1
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Rectal Douching and Anal Human Papillomavirus Among Young Men Who Have Sex With Men in China. Sex Transm Dis 2021; 48:550-556. [PMID: 34110748 DOI: 10.1097/olq.0000000000001392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Young men who have sex with men (YMSM) are particularly at increased risk for human papillomavirus (HPV) infection and related malignancies. Rectal douching, commonly practiced among MSM, has been associated with HIV, chlamydia, gonorrhea, and viral hepatitis in cross-sectional studies. We conducted this study to understand the association between self-reported rectal douching and anal HPV among YMSM in China. METHODS Between September 2018 and March 2019, MSM aged 15 to 24 years who ever engaged in receptive anal intercourse over the last 3 months were recruited via community-based organizations and centers for disease control located in 4 cities in China. Participants were asked to complete an online survey. We performed multivariate logistic regression adjusted for potential confounders to examine the association between self-reported rectal douching and anal HPV. RESULTS Among 273 MSM with a median age of 20 years (interquartile range, 19-21 years) included in this study, 130 (47.6%) practiced rectal douching during the preceding 3 months and 96 (36.2%) were infected with anal HPV. Self-reported rectal douching was found to be associated with increased odds of anal HPV infection (odds ratio, 2.16; 95% confidence interval, 1.22-3.82) among YMSM, after adjusting for age, sexual debut, sex with alcohol or drugs, and HIV testing history. CONCLUSIONS Self-reported rectal douching is associated with higher odds of anal HPV infection independent of sexual behaviors among YMSM. More prospective studies to ascertain this association are needed. Health education materials should inform men of the potential risk of rectal douching. Research on safer rectal douching procedures is warranted.
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2
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Hall CDX, Luu M, Nehl EJ, He N, Zheng T, Haardörfer R, Wong FY. Do the same socio-demographic variables predict testing uptake and sero-status? HIV and syphilis among an observational sample of Chinese men who have sex with men in Shanghai, China. Int J STD AIDS 2021; 31:939-949. [PMID: 32772687 DOI: 10.1177/0956462420909733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
HIV and syphilis are pronounced among men who have sex with men (MSM) in China and often occur as co-infections, while testing remains low. Few studies examine common predictors across these outcomes. This observational venue-based sample of 546 MSM in Shanghai, China used a common set of psychosocial predictors to construct logistic models for the outcomes (HIV non-testing, syphilis non-testing, HIV sero-status, and syphilis sero-status). Fifty-seven (10.7%) participants tested positive for HIV, 126 (23.5%) for syphilis, and 33% of HIV-positive participants had a co-infection. Non-sex working MSM had consistently higher odds of HIV and syphilis non-testing (OR= 2.2, 95% CI 1.4-3.5, p < 0.001; OR = 2.4, 95, 95% CI 1.5-3.8, p < 0.001, respectively) compared to 'money boy' sex workers. Participants with a 0 score on HIV knowledge had 4.1 times (95% CI 1.4-12.5, p = 0.01) the odds of reporting HIV non-testing, 6.0 (95% CI 1.96-18.5, p < 0.01) times the odds of reporting non-testing for syphilis, and 8.44 times (95% CI 1.19-59.7, p = 0.03) the odds of testing positive for HIV, compared to a score of 8. The results highlighted the importance of integrating HIV/syphilis education and promoting testing for both HIV and syphilis among all sub-groups of MSM in China.
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Affiliation(s)
- Casey D Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Minh Luu
- Department of Behavioral Sciences and Health Education, Emory University's Rollins School of Public Health, Atlanta, GA, USA
| | - Eric J Nehl
- Department of Behavioral Sciences and Health Education, Emory University's Rollins School of Public Health, Atlanta, GA, USA
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Tony Zheng
- Shanghai Piaoxue Multicultural Medua, Ltd, Shanghai, China
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory University's Rollins School of Public Health, Atlanta, GA, USA
| | - Frank Y Wong
- Department of Behavioral Sciences and Health Education, Emory University's Rollins School of Public Health, Atlanta, GA, USA.,Center for Indigenous Nursing Research for Health Equity, Florida State University, Tallahassee, FL, USA.,Department of Psychology, University of Hawai'i, Mānoa, Honolulu, HI, USA
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3
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Li P, Yuan T, Wang Z, Huang R, Meng X, Zhang K, Wang G, Zhou Y, Luo D, Wang Y, Cai Y, Zou H. Rectal douching among men who have sex with men in six cities in China: a cross-sectional study. Sex Health 2021; 17:437-443. [PMID: 33497599 DOI: 10.1071/sh19239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 07/28/2020] [Indexed: 11/23/2022]
Abstract
Background Rectal douching, which is a common practice among men who have sex men (MSM) as a preparation for anal sex, may potentially increase the risk of HIV infection. However, little is known about the practice of rectal douching among Chinese MSM. This study investigated the characteristics of rectal douching and factors associated with rectal douching. METHODS Between January and March 2019, MSM aged ≥18 years in six cities in China were recruited to the study. Participants were asked to complete a self-administered online questionnaire. Chi-squared tests and multivariable logistic regression were used to examine factors associated with rectal douching by calculating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Of 485 MSM in this study, 278 (57.3%) practiced rectal douching in the preceding 6 months. The most common reasons for douching before and after anal sex were hygiene/cleanliness (78.6% and 66.1% respectively) and HIV/STI prevention (8.5% and 17.4% respectively). The most used enemas and equipment before and after anal sex were tap water (73.5% and 70.2% respectively) and showerhead hoses (76.1% and 75.2% respectively). Men who engaged in both insertive and receptive anal sex (OR 8.84; 95% CI 4.52-17.30), exclusively receptive anal sex (OR 6.56; 95% CI 3.55-12.13), condom-less anal intercourse (OR 1.64; 95% CI 1.03-2.63) and anal sex after alcohol use (OR 1.54; 95% CI 1.00-2.35) were more likely to perform douching. CONCLUSION Rectal douching is common in MSM, some of whom may not realise the potential risks associated with douching. The co-occurrence of douching and other high-risk behaviours would make MSM more vulnerable to HIV. Health education aimed at informing MSM of the potential risks and addressing the high prevalence of douching are urgently needed.
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Affiliation(s)
- Peiyang Li
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 510006, PR China
| | - Zhenyu Wang
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Ruonan Huang
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Xiaojun Meng
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi 214000, PR China
| | - Kechun Zhang
- Shenzhen Longhua District Center for Disease Control and Prevention, Shenzhen 518000, PR China
| | - Guanghui Wang
- Qingdao Qingtong AIDS Prevention Volunteer Service Center, Qingdao 266000, PR China
| | - Yepeng Zhou
- Foshan Friends Care Center for AIDS/HIV Control, Foshan 528000, PR China
| | - Danyang Luo
- Zhitong Guangzhou LGBT Center, Guangzhou 510000, PR China
| | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200000, PR China
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200000, PR China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 510006, PR China; and Kirby Institute, UNSW Sydney, Sydney, NSW 2052, Australia; and Corresponding author.
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4
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Luo Q, Wu Z, Chen Z, Ma Y, Mi G, Liu X, Xu J, Rou K, Zhao Y, Scott SR. App use frequency and condomless anal intercourse among men who have sex with men in Beijing, China: a cross-sectional study. Int J STD AIDS 2019; 30:1146-1155. [PMID: 31558122 DOI: 10.1177/0956462419860293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Gay dating applications (apps) are popular among men who have sex with men (MSM) in China. This study examined the relationship between gay dating app use frequency and condomless anal intercourse (CAI) in a sample of MSM in Beijing. In October 2017, a web-based, cross-sectional survey was conducted among MSM from Beijing, China. Demographics, frequency of app use, and sexual behaviors were collected and analyzed. Multivariable logistic regression and restricted cubic splines were used to evaluate the association between app use frequency and CAI. Of the 9280 participants, the proportion of CAI within one month prior to the survey was 43.3%, and 43.7% logged onto the app ≥11 times per week. In adjusted logistic regression analysis, logging onto the app 6–10 times per week and ≥11 times per week were inversely associated with CAI (adjusted odds ratio [AOR] =0.88 [95%CI, 0.78–0.99]; AOR = 0.88 [95%CI, 0.82–0.97], respectively). Among those 40 years of age or older, logging onto the app ≥11 times per week was associated with lower rates of CAI (AOR = 0.57 [95%CI, 0.40–0.81]). Results indicate that frequent app use was associated with lower odds of CAI among MSM in Beijing, China. Innovative interventions, which take advantage of this popular media platform, should be developed as such apps have been found to reduce the odds of CAI in Beijing.
