A systematic review and meta-analysis of the prevalence, trends, and geographical distribution of HIV among Chinese female sex workers (2000-2011): implications for preventing sexually transmitted HIV

Epidemiology of Nontuberculous Mycobacteria in Tuberculosis suspects, Southwest of China, 2017-2022

Objectives

This study summarizes the epidemiological characteristics, species distribution, and drug sensitivity of clinical nontuberculous mycobacteria (NTM) isolates at the Public Health Clinical Center of Chengdu, China, from January 2017 to December 2022.

Methods

We retrospectively analyzed data from patients with clinically isolated NTM strains. Chi-square analysis assessed the rate of Mycobacterium strain isolation over 6 years.

Results

The number of samples tested for Mycobacterium tuberculosis (MTB) and/or NTM increased each year, while MTB detection decreased and NTM detection rose significantly each year (P=0.03). The average age of NTM patients was 51 ± 17.53 years, with a 14.1% HIV infection rate. The predominant isolates were Mycobacterium avium-intracellulare (MAC) and M. chelonae/M. abscessus, with 96.4% of cases being of Han ethnicity. Amikacin, moxifloxacin, and clarithromycin were effective against M. avium and M. intracellulare; linezolid, amikacin, and cefoxitin were effective against M. chelonae/M. abscessus. Over 90% of NTM cases originated from the respiratory tract.

Conclusion

The NTM isolation rate in Southwest China has risen in recent years, primarily among elderly patients with a high HIV co-infection rate. The main NTM isolates were MAC and M. chelonae/M. abscessus. Amikacin, moxifloxacin, clarithromycin, and linezolid exhibited strong antibacterial activity against SGM, while amikacin and linezolid displayed relatively better antibacterial activity against RGM. The prevalence of NTM infection may be positively associated with regional economic development and health conditions.

An exploratory transmission mode of HIV/AIDS among older people based on data from multiple sources in China

The HIV/AIDS cases and proportion in older people are continuously and rapidly increasing in China, especially in males. However, the transmission mechanism is not well understood. This study aims to explore the transmission mechanism of HIV/AIDS and potential ways to prevent or control HIV/AIDS transmission in a city in southwestern China. Data from multiple sources, including HIV/AIDS case reports in 2010–2020, a survey of HIV/AIDS cases in 2020, and sentinel surveillance data of female sex workers (FSWs) in 2016–2020 were analyzed. We explored the transmission mechanism of HIV/AIDS cases aged 50 years and older. In this city, the number of newly reported HIV/AIDS cases aged 50 years and older increased from 2010 to 2019, and decreased in 2020. The number of male and female cases aged 50 years and older both increased rapidly in 2017–2019, though the number of male cases was larger than that of female. The survey data showed that 84.7% of older male cases reported commercial sexual behavior, among whom 87.7% reported never using condom and 37.6% reported more than 10 times of commercial sexual behaviors in 1 year. In terms of price of sexual behavior, 68.3% of older male cases sought low-tier FSWs among whom the HIV/AIDS positive rate was 5.4% from the sentinel surveillance data. These results suggested HIV transmission between older men and low-tier FSWs through commercial sexual behavior. Among female cases aged 50 years and older, most reported non-marital and non-commercial heterosexual (60.5%) or regular sexual partner (31.4%) transmission, suggesting that they were infected by their spouse/regular sexual partner. Data of matched couples showed that most male cases had both marital sexual behavior and commercial sexual behavior, or acquired HIV through commercial sexual behavior, while most female cases had only marital sexual behavior. Based on these findings, we proposed a transmission mode of that local older male people and FSWs are transmitting bilaterally through commercial sexual behavior, and local older male people are spreading to local older female people through spouse or regular sexual partner route. By studying data from multiple sources, we explored the HIV transmission mode among older people. In the meantime, we found that marital status had a different impact on male and female old people in their sex behaviors.

