1186/s12889-015-1683-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Yunnan is not only considered the region with the most concerning human immunodeficiency virus (HIV)-1 prevalence, but is also the central hub for the spread of HIV-1 from Southeast Asia to the other provinces of China. Yunnan has the highest proportion of entry travelers who have transmitted HIV from neighbored Southeast Asian countries to mainland of China. METHODS Between 2003 and 2012, we recruited 280,961 entry travelers at land ports located in 7 bordering prefectures respectively in the Yunnan Province for HIV-1 screening. Based on the detection of HIV-1 antibody, the HIV-1 infection rate was determined. RESULTS Among the recruited entry travelers, 2380 were determined HIV-1 positive with infection rate of 0.85%. Travelers entering the Dehong port had the highest HIV-1 infection rate (5.12%), followed by those entering Baoshan (0.88%), Lincang (0.83%), and Honghe (0.71%). For all HIV-1 positive cases, travelers aged 21-30 and 31-40 were the most commonly infected individuals, accounting for 38.45% and 37.77% of all cases, respectively. The most common occupation of the infected population was driver (42.38%), and the proportion of industrials had increased yearly. Based on the reported risk factors, sexual transmission was the main HIV-1 infection route (77.11%) of this population. CONCLUSIONS We have clarified the rate of HIV-1 infection among this bridge population. The characteristics of HIV-1 positive population and high geographical heterogeneity have provided the necessary epidemiological data for monitoring the HIV-1 epidemic among cross-border travelers in Yunnan and to further understand the cross-border spreading of the HIV-1 infection.
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Affiliation(s)
- Binghui Wang
- Faculty of Environmental Science and Engineering & Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China.
| | - Yaobo Liang
- Care Center for International Travel Health in Yunnan, Kunming, China.
| | - Yue Feng
- Faculty of Environmental Science and Engineering & Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China.
| | - Yaping Li
- Care Center for International Travel Health in Yunnan, Kunming, China.
| | - Yajuan Wang
- Faculty of Environmental Science and Engineering & Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China.
| | - A-Mei Zhang
- Faculty of Environmental Science and Engineering & Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China.
| | - Zulqarnain Baloch
- Faculty of Environmental Science and Engineering & Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China.
| | - Li Liu
- Faculty of Environmental Science and Engineering & Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China.
| | - Weihong Qin
- Care Center for International Travel Health in Yunnan, Kunming, China.
| | - Xueshan Xia
- Faculty of Environmental Science and Engineering & Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, China.
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17
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Song Y, Kang D, Wang G, Wei C, Tao X, Huang T, Qian Y, Zhu T, Yang S, Yu S, Wang H, Ma W. HIV/AIDS-related knowledge and behaviors among rural married migrant women in Shandong Province, China: a comparison study. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:367-374. [PMID: 25323941 DOI: 10.1007/s10508-014-0360-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 04/26/2014] [Accepted: 05/26/2014] [Indexed: 06/04/2023]
Abstract
Migrant women in China are disproportionately affected by HIV/AIDS. This study described HIV/AIDS-related knowledge and behaviors among married migrant women in Shandong province in comparison to non-migrant local women and identified factors associated with HIV testing history and extramarital sex among married migrant women. A probability-based sample of 1,076 migrant and 1,195 local women were included in the analyses. Compared to local women, married migrant women had lower levels of HIV/AIDS knowledge and were more likely to have had premarital sex, extramarital sex, history of sexually transmitted diseases, and drug use. Less than a quarter of migrant women used condoms consistently in extramarital sex. Only 31.0 % of married migrant women had ever tested for HIV, and the rate of premarital HIV testing was very low. Multivariable analysis showed that married migrant women with a history of extramarital sex were more likely to be from Yunnan province, be living in Yantai city, be in their first marriage, have lower family income, have poor relationship with spouses, use drug, have a history of sexually transmitted diseases, and have lower social support. Our findings provide further evidence that married migrant women are at higher risk for HIV infection and that targeted interventions need to be developed for this population.
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Affiliation(s)
- Yapei Song
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, 250012, Shandong Province, China
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18
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Lim TW, Davis WW, Quan VM, Frangakis C, Ha TV, Le Minh N, Latkin C, Zelaya C, Mo TT, Go VF. ASSOCIATION BETWEEN HIV KNOWLEDGE AND RISK BEHAVIOR IN PERSONS WHO INJECT DRUGS IN THAI NGUYEN, VIETNAM. THE SOUTHEAST ASIAN JOURNAL OF TROPICAL MEDICINE AND PUBLIC HEALTH 2014; 45:1425-1436. [PMID: 26466429 PMCID: PMC4820241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In Vietnam HIV infection is concentrated in key populations, including persons who inject drugs (PWID). The majority of PWID can name specific transmission routes of HIV, yet risk behaviors remain high. We conducted a cross-sectional survey of 1,355 PWID in Thai Nguyen Province, Vietnam, to compare their HIV knowledge with their self-reported risk behavior. Broader knowledge of HIV transmission, measured by a higher composite HIV knowledge score, was associated with a 19.5% lower adjusted odds of giving a used needle to another (p = 0.011) and 20.4% lower adjusted odds of using a needle that another had used (p = 0.001). A higher knowledge score was associated with 13.1% higher adjusted odds of consistent condom use (p = 0.083). These results suggest a broader knowledge may reflect characteristics about how individuals obtain knowledge or the way that knowledge is delivered to them and may be associated with their ability to engage in risk reduction behavior.