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Affiliation(s)
- Qianqian Luo
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,School of Nursing, Binzhou Medical University, Yantai, China
| | - Zunyou Wu
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - Yue Ma
- Blue City Holdings, Ltd, Beijing, China
| | - Guodong Mi
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,Blue City Holdings, Ltd, Beijing, China
| | - Xuejiao Liu
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jie Xu
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Keming Rou
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan Zhao
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sarah R Scott
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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5
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Wang C, Tucker JD, Liu C, Zheng H, Tang W, Ling L. Condom use social norms and self-efficacy with different kinds of male partners among Chinese men who have sex with men: results from an online survey. BMC Public Health 2018; 18:1175. [PMID: 30326880 PMCID: PMC6192108 DOI: 10.1186/s12889-018-6090-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/04/2018] [Indexed: 01/09/2023] Open
Abstract
Background Social norms and self-efficacy play important roles in promoting consistent condom use among men who have sex with men (MSM). Few studies have investigated the association between social norms, self-efficacy and consistent condom use with different kinds of male partners among MSM. We conducted an online survey of MSM to evaluate this in China. Methods A cross-sectional online survey was conducted in 2015. Participants completed a validated questionnaire covering socio-demographic information, consistent condom use, condom use social norms and self-efficacy. Eligible participants were 16 or older, born biologically as a male, engaged in anal sex with a man at least once during their lifetime, engaged in condomless anal or vaginal sex in the last three months. In this study, we further restricted to people who had sex with male partners in the last three months. Participants were classified into three groups: engaged in sex only with regular partners, engaged in sex only with casual partners and engaged in sex with both regular partners and casual partners. Results Participants were recruited from 32 provinces in China. Among 1057 participants, 451(42.7%), 217(20.5%), and 389(36.8%) engaged in sex with regular partners only, casual partners only and both types in the last three months, respectively. Men engaged in sex only with regular partners in the last three months had a higher condom use self-efficacy than with other two types of partners (P < 0.01). Both social norms (regular partners: adjusted OR:1.59, 95% CI: 0.97–2.60; casual partners: adjusted OR: 1.58, 95% CI: 1.19–2.09; both types: adjusted OR: 1.48, 95% CI: 1.13–1.95) and self-efficacy (regular partners: adjusted OR: 2.88, 95% CI: 1.59–5.22; casual partners: adjusted OR: 2.35, 95% CI: 1.69–3.26; both types: adjusted OR: 2.45, 95% CI: 1.81–3.32) were positively associated with consistent condom use. No interaction effect was detected between condom social norms and self-efficacy on consistent condom use among Chinese MSM (p > 0.05). Conclusions Both social norms and self-efficacy were positively correlated with consistent condom use with any types of partners among Chinese MSM. Tailored interventions that aimed to improve social norms and self-efficacy has the potential to improve overall condom use among Chinese MSM. Trial registration ClinicalTrials.gov: NCT02516930. August 6, 2015. Electronic supplementary material The online version of this article (10.1186/s12889-018-6090-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cheng Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and STI Control, Guangzhou, China
| | - Joseph D Tucker
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China.,SESH study group of University of North Carolina at Chapel Hill, Guangzhou, China.,School of Medicine of University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Chuncheng Liu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China.,SESH study group of University of North Carolina at Chapel Hill, Guangzhou, China
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou, China.,Guangdong Center for Skin Diseases and STI Control, Guangzhou, China
| | - Weiming Tang
- Dermatology Hospital, Southern Medical University, Guangzhou, China. .,Guangdong Center for Skin Diseases and STI Control, Guangzhou, China. .,University of North Carolina at Chapel Hill Project-China, Guangzhou, China. .,SESH study group of University of North Carolina at Chapel Hill, Guangzhou, China. .,School of Medicine of University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Li Ling
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
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6
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Ye M, Giri M. Prevalence and correlates of HIV infection among men who have sex with men: a multi-provincial cross-sectional study in the southwest of China. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2018; 10:167-175. [PMID: 30323685 PMCID: PMC6178892 DOI: 10.2147/hiv.s176826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective This study aims to assess the prevalence and correlates of HIV Infection among men who have sex with men (MSM) in two major provinces in southwest of China. Method We adopted the method of anonymous survey and HIV blood test on 1,245 MSM >18 years of age from Chongqing and Sichuan Province, China. Results The prevalence of HIV infection among MSM was 21.20%. Multiple logistic regression analysis revealed significant independent predictors of HIV infection among MSM as follows: lower level of education, preference to be receptive, lower frequency of condom use, drug usage, higher number of sexual partners in the past 1 month, and people suffering from sexually transmitted diseases. The distribution of HIV infection probability scores among HIV-negative MSM shows a positively skewed distribution, which will help to find persons at higher risk of HIV infection. Conclusion HIV prevalence in Chongqing and Sichuan Province is extremely high. We must find a way to identify people at high risk of HIV infection and employ different interventions among different risk levels of HIV infection in order to achieve maximum prevention and treatment benefit. Considering the relative shortage of resources, efforts to prevent HIV might be more effectively employed if they stratify men based on validated risk criteria.
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Affiliation(s)
- Mengliang Ye
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China,
| | - Mohan Giri
- Department of Respiratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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7
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Yin L, Zhao Y, Peratikos MB, Song L, Zhang X, Xin R, Sun Z, Xu Y, Zhang L, Hu Y, Hao C, Ruan Y, Shao Y, Vermund SH, Qian HZ. Risk Prediction Score for HIV Infection: Development and Internal Validation with Cross-Sectional Data from Men Who Have Sex with Men in China. AIDS Behav 2018; 22:2267-2276. [PMID: 29786768 DOI: 10.1007/s10461-018-2129-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Receptive anal intercourse, multiple partners, condomless sex, sexually transmitted infections (STIs), and drug/alcohol addiction are familiar factors that correlate with increased human immunodeficiency virus (HIV) risk among men who have sex with men (MSM). To improve estimation to HIV acquisition, we created a composite score using questions from routine survey of 3588 MSM in Beijing, China. The HIV prevalence was 13.4%. A risk scoring tool using penalized maximum likelihood multivariable logistic regression modeling was developed, deploying backward step-down variable selection to obtain a reduced-form model. The full penalized model included 19 sexual predictors, while the reduced-form model had 12 predictors. Both models calibrated well; bootstrap-corrected c-indices were 0.70 (full model) and 0.71 (reduced-form model). Non-Beijing residence, short-term living in Beijing, illegal drug use, multiple male sexual partners, receptive anal sex, inconsistent condom use, alcohol consumption before sex, and syphilis infection were the strongest predictors of HIV infection. Discriminating higher-risk MSM for targeted HIV prevention programming using a validated risk score could improve the efficiency of resource deployment for educational and risk reduction programs. A valid risk score can also identify higher risk persons into prevention and vaccine clinical trials, which would improve trial cost-efficiency.
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Affiliation(s)
- Lu Yin
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuejuan Zhao
- Beijing Municipal Center for Disease Control and Prevention & Centers for Preventive Medical Research, Beijing, China
| | | | - Liang Song
- Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Xiangjun Zhang
- Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Ruolei Xin
- Beijing Municipal Center for Disease Control and Prevention & Centers for Preventive Medical Research, Beijing, China
| | - Zheya Sun
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunan Xu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Li Zhang
- Beijing Municipal Center for Disease Control and Prevention & Centers for Preventive Medical Research, Beijing, China
| | - Yifei Hu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Child, Adolescent Health and Maternal Health, School of Public Health, Capital Medical University, Beijing, China
| | - Chun Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.
- Yale School of Public Health, Yale University, New Haven, CT, USA.
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Yale School of Public Health, Yale University, New Haven, CT, USA
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8
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Abstract
African men who have sex with men (MSM) frequently, and often concurrently, have female partners, raising concerns about HIV sexual bridging. We explored potential HIV transmission in Mozambique from and to female partners of MSM focusing on preferred anal sex role and circumcision status. Data collected in a respondent-driven sampling study of MSM in 2011 in Maputo and Beira. Men who had oral or anal sex with other men 12 months prior completed a questionnaire and consented for HIV testing. Statistical analysis explored demographic/risk characteristics and associations among circumcision status, anal sex with men, sexual positions during anal sex with men and vaginal or anal sex with women. We identified 326 MSM in Maputo and 237 in Beira with both male and female partners 3 months before the study. Of these, 20.8% in Maputo and 36.0% in Beira had any receptive anal sex with men 12 months prior, including 895 unprotected sexual acts with males in Maputo and 692 in Beira. Uncircumcised and exclusively insertive males, 27.7% of the sample in Maputo and 33.6% in Beira, had the most unprotected sex with females: 1159 total acts in Maputo and 600 in Beira. Sexual bridging between MSM and women likely varies geographically and is probably bi-directional, occurring within a generalized epidemic where HIV prevalence is higher among reproductive-age women than MSM. Prevention strategies emphasizing correct and consistent condom use for all partners and circumcision for bisexual men should be considered.
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9
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Yang Y, Zhao XP, Zou HC, Chu MJ, Zhong P, Li XS, Li XY, Yu YH, Zhu KX, Chen YJ, Xia F, Zhu BW, Ruan LQ, Bao YN, Zhuang X. Phylogenetic and temporal dynamics of human immunodeficiency virus type 1 CRF01_AE and CRF07_BC among recently infected antiretroviral therapy-naïve men who have sex with men in Jiangsu province, China, 2012 to 2015: A molecular epidemiology-based study. Medicine (Baltimore) 2018; 97:e9826. [PMID: 29419684 PMCID: PMC5944696 DOI: 10.1097/md.0000000000009826] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 12/31/2017] [Accepted: 01/17/2018] [Indexed: 11/25/2022] Open
Abstract
The prevalence and incidence of human immunodeficiency virus type 1 (HIV-1) among men who have sex with men (MSM) are on the rise throughout China. With a large population of MSM, Jiangsu Province is facing an escalating HIV-1 epidemic.The aim of this study was to explore the phylogenetic and temporal dynamics of HIV-1 CRF01_AE and CRF07_BC among antiretroviral therapy (ART)-naïve MSM recently infected with HIV-1 in Jiangsu Province.We recruited MSM in Jiangsu Province (Suzhou, Wuxi, Nantong, Taizhou and Yancheng) 2012 to 2015. We collected information on demographics and sexual behaviors and a blood sample for HIV genome RNA extraction, RT-PCR amplification, and DNA sequencing. Multiple alignments were made using Gene Cutter, with the selected reference sequences of various subtypes/recombinants from the Los Alamos HIV-1 database. Phylogenetic and Bayesian evolutionary analysis was performed by MEGA version 6.0, Fasttree v2.1.7. and BEAST v1.6.2. Categorical variables were analyzed using χ test (or Fisher exact test where necessary). χ test with trend was used to assess the evolution of HIV-1 subtype distribution over time. All data were analyzed using SPSS20.0 software package (IBM Company, New York, NY).HIV-1 phylogenetic analysis revealed a broad viral diversity including CRF01_AE (60.06%), CRF07_BC (22.29%), subtype B (5.88%), CRF67_01B (5.26%), CRF68_01B (2.79%), CRF55_01B (1.55%), CRF59_01B (0.93%), and CRF08_BC (0.62%). Two unique recombination forms (URFs) (0.62%) were also detected. Four epidemic clusters and 1 major cluster in CRF01_AE and CRF07_BC were identified. The introduction of CRF01_AE strain (2001) was earlier than CRF07_BC strain (2004) into MSM resided in Jiangsu based on the time of the most recent common ancestor.Our study demonstrated HIV-1 subtype diversity among ART-naïve MSM recently infected with HIV-1 in Jiangsu. We first depicted the spatiotemporal dynamics, traced the dates of origin for the HIV-1 CRF01_AE/07_BC strains and made inference for the effective population size among newly infected ART-naïve MSM in Jiangsu from 2012 to 2015. A real-time surveillance of HIV-1 viral diversity and phylodynamics of epidemic cluster would be of great value to the monitoring of the epidemic and control of transmission, improvement of antiretroviral therapy strategies, and design of vaccines.