Challenges Faced by Female Commercial Sex Workers in Puducherry, India: A Qualitative Inquiry

Sex work is considered one of the oldest professions in the world. In India, selling sex in private is legal, while all other activities related to sex work, such as pimping, brothel-keeping, are considered to be illegal. Despite their vulnerability to HIV and other sexually transmitted infections, the research has been less focused on the other challenges faced by sex workers. This article aims to understand the major challenges faced by female commercial sex workers (CSWs) through a qualitative study covering 15 CSWs who work in Puducherry Union Territory in South India. The data were collected by using an in-depth interview guide, and the case study method. Thematic analysis was employed to analyse the data. The article discusses in detail the challenges CSWs face in terms of economical, psychological and social spheres of their lives.

Clinical characteristic, Common sites and Drug resistance profile in Culture-confirmed EPTB/ HIV co-infection patients, Southwest of China

OBJECTIVES

There are few reports on EPTB/HIV co-infection patients, especially the drug resistance profile of culture-confirmed EPTB. The purpose of our study was to analysis the clinical characteristic, common sites and drug resistance profile of culture-confirmed EPTB/HIV co-infection patients in recent years in southwest of China.

METHODS

A total of 201 EPTB/HIV co-infection cases were selected for this study. Patient demographic and clinical characteristics were collected. Mycobacterium tuberculosis drug sensitivity testing was performed using the microporousplate ratio method.

RESULTS

For the 2884 culture-confirmed EPTB cases recruited, patients were predominantly male1921/2884(66.6%). Mean age was 31years. Two hundred and one cases were EPTB/ HIV co-infection patients(7.0 %), from 201 cases male make up 84.6% (170/201), mean age was 42 years (range 13-86/year). During the 7-years period, the mean number of EPTB/ HIV co-infection cases was 29 per year(range 12-49/year) at this institution. Diarrhea, headache and fever were the most common presenting symptom.DST results showed the resistance to any anti-tuberculosis drug was observed in 62(30.8%) patient isolates, while multidrug-resistant TB and extensively drug-resistant TB were found in 14(7.0%) and 10(5.0%) patients, respectively. The distribution of EPTB tissue type mainly in Meningeal and Lymph node, varies between different genders.

CONCLUSIONS

The immune level of EPTB/HIV co-infected patients was low and most were in advanced AIDS stage. Mainly young male, and the site of EPTB was mainly in the Meningeal and Lymph node. The most common symptoms were diarrhea, headache and fever and high rates of drug resistance were found.

Characteristics of low-tier female sex workers who engage in commercial sex with old male clients in Zhejiang province, China: a cross-sectional study

OBJECTIVES

To characterise low-tier female sex workers (FSWs) who engage in commercial sex with old male clients (OMCs).

DESIGN

Cross-sectional study.

SETTING

Twenty-one counties in Zhejiang province, China.

PARTICIPANTS

A total of 2647 low-tier FSWs who participated in our survey from September to November 2013, and responded to the question regarding whether they engaged in commercial sex with OMCs during the previous month.

MAIN OUTCOME MEASURES

Data on sociodemographic characteristics, sexual behaviours, risk perception of HIV/sexually transmitted infection (STI), ever exposure to an HIV prevention service and degree of self-efficacy regarding condom use were collected via a face-to-face questionnaire administered by trained interviewers.

RESULTS

Of the 2647 participants, 1165 (44.0%) had engaged in commercial sex with OMCs in the previous month. Low-tier FSWs working out of roadside shops, those who had engaged in sex work for longer, those with a larger number of clients, those who had engaged in anal or oral sex during the previous month, those currently using contraception measures, those who had STI symptoms and those who had been exposed to HIV prevention services during the previous 6 months were more likely to engage in commercial sex with OMCs. FSWs with a high level of education; those working out of small venues other than streets, hair salons and roadside shops; those who charged more for commercial sex; those who had sex with young clients during the previous month and those who had seen a doctor during the previous 6 months were less likely to engage in commercial sex with OMCs.

CONCLUSIONS

Low-tier FSWs who engaged in commercial sex with OMCs reported more risky behaviours than those who did not engage in this behaviour. Attention should be paid to these behaviours in future interventions targeting low-tier FSWs.