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Affiliation(s)
- Travis W. Lim
- Department of International Health, Johns Hopkins University Bloomberg, School of Public Health, Baltimore, MD
| | - Wendy W. Davis
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Vu Minh Quan
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Constantine Frangakis
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Tran Viet Ha
- Johns Hopkins University Bloomberg School of Public Health, Hanoi, Vietnam
| | | | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Carla Zelaya
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Tran Thi Mo
- Johns Hopkins University Bloomberg School of Public Health, Hanoi, Vietnam
| | - Vivian F. Go
- Department of International Health, Johns Hopkins University Bloomberg, School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC
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Chen Y, Chen S, Kang J, Fang H, Dao H, Guo W, Lai C, Lai M, Fan J, Fu L, Andrieu JM, Lu W. Evolving molecular epidemiological profile of human immunodeficiency virus 1 in the southwest border of China. PLoS One 2014; 9:e107578. [PMID: 25207977 PMCID: PMC4160289 DOI: 10.1371/journal.pone.0107578] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 08/19/2014] [Indexed: 11/23/2022] Open
Abstract
Background We have previously reported in Xishuangbanna (Banna) Dai Autonomous Prefecture, a well-developed tourist destination in the southwest border of China, that HIV-1 transmitted dominantly through heterosexual contact with less divergent genotypes and few drug resistant mutations [1]. Due to the rapid increase of newly diagnosed HIV-1 cases per year in Banna in recent years, it’s important to evaluate the evolution of HIV-1 molecular epidemiology for the better understanding of ongoing HIV-1 outbreak in this region. Methodology/Principal Findings By sequencing of HIV-1 pol genes and phylogenetic analysis, we conducted a molecular epidemiologic study in 352 HIV-1-seropositive highly active antiretroviral treatment (HAART)-naïve individuals newly diagnosed at the Banna Center for Disease Control and Prevention between 2009 and 2011. Of 283 samples (84.1% taken from heterosexually acquired adults, 10.6% from needle-sharing drug users, 2.8% from men who have sex with men, 0.4% from children born from HIV-1-infected mothers, and 2.1% remained unknown) with successful sequencing for pol gene, we identified 108 (38.2%) HIV-1 subtype CRF08_BC, 101 (35.7%) CRF01_AE, 49 (17.3%) CRF07_BC, 5 (1.8%) C/CRF57_BC, 3 (1.1%) B’, 1 (0.4%) B/CRF51_01B, and 16 (5.7%) unique recombinants forms. Among these infected individuals, 104 (36.7%) cases showed drug resistant or resistance-relevant mutations, and 4 of them conferring high-level resistance to 3TC/FTC, EFV/NVP or NFV. Phylogenetic analysis revealed 21 clusters (2–7 sequences) with only 21.2% (60/283) sequences involved. Conclusion/Significance In contrast to our previous findings, CRF08_BC, replaced CRF01_AE, became the dominant genotype of HIV-1 in Banna prefecture. The viral strains with drug resistance mutations were detected frequently in newly diagnosed HIV-1-infected individuals in this region.
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Affiliation(s)
- Yingyu Chen
- Sino-French Collaborative Laboratory, Tropical Medicine Institute, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Song Chen
- Sino-French Collaborative Laboratory, Tropical Medicine Institute, Guangzhou University of Chinese Medicine, Guangzhou, China
- Institut de Recherche sur les Vaccins et l’Immunologie des Cancers et du Sida, Université Paris Descartes/Institut de Recherche pour le Développement, Paris, France
| | - Jun Kang
- Xishuangbanna Center for Disease Control and Prevention, Jinghong, Yunnan, People’s Republic of China
| | - Hua Fang
- Xishuangbanna Center for Disease Control and Prevention, Jinghong, Yunnan, People’s Republic of China
| | - Hong Dao
- Xishuangbanna Center for Disease Control and Prevention, Jinghong, Yunnan, People’s Republic of China
| | - Weizhong Guo
- Sino-French Collaborative Laboratory, Tropical Medicine Institute, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chunhui Lai
- Sino-French Collaborative Laboratory, Tropical Medicine Institute, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingyue Lai
- Xishuangbanna Center for Disease Control and Prevention, Jinghong, Yunnan, People’s Republic of China
| | - Jianhua Fan
- Xishuangbanna Center for Disease Control and Prevention, Jinghong, Yunnan, People’s Republic of China
| | - Linchun Fu
- Sino-French Collaborative Laboratory, Tropical Medicine Institute, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jean-Marie Andrieu
- Institut de Recherche sur les Vaccins et l’Immunologie des Cancers et du Sida, Université Paris Descartes/Institut de Recherche pour le Développement, Paris, France
| | - Wei Lu
- Sino-French Collaborative Laboratory, Tropical Medicine Institute, Guangzhou University of Chinese Medicine, Guangzhou, China
- Institut de Recherche sur les Vaccins et l’Immunologie des Cancers et du Sida, Université Paris Descartes/Institut de Recherche pour le Développement, Paris, France
- * E-mail:
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20
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Li L, Assanangkornchai S, Duo L, McNeil E, Li J. Risk behaviors, prevalence of HIV and hepatitis C virus infection and population size of current injection drug users in a China-Myanmar border city: results from a Respondent-Driven Sampling Survey in 2012. PLoS One 2014; 9:e106899. [PMID: 25203256 PMCID: PMC4159231 DOI: 10.1371/journal.pone.0106899] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 08/10/2014] [Indexed: 02/06/2023] Open
Abstract
Background Injection drug use has been the major cause of HIV/AIDS in China in the past two decades. We measured the prevalences of HIV and hepatitis C virus (HCV) prevalence and their associated risk factors among current injection drug users (IDUs) in Ruili city, a border region connecting China with Myanmar that has been undergoing serious drug use and HIV spread problems. An estimate of the number of current IDUs is also presented. Methods In 2012, Chinese IDUs who had injected within the past six months and aged ≥18 years were recruited using a respondent-driven sampling (RDS) technique. Participants underwent interviews and serological testing for HIV, HBV, HCV and syphilis. Logistic regression indentified factors associated with HIV and HCV infections. Multiplier method was used to obtain an estimate of the size of the current IDU population via combining available service data and findings from our survey. Results Among 370 IDUs recruited, the prevalence of HIV and HCV was 18.3% and 41.5%, respectively. 27.1% of participants had shared a needle/syringe in their lifetime. Consistent condom use rates were low among both regular (6.8%) and non-regular (30.4%) partners. Factors independently associated with being HIV positive included HCV infection, having a longer history of injection drug use and experience of needle/syringe sharing. Participants with HCV infection were more likely to be HIV positive, have injected more types of drugs, have shared other injection equipments and have unprotected sex with regular sex partners. The estimated number of current IDUs in Ruili city was 2,714 (95% CI: 1,617–5,846). Conclusions IDUs may continue to be a critical subpopulation for transmission of HIV and other infections in this region because of the increasing population and persistent high risk of injection and sexual behaviours. Developing innovative strategies that can improve accessibility of current harm reduction services and incorporate more comprehensive contents is urgently needed.