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Affiliation(s)
- Yue Yang
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
- Department of Infection Management Office, the First
Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital, Nanjing,
Jiangsu Province
- Department of AIDS and STD, Shanghai Municipal Center for
Disease Control and Prevention; Shanghai Municipal Institute for Preventive Medicine,
Shanghai
| | - Xiu-Ping Zhao
- Department of AIDS and STD, Suzhou Center for Disease
Prevention and Control, Suzhou, Jiangsu Province
| | - Hua-Chun Zou
- School of Public Health, Sun Yat-sen University, Guangzhou,
Guangdong Province, China
- Kirby Institute, University of New South Wales, Sydney,
Australia
| | - Min-Jie Chu
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
| | - Ping Zhong
- Department of AIDS and STD, Shanghai Municipal Center for
Disease Control and Prevention; Shanghai Municipal Institute for Preventive Medicine,
Shanghai
| | - Xiao-Shan Li
- Teaching and Research Office of Epidemiology and Health
Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu
Province
| | - Xiao-Yan Li
- Ningbo Medical Center Lihuili Eastern Hospital; Taipei
Medical University Ningbo Medical Center, Ningbo, Zhejiang Province, China
| | - Yu-Hui Yu
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
| | - Ke-Xin Zhu
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
| | - Yu-Jia Chen
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
| | - Fei Xia
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
| | - Bo-Wen Zhu
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
| | - Luan-Qi Ruan
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
| | - Yi-Ning Bao
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
| | - Xun Zhuang
- Department of Epidemiology and Health Statistics, School of
Public Health, Nantong University, Nantong
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10
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The Where and How for Reaching Transgender Women and Men Who Have Sex with Men with HIV Prevention Services in Guatemala. AIDS Behav 2017; 21:3279-3286. [PMID: 28008544 DOI: 10.1007/s10461-016-1655-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aims to describe the transgender women and men who have sex with men (MSM) missed through venue-based sampling and illustrate how data on venues can be used to prioritize service delivery. Respondent-driven sampling (RDS) and time-location sampling (TLS) were used concurrently in 2010 for behavioral surveillance among MSM and transgender women in Guatemala City. RDS recruits who did not frequent venues (n = 106) were compared to TLS recruits (n = 609). TLS participants recruited at different types of venues were compared. RDS recruits who did not frequent venues were less educated, less likely to identify as gay, more likely to have concurrent partners and female sexual partners. Participants recruited at NGOs, saunas, hotels, streets and parks had more partners, were more likely to receive money for sex or have concurrent partners. Prevention programs for MSM and transgender women should characterize social venues and people that frequent them and improve service coverage through venues and social networks.
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11
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Changing Epidemic of HIV and Syphilis Among Resident and Migrant Men Who Have Sex with Men in Jiangsu, China. Sci Rep 2017; 7:9478. [PMID: 28842553 PMCID: PMC5573352 DOI: 10.1038/s41598-017-08671-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 07/12/2017] [Indexed: 11/08/2022] Open
Abstract
Men who have sex with men (MSM) in China face high rates of HIV and syphilis infection exacerbated by internal migration. Studies on the differences of HIV and syphilis epidemics changing trends in high-risk behaviors and geographic distribution between resident and migrant MSM in Jiangsu, China were conducted. MSM were recruited from 14 surveillance sites in the serial cross-sectional study. Data on demographics, sexual behaviors, HIV and syphilis prevalence were collected. Participants were classified as residents or migrants based on household registration. During 2010–2014, 19,750 MSM were investigated. Engaged in anal sex (76.3% to 80.2%, P < 0.01) as well as received HIV-related services (72.1% to 79.2%, P < 0.01) were increasing. In contrast, engaged in commercial anal sex with males (7.4% to 5.0%, P < 0.01) and drug use (1.6% to 0.8%, P < 0.01) were decreasing. HIV prevalence ranged between 8.6% to 9.6%, while syphilis prevalence decreased over time (13.4–6.8%, P < 0.01). Further, we found that migrant MSM were more likely to engage in condomless anal sex, also had a higher HIV and syphilis prevalence than resident. During the study period, while syphilis prevalence decreased, higher rates of risk behaviors among migrant MSM called for targeted intervention strategies to reduce the HIV transmission.
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12
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Lau JTF, Wang Z, Kim Y, Li J, Gu J, Mo PKH, Wang X. Low sustainability, poor governance, and other challenges encountered by grassroots non-governmental organizations targeting HIV prevention for men who have sex with men in China - a nation-wide study. AIDS Care 2017; 29:1480-1490. [PMID: 28271717 DOI: 10.1080/09540121.2017.1300630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Grassroots non-governmental organizations (NGOs) played pivotal roles in HIV prevention among men who have sex with men (MSM) in China. Their governance and sustainability issues were under-studied. This nation-wide study surveyed leaders of 202 of the HIV related NGOs in China.58.4% of the leaders believed that their NGO would last for ≤5 years; which was negatively associated with perceived good relationship with CDC. 65.3% mentioned ≥3 non-sustainability issues; associated factors included perceived inadequacies in prevention skills, management skills, policy support, technical support, operational support, and CDC's support; a reverse association was found for frequent collaboration with organizations in China. 30.6% of the leaders mentioned ≥7 governance issues; a stepwise model found a positive association with having no office and negative associations with number of full-time staff and core volunteers. These problems would severely limit the effectiveness of HIV prevention among MSM. Related improvements and support are warranted.
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Affiliation(s)
- Joseph T F Lau
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong SAR , China.,b Shenzhen Research Institute, The Chinese University of Hong Kong , Shenzhen , China.,c Centre for Medical Anthropology and Behavioral Health , Sun Yat-sen University , Guangzhou , China
| | - Zixin Wang
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong SAR , China.,b Shenzhen Research Institute, The Chinese University of Hong Kong , Shenzhen , China
| | - Yoona Kim
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong SAR , China
| | - Jinghua Li
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong SAR , China
| | - Jing Gu
- d School of Public Health , Sun Yat-sen University , Guangzhou , China
| | - Phoenix K H Mo
- a Centre for Health Behaviours Research , JC School of Public Health and Primary Care, The Chinese University of Hong Kong , Hong Kong SAR , China
| | - Xiaodong Wang
- e Chengdu Tongle Health Consulting Service Center , Chengdu , China
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13
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He H, Lv F, Zhang NN, Wu Z, Liao Q, Chang Z, Li Y, Xu H, OuYang L, Huan X, Yang J. Look into the HIV Epidemic of Gay Community with a Socio-Cultural Perspective: A Qualitative Study in China, 2015-2016. PLoS One 2017; 12:e0170457. [PMID: 28107523 PMCID: PMC5249147 DOI: 10.1371/journal.pone.0170457] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/05/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Current Chinese studies continue to view male homosexuality through a disease focused lens which pays limited attention to socio-cultural aspects of sexual behavior and HIV transmission. This qualitative study aimed to investigate how socio-cultural factors influence gay men's sexual beliefs and behaviors in contemporary China, and their implications for HIV epidemic. METHODS AND FINDINGS Qualitative methodology was used in this study. During 2015-2016, in-depth interviews were conducted with 61 self identified gay men in Jiangxi, Henan, Heilongjiang, Guangdong, Jiangsu provinces and Chongqing municipality of China. Our study revealed that: 1) influenced by Chinese traditional culture, gay men have conflicts on self-identity, which led to low self-acceptance and negative attitude on sex, and huge socio-psychological stress; 2) a generational differences within gay community was observed, reflected in varied sexual attitudes and practices as well as way for approaching new friends, both of which have implications and challenges on HIV control and prevention; 3) socio-cultural barriers, including open minds towards casual sex and nonmonogamous relationship, and low priority of health demands were widely observed and led to negative coping with AIDS among gay community. CONCLUSIONS It is essential to take a holistic view into gay men's HIV epidemic in China. Socio-cultural barriers for HIV control and prevention found in this study call for serious and imperative consideration on integrated measures, including targeted efforts towards effective sex education and further inclusion of socio-cultural perspectives in HIV/AIDS interventions for gay men.
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Affiliation(s)
- Huijing He
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fan Lv
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail:
| | - Nanci Nanyi Zhang
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zunyou Wu
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qinghua Liao
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Zhanjun Chang
- Zhengzhou Center for Disease Control and Prevention, Zhengzhou, Henan Province, China
| | - Yi Li
- Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, Heilongjiang Province, China
| | - Huifang Xu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong Province, China
| | - Lin OuYang
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Xiping Huan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China
| | - Juan Yang
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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14
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Qin Q, Tang W, Ge L, Li D, Mahapatra T, Wang L, Guo W, Cui Y, Sun J. Changing trend of HIV, Syphilis and Hepatitis C among Men Who Have Sex with Men in China. Sci Rep 2016; 6:31081. [PMID: 27535092 PMCID: PMC4989164 DOI: 10.1038/srep31081] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 07/13/2016] [Indexed: 11/21/2022] Open
Abstract
Dearth of information regarding the trend and correlates of HIV, syphilis and Hepatitis C (HCV) in a country-wide sample of understudied though high-risk Chinese men who have sex with men (MSM) called for a comprehensive serial cross-sectional study. Using a multistage mixed-method strategy, 171,311 MSM from 107 selected cities/counties in 30 provinces of mainland China, were interviewed and tested. Descriptive, bivariate, multivariate and Cochran-Armitage trend analyses were conducted using SAS 9.2. During 2009-13, recent (71.5% to 78.6%, p < 0.001) and consistent (40.4% to 48.8%, p < 0.001) condom use as well as condom use during commercial anal sex (46.5% to 55.0%, p < 0.001) were increasing. In contrast, commercial anal sex with male (11.9% to 7.1%, p < 0.001) and drug use (1.9% to 0.8%, p < 0.001) were decreasing over time. HIV prevalence increased gradually (5.5% to 7.3%, p < 0.001), while syphilis (9.0% to 6.3%, p < 0.001) and HCV prevalence (1.5% to 0.7%, p < 0.001) decreased over time. A positive correlation was observed between HIV and syphilis prevalence (r = 0.38). HIV infection was associated with HIV-related knowledge, services and injecting drug use. An increasing trend of HIV prevalence was observed during 2009–13 among MSM in China. While gradual reduction of risk behaviors along with syphilis and HCV prevalence supported expansion of testing and prevention services, increasing HIV burden called for deeper thematic investigations.