Pooled estimate of vitamin D deficiency among pregnant women in India: a systematic review and meta-analysis

BACKGROUND

Vitamin D deficiency among pregnant women is a public health concern globally. In India, individual studies report high prevalence. However, lack of national data masks the true burden. This work determined the pooled prevalence of vitamin D deficiency among pregnant women in India through a systematic review of literature and meta-analysis.

METHODS

Three different search engines yielded 15 eligible articles. Study quality was assessed by 10 different criteria and summary of study quality was categorized as per Cochrane standards. Meta-analysis was performed to estimate pooled prevalence of vitamin D deficiency among healthy pregnant women and heterogeneity among selected studies. A sample of n = 4088 was used to study the pooled prevalence among pregnant women.

RESULTS

The random effects combined estimate was 32.35% (95% CI, (12.58-117.48). High heterogeneity (tau² = 0.39, I² = 100%) and high risk of bias was observed among the selected studies. The test for overall effect was observed to be z = 2.54(P = 0.01).

CONCLUSION

Pooled estimate > 30% emphasizes the need for screening through antenatal care services and initiate preventive measures to address the deficiency.

Prevalence of sexually transmitted infections among foreigners living in Guangzhou, China: a cross-sectional study (2010-2017)

BACKGROUND

The prevalence of HIV/HCV/HBV/ Treponema pallidum is an essential health issue in China. However, there are few studies focused on foreigners living in China. This study aimed to assess the prevalence and socio-demographic distribution of HIV, HBV, HCV, and T. pallidum among foreigners in Guangzhou in the period of 2010-2017.

METHODS

A cross-sectional study was conducted to screen serological samples of 40,935 foreigners from 2010 to 2017 at the Guangdong International Travel Health Care Center in Guangzhou. Samples were tested for hepatitis B surface antigen (HBsAg), anti-HCV, syphilis antibody (anti-TPPA) and anti-HIV 1 and 2. We collected secondary data from laboratory records and used multiple logistic regression analyses to verify the association between different factors and the seroprevalence of HIV/HBV/HCV/ T. pallidum.

RESULTS

The prevalence of HBV/HCV/HIV/ T. pallidum was 2.30, 0.42, 0.02, and 0.60%, respectively, and fluctuated slightly for 7 years. The results of multiple logistic regression showed that males were less susceptible to HBV than females (odds ratio [OR] = 0.77, 95% CI: 0.67-0.89). Participants under the age of 20 had a lower risk of HBV (OR = 0.25, 95% CI: 0.18-0.35), HCV (OR = 0.06, 95% CI: 0.02-0.18), and T. pallidum (OR = 0. 10, 95% CI: 0.05-0.20) than participants over the age of 50. Participants with an education level below high school were more likely to have HBV (OR = 2.98, 95% CI: 1.89-4.70) than others, and businessmen (OR = 3.02, 95% CI: 2.03-4.49), and designers (OR = 3.83, 95% CI: 2.49-5.90) had a higher risk of T. pallidum than others. Co-infection involved 58 (4.20%) total cases, and the highest co-infection rate was observed for HBV and T. pallidum (2.60%).

CONCLUSION

The prevalence of HBV/HCV/HIV/ T. pallidum was low among foreigners in Guangzhou. Region, gender, age, educational level, and occupation were risk factors for positive infection.

Evolving HIV Epidemiology in Mainland China: 2009-2018

PURPOSE OF REVIEW

This review is intended to provide an overview of the evolution of HIV epidemiology over the past decade in China.

RECENT FINDINGS

We provided a succinct overall view of the epidemic, followed by surveillance data, profiles of key populations, HIV molecular epidemiology, and drug resistance, as well as survival in the age of antiretroviral therapy usage. For each topical issue, we first reviewed the latest empirical evidence, followed by a brief summary assessment. We briefly addressed the challenges and opportunities of the next generation of HIV control and prevention efforts in China. Notably, macro-social factors need to be integrated into the next generation of clinical and/or behavioral HIV research to inform disease progression and management, as well as control and prevention.