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Affiliation(s)
- Lei Li
- Yunnan Institute of Drug Abuse, Kunming, Yunnan, P.R. China
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
- * E-mail:
| | - Lin Duo
- HIV/AIDS Asia Regional Program Yunnan Management Office, Kunming, Yunnan, P.R. China
| | - Edward McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Jianhua Li
- Yunnan Institute of Drug Abuse, Kunming, Yunnan, P.R. China
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Wang L, Wei X, Wang X, Li J, Li H, Jia W. Long-term effects of methadone maintenance treatment with different psychosocial intervention models. PLoS One 2014; 9:e87931. [PMID: 24498406 PMCID: PMC3912169 DOI: 10.1371/journal.pone.0087931] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 12/31/2013] [Indexed: 11/18/2022] Open
Abstract
This study evaluated the long-term effects of different psychosocial intervention models in methadone maintenance treatment (MMT) in Xi'an China. Patients from five MMT clinics were divided into three groups receiving MMT only, MMT with counseling psychology (CP) or MMT with contingency management (CM). A five-year follow-up was carried out with daily records of medication, monthly random urine morphine tests, and tests for anti-HIV and anti-HCV every six months. Drug use behavior was recorded six months after initial recruitment using a survey. Adjusted RRs and their 95% confidence intervals (CIs) were estimated using an unconditional logistic regression model or a Cox proportional hazard model. A total of 2662 patients were recruited with 797 in MMT, 985 in MMT with CP, and 880 in MMT with CM. Following six months of treatment, the injection rates of MMT with CP and MMT with CM groups were significantly lower than that of MMT (5.1% and 6.9% vs. 16.3%, x² = 47.093 and 29.908, respectively; P<0.05). HIV incidences for MMT, MMT with CP and MMT with CM at the five year follow-up were 20.09, 0.00 and 10.02 per ten thousand person-years, respectively. HCV incidences were 18.35, 4.42 and 6.61 per hundred person-years, respectively, demonstrating that CP and CM were protective factors for HCV incidence (RR = 0.209 and 0.414, with range of 0.146-0.300 and 0.298-0.574, respectively). MMT supplemented with CP or CM can reduce heroin use and related risk behaviors, thereby reducing the incidence of HIV and HCV.
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Affiliation(s)
- Lirong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Xiaoli Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Xueliang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
- * E-mail:
| | - Jinsong Li
- Xi'an Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Hengxin Li
- Xi'an Center for Disease Control and Prevention, Xi'an, Shaanxi, China
| | - Wei Jia
- Methadone Maintenance Therapy Clinic, Xi’an Mental Health Center, Xi'an, Shaanxi, China
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Huang J, Jiang J, Abdullah AS, Yang X, Wei B, Deng W, Qin B, Upur H, Zhong C, Wang Q, Wang Q, Ruan Y, Zou Y, Ye L, Xie P, Wei F, Xu N, Liang H. Factors associated with acceptability of circumcision among male drug users in western China: a cross-sectional study. Int J STD AIDS 2013; 24:541-7. [PMID: 23970769 DOI: 10.1177/0956462412473893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study is aimed to investigate whether male circumcision (MC) is feasible among IDUs in China. 1304 drug users who attended methadone maintenance therapy clinics in Guangxi, Chongqing and Xinjiang were selected for participation by using convenience sampling, and completed a self-administered questionnaire. The factors associated with the acceptability of MC were examined via multiple logistic regression models. 45.2% (589/1304) of the participants reported an acceptance of MC. Many of the participants who were initially not willing to accept MC (715/1304) had changed their mind when they were informed that MC would reduce the risk of HIV and STDs (43.4%; 310/715), that MC is associated with few surgery-related complications (23.1%; 165/715), that the surgical procedure could be arranged free of charge (20.1%, 144/715). In the multivariate analysis, higher acceptability of MC was associated with knowledge of the hazards of phimosis (OR=2.22), the presence of phimosis (OR=14.87), and knowledge that MC can prevent AIDS and STDs (OR=1.49); while lower acceptability was associated with residing in Chongqing province (OR=0.41) and an educational level of junior (OR=0.64) and senior high (OR=0.63) school. The MC policy targeting IDUs in China should take into account these factors associated with MC acceptability.
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Affiliation(s)
- J Huang
- School of Public Health, Guangxi Medical University, Nanning, China
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Zhang L, Chen X, Zheng J, Zhao J, Jing J, Zhang J, Chow EPF, Wilson DP. Ability to access community-based needle-syringe programs and injecting behaviors among drug users: a cross-sectional study in Hunan Province, China. Harm Reduct J 2013; 10:8. [PMID: 23651665 PMCID: PMC3667044 DOI: 10.1186/1477-7517-10-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 04/29/2013] [Indexed: 11/23/2022] Open
Abstract
Background Needle-syringe exchange programs (NSPs) have been substantially rolled-out in China since 2002. Limited studies reported effectiveness of NSPs in a Chinese setting. This study aimed to assess the association between accessibility to NSPs and drug-use risk behaviors of IDUs by investigating primary (self-reported) data of IDUs recruited from NSP sites, community settings and mandatory detoxification centers (MDCs) in Hunan province, China. Methods A cross-sectional survey was conducted in Hunan province in 2010. IDU recruits participated in a face-to-face interview to provide information related to their ability to access NSPs, demographic characteristics, and injecting behaviors in the past 30 days. Results Of the total 402 participants, 35%, 14% and 51% participants indicated low, medium and high ability to access NSPs in the past 30 days, respectively. A significantly higher proportion of IDUs (77.3%) from the high-access group reported ≤2 injecting episodes per day compared with medium- (46.3%) and low-access (58.8%) groups. Only 29.0% of high-access IDUs re-used syringes before disposal in the past 30 days, significantly lower than those in the medium- (43.1%) and low-access (41.3%) groups. Reported levels of needle/syringe sharing decreased significantly as the ability to access NSPs increased (16.3%, 12.7% and 2.5% in the low, medium and high access groups, respectively). Ninety percent of IDUs recruited from MDCs had low ability to access NSPs. Conclusions Increased NSP accessibility is associated with decreased levels of injecting frequency, repetitive use and sharing of injecting equipment among Chinese IDUs. Mandatory detention of IDUs remains as a major barrier for IDUs to access NSPs in China.