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Affiliation(s)
- Qianqian Qin
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Weiming Tang
- University of North Carolina at Chapel Hill, Project-China. No. 2 Lujing Road, Guangzhou, 510095, China.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, USA
| | - Lin Ge
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dongmin Li
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tanmay Mahapatra
- National Institute of Cholera and Enteric Diseases, Kolkata, 700010, India
| | - Liyan Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wei Guo
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan Cui
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiangping Sun
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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15
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Geng GZ, Gao G, Ruan YH, Yu MR, Zhou YH. Behavioral Risk Profile of Men Who Have Sex with Men in Beijing, China: Results from a Cross-sectional Survey with Randomized Response Techniques. Chin Med J (Engl) 2016; 129:523-9. [PMID: 26904985 PMCID: PMC4804432 DOI: 10.4103/0366-6999.177003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Human immunodeficiency virus (HIV) is spreading rapidly among men who have sex with men (MSM) in China. Anonymous questionnaires or direct interviews have been frequently used to study their behavior. The aim of the study was to describe the behavioral risk profile of the MSM in Beijing using the randomized response techniques (RRTs). Methods: A cross-sectional survey of sexual behavior among a sample of MSM was conducted in two HIV counseling and testing clinics in Beijing. The survey was carried out with an anonymous questionnaire containing sensitive questions on sexual behavior. To obtain the honest responses to the sensitive questions, three distinctive RRTs were used in the questionnaire: (1) Additive randomized response model for quantitative questions, (2) randomized response model for multiple choice questions, and (3) Simmons randomized response model for binomial questions. Formulae for the point estimate, variance, and confidence interval (CI) were provided for each specific model. Results: Using RRTs in a sample of 659 participants, the mean age at first homosexual encounter was estimated to be 21.7 years (95% CI: 21.2–22.2), and each had sex with about three (2.9, 95% CI: 2.4–3.4) male partners on average in the past month. The estimated rate for consistent condom use was 56.4% (95% CI: 50.1–62.8%). In addition, condom was estimated to be used among 80.0% (95% CI: 74.1–85.9%) of the population during last anal sex with a male partner. Conclusions: Our study employed RRTs in a survey containing questions on sexual behavior among MSM, and the results showed that RRT might be a useful tool to obtain truthful feedback on sensitive information such as sexual behavior from the respondents, especially in traditional Chinese cultural settings.
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Affiliation(s)
| | - Ge Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu 215123, China
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16
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Li D, Yang X, Zhang Z, Wang Z, Qi X, Ruan Y, Zhou Y, Li C, Luo F, Lau JTF. Incidence of Co-Infections of HIV, Herpes Simplex Virus Type 2 and Syphilis in a Large Cohort of Men Who Have Sex with Men in Beijing, China. PLoS One 2016; 11:e0147422. [PMID: 26820145 PMCID: PMC4731205 DOI: 10.1371/journal.pone.0147422] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 01/04/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The HIV-epidemic among MSM in China has worsened. In this key population, prevalence of HSV-2 and syphilis infection and co-infection with HIV is high. METHODS A longitudinal study was conducted (n = 962) in Beijing, China, with three overlapping cohorts (n = 857, 757 and 760) consisting of MSM that were free from pairs of infections of concern (i.e. HIV-HSV-2, HIV-syphilis, HSV-2-syphilis) at baseline to estimate incidence of HIV, HSV-2, syphilis, and those of co-infection. RESULTS The incidence of HIV, HSV-2 and syphilis in the overall cohort was 3.90 (95% CI = 2.37, 5.43), 7.87 (95% CI = 5.74, 10.00) and 6.06 (95% CI = 4.18, 7.94) cases per 100 person-years (PYs), respectively. The incidence of HIV-HSV-2, HIV-Syphilis and HSV-2-Syphilis co-infections was 0.30 (95% CI = 0.29, 0.88), 1.02 (95% CI = 0.13, 2.17) and 1.41 (95% CI: 0.04, 2.78) cases per 100 PYs, respectively, in the three sub-cohorts constructed for this study. CONCLUSIONS The incidence of HIV, HSV-2 and syphilis was very high and those of their co-infections were relatively high. Such co-infections have negative impacts on the HIV/STI epidemics. Prevention practices need to take such co-infections into account.
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Affiliation(s)
- Dongliang Li
- Chaoyang Center for Disease Control and Prevention, Beijing, PR China
| | - Xueying Yang
- Chaoyang Center for Disease Control and Prevention, Beijing, PR China
- Center for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong SAR, Hong Kong, China
| | - Zheng Zhang
- Chaoyang Center for Disease Control and Prevention, Beijing, PR China
| | - Zixin Wang
- Center for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong SAR, Hong Kong, China
| | - Xiao Qi
- Chaoyang Center for Disease Control and Prevention, Beijing, PR China
| | - Yuhua Ruan
- State Key Laboratory for 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
| | - Yunhua Zhou
- Department of Epidemiology and Health Statistics, School of Public Health, Soochow University, Suzhou, Jiangsu, China
| | - Chunrong Li
- Center for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong SAR, Hong Kong, China
| | - Fengji Luo
- Chaoyang Center for Disease Control and Prevention, Beijing, PR China
- * E-mail: (JTFL); (FJL)
| | - Joseph T. F. Lau
- Center for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong SAR, Hong Kong, China
- * E-mail: (JTFL); (FJL)
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17
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Zhao Y, Ma Y, Chen R, Li F, Qin X, Hu Z. Non-disclosure of Sexual Orientation to Parents Associated with Sexual Risk Behaviors Among Gay and Bisexual MSM in China. AIDS Behav 2016; 20:193-203. [PMID: 26174317 DOI: 10.1007/s10461-015-1135-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The objective of this study was to explore the relationship between non-disclosure of sexual orientation to parents and sexual risk behaviors among gay and bisexual men who have sex with men (MSM) in China. A total of 295 eligible participants (gay n = 179, bisexual n = 116) were recruited from MSM venues and MSM organizations in Anhui Province, China. Overall, 16.6 % of participants chose to disclose their sexual orientation to parents. Fewer bisexual participants chose to disclose their sexual orientation than gay participants (9.5 vs. 21.2 %, p < 0.01). A multivariate logistic regression analysis indicated that non-disclosers were more likely than disclosers to report having one or more female sex partners among gay and bisexual MSM (AOR = 2.91), non-disclosure of sexual orientation to parents was positively associated with the number of female sex partners (AOR = 3.40) and with engagement in unprotected anal intercourse with men (AOR = 2.49) among gay MSM, in the past 6 months. Our findings indicated that HIV/AIDS intervention programs should promote the disclosure of sexual orientation and should design interventions specific to gay and bisexual MSM separately.
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Affiliation(s)
- Ye Zhao
- School of Health Service management, Anhui Medical University, Hefei, China
- Department of Literature Review and Analysis, Library of Anhui Medical University, Hefei, China
| | - Ying Ma
- School of Health Service management, Anhui Medical University, Hefei, China
| | - Ren Chen
- School of Health Service management, Anhui Medical University, Hefei, China
| | - Feng Li
- Medicare Office, Anhui Provincial Children's Hospital, Hefei, China
| | - Xia Qin
- School of Health Service management, Anhui Medical University, Hefei, China
| | - Zhi Hu
- School of Health Service management, Anhui Medical University, Hefei, China.
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18
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Pan X, Wu M, Ma Q, Wang H, Ma W, Zeng S, Chen J, Zhang Y, Miao D, Zhou X, Jiang T, He L, Xia Y, Peng Z, Xia S. High prevalence of HIV among men who have sex with men in Zhejiang, China: a respondent-driven sampling survey. BMJ Open 2015; 5:e008466. [PMID: 26656982 PMCID: PMC4679937 DOI: 10.1136/bmjopen-2015-008466] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To examine the prevalence of HIV and risk behaviours among men who have sex with men (MSM) and to explore the feasibility of using respondent-driven sampling in this population in order to conduct customised interventions among MSM in the future. DESIGN Cross-sectional study. SETTING Zhejiang, China. PARTICIPANTS 1316 MSM. PRIMARY AND SECONDARY OUTCOME MEASURES HIV prevalence rates and factors associated with HIV infection; sociodemographic and behavioural information of participants, syphilis prevalence rates. RESULTS The adjusted prevalence of HIV and syphilis were 13.8% and 11.4%, respectively. Multivariate analysis showed that higher educational level, support treatment of HIV, negative syphilis are protective factors of HIV infection. MSM who had heterosexual behaviour before and whose primary sexual partner was HIV-positive were less likely to be infected with HIV compared with their counterparts, while frequency of sexual behaviour with primary sexual partner was positively associated with HIV infection. CONCLUSIONS This survey confirmed a high HIV prevalence among MSM in Zhejiang province. MSM are extremely vulnerable to HIV infection and comprehensive interventions are urgently needed to slow the spread of HIV among MSM.
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Affiliation(s)
- Xiaohong Pan
- Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Minni Wu
- Department of Epidemiology & Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qiaoqin Ma
- Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Hui Wang
- Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Wenzhe Ma
- Department of Epidemiology & Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shidian Zeng
- Wenzhou Center for Disease Control and Prevention, Wenzhou, Zhejiang, China
| | - Junfang Chen
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Yan Zhang
- Ningbo Center for Disease Control and Prevention, Ningbo, Zhejiang, China
| | - Dandan Miao
- Department of Epidemiology & Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xin Zhou
- Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Tingting Jiang
- Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Lin He
- Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yan Xia
- Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zhihang Peng
- Department of Epidemiology & Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shichang Xia
- Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, Zhejiang, China
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19
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Davis A, Best J, Luo J, Van Der Pol B, Dodge B, Meyerson B, Aalsma M, Wei C, Tucker JD. Differences in risk behaviours, HIV/STI testing and HIV/STI prevalence between men who have sex with men and men who have sex with both men and women in China. Int J STD AIDS 2015; 27:840-9. [PMID: 26185041 DOI: 10.1177/0956462415596302] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/18/2015] [Indexed: 11/17/2022]
Abstract
Differences in risk behaviours between men who have sex with men (MSM) and men who have sex with both men and women (MSMW) have important implications for HIV and sexually transmitted infection (STI) transmission. We examined differences in risk behaviours, HIV/STI testing, self-reported HIV/STI diagnoses, and linkage to HIV care between MSM and MSMW across China. Participants were recruited through three MSM-focused websites in China. An online survey containing items on socio-demographics, risk behaviours, testing history, self-reported HIV/STI diagnosis, and linkage to and retention in HIV care was completed from September to October 2014. Chi square tests and logistic regression analyses were conducted. MSMW were less likely to use a condom during last anal sex (p ≤ 0.01) and more likely to engage in group sex (p ≤ 0.01) and transactional sex (p ≤ 0.01) compared to MSM. Self-reported HIV/STI testing and positivity rates between MSM and MSMW were similar. Among HIV-infected MSM, there was no difference in rates of linkage to or retention in antiretroviral therapy when comparing MSM and MSMW. Chinese MSM and MSMW may benefit from different HIV and STI intervention and prevention strategies. Achieving a successful decrease in HIV/STI epidemics among Chinese MSM and MSMW will depend on the ability of targeted and culturally congruent HIV/STI control programmes to facilitate a reduction in risk behaviours.