Vietnamese female sex workers in rural cross-border areas of Guangxi, China: migration and HIV/STI risk behaviors

China's HIV/AIDS epidemic continues to grow in rural and less developed areas. This consecutive cross-sectional study examines demographic and behavioral factors associated with HIV/STI infection, Hepatitis C (HCV) and other sexually transmitted infections (STIs) among Vietnamese female sex workers (FSW), a vulnerable population who cross into Guangxi, China. This study is a secondary data analysis of 303 Vietnamese and 4,348 Chinese FSWs recruited over seven years from two Chinese counties that border Vietnam. Logistic regression models compared demographics, HIV/STI status, HIV/AIDS-related knowledge, attitudes, and risk behaviors between Vietnamese FSWs and Chinese FSWs. Compared with Chinese FSWs, Vietnamese FSWs were younger, had attained lower education levels, were highly mobile, more likely to report using drugs, and were more vulnerable to HIV/STIs. Younger age, less educational attainment, shorter time in their current working location, no voluntary HIV testing in the last year, greater drug use, and not using condoms for all commercial sex in the last month were associated with higher HIV/STIs. In conclusion, several factors were associated with HIV/STI risk in Vietnamese cross-border FSWs. There is a pressing need to improve support systems for Vietnamese cross-border FSW and health system cooperation across the Chinese/Vietnamese border.

A community-based comprehensive intervention to reduce syphilis infection among low-fee female sex workers in China: a matched-pair, community-based randomized study

Background

Low-fee female sex workers (FSWs) are at high risk of acquiring and spreading human immunodeficiency virus (HIV)/sexually transmitted diseases (STDs) in China. There is an urgent need to develop comprehensive intervention measures targeted towards low-fee FSWs to reduce HIV/STD infections. Thus, this study aimed to reduce HIV/STD infections among low-fee FSW through a matched-pair, community-based randomized intervention trial carried out in 12 cities in three provinces in China.

Methods

Four cities from Guangxi Zhuang Autonomous Region, four from Yunnan Province, and four from Hunan Province were paired and participants received either the intervention package (including condom promotion, HIV and syphilis testing, reimbursement for syphilis treatment costs, and free anti-retroviral therapy or the current standard of care. Venue-based, convenience sampling was used to recruit FSWs. A face-to-face interview and HIV and syphilis blood testing was conducted at baseline and follow-up intervals of 24 months. Generalized linear mixed models (GLMM) were used to evaluate the effect of the intervention package on reducing HIV/STD infection in the FSWs.

Results

A total of 1024 eligible FSWs were enrolled in the baseline survey and 843 in the follow-up. GLMM results showed that syphilis infection was reduced by 49% in the intervention group compared to the current standard of care group (P = 0.0378, OR = 0.51, 95% CI: 0.27–0.96). FSWs aged 35 years or older were 2.38 times more likely to get syphilis infection compared to those younger than 35 years old (P <  0.0001, OR = 2.38, 95% CI: 1.55–3.65). The risk of syphilis infection among more educated FSWs was 0.43 times less than those with lower levels of education (P <  0.05, OR = 0.43, 95% CI: 0.63–0.93).

Conclusions

This study demonstrates that comprehensive interventions can lead to significant declines in syphilis infection amongst low-tier FSWs. Integrating both behavioral and biomedical intervention measures should be considered when developing programs for low-fee FSWs.

Trial registration

CHiCTR-TRC-12002655.

Interventions to improve the HIV continuum of care in China

PURPOSE OF REVIEW

To describe HIV epidemic and interventions for improving HIV continuum of care in China.

RECENT FINDINGS

The reported HIV epidemic has been continuously increasing, partially due to the expansion of active HIV testing campaign. Public health intervention programs have been effective in containing HIV spread among former plasma donors and people who inject drugs (PWID), but more infections occur among heterosexual men and women and young men who have sex with men. Of 1.25 million Chinese people are living with HIV, one-third do not know their status. About two-thirds of diagnosed individuals have used antiretroviral therapy (ART) and two-thirds of those on ART have achieved viral suppression, but some risk groups such as PWID have lower rates. The national free ART program has reduced adult and pediatric mortality and reduced heterosexual transmission. China faces great challenges to reduce HIV sexual transmission, improve the HIV continuum of care, and close the gaps to the UNAIDS Three "90" Targets.