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Huang J, Jiang J, Li JZ, Yang X, Deng W, Abdullah AS, Qin B, Upur H, Zhong C, Wang Q, Wang Q, Ruan Y, Zou Y, Ye L, Xie P, Wei F, Xu N, Wei B, Liang H. Prevalence and correlates of sexual risk behaviors among drug users in western China: implications for HIV transmission. AIDS Res Hum Retroviruses 2013; 29:673-80. [PMID: 23210514 DOI: 10.1089/aid.2012.0272] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The prevalence and correlates of sexual risk behaviors among drug users in western China and the implications for HIV transmission in this population are described. A cross-sectional survey of male drug users was conducted in methadone maintenance therapy clinics and detoxification centers in three western provinces of China between September 2009 and December 2010. Participants in the study completed a questionnaire about demographics, HIV/AIDS knowledge, drug use history, sexual risk behaviors, and other psychosocial variables. Factors associated with HIV sexual risk behaviors were identified by multiple logistic regression analysis. Of 1,304 drug users surveyed, nearly 54% never used condoms during sexual intercourse with a spouse or cohabitant, and this behavior was associated with coming from Chongqing (OR=1.86, p<0.05), being aged 36 and older (OR=5.03, p<0.05), being married or cohabiting (OR=1.68, p<0.05), having first taken drugs at age 30 and above (OR=1.80, p<0.05), and having received AIDS advice or detection from authorities in the past year (OR=1.95, p<0.05). Twenty-six percent had had sex with casual sexual partners in the past year, and this behavior was associated with being married or cohabiting (OR=0.30, p<0.05), first taking drugs at age 31 and above (OR=0.42, p<0.05), and receiving AIDS advice or HIV detection from authorities in the past year (OR=0.70, p<0.05). About 34% never used a condom when having sex with casual sexual partners, and this behavior was associated with coming from Guangxi (OR=2.81, p<0.05) or Chongqing (OR=2.73, p<0.05). Almost 14% had had commercial sex in the past year, and this behavior was associated with coming from Guangxi (OR=6.26, p<0.05) or Chongqing (OR=5.44, p<0.05) and having exchanged needles or received clean needles from the Needle Exchange Centers in the past year (OR=2.76, p<0.05). Nearly 23% had never used condoms when having commercial sex, and this behavior was associated with having received free condoms from authorities in the past year (OR=0.26, p<0.05). Sexual risk behaviors among drug users in Guangxi, Chongqing, and Xinjiang are common. Additional intervention strategies are needed to control the spread of HIV in this population.
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Affiliation(s)
- Jiegang Huang
- School of Public Health, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory Cultivation Base of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
| | - Junjun Jiang
- School of Public Health, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory Cultivation Base of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
| | - Jonathan Z. Li
- Section of Retroviral Therapeutics, Brigham and Women's Hospital, Harvard Medical School, Cambridge, Massachusetts
| | - Xiaobo Yang
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Wei Deng
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Abu S. Abdullah
- School of Public Health, Guangxi Medical University, Nanning, China
- Department of Medicine (MISU), Boston Medical Center, Boston, Massachusetts
| | - Bo Qin
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Halmurat Upur
- School of Public Health, Xinjiang Medical University, Xinjiang, China
| | - Chaohui Zhong
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qianqiu Wang
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Qian Wang
- School of Public Health, Xinjiang Medical University, Xinjiang, China
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunfeng Zou
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Li Ye
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Peiyan Xie
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Fumei Wei
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Na Xu
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Bo Wei
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Hao Liang
- School of Public Health, Guangxi Medical University, Nanning, China
- Guangxi Key Laboratory Cultivation Base of AIDS Prevention and Treatment, Guangxi Medical University, Nanning, China
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Xu J, Smith MK, Ding G, Chu J, Wang H, Li Q, Chang D, Wang G, Shang H, Jiang Y, Wang N. Drug use and sex work: competing risk factors for newly acquired HIV in Yunnan, China. PLoS One 2013; 8:e59050. [PMID: 23555616 PMCID: PMC3610908 DOI: 10.1371/journal.pone.0059050] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 02/11/2013] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the HIV incidence and its related factors among female sex workers (FSWs) in a high prevalence area where injection drug use is also widely documented. Method A cross-sectional study of 1642 female sex workers (FSWs) was conducted in Honghe Prefecture of Yunnan Province. Interviewed-questionnaires were administrated to collect information on sexual partnerships, condom use and illicit drug using behaviors etc. Blood samples were collected to test for HIV antibodies, and all HIV seropositive specimens were tested with the BED IgG capture-based enzyme immunosorbent assay (BED-CEIA) to distinguish between new and established HIV infection (<153 days). Results 15.9% (261/1642) of participants reported ever having used drugs, and 7.4% had injected in recent 3 months. The overall HIV prevalence was 10.2% (168/1642), among which 16.7% (28/168) were identified as recent infections using BED-CEIA. The crude HIV incidence estimated from BED-CEIA results was 4.4 (95%CI 2.8–6.0) /100 person years (PY). Multivariate logistic analysis showed that an illicit drug using history (by either self-reporting or urine opiates testing) was both significant risk factors both for HIV established and recent infection (each p<0.05). Drug using FSWs (DU-FSW) reported more male clients in the previous week, and had significantly higher prevalence of HIV, chlamydia trachomatis and HSV-2 as compared to non DU-FSW (each p<0.05). Conclusion Our results show that a history of drug use poses significant risks for both new and established HIV infection among FSWs, and that HIV-incidence among Honghe FSWs is relatively high compared to similar populations. Comprehensive interventions targeted at DU-FSWs' injection drug using and high risk sexual behaviors are urgently needed to reduce the rapid spread of HIV epidemic.
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Affiliation(s)
- Junjie Xu
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No.1 Hospital of China Medical University, Shenyang, China
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - M. Kumi Smith
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Guowei Ding
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jennifer Chu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haibo Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qinghua Li
- Honghe Prefecture Center for Disease Control and Prevention, Mengzi City, Yunnan, China
| | - Dongfang Chang
- Kaiyuan City Center for Disease Control and Prevention, Kaiyuan, Yunnan, China
| | - Guixiang Wang
- Kaiyuan City Center for Disease Control and Prevention, Kaiyuan, Yunnan, China
| | - Hong Shang
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No.1 Hospital of China Medical University, Shenyang, China
| | - Yan Jiang
- National AIDS Reference Laboratory, National Center for AIDS/STD Control and Prevention, Beijing, China
| | - Ning Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: .