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Affiliation(s)
- Alissa Davis
- Department of Epidemiology & Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA UNC-Project China, Guangzhou, China Rural Center for AIDS/STD Prevention, Indiana University School of Public Health, Bloomington, IN, USA
| | - John Best
- UNC-Project China, Guangzhou, China School of Medicine, University of California, San Francisco, CA, USA
| | - Juhua Luo
- Department of Epidemiology & Biostatistics, Indiana University School of Public Health, Bloomington, IN, USA
| | | | - Brian Dodge
- Center for Sexual Health Promotion, Indiana University School of Public Health, Bloomington, IN, USA
| | - Beth Meyerson
- Rural Center for AIDS/STD Prevention, Indiana University School of Public Health, Bloomington, IN, USA Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA
| | - Matthew Aalsma
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chongyi Wei
- Department of Epidemiology & Biostatistics and Global Health Sciences, University of California, San Francisco, CA, USA
| | - Joseph D Tucker
- UNC-Project China, Guangzhou, China School of Medicine, University of North Carolina-Chapel Hill, NC, USA
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20
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Li X, Xue Y, Cheng H, Lin Y, Zhou L, Ning Z, Wang X, Yu X, Zhang W, Shen F, Zheng X, Gai J, Li X, Kang L, Nyambi P, Wang Y, Zhuang M, Pan Q, Zhuang X, Zhong P. HIV-1 Genetic Diversity and Its Impact on Baseline CD4+T Cells and Viral Loads among Recently Infected Men Who Have Sex with Men in Shanghai, China. PLoS One 2015; 10:e0129559. [PMID: 26121491 PMCID: PMC4486722 DOI: 10.1371/journal.pone.0129559] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/10/2015] [Indexed: 11/20/2022] Open
Abstract
The HIV-1 epidemic among men who have sex with men (MSM) has been spreading throughout China. Shanghai, a central gathering place for MSM, is facing a continuously increasing incidence of HIV-1 infection. In order to better understand the dynamics of HIV-1 diversity and its influence on patient's immune status at baseline on diagnosis, 1265 newly HIV-1-infected MSM collected from January 2009 to December 2013 in Shanghai were retrospectively analyzed for genetic subtyping, CD4+T cell counts, and viral loads. HIV-1 phylogenetic analysis revealed a broad viral diversity including CRF01_AE (62.13%), CRF07_BC (24.51%), subtype B (8.06%), CRF55_01B (3.24%), CER67_01B (0.95%), CRF68_01B (0.4%), CRF08_BC (0.08%) and CRF59_01B (0.08%). Twenty-four unique recombination forms (URFs) (1.98%) were identified as well. Bayesian inference analysis indicated that the introduction of CRF01_AE strain (1997) was earlier than CRF07_BC strain (2001) into MSM population in Shanghai based on the time of the most recent common ancestor (tMRCA). Three epidemic clusters and five sub-clusters were found in CRF01_AE. Significantly lower CD4+T cell count was found in individuals infected with CRF01_AE than in those infected with CRF07_BC infection (P<0.01), whereas viral load was significantly higher those infected with CRF01_AE than with CRF07_BC (P<0.01). In addition, the patients with >45 years of age were found to have lower CD4+T cell counts and higher viral loads than the patients with <25 years of age (P<0.05). This study reveals the presence of HIV-1 subtype diversity in Shanghai and its remarkable influence on clinical outcome. A real-time surveillance of HIV-1 viral diversity and phylodynamics of epidemic cluster, patient's baseline CD4+T cell count and viral load would be of great value to monitoring of disease progression, intervention for transmission, improvement of antiretroviral therapy strategy and design of vaccines.
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Affiliation(s)
- Xiaoyan Li
- Department AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
- Public Health College, Nantong University, Nantong, Jiangsu Province, China
| | - Yile Xue
- Department AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Hua Cheng
- Department AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Yi Lin
- Department AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Leiming Zhou
- Department AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Zhen Ning
- Department AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Xuqin Wang
- Department AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Xiaolei Yu
- Department AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Wei Zhang
- Department AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Fangwei Shen
- Department AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Xiaohong Zheng
- Department AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Jing Gai
- Department AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Xiaoshan Li
- Public Health College, Nantong University, Nantong, Jiangsu Province, China
| | - Laiyi Kang
- Department AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Phillipe Nyambi
- Department of Pathology, New York University School of Medicine, New York, United States of America
| | - Ying Wang
- Department AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Minghua Zhuang
- Department AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Qichao Pan
- Department AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Xun Zhuang
- Public Health College, Nantong University, Nantong, Jiangsu Province, China
| | - Ping Zhong
- Department AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
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Factors Associated with Low Levels of HIV Testing among Men Who Have Sex with Men (MSM) in Brazil. PLoS One 2015; 10:e0130445. [PMID: 26098559 PMCID: PMC4476690 DOI: 10.1371/journal.pone.0130445] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/20/2015] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to assess risk factors associated with low levels of HIV testing among MSM recruited through respondent driven sampling (RDS) in Brazil. Of 3,617 participants, 48.4% had never tested previously for HIV. A logistic model indicated that younger age, lower socioeconomic class, education, poor HIV/AIDS knowledge, no history of cruising, and having been tested during the study were characteristics independently associated with low levels of previous HIV testing. The HIV testing rate among MSM in Brazil is still low in spite of the availability of a large number services providing universal and free access to HIV/AIDS diagnosis and treatment. To respond to low utilization, the authors propose a higher priority for testing for key populations such as MSM, expanded education, expanding testing sites and a welcoming and nonjudgmental environment in health services.
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Lin H, Ding Y, Liu X, Wu Q, Shen W, He N. High Prevalence of HIV Infection and Bisexual Networks among a Sample of Men Who Have Sex with Men in Eastern China. PLoS One 2015; 10:e0129300. [PMID: 26053179 PMCID: PMC4459882 DOI: 10.1371/journal.pone.0129300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 05/08/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine homosexual and heterosexual behaviors, behavioral networks and HIV infection among men who have sex with men (MSM) in Eastern China. METHODS A cross-sectional survey was conducted among MSM in 2013 in a rural prefecture of Zhejiang province. Participants were interviewed for their sexual behaviors and sexual networks and were tested for HIV infection. RESULTS A total of 620 MSM from gay bath houses and bars participated in the survey. Of them, 58.2% aged 18 to 39 years and 49.5% were currently married with a female. The age of first homosexual contact was 26.7 years on average, ranging from 12 to 66 years. 91.0% had multiple male sex partners and 86.1% also had female sex partners in lifetime. 70 (11.3%) of the participants were tested HIV-positive. A total of 620 independent egocentric sexual networks involving 620 study participants and 1,971 reported sexual partners in the past 12 months were constructed, including 70 networks for the 70 HIV-positive participants with their 221 sexual partners and 550 networks for the 550 HIV-negative participants with their 1,750 sexual partners. The median network degree was 3 (IQR 2-4) overall and was not different between HIV-positive participants (Median: 3; IQR: 2-4) and HIV-negative participants (Median: 3; IQR: 2-4) (Mann-Whitney test, Z=-0.015, P=0.998). The proportion of networks with a multiple male sexual partnership was 63.7% overall, 62.8% for HIV-positive participants and 63.8% for HIV-negative participants (χ2=0.025, P=0.875). The proportion of networks with both male and female sexual partners was 44.8% overall, 47.1% for HIV-positive participants and 44.5% for HIV-negative participants (χ2=0.169, P=0.681). Consistent condom use and knowledge of HIV infection status were rare within the network partners. CONCLUSIONS The currently high HIV prevalence and complicated bisexual networks among MSM in the study area provides enhanced evidence for developing tailored prevention strategies for HIV transmission among and beyond the MSM population.
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Affiliation(s)
- Haijiang Lin
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
- Taizhou City Center for Disease Control and Prevention, Taizhou city of Zhejiang Province, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Xing Liu
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Qionghai Wu
- Taizhou City Center for Disease Control and Prevention, Taizhou city of Zhejiang Province, China
| | - Weiwei Shen
- Taizhou City Center for Disease Control and Prevention, Taizhou city of Zhejiang Province, China
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- * E-mail:
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Increase of RT-related transmitted drug resistance in non-CRF01_AE among HIV type 1-infected men who have sex with men in the 7 cities of China. J Acquir Immune Defic Syndr 2015; 68:250-5. [PMID: 25469530 DOI: 10.1097/qai.0000000000000467] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To elucidate new features in the prevalence of HIV-1 transmitted drug resistance (TDR) in men who have sex with men (MSM) in China. METHODS A total of 441 HIV-1-positive subjects were recruited from high-risk MSM populations in 7 cities across China between 2012 and 2013. Nucleotide sequences of 1.1-kb pol-RT regions were amplified and sequenced from 367 of the 441 samples. Phylogenetic and genetic drug-resistant analyses were performed. RESULTS The overall distribution of HIV-1 genotypes was as the following: CRF01_AE, 52.3%; CRF07_BC, 33.2%; 01/B recombinants, 6.0%; subtype B (United States-European), 3.8%; subtype B', 3.8%; and CRF08_BC, 0.8%. About 91.3% of the sequences clustered together. An overall 4.6% TDR rate was found. Reverse transcriptase (RT)-related TDR reached 2.7%. TDR of 2.2% was detected in protease region. Most of RT-related TDRs were detected in non-CRF01_AE subtypes (90.0%, 9/10), including T215A/S, K101E, K103N, V106M, and E138G. Most of the strains with TDRs (88.2%, 15/17) were presented in the clusters. TDR strains against non-nucleoside reverse transcriptase inhibitors in non-CRF01_AE subtypes also formed some subclusters (70.0%, 7/10). One CRF07_BC subject with K103N in Kunming had a very close genetic distance with one that received highly active antiretroviral therapy locally (bootstrap = 99%). Two CRF55_01B subjects carrying K103N in Changsha and Nanjing also had a very close genetic distance (bootstrap = 100%). CONCLUSIONS RT-related TDR of non-CRF01_AE became the main TDR among MSM in China. There is an increasing trend and a potential transmission risk for the RT-related TDR among MSM throughout China. Some TDRs could have already been transmitted among different cities. Intervention efforts should be strengthened among MSM to prevent further transmission of HIV and the proliferation of the strains with TDR.