Drug resistance and pathogenic spectrum of patients coinfected with nontuberculous mycobacteria and human-immunodeficiency virus in Chengdu, China

BACKGROUND

Human-immunodeficiency virus (HIV) infection is increasing worldwide and nontuberculous mycobacteria (NTM) is an established microbiologic cause of pulmonary disease, lymphadenitis, and disseminated disease in cases of advanced immune suppression. Data on patients coinfected with HIV and NTM are limited. Thus, this study aimed to analyze the clinical characteristics, drug resistance, and pathogen spectrum of patients coinfected with both HIV and NTM in the Chengdu area of China.

METHODS

Data of 59 patients coinfected with both HIV and NTM collected from the Public Health Clinical Center of Chengdu, between January 2014 and December 2018, were analyzed. NTM drug sensitivity testing was performed using the microporous plate ratio method. Data were analyzed using SPSS 19.0, and the change in drug resistance rate was analyzed using the chi-square (χ) test.

RESULTS

Seven species/complex of NTM were identified from patients coinfected with HIV and NTM in this study, with Mycobacterium avium-intracellulare complex (52.5%) and M. kansasii (27.1%) as the predominant species. Male patients were more affected 50/59 (84.7%); the mean age of the 59 cases was 45 years. The clinical characteristics mainly included anemia (86.4%), cough and expectoration (79.7%). The baseline CD4 count was <50 cells/μL (84.7%). Patients were mainly in advanced acquired immunodeficiency syndrome (AIDS) stage. Chest imaging mainly showed patchy shadows (42.4%) and nodules (32.2%), with various degrees of AIDS-defining diseases. The drug resistance of NTM was severe, and the rate of isoniazid resistance (100.0%) was the highest, followed by rifampicin (94.9%), streptomycin (94.9%), ofloxacin (93.2%), and others. Ethambutol (52.5%) and clarithromycin (33.9%) were relatively low. No significant difference was found in the drug resistance rate of NTM strain against nine antituberculosis drugs in 5 years (P > 0.05).

CONCLUSIONS

The immune level of patients coinfected with HIV and NTM is low in advanced AIDS stage; more male are affected in patients who are mainly infected with MAC and M. kansasii and with serious drug resistance. The drug resistance rate of ethambutol and clarithromycin is relatively low.

Investigation of HIV/AIDS prevalence and associated risk factors among female sex workers from 2010 to 2017: a meta-analysis study

Objectives: Female sex workers (FSW) are highly at risk of HIV, and can potentially transmit the human immunodeficiency virus (HIV) in different societies. Study design: The aims of the present study were to investigate the prevalence of HIV/AIDS and associated risk factors among FSW between 2010 and 2017 using a systematic literature review and meta-analysis approach. Methods: International databases were searched, including ISI Web of Science, Embase, PubMed, and Scopus. Using the appropriate keywords, relevant studies published on the HIV/AIDS prevalence among FSW between 2010 and 2017 were identified. Afterwards, the information was extracted and analyzed by STATA version 14. Results: Thirty-seven studies were found eligible for inclusion in this research, encompassing a total of 46,657 subjects. The results revealed that the global prevalence of HIV/AIDS among FSW was 2.17 (95% CI=1.37-3.14). Conclusion: These findings demonstrated the high prevalence of HIV/AIDS among FSWs worldwide. Accordingly, strict educational and interventional programs should be implemented globally to reduce HIV/AIDS prevalence among this group, as well as to prevent probable HIV transmission.

A systematic review and meta-analysis of prevalence of vitamin D deficiency among adolescent girls in selected Indian states

BACKGROUND:

Vitamin D deficiency among adolescents is an emerging public health priority as adolescence marks a period of rapid growth and the onset of the reproductive phase. However, lack of national prevalence data and intervention strategies is of public health concern.

OBJECTIVE:

The objective of this study was to determine the pooled prevalence of vitamin D deficiency among adolescent girls in selected Indian states.

METHODS:

A systematic literature review was performed using three different search engines. The searches yielded nine eligible articles. Study quality was assessed for 10 different criteria. Meta-analysis was performed to estimate pooled prevalence of vitamin D deficiency among adolescent girls and to assess the heterogeneity among selected studies.