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Chen M, Yang L, Ma Y, Su Y, Yang C, Luo H, Chen H, Chen L, Yan W, Shi Y, Jia M, Lu L. Emerging variability in HIV-1 genetics among recently infected individuals in Yunnan, China. PLoS One 2013; 8:e60101. [PMID: 23555898 PMCID: PMC3608604 DOI: 10.1371/journal.pone.0060101] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 02/21/2013] [Indexed: 11/18/2022] Open
Abstract
Background Yunnan has the longest endured Human Immunodeficiency Virus-1 (HIV-1) epidemic in China, and the genetic diversity of HIV-1 constitutes an essential characteristic of molecular epidemiology in this region. To obtain a more comprehensive picture of the dynamic changes in Yunnan’s HIV-1 epidemic, a cross-sectional molecular epidemiological investigation was carried out among recently infected individuals. Methodology/Principal Findings We sequenced partial gag (HXB2∶781–1861) and env (HXB2∶7002–7541) genes from 308 plasma samples of recently infected patients. With phylogenetic analysis, 130 specimens generated interpretable genotyping data. We found that the circulating genotypes included: CRF08_BC (40.8%), unique recombinant forms (URFs, 27.7%), CRF01_AE (18.5%), CRF07_BC (9.2%), subtype B (2.3%) and C (1.5%). CRF08_BC was the most common genotype, and was predominant in both intravenous drug users (IDUs) and heterosexually transmitted populations. CRF08_BC and CRF07_BC still predominated in eastern Yunnan, but CRF08_BC showed increasing prevalence in western Yunnan. Strikingly, the URFs raised dramatically in most regions of Yunnan. Seven different types of URFs were detected from 12 prefectures, suggesting that complicated and frequent recombination is a salient feature of Yunnan’s HIV-1 epidemic. Among URFs, two BC clusters with distinctive recombination patterns might be potential new CRF_BCs. CRF01_AE was no longer confined to the prefectures bordering Myanmar, and had spread to the eastern part of Yunnan, especially the capital city of Kunming, with a large number of infections in the transient population. The ratios of the main genotypes showed no statistical differences between infected IDUs and heterosexually transmitted infections. Conclusions/Significance The changing patterns of the dominant HIV-1 genotypes in Yunnan indicate the complex evolving dynamic nature of the epidemic. Understanding new trends in molecular epidemiology of HIV-1 infection is critical for adjusting current prevention strategies and vaccine development in Yunnan.
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Affiliation(s)
- Min Chen
- Center for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Li Yang
- Center for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Yanling Ma
- Center for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Yingzhen Su
- Center for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Chaojun Yang
- Center for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Hongbing Luo
- Center for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Huichao Chen
- Center for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Ling Chen
- Center for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Wenyun Yan
- Center for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Yuhua Shi
- Center for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Manhong Jia
- Center for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
- * E-mail: (MJ); (LL)
| | - Lin Lu
- Center for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
- College of Public Health, Kunming Medical University, Kunming, Yunnan, China
- * E-mail: (MJ); (LL)
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HIV and associated risk factors among male clients of female sex workers in a Chinese border region. Sex Transm Dis 2013; 39:750-5. [PMID: 23007705 DOI: 10.1097/olq.0b013e31825f7af7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Male clients of female sex workers (FSWs) serve as a potential bridge of human immunodeficiency virus (HIV) to the general population. Little is known about the characteristics and risk factors for HIV infection among male clients patronizing FSWs in Hekou County, Yunnan Province in southern China bordering with Vietnam. METHODS Male clients were recruited through outreach of study staff, referrals by Vietnamese FSWs and their bosses, and snowball sampling. Each participant completed a questionnaire survey and donated a blood specimen to test for HIV, herpes simplex virus type 2 (HSV-2), and syphilis. Logistic regression models were fitted to identify factors associated with HIV infection. RESULTS Among 306 participants, 28 (9.2%) were HIV positive, 81 (26.5%) were HSV-2 positive, and none was infected with syphilis. Approximately half (n = 149, 49.2%) reported always using condoms with sex workers in the past year; 36 (11.8%) reported a history of injection drug use (IDU). Compared with HIV-negative men, HIV-positive men were more likely to have a history of IDU (64.3% vs. 6.5%) and be coinfected with HSV-2 (50.0% vs. 24.1%). CONCLUSIONS IDU was the most salient risk factor for HIV infection in this study, which suggests that male clients may acquire HIV from routes other than commercial sex, but the significance of HSV-2 infection indicates that sexual transmission is also of concern. HIV prevention intervention programs for this often ignored and hard-to-reach risk group should be two-pronged, addressing both drug use and commercial sex.
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Should associations between HIV-related risk perceptions and behaviors or intentions be positive or negative? PLoS One 2012; 7:e52124. [PMID: 23284896 PMCID: PMC3526527 DOI: 10.1371/journal.pone.0052124] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 11/08/2012] [Indexed: 11/24/2022] Open
Abstract
Risk perceptions are important in HIV research and interventions; mixed results were found between HIV-related perceptions and behaviors. We interviewed 377 sexually active injecting drug users in China, finding mixed associations between HIV-related risk perception assessed by two general measures and two previous risk behaviors (syringe sharing: p<.05; unprotected sex: p>.05) – partially supporting the ‘reflective hypothesis’ that reflection on previous behaviors increases risk perceptions. When we use specific measures for risk perceptions (HIV transmission via unprotected sex with specific types of sex partner and via syringe sharing) and use behavioral intention to adopt protective risk behaviors (condom use and avoid syringe sharing totally) as dependent variables, positive significant associations were observed – supporting the motivational hypothesis that risk perceptions motivate one to adopt protective behaviors. The direction and significance of the associations of concern depends on types of measures used. It has important implications on research design, data interpretation and services.