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Gu J, Lau JTF, Wang Z, Wu AMS, Tan X. Perceived empathy of service providers mediates the association between perceived discrimination and behavioral intention to take up HIV antibody testing again among men who have sex with men. PLoS One 2015; 10:e0117376. [PMID: 25693179 PMCID: PMC4333296 DOI: 10.1371/journal.pone.0117376] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 12/26/2014] [Indexed: 11/18/2022] Open
Abstract
HIV antibody testing is a key measure of HIV prevention for men who have sex with men (MSM). The World Health Organization recommends sexually active and at-risk MSM to take up HIV antibody testing regularly. This study aimed to investigate the prevalence of behavioral intention to take up HIV antibody testing in the next six months among Hong Kong MSM who were ever-testers. An anonymous cross-sectional survey recruited 326 MSM who had taken up HIV antibody testing from gay-friendly venues and internet in Hong Kong. Of the participants, 40.8% had had unprotected anal intercourse with regular or non-regular male sex partners in the last six months; they were at risk of HIV transmission despite experience in HIV antibody testing. Only 37.2% showed a strong intention to take up HIV antibody testing again in the next six months. Adjusted analysis showed that both perceived discrimination toward Hong Kong MSM (AOR = .60, 95% CI: .36–.98) and the CARE Measure assessing perceived empathy of service providers (AOR = 1.05, 95% CI: 1.02–1.08) were significantly associated with intention for retesting. Perceived discrimination, however, became statistically non-significant (AOR = .68, 95% CI: .41–1.14), when both CARE Measure and perceived discrimination entered into the adjusted model. It is warranted to increase HIV retesting rate by removing perceived discrimination and reducing the negative effect of perceived discrimination through enhancement of empathy of service providers.
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Affiliation(s)
- Jing Gu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Joseph T. F. Lau
- Centre for Health Behaviors Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China
- * E-mail:
| | - Zixin Wang
- Centre for Health Behaviors Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China
| | - Anise M. S. Wu
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, China
| | - Xuhui Tan
- School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
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Chen H, Li Y, Wang L, Zhang B. Causes of suicidal behaviors in men who have sex with men in China: a national questionnaire survey. BMC Public Health 2015; 15:91. [PMID: 25885430 PMCID: PMC4338620 DOI: 10.1186/s12889-015-1436-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) have become a high-risk group of HIV infection in China. To date, little is known regarding the psychological characteristics in Chinese MSM, especially the prevalence of suicidal ideation and attempts. METHODS A questionnaire survey was conducted on 2,250 MSM recruited from gay bars in 9 large cities in mainland China. Data on the prevalence of suicidal ideation and attempts as well as the underlying causes in the respondents were analyzed. RESULTS A total of 1530 MSM responded to the question regarding previous suicidal ideation and attempts. Of these respondents, 26.01% had ever considered suicide and 12.55% actually attempted suicide at least once. Romantic gay relationship breakup was the number one cause of suicide behaviors, followed by self-objection to homosexuality, difficulties in finding gay partners or in getting used to heterosexual marriage life, sudden emotional hurts from unexpected events, illegal status of gay marriage in China and disclosure of homosexuality. CONCLUSIONS The survey study has led to a better understanding of the factors contributing to suicide behaviors of MSM in China, which may have significant implications in developing preventive strategies against suicide behaviors in this unique group of individuals.
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Affiliation(s)
- Hongquan Chen
- Department of Dermatology, the Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, Shandong, 266003, China.
| | - Yang Li
- Department of Dermatology, Qingdao Sanatorium of Shandong Province, No.16 Zhengyangguan Road, Qingdao, 266071, Shandong, China.
| | - Lixin Wang
- Department of Dermatology, the Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, Shandong, 266003, China.
| | - Beichuan Zhang
- Sex Health Center, the Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, Shandong, 266003, China.
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Suguimoto SP, Techasrivichien T, Musumari PM, El-saaidi C, Lukhele BW, Ono-Kihara M, Kihara M. Changing patterns of HIV epidemic in 30 years in East Asia. Curr HIV/AIDS Rep 2015; 11:134-45. [PMID: 24664878 DOI: 10.1007/s11904-014-0201-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The HIV epidemic in East Asia started relatively late compared to the rest of the world. All countries or areas, except for North Korea, had reported HIV and AIDS cases, with China being the major contributor to the epidemic. Though initially driven by injecting drug use in China, East Asia did not experience an explosive spread. Strong commitment in China and early harm reduction programs in Taiwan managed to reduce transmission substantially among injecting drug users. In contrast to China and Taiwan, injection drug use has accounted just a little, if not at all, for the spread of HIV in other East Asian counties. However, following a global trend, sexual contact has become a major route of infection across the region. While much progress has been achieved in this region, with the epidemic among other key populations relatively stable, the emerging epidemic through sex between men is a growing concern. Recent estimates suggest that HIV prevalence among men who have sex with men (MSM) has reached 6.3 % in China, 7.5 % in Mongolia, and ranges between 8.1 %-10.7 % in Taiwan and between 2.7 %- 6.5 % in South Korea. In Japan, 74 % of male HIV cases were among MSM in 2012, while Hong Kong has witnessed a sharp increase of HIV cases among MSM since 2004. There is urgent need to address issues of discrimination and stigma toward homosexuality, and to strengthen the strategies to reach and care for this population.
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Affiliation(s)
- S Pilar Suguimoto
- Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan,
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Tang W, Huan X, Zhang Y, Mahapatra T, Li J, Liu X, Mahapatra S, Yan H, Fu G, Zhao J, Gu C, Detels R. Factors associated with loss-to-follow-up during behavioral interventions and HIV testing cohort among men who have sex with men in Nanjing, China. PLoS One 2015; 10:e115691. [PMID: 25559678 PMCID: PMC4283967 DOI: 10.1371/journal.pone.0115691] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 11/24/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Behavioral interventions (BIs) remained the cornerstone of HIV prevention in resource-limited settings. One of the major concerns for such efforts is the loss-to-follow-up (LTFU) that threatens almost every HIV control program involving high-risk population groups. METHODS To evaluate the factors associated with LTFU during BIs and HIV testing among men who have sex with men (MSM), 410 HIV sero-negatives MSM were recruited using respondent driven sampling (RDS) in Nanjing, China during 2008, they were further followed for 18 months. At baseline and each follow-up visits, each participant was counseled about various HIV risk-reductions BIs at a designated sexually transmitted infection (STI) clinic. RESULTS Among 410 participants recruited at baseline, altogether 221 (53.9%) were LTFU at the 18-month follow-up visit. Overall, 46 participants were found to be positive for syphilis infection at baseline while 13 participants were HIV sero-converted during the follow-up period. Increasing age was less (Adjusted Odds Ratio(aOR) of 0.90, 95% confidence Interval (CI) 0.86-0.94) and official residency of provinces other than Nanjing (AOR of 2.49, 95%CI 1.32-4.71), lower level of education (AOR of 2.01, 95%CI 1.10-3.66) and small social network size (AOR of 1.75, 95%CI 1.09-2.80) were more likely to be associated with higher odds of LTFU. CONCLUSION To improve retention in the programs for HIV control, counseling and testing among MSM in Nanjing, focused intensified intervention targeting those who were more likely to be LTFU, especially the young, less educated, unofficial residents of Nanjing who had smaller social network size, might be helpful.
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Affiliation(s)
- Weiming Tang
- Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, Guangdong, 510095, China
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
- University of North Carolina Project-China, Number 2 Lujing Road, Guangzhou, 510095, China
| | - Xiping Huan
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
| | - Ye Zhang
- Guangdong Provincial Center for Skin Disease and STI Control, Guangzhou, Guangdong, 510095, China
| | - Tanmay Mahapatra
- Department of Epidemiology, School National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Jianjun Li
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
| | - Xiaoyan Liu
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
| | - Sanchita Mahapatra
- Department of Epidemiology, School National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Hongjing Yan
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
| | - Gengfeng Fu
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
| | - Jinkou Zhao
- Strategy, Investment and Impact Division, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Chenghua Gu
- Jiangsu Provincial Central for Disease Control and Prevention, Nanjing, Jiangsu, 210009, China
- * E-mail: (CG); (RD)
| | - Roger Detels
- Department of Epidemiology, School National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
- * E-mail: (CG); (RD)
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Abstract
BACKGROUND This study explores patterns of drug use and related correlates among a sample of men who have sex with men (MSM) and men who sell sex to other men (aka "money boys") in China. OBJECTIVES Data were collected from MSM and money boys (MBs) in Shanghai, China using a Community Popular Opinion Leader (CPOL) research design with a self-administered cross-sectional survey to: (1) describe drug use and drug use correlates and (2) examine relationships between drug use and sexual behaviors in general MSM and MBs. METHODS The sample consisted of 402 MSM (203 MBs) who live in Shanghai, China. Descriptive statistics and regression analyses were used to explore associations between drug use and sexual behaviors and make comparisons between MBs and general MSM. RESULTS MBs reported using more drugs in the last week, 3 months and ever; sex after using drugs, and unprotected sex after using drugs more frequently than general MSM. Additionally, many MBs reported receiving free drugs from their clients and those who did receive free drugs were very likely to report having unprotected sex. CONCLUSIONS It is crucial to increase research and include Chinese MSM and their drug use in the Chinese policy conversation. These data suggest that drug use and sexual behaviors after drug use among Chinese MSM differ widely based upon selling sex and separate intervention strategies may be appropriate.
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Affiliation(s)
- Eric J Nehl
- 1Department of Behavioral Sciences & Health Education, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
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Dai L, Li N, Wei F, Li J, Liu Y, Xia W, Zhang T, Guo C, Wang W, Schwartz SA, Mahajan SD, Hsiao CB, Wu H. Transmitted antiretroviral drug resistance in the men who have sex with men HIV patient cohort, Beijing, China, 2008-2011. Viral Immunol 2014; 27:392-7. [PMID: 25084305 DOI: 10.1089/vim.2014.0025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Transmitted drug resistance (TDR) is an ongoing public health problem in HIV disease treatment. However, little is known about TDR among men who have sex with men (MSM) patients in China. In addition, TDR prevalence among patients with acute HIV infection (AHI) or early HIV infection (EHI) was believed higher than that of patients with chronic HIV infection (CHI), but as AHI is typically either unidentified or crudely defined in large populations, very few direct comparisons have been made. We did a retrospective analysis of TDR in 536 antiretroviral-naive MSM patients from our immunodeficiency clinics at You'an Hospital, Capital Medical University (CMU), in Beijing, China, 2008-2011. The cohort included 266 patients with AHI/EHI and 270 patients with CHI. We analyzed the subtype, estimated the TDR prevalence, and characterized the model of TDR and the predicted drug sensitivity. Additionally, we made a comparison of TDR between the patients with AHI/EHI and patients with CHI. Our results indicated that among the 536 patients, HIV-1 subtype CRF01_AE accounted for 52.1%, subtype B accounted for 24.8%, CRF07_BC/ CRF08_BC accounted for 21.6% (116/536), and 1.3% were denoted as unique recombinant forms (URFs). A total of 7.8% patients had one or more transmitted HIV-1 drug resistance mutations, representing 6.2% for PI-related mutations, 0.9% for NRTI-related mutations, and 1.7% for NNRTI-related mutations. Although patients with AHI/EHI had a higher TDR prevalence as compared to that of patients with CHI, the difference was not statistically significant. There was no significant difference in TDR model and predicted drug susceptibility between the two groups of patients either. This study provides important strategic information for public health planning by healthcare officials in China and warrants a comprehensive study with larger patient cohorts from various healthcare centers within China.