RESULTS:

A sample of n=1352 was used to study prevalence among adolescent girls. The random effects combined estimate for overall prevalence was 25.70% (95% CI 3.89-2137.9). High heterogeneity (tau²=1.71, I²=100%) was observed and seven out of nine studies showed low to moderate risk and two showed high risk of bias. The test for overall effect was observed to be Z=0.77 ( p=0.44).

CONCLUSIONS:

High prevalence of vitamin D deficiency among adolescent girls identifies the need to introduce screening of adolescents and introduce proven public-health interventions such as fortification of foods to address deficiency.

Trend and Factors Associated with Condom Use Among Male Clients of Female Sex Workers in Hong Kong: Findings of 13 Serial Behavioural Surveillance Surveys

This study investigated the trend and associated factors of condom use among male clients of female sex workers (CFSW) in Hong Kong. A total of 25,443 males of the general population were screened to identify 2,330 CFSW via 13 rounds of population-based serial cross-sectional telephone surveys during 1998 through 2015. Over time, there were no significant changes in condom use with various types of female sex partners (p ranged 0. 219-0.837) and prevalence of self-reported STI (p = 0.975) in the past 6 months. Decrease in the prevalence of non-regular sex partners (p < 0.001) and increase in perceived efficacy of condom use for HIV prevention (p = 0.028) were observed. Perceived efficacy of condom use for HIV prevention and self-reported STI experience were significantly associated with condom use with various types of female sex partners in the past 6 months. No evident improvement for condom use was found. Tailored intervention programs are warranted.

HIV prevalence among female sex workers in Guigang City, Guangxi, China: an 8-year consecutive cross-sectional study

Background

Female sex workers (FSW) are a population that are at high risk for HIV infection, and their HIV/AIDS knowledge levels and sexual behaviors are of concern. This study describes changes in HIV prevalence and factors associated among female sex workers in Guigang City, Guangxi, one of the highest HIV prevalence areas in China.

Methods

Data were derived from an annual cross-sectional venue-based survey, 2008 to 2015, in the form of sentinel surveillance. The participants were recruited using cluster sampling. FSW aged 16 years and above who completed a questionnaire and HIV testing. Both descriptive and multi-level analyses were used to explore factors associated with changes in HIV prevalence.

Results

Seven thousand four hundred ninety-six FSW were recruited in this study. HIV prevalence among FSW in Guigang City fell into two periods, one with an increasing trend (2008–2011) and one with a decline (2012–2015). Differences between these time periods included age, relationship status, HIV knowledge, consistent condom use, lifetime illicit drug use, history of sexually transmitted infection in the past year, HIV testing, receipt of a condom distribution and education program or HIV counseling and testing, and peer education services.

Conclusions

Since 2012, a reduction in HIV prevalence among FSW in Guigang City has been observed. The decline of HIV prevalence was associated with coinciding changes in demographic characteristics of FSW, improvement of HIV knowledge and safer sexual behaviors, and a program that promotes condom use, HIV counseling & testing, and peer education.

Consistent condom use and its correlates among female sex workers at hair salons: a cross-sectional study in Zhejiang province, China

Background

This study investigated condom use among female sex workers (FSWs) at hair salons during commercial sexual interactions over 1 month. We explored the associations of such use with various sexual behaviours, HIV/STI risk perception and related knowledge, self-efficacy regarding condom use, exposure to behavioural interventions, and other factors. This type of information has not been reported in China and is critical for designing and modifying programs aimed at preventing HIV/STI transmission in this group of FSWs and their clients.

Methods

Our data were derived from a large cross-sectional study conducted among low-tier FSWs in 21 counties within Zhejiang province, China. Data were collected from September to November 2013.Bivariable and multiple logistic regression analyses were used to identify factors associated with self-reported consistent condom use among FSWs working at hair salons.

Results

Of 1682 FSWs working at hair salons, 50.5% consistently used condom with clients during the previous month. Multivariable analysis revealed that condom use for commercial sex, consistent vaginal douching after commercial sex, adopting contraceptive measures, high scores on perceived self-efficacy regarding condom use, and exposure to interventions were associated with self-reported consistent condom use; early initiation of commercial sex, experiences with oral sex, rarely/sometimes/often using oral contraceptives, and having seen a doctor were associated with not using condoms.