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Shi Y, Guo S, Bo F, Zhang X, Cao W, Wang P. Impact evaluation of a sexually transmitted disease preventive intervention among female sex workers in Hohhot, China. Int J Infect Dis 2012; 17:e59-64. [PMID: 23154177 DOI: 10.1016/j.ijid.2012.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/24/2012] [Accepted: 09/03/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of HIV and sexually transmitted disease (STD) prevention interventions among female sex workers (FSWs) in the city of Hohhot in northern China. METHODS Three serial cross-sectional surveys were conducted in 2006, 2007, and 2008 among FSWs. A questionnaire was administered to the FSWs, and HIV and syphilis tests were performed for all participants. Intervention activities including condom promotion and provision, increased condom availability and accessibility, and voluntary HIV counseling and testing (VCT) were carried out among FSWs. RESULTS There were 624 participants in the 2006 survey, 444 in the 2007 survey, and 451 in the 2008 survey. The United Nations General Assembly Special Session (UNGASS) indicators for FSWs increased from 13.9% in 2006 to 37.7% in 2008 (p<0.001). The average rate of consistent condom use with commercial clients in the month preceding the interview increased significantly from 39.8% in 2006 to 59.6% in 2008 (p<0.001). Not a single HIV-positive case was found among the FSWs over these 3 years, and the prevalence of syphilis decreased remarkably from 9.5% in 2006 to 1.3% in 2008. Logistic regression analysis showed that sauna or hair salon work venues, receiving services from intervention programs, and accepting HIV tests were factors associated with consistent condom use. CONCLUSIONS The findings suggest that consistent condom use and awareness of HIV/AIDS prevention-related knowledge among FSWs have been improved by the intervention. Further prioritized and combined prevention programs aimed at FSWs are needed in order to prevent the HIV/AIDS epidemic spreading in the general population in China.
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Affiliation(s)
- Yuhui Shi
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, 100191, China
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Zhou YH, Yao ZH, Liu FL, Li H, Jiang L, Zhu JW, Zheng YT. High prevalence of HIV, HCV, HBV and co-infection and associated risk factors among injecting drug users in Yunnan province, China. PLoS One 2012; 7:e42937. [PMID: 22916185 PMCID: PMC3420897 DOI: 10.1371/journal.pone.0042937] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Accepted: 07/15/2012] [Indexed: 01/30/2023] Open
Abstract
Objective To estimate the prevalence of HIV, HCV, HBV and co-infection with 2 or 3 viruses and evaluate risk factors among injecting drug users (IDUs) in Yunnan province, China. Methods 2080 IDUs were recruited from 5 regions of Yunnan Province, China to detect the infection status of HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). Statistical analysis was performed to evaluate risk factors related to HIV, HCV and HBV infections. Results The infection rates among all participants were 25.5% for HIV, 77.7% for HCV, 19.2% for HBV, 15% for HIV/HCV, 0.3% for HIV/HBV, 7.8% for HCV/HBV and 7.1% for HIV/HCV/HBV. The prevalence of virus infection varied widely by region in Yunnan of China. Statistical analyses indicated that high prevalence of HIV and HCV among IDUs was positively associated with the duration of drug injection and sharing needles/syringes; besides, HCV infection was associated with the frequency of drug injection. Conclusions HIV, HCV, HBV infections and co-infections were still very prevalent among IDUs in Yunnan province because of drug use behaviors.
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Affiliation(s)
- Yan-Heng Zhou
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
- The Graduate School of the Chinese Academy of Sciences, Beijing, China
| | - Zhi-Hong Yao
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
- The Graduate School of the Chinese Academy of Sciences, Beijing, China
| | - Feng-Liang Liu
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
| | - Hong Li
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Li Jiang
- Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Jia-Wu Zhu
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
- The Graduate School of the Chinese Academy of Sciences, Beijing, China
| | - Yong-Tang Zheng
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences & Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
- * E-mail:
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Des Jarlais DC, Feelemyer JP, Modi SN, Arasteh K, Mathers BM, Degenhardt L, Hagan H. Transitions from injection-drug-use-concentrated to self-sustaining heterosexual HIV epidemics: patterns in the international data. PLoS One 2012; 7:e31227. [PMID: 22396729 PMCID: PMC3291614 DOI: 10.1371/journal.pone.0031227] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 01/04/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Injecting drug use continues to be a primary driver of HIV epidemics in many parts of the world. Many people who inject drugs (PWID) are sexually active, so it is possible that high-seroprevalence HIV epidemics among PWID may initiate self-sustaining heterosexual transmission epidemics. METHODS Fourteen countries that had experienced high seroprevalence (<20%) HIV epidemics among PWID and had reliable data for injection drug use (IDU) and heterosexual cases of HIV or AIDS were identified. Graphs of newly reported HIV or AIDS cases among PWID and heterosexuals were constructed to identify temporal relationships between the two types of epidemics. The year in which newly reported cases among heterosexuals surpassed newly reported cases among PWID, aspects of the epidemic curves, and epidemic case histories were analyzed to assess whether it was "plausible" or "highly unlikely" that the HIV epidemic among PWID might have initiated the heterosexual epidemic in each country. RESULTS Transitions have occurred in 11 of the 14 countries. Two types of temporal relationships between IDU and heterosexual HIV epidemics were identified, rapid high incidence transitions vs. delayed, low incidence transitions. In six countries it appears "plausible" that the IDU epidemic initiated a heterosexual epidemic, and in five countries it appears "highly unlikely" that the IDU epidemic initiated a heterosexual epidemic. A rapid decline in incidence among PWID after the peak year of new cases and national income were the best predictors of the "highly unlikely" initiation of a heterosexual epidemic. DISCUSSION Transitions from IDU concentrated epidemics to heterosexual epidemics are common in countries with high seroprevalence among PWID though there are distinct types of transitions. Interventions to immediately reduce HIV incidence among PWID may reduce the likelihood that an IDU epidemic may initiate a heterosexual epidemic.
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Affiliation(s)
- Don C Des Jarlais
- The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, United States of America.