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Affiliation(s)
- Lili Dai
- 1 Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University , Beijing, China
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Increasing HIV and decreasing syphilis prevalence in a context of persistently high unprotected anal intercourse, six consecutive annual surveys among men who have sex with men in Guangzhou, China, 2008 to 2013. PLoS One 2014; 9:e103136. [PMID: 25061936 PMCID: PMC4111575 DOI: 10.1371/journal.pone.0103136] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 06/13/2014] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Previous studies have reported a possibly increasing HIV prevalence among men who have sex with men (MSM) in China. However there have been limited systematic analyses of existing surveillance data to learn the trend of HIV prevalence and factors driving the trend. The aims of this study were to examine the trend of HIV prevalence among MSM in Guangzhou and to explore the role of unprotected anal intercourse (UAI) in the trend. METHODS Snow-ball sampling was applied in the subject recruitment for the annual serological and behavioral surveys among MSM from 2008 to 2013. Data collected in the behavioral survey include demographic information, HIV related sexual behavior with men and women, access to HIV prevention services, and symptoms of sexually transmitted infections. Chi-square test was used to analyze the trend of HIV prevalence. Multivariate logistic regression was conducted to test the factors associated with HIV infection. RESULTS HIV prevalence increased significantly from 5.0% in 2008 to 11.4% in 2013 while syphilis prevalence decreased from 17.4% to 3.3% in the same period. UAI rates were high and stable in every single year, ranging from 54.5% to 62.0%. Those who were having UAI (OR = 1.80, 95% confidence interval (CI): 1.26-2.58), being migrants, having more than 10 partners, and infected with syphilis had higher risk for HIV infection. CONCLUSIONS HIV epidemic is expanding in Guangzhou. The persistently high UAI may have played a major role in the increasing trend of HIV prevalence. Targeted prevention program should be conducted among MSM who are migrants, low educational level, syphilis infected, or having multiple partners to encourage HIV test and change UAI behavior. The general high UAI calls for tailored intervention program to promote healthy culture and form a safe sex social norm in the MSM community.
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Sex networking of young men who have sex with men in densely connected saunas in Hong Kong. Sex Transm Dis 2014; 40:933-8. [PMID: 24220354 DOI: 10.1097/olq.0000000000000052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Some men who have sex with men (MSM) meet and have sex with male partners at gay saunas, the connections between which are little explored for designing HIV prevention measures. This study aims to describe the network configuration of gay saunas and explore its relationship with risk behavior of MSM in the respective sauna communities, in the city of Hong Kong. METHODS Using venue-based sampling, 205 MSM were recruited in 8 saunas in July 2011 for a cross-sectional anonymous questionnaire survey. A network of saunas was constructed based on the proportion of clients shared between them. Core saunas with higher intensity of linkages were delineated from core-periphery analysis. Men who have sex with men in core saunas were compared with those in peripheral ones in terms of their demographics and risk behavioral profiles. RESULTS Eight core saunas were differentiated from a highly connected sauna network, consisting of 13 saunas with a diameter of 2. Men who have sex with men visiting core saunas were more likely to be younger and users of the Internet for sex networking (odds ratio, 5.43; 95% confidence interval, 1.84-16.01). On average, they visited 1.7 saunas and had 2.6 sauna partners over a 1-month period, which were both significantly higher than those for MSM in peripheral saunas. However, there was no association between having unprotected anal sex and visiting core saunas. Sauna affiliation patterns were age dependent and geographically related. CONCLUSIONS Saunas were not homogeneously connected with each other. Prioritization may be considered so that public health interventions can be targeted at saunas in denser networks. An assortative mixing in age among MSM in sauna community informs planning for client-specific venue-based prevention programs.
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Yan H, Zhang R, Wei C, Li J, Xu J, Yang H, McFarland W. A peer-led, community-based rapid HIV testing intervention among untested men who have sex with men in China: an operational model for expansion of HIV testing and linkage to care. Sex Transm Infect 2014; 90:388-93. [DOI: 10.1136/sextrans-2013-051397] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Hu Y, Lu H, Raymond HF, Sun Y, Sun J, Jia Y, He X, Fan S, Xiao Y, McFarland W, Ruan Y. Measures of condom and safer sex social norms and stigma towards HIV/AIDS among Beijing MSM. AIDS Behav 2014; 18:1068-74. [PMID: 24057931 DOI: 10.1007/s10461-013-0609-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Social norms around condom use and safe sex as well as HIV/AIDS stigma are used to identify persons at higher risk for HIV. These measures have been developed and tested in a variety of settings and populations. While efforts have been undertaken to develop context specific measures of these domains among Chinese MSM, the feasibility of using existing measures is unknown. A survey of MSM, based on respondent-driven sampling, was conducted in Beijing. Existing measures of condom social norms, attitudes towards safer sex and HIV/AIDS stigma were piloted. Internal consistency of all measures was high. As expected higher levels of condom social norms and positive attitudes towards safer sex were associated with condom use. HIV/AIDS stigma and discrimination had a significant relationship with never having an HIV test and lack of discussion of HIV/AIDS with male partners. Correlates of low condom social norms were age, education, employment and resident status. Existing measures of condom social norms, attitudes towards safer sex and HIV/AIDS stigma appear to be appropriate for use among Chinese MSM. Using existing measures as opposed to developing new measures has the potential to expedite investigations into psychosocial correlates of HIV risk behavior.
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Zhao J, Chen L, Cai WD, Tan JG, Tan W, Zheng CL, Cheng JQ, Yang ZR, He ML, Wang XR. HIV infection and sexual behaviors among non-commercial men who have sex with men at different venues. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:801-809. [PMID: 23982566 DOI: 10.1007/s10508-013-0167-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 05/01/2013] [Accepted: 05/12/2013] [Indexed: 06/02/2023]
Abstract
The prevalence of HIV infection among men who have sex with men (MSM) has increased rapidly in China. Previous studies suggested that some venue-specific characteristics could significantly affect MSM's sexual behaviors that were related to HIV transmission. Thus, to compare the HIV infection rates and related risky sexual behaviors among MSM at different venues, we conducted a cross-sectional study with time-location sampling in Shenzhen, China. Among the 801 MSM recruited in the study, 7.0 % (n = 56) were found to be HIV positive, with 0.9 % of MSM at bars (BMSM), 3.5 % of MSM at suburban recreational centers (RMSM), 8.1 % of MSM at saunas (SMSM), 9.3 % of MSM at parks (PMSM), and 10.1 % of MSM at dorm-based venues (DMSM). HIV infection was significantly more prevalent in MSM in dorm-based venues, parks, and saunas than in other venues. Compared to MSM in other venues, BMSM were more likely to be single, drug and alcohol users, but less likely to be HIV and syphilis positive. More PMSM reported having unprotected anal intercourse with other men while more SMSM reported having multiple male sex partners and more RMSM had a low level of HIV-related knowledge. The results indicated that MSM frequenting different venues were inconsistent with regards to demographic characteristics, HIV and syphilis infection rates, and risky sexual behaviors. Greater efforts are needed to develop intervention strategies that target specific venues and risky behaviors.
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Affiliation(s)
- Jin Zhao
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
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Cai Y, Lau JTF. Multi-dimensional factors associated with unprotected anal intercourse with regular partners among Chinese men who have sex with men in Hong Kong: a respondent-driven sampling survey. BMC Infect Dis 2014; 14:205. [PMID: 24735186 PMCID: PMC3996134 DOI: 10.1186/1471-2334-14-205] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/10/2014] [Indexed: 11/14/2022] Open
Abstract
Background The HIV prevalence and incidence among men who have sex with men (MSM) are high. Unprotected anal intercourse (UAI) with male regular partners (RP) is an important but under-emphasized risk behavior. The current study aimed to describe the prevalence of UAI with regular partner and the associated multi-dimensional factors with UAI among MSM in Hong Kong, China. Methods Respondent Driven Sampling method was used to recruit participants. A total of 285 participants were recruited, of whom 211 (75.1%) had had anal sex with RP in the last six months and their data were analyzed in this report. Weighed data were presented and logistic regression methods were fit. Results Participants’ high risk behaviors in the last six months included high prevalence of having had UAI with RP (45.8%), having had non-regular male sex partners (NRP: 27.3%) and UAI with such partners (18.9%). Adjusted for socio-demographic variables, factors associated with UAI with RP included: 1) substances use prior to having anal sex (65.7% versus 43.8%; AOR =2.36; 95% CI =1.07-5.18), 2) worry that condom use symbolizes mistrust (67.9% versus 44.3%; AOR = 2.91; 95% CI =1.19-7.10), 3) a lower perceived degree of the RP’s acceptance of condom use (91.7% versus 38.3%; AOR = 22.70; 95% CI =6.20-83.10), and 4) a higher level of impulsivity (61.1% versus 35.0%; AOR =4.02; 95% CI = 1.62-9.97). Two of these four variables, substances use (ORm = 2.28, 95% CI = 1.01-5.16) and perceived lower level of RP’s acceptance of condom use (ORm = 17.22; 95% CI = 5.06-58.62) were selected by the forward stepwise logistic regression model. Conclusions MSM with RP in Hong Kong is subjected to high risk of HIV transmission. Risk factors of UAI are multi-dimensional and interventions need to take into account factors of structural, interpersonal and individual levels.
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Affiliation(s)
| | - Joseph T F Lau
- Centre for Health Behaviors Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, 5/F,, School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong 030000, PR China.