Conclusions

Commercial sex is not effectively protected, and behavioural interventions targeting FSWs should take into account the various factors that are correlated to condom use.

HIV prevalence and correlated factors of female sex workers and male clients in a border region of Yunnan Province, China

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.

Declining Inconsistent Condom Use but Increasing HIV and Syphilis Prevalence Among Older Male Clients of Female Sex Workers: Analysis From Sentinel Surveillance Sites (2010-2015), Guangxi, China

Clients of female sex workers (CFSWs) are a bridge population for the spread of HIV and syphilis to low or average risk heterosexuals. Most studies have examined the point prevalence of these infections in CFSWs. Limited evidence suggests that older age CFSWs are at a higher risk of acquiring sexually transmitted diseases compared with younger clients. Thus, we sought to describe long-term trends in HIV, syphilis, and hepatitis C (HCV) to better understand how these infections differ by sex worker classification and client age. We also examined trends in HIV, syphilis, and HCV among categories of female sex workers (FSWs).We conducted serial cross-sectional studies from 2010 to 2015 in Guangxi autonomous region, China. We collected demographic and behavior variables. FSWs and their clients were tested for HIV, syphilis, and HCV antibodies. Positive HIV and syphilis serologies were confirmed by Western blot and rapid plasma regain, respectively. Clients were categorized as middle age (40-49 years) and older clients (≥50 years). FSWs were categorized as high-tier, middle-tier, or low-tier based on the payment amount charged for sex and their work venue. Chi-square test for trends was used for testing changes in prevalence over time.By 2015, low-tier FSWs (LTFSWs) accounted for almost half of all FSWs; and they had the highest HIV prevalence at 1.4%. HIV prevalence declined significantly for FSWs (high-tier FSW, P = 0.003; middle-tier FSWs; P = 0.021; LTFSWs, P < 0.001). Syphilis infections significantly declined for FSWs (P < 0.001) but only to 7.3% for LTFSWs. HCV and intravenous drug use were uncommon in FSWs. HIV prevalence increased for older age clients (1.3%-2.0%, P = 0.159) while syphilis prevalence remained stable. HCV infections were halved among older clients in 3 years (1.7%-0.8%, P < 0.001). Condom use during the last sexual encounter increased for FSWs and CFSWs. Few clients reported sex with men or intravenous drug use. Clients preferred LTFSWs, especially older clients (81.9%).Our results suggest that HIV and syphilis infections are increasing in older clients who prefer LTFSWs. HIV and syphilis are likely increasing in Guangxi Province through heterosexual transmission.

Prevalence and care index of early childhood caries in mainland China: evidence from epidemiological surveys during 1987-2013

Early childhood caries (ECC) is the most common chronic disease in young children. Its reported prevalence varies greatly across China. This systematic review aimed to explore the epidemiological characteristics of ECC in mainland China from 1987 to 2013. In total, 102 articles were included. The pooled national prevalence and care index (ft/dmft%) for ECC were 65.5% and 3.6%, respectively. The overall ECC prevalence declined from 77.9% during 1987-1994 to 56.4% during 2010-2013. The pooled ECC prevalence for children aged 1-6 years was 0.3%, 17.3%, 40.2%, 54.4%, 66.1%, and 70.7%, respectively. There was no significant difference in prevalence between boys (59.1%) and girls (58.9%); and the care index was also similar (8.1% versus 7.7%). Slightly higher ECC prevalence was observed in rural areas (63.5%) compared with urban areas (59.5%) (RR = 1.08, 95% CI: 1.02-1.14); but a much higher care index was reported in urban children (6.0%) than their rural counterparts (1.6%) (RR = 3.68, 95% CI: 2.54-5.35). The 2006-2013 map of ECC prevalence among 5-year-olds showed wide geographic variations across China. Four adjacent provinces, including Sichuan, Chongqing, Hubei, and Shaanxi, constituted the areas with the lowest ECC prevalence in mainland China.