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Shen SY, Zhang ZB, Tucker JD, Chang H, Zhang GR, Lin AH. Peer-based behavioral health program for drug users in China: a pilot study. BMC Public Health 2011; 11:693. [PMID: 21899764 PMCID: PMC3189137 DOI: 10.1186/1471-2458-11-693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 09/07/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many injection drug users (IDUs) in China have high risk sexual behaviors that contribute to the spread of HIV infection. Although many IDUs in China move through drug rehabilitation centers, this opportunity for sexual health education has largely been overlooked. METHODS A convenience sample of 667 drug users from two rehabilitation centers in South China was recruited in the study. Two hundred and forty seven drug users from a single Guangdong Province rehabilitation center received the peer-based education intervention, while 420 drug users from another rehabilitation center received routine HIV/STI education and was used as the control. One hundred and eighty nine (22.1%) individuals refused to participate in the study. HIV/STI behavioral and knowledge domains were assessed at 3 months in rehabilitation centers after the intervention (first follow-up) and at 2-23 months in the community after release (second follow-up). RESULTS Drug users who completed the intervention reported more frequent condom use with casual sex partners (60.0% vs. 12.5% condom use every time, p = 0.011) and less frequent injection (56.7% vs. 26.4% no injection per day, p = 0.008) at the second follow-up compared to those in the routine education group. Loss to follow up was substantial in both control and intervention groups, and was associated with living far from the detention center and having poor HIV knowledge at baseline. CONCLUSIONS This study shows that rehabilitation centers may be a useful location for providing behavioral HIV/STI prevention services and referral of individuals to community-based programs upon release. More research is needed on behalf of detained drug users in China who have complex social, medical, and legal needs.
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Affiliation(s)
- Song-Ying Shen
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun-Yat-sen University, Guangzhou, PR China
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Zhang L, Yap L, Xun Z, Wu Z, Wilson DP. Needle and syringe programs in Yunnan, China yield health and financial return. BMC Public Health 2011; 11:250. [PMID: 21507267 PMCID: PMC3102626 DOI: 10.1186/1471-2458-11-250] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 04/21/2011] [Indexed: 11/10/2022] Open
Abstract
Background As a harm reduction strategy in response to HIV epidemics needle and syringes programs (NSPs) were initiated throughout China in 2002. The effectiveness of NSPs in reducing the spread of infection in such an established epidemic is unknown. In this study we use data from Yunnan province, the province most affected by HIV in China, to (1) estimate the population benefits in terms of infections prevented due to the programs; (2) calculate the cost-effectiveness of NSPs. Methods We developed a mathematical transmission model, informed by detailed behavioral and program data, which accurately reflected the unique HIV epidemiology among Yunnan injecting drug users (IDUs) in the presence of NSPs. We then used the model to estimate the likely epidemiological and clinical outcomes without NSPs and conducted a health economics analysis to determine the cost-effectiveness of the program. Results It is estimated that NSPs in Yunnan have averted approximately 16-20% (5,200-7,500 infections) of the expected HIV cases since 2002 and led to gains of 1,300-1,900 DALYs. The total $1.04 million spending on NSPs from 2002 to 2008 has resulted in an estimated cost-saving over this period of $1.38-$1.97 million due to the prevention of HIV and the associated costs of care and management. Conclusion NSPs are not only cost-effective but cost-saving in Yunnan. Significant scale-up of NSPs interventions across China and removal of the societal and political barriers that compromise the effects of NSPs should be a health priority of the Chinese government.
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Affiliation(s)
- Lei Zhang
- National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia.
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Prevalence and correlates of syphilis and condom use among male injection drug users in four Afghan cities. Sex Transm Dis 2011; 37:719-25. [PMID: 20585276 DOI: 10.1097/olq.0b013e3181e2c76a] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND : Injecting drug use is increasing in Afghanistan but little is known about sexual risk behaviors and sexually transmitted infection (STI) prevalence among injection drug users (IDU). The purpose of this study is to assess prevalence and correlates of syphilis and condom use with female sex workers (FSWs) among male IDUs in Hirat, Jalalabad, Kabul, and Mazar-i-Sharif, Afghanistan. METHODS : Participants in this cross-sectional study completed an interviewer-administered questionnaire and serologic testing for syphilis between June 2005 and January 2008. Factors associated with syphilis condom use with FSWs were assessed with site-controlled logistic regression analysis. RESULTS : Of 1078 male IDUs, most (90.3%) reported prior sexual experience, of whom 27.6% reported any condom use. Sexual experiences with FSWs (58.1%) and men or boys (25.7%) were common, although prior condom use with FSWs (32.6%) or male partners (10.8%) was relatively rare. Few reported having a lifetime STI diagnosis (6.3%, n = 68) or symptoms (10.4%, n = 110) in the last 6 months. Prevalence of syphilis was 3.72% (95% CI: 2.66%-5.06%) and varied significantly between sites ranging from 0% (Jalalabad) to 13.9% (Mazar-i-Sharif) (P < 0.001)). Syphilis was significantly associated with STI diagnosis (adjusted odds ratio [AOR] = 3.84) or sex with FSWs (AOR = 3.82) in the last 6 months, and with lower (≤6 years) educational level (AOR = 2.20). Prior condom use with FSWs was independently associated with living outside Afghanistan in the last decade (AOR = 5.52, 95% CI: 1.83-16.71), higher income (AOR = 2.03, 95% CI: 1.17-3.51), greater number of lifetime partners (AOR = 1.80, 95% CI: 1.32-2.45), and younger age (AOR = 0.985, 95% CI: 0.973-0.998). CONCLUSIONS : Although prevalence of syphilis and condom use varied significantly by site, high levels of risky sexual behavior were common, and consistent condom use was rare among IDUs in Afghanistan. Harm reduction programming should incorporate sexual risk reduction and condom promotion and distribution in Afghan cities.