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HIV prevalence trends, risky behaviours, and governmental and community responses to the epidemic among men who have sex with men in China. BIOMED RESEARCH INTERNATIONAL 2014; 2014:607261. [PMID: 24822214 PMCID: PMC4005141 DOI: 10.1155/2014/607261] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/06/2013] [Accepted: 01/03/2014] [Indexed: 11/18/2022]
Abstract
Purpose of Review. Numerous studies reported the rapid spread of HIV/AIDS epidemic among men who have sex with men (MSM) in China. This paper aims to investigate the overall epidemic trend and associated high-risk behaviours among Chinese MSM and to explore the governmental and community responses to the epidemic. Recent Findings. HIV prevalence among Chinese MSM increased rapidly in all Chinese regions in the past decade and disproportionally affected the Southwest China. In addition to the high-risk homosexual behaviours, overlapping bisexual, commercial, and drug use behaviours are commonly observed among Chinese MSM. The Chinese government has significantly expanded the surveillance efforts among MSM over the past decade. Community responses against HIV have been substantially strengthened with the support of international aid. However, lack of enabling legal and financial environment undermines the role of community-based organisations (CBOs) in HIV surveillance and prevention. Conclusion. HIV continues to spread rapidly among MSM in China. The hidden nature of MSM and the overlapping homosexual, bisexual, and commercial behaviours remain a challenge for HIV prevention among MSM. Strong collaboration between the government and CBOs and innovative intervention approaches are essential for effective HIV surveillance and prevention among MSM in China.
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Disparities and risks of sexually transmissible infections among men who have sex with men in China: a meta-analysis and data synthesis. PLoS One 2014; 9:e89959. [PMID: 24587152 PMCID: PMC3933676 DOI: 10.1371/journal.pone.0089959] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/24/2014] [Indexed: 01/04/2023] Open
Abstract
Background Sexually transmitted infections (STIs), including Hepatitis B and C virus, are emerging public health risks in China, especially among men who have sex with men (MSM). This study aims to assess the magnitude and risks of STIs among Chinese MSM. Methods Chinese and English peer-reviewed articles were searched in five electronic databases from January 2000 to February 2013. Pooled prevalence estimates for each STI infection were calculated using meta-analysis. Infection risks of STIs in MSM, HIV-positive MSM and male sex workers (MSW) were obtained. This review followed the PRISMA guidelines and was registered in PROSPERO. Results Eighty-eight articles (11 in English and 77 in Chinese) investigating 35,203 MSM in 28 provinces were included in this review. The prevalence levels of STIs among MSM were 6.3% (95% CI: 3.5–11.0%) for chlamydia, 1.5% (0.7–2.9%) for genital wart, 1.9% (1.3–2.7%) for gonorrhoea, 8.9% (7.8–10.2%) for hepatitis B (HBV), 1.2% (1.0–1.6%) for hepatitis C (HCV), 66.3% (57.4–74.1%) for human papillomavirus (HPV), 10.6% (6.2–17.6%) for herpes simplex virus (HSV-2) and 4.3% (3.2–5.8%) for Ureaplasma urealyticum. HIV-positive MSM have consistently higher odds of all these infections than the broader MSM population. As a subgroup of MSM, MSW were 2.5 (1.4–4.7), 5.7 (2.7–12.3), and 2.2 (1.4–3.7) times more likely to be infected with chlamydia, gonorrhoea and HCV than the broader MSM population, respectively. Conclusion Prevalence levels of STIs among MSW were significantly higher than the broader MSM population. Co-infection of HIV and STIs were prevalent among Chinese MSM. Integration of HIV and STIs healthcare and surveillance systems is essential in providing effective HIV/STIs preventive measures and treatments. Trial Registration PROSPERO No: CRD42013003721
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Chen M, Ma Y, Su Y, Yang L, Zhang R, Yang C, Chen H, Yan W, Shi Y, Dong L, Chen L, Jia M, Lu L. HIV-1 genetic characteristics and transmitted drug resistance among men who have sex with men in Kunming, China. PLoS One 2014; 9:e87033. [PMID: 24489829 PMCID: PMC3906090 DOI: 10.1371/journal.pone.0087033] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 12/17/2013] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Yunnan has been severely affected by HIV/AIDS in China. Recently, the reported prevalence of HIV-1 among men who have sex with men (MSM) in Yunnan was high in China. To monitor dynamic HIV-1 epidemic among Yunnan MSM, HIV-1 genetic characteristics and transmitted drug resistance (TDR) were investigated. METHODS Blood samples from 131 newly HIV-1 diagnosed MSM were continuously collected at fixed sites from January 2010 to December 2012 in Kunming City, Yunnan Province. Partial gag, pol and env genes were sequenced. Phylogenetic, evolutionary and genotypic drug resistance analyses were performed. RESULTS Multiple genotypes were identified among MSM in Kunming, including CRF01_AE (64.9%), CRF07_BC (25.2%), unique recombinant forms (URFs, 5.3%), subtype B (3.1%) and CRF08_BC (1.5%). CRF01_AE and CRF07_BC were the predominant strains. The mean of genetic distance within CRF01_AE were larger than that within CRF07_BC. The estimated introducing time of CRF01_AE in Yunnan MSM (1996.9) is earlier than that of CRF07_BC (2002.8). In this study, subtype B was first identified in Yunnan MSM. CRF08_BC seems to be the distinctive strain in Yunnan MSM, which was seldom found among MSM outside Yunnan. The proportion of URFs increased, which further contributed to genetic diversity among MSM. Strikingly, genetic relatedness was found among these strains with MSM isolates from multiple provinces, which suggested that a nationwide transmission network may exist. TDR-associated mutations were identified in 4.6% individuals. The multivariate analysis revealed that non-native MSM and divorced/widowed MSM were independently associated with a higher TDR rate. CONCLUSION This work revealed diverse HIV-1 genetics, national transmission networks and a baseline level of TDR in MSM. These findings enhance our understanding of the distribution and evolution of HIV-1 in MSM, and are valuable for developing HIV prevention strategies for MSM.
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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
| | - 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
| | - Li Yang
- Center for AIDS/STD Control and Prevention, Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Renzhong Zhang
- 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
| | - Huichao 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
| | - Lijuan Dong
- 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
| | - 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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Ruan Y, Wu G, Lu H, Xiao Y, Zhao Y, Lu R, He X, Feng L, McFarland W, Shao Y, Raymond HF. Sexual partnerships with men and women among men who have sex with men in Beijing and Chongqing, China, 2010. AIDS Behav 2014; 18:180-8. [PMID: 23666182 DOI: 10.1007/s10461-013-0505-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
HIV is spreading among Chinese MSM and may possibly lead to infection of female partners. Pressure to marry may drive a greater proportion of Chinese MSM to have female partners than MSM elsewhere in the world. Measurement of the size of the potential risk to female partners of Chinese MSM is inconsistent in the literature. From samples of MSM in two Chinese cities, we documented numbers of sexual partners and sexual activity with those partners. About 500 MSM were sampled in each city. 11.0 and 12.6 % of men reported having any female partners in the past 6 months in Chongqing and Beijing, respectively. Men also reported that only 7.3 and 6.7 % of their entire partnerships were with women in Chongqing and Beijing, respectively. Defining transmission risk accounting for receptive anal sex among men and condom non-use with both male and female partners, 3.4 % of MSM in both Chongqing and Beijing would have the potential to transmit HIV to female partners. Only 9 (1.8 ) men in Chongqing and 2 (0.4 %) in Beijing were HIV-positive and also had unprotected intercourse with females. The majority of HIV transmission risk among MSM in China is not from MSM to females.
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Affiliation(s)
- Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, People's Republic of China
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Identification of 3 distinct HIV-1 founding strains responsible for expanding epidemic among men who have sex with men in 9 Chinese cities. J Acquir Immune Defic Syndr 2013; 64:16-24. [PMID: 23542640 PMCID: PMC3814940 DOI: 10.1097/qai.0b013e3182932210] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Supplemental Digital Content is Available in the Text. Objectives: To investigate the epidemiological relationships between HIV-1 strains that are spread among the men who have sex with men (MSM) populations of 9 cities across China and to analyze the origins and divergence times of the major epidemic strains found in the MSM population. Methods: A total of 583 HIV-1-positive subjects were recruited from high-risk MSM populations in 9 cities across China between 2009 and 2011. Nucleotide sequences of 1.0-kb pro-RT regions were amplified and sequenced. Phylogenetic and Bayesian molecular clock analyses were performed. Results: The overall distribution of HIV-1 genotypes was as follows: CRF01_AE, 62.1%; CRF07_BC, 18.2%; subtype B (United States–European), 15.9%; subtype B', 0.7%; other recombinants, 3.1%. In addition to the 2 distinct CRF01_AE clusters [cluster 1 (n = 157, 26.9%) and cluster 2 (n = 196, 33.6%)] previously reported by our group, we identified a novel CRF07_BC cluster (cluster 3) (n = 94, 16.1%) unique to China's MSM population whose strains were homologous and could be detected in all 9 cities. These 3 lineages of HIV-1 strains (clusters 1–3) accounted for 76.7% (447 of 583) of infections among MSM in China as a whole. Clusters 1, 2, and 3 were estimated to have been introduced into the MSM population in 1999, 2001, and 2001, respectively, indicating that the newly identified CRF07_BC cluster 3 is not a young lineage. However, it spread quickly in recent years. Conclusions: We identified 3 distinct HIV-1 lineages (clusters 1–3) responsible for the recent upsurge of the AIDS epidemic among MSM in China. These 3 HIV-1 variants are spread widely among MSM throughout China, demonstrating remarkable founding effects.
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Abstract
BACKGROUND HIV testing is the gateway for prevention and care. We explored factors associated with HIV testing among Chinese men who have sex with men (MSM). METHODS In Chongqing City, we recruited 492 MSM in 2010 using respondent-driven sampling in a cross-sectional study. Computer-assisted self-interviews were conducted to collect information on history of HIV testing. RESULTS Only 58% of participants reported ever having taken an HIV test. Men who have sex with men who had a college degree (adjusted odds ratio [AOR], 1.7; 95% confidence interval (CI), 1.2-2.6; P = 0.008) were more likely to take a test; those who preferred a receptive role in anal sex were less likely to do so than those with insertive sex preference (AOR, 0.6; 95% CI, 0.35-0.94; P = 0.03); and those who used condoms with the recent male partner during the past 6 months were more likely to get tested (AOR, 2.87; 95% CI, 1.25-6.62; P = 0.01). Principal perceived barriers to testing included the following: fear of knowing a positive result, fear of discrimination if tested positive, low perceived risk of HIV infection, and not knowing where to take a test. Factors reported to facilitate testing were sympathetic attitudes from health staff and guaranteed confidentiality. Prevalence was high: 11.7% HIV positive and 4.7% syphilis positive. CONCLUSIONS The HIV testing rate among MSM in Chongqing is still low, although MSM prevalence is high compared with other Chinese cities. Men who have sex with men preferring receptive anal sex are less likely to get testing and perceive having lower HIV