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Jin X, Chan S, Ding G, Wang H, Xu J, Wang G, Chang D, Reilly KH, Wang N. Prevalence and risk behaviours for Chlamydia trachomatis and Neisseria gonorrhoeae infection among female sex workers in an HIV/AIDS high-risk area. Int J STD AIDS 2011; 22:80-4. [DOI: 10.1258/ijsa.2010.010289] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- X Jin
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control & Prevention, Beijing
| | - S Chan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control & Prevention, Beijing
| | - G Ding
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control & Prevention, Beijing
| | - H Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control & Prevention, Beijing
| | - J Xu
- Key Laboratory of Immunology of AIDS, Ministry of Health, First Hospital of China Medical University
| | - G Wang
- Kaiyuan City Center for Disease Control & Prevention, Yunnan Province, PRChina
| | - D Chang
- Kaiyuan City Center for Disease Control & Prevention, Yunnan Province, PRChina
| | - K H Reilly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
- Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - N Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control & Prevention, Beijing
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Jia Z, Wang W, Dye C, Bao Y, Liu Z, Lu L. Exploratory analysis of the association between new-type drug use and sexual transmission of HIV in China. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2010; 36:130-3. [PMID: 20337511 DOI: 10.3109/00952991003734269] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A recent assessment by the Chinese government showed that sexual transmission is becoming the main mode of spreading human immunodeficiency virus (HIV) in China. The annual report on drug abuse demonstrated a seven-fold increase of use of Amphetamine Type Stimulants (ATS), which has been strongly correlated with sexual risk-taking behaviors, in 2007 than that in 2003. These observations suggest that ATS use may have contributed to the rapid increase in sexual transmission of HIV in China. OBJECTIVE The present study aims to investigate the potential association between new drug users and transmission modes. METHODS Partial Least Squares Path Model and Partial Least Squares Regression Models have been used to evaluate the potential correlation between ATS users and the sexual transmission of HIV. RESULTS Our analysis indicates that HIV infection by drug use mode mainly results from heroin users (R = .5). ATS (R = -.9) and other drug users (R = -.4) have a negative relationship with HIV infection by drug use mode. However, for HIV infection by sexual transmission mode, ATS (R = 5.5) and other drug users (R = .6) show a positive association. ATS, especially, presents a strongly association with the sexual transmission of HIV. CONCLUSION The study results suggest that ATS users significantly contribute to the sexual transmission of HIV. SCIENTIFIC SIGNIFICANCE It is helpful to evaluate and predict the potential risk factors related with epidemic of HIV in China and provide theoretical evidence for HIV/AIDS health officers and policy makers to better construct target interventions and implement control measures.
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Affiliation(s)
- Zhongwei Jia
- School of Public Health and Family Medicine, Capital Medical University, Beijing, China.
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Abstract
OBJECTIVE To investigate the characteristics and trends in the HIV epidemic in Yunnan province, China, between 1989 and 2007. METHODS Statistical analysis of serological data from voluntary testing and counseling sites, medical case reports, mass screenings, sentinel surveillance, and other sources. RESULTS By 2007, a cumulative total of 57,325 cases of HIV infection were reported in Yunnan, and unsafe drug injection practices and unsafe sexual behaviors were identified as the dominant modes of transmission. HIV affects injecting drug users most, particularly in Jingpo, Dai, and Yi ethnicities, more than 40% in 7 counties. HIV prevalence rates among female sex workers (FSWs) increased from 0.5% in 1995 to 4.0% in 2007; among men who have sex with men, from 4.0% in 2005 to 13.2% in 2007; among male clients of FSWs, from 0% in 1995-1997 to 1.8% in 2007; among male sexually transmitted disease clinic attendees, from 0% in 1992 to 2.1% in 2007; among pregnant women from 0.16% in 1992 to 0.5% in 2007; and among blood donors, from 0.0075% in 1992 to 0.084% in 2007. CONCLUSIONS The HIV epidemic in Yunnan has progressed to a concentrated epidemic. Future efforts must focus on not only groups at risk for primary infection (injecting drug users, men who have sex with men, and FSWs) but also on their low-risk sexual partners.
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HIV prevalence and risk behaviors among male clients of female sex workers in Yunnan, China. J Acquir Immune Defic Syndr 2010; 53:131-5. [PMID: 19730110 DOI: 10.1097/qai.0b013e3181b3552a] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the prevalence and risk factors of HIV among male clients of female sex workers (FSWs) in China. METHODS Convenience sampling methods were used to recruit 315 clients using FSW-client and client-client networks. Subjects provided information on sociodemographic characteristics and sexual and drug behavior patterns. Blood samples were collected for HIV testing and urine samples for opiate testing. RESULTS Overall HIV prevalence was 6.0%; among drug users, it was 30.8%. 33.7% of respondents reported that they always use condoms in commercial sex and 63.5% that they used a condom in the last commercial sex episode. Drug use (OR: 6.1; 95% CI: 1.7 to 21.4) and lack of a regular sexual partner (OR: 6.3; 95% CI: 1.8 to 21.9) were significantly associated with HIV infection. CONCLUSIONS Clients of FSWs serve as potential bridges for HIV transmission from the high-risk FSWs to the low-risk general population, making them a key target for intervention. High HIV prevalence rates among clients in Kaiyuan is particularly alarming given their risk behavior patterns including high rates of partner exchange, low condom use rates, and drug-using behaviors. Innovative interventions are needed to reduce the risk of HIV among clients and reduce the bridge of transmission to the general population.
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HIV, hepatitis C virus, and hepatitis B virus co-infections among injecting drug users in Tehran, Iran. Int J Infect Dis 2009; 14:e28-33. [PMID: 19464218 DOI: 10.1016/j.ijid.2009.03.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 02/18/2009] [Accepted: 03/01/2009] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To assess the prevalence of HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and co-infections among injecting drug users (IDUs) in Tehran. METHODS A sample of 899 IDUs (861 male and 38 female) was recruited in Tehran from treatment and harm reduction facilities and from drug user hangouts in public areas in equal proportions. ELISA testing for HIV, HCV antibody (HCV-Ab), hepatitis B surface antigen (HBsAg), and hepatitis B core antibody (HBcAb) was carried out. Positive HIV tests were rechecked by Western blot. RESULTS The prevalence of HIV was 10.7%, HCV infection was 34.5%, and past or current HBV infection was 50.7%. Infection with all three viruses was seen in 6.5% (95% confidence interval 4.9-8.2) of participants. HIV/HCV, HIV/HBV, and HBV/HCV co-infections were seen in 8.7%, 7.8%, and 21.0% of participants, respectively. The rate of HCV infection among HIV-positive cases was significantly higher than in HIV-negative IDUs (80.6% vs. 28.7%, p<0.0001). There was no significant association between these infections and co-infections with gender and source of sampling. CONCLUSION In general, co-infection with these three blood-borne viruses is common among IDUs. Since co-infection increases the morbidity and mortality of all infections, the observed level of co-infection in the high number of IDUs in Iran necessitates a serious comprehensive response.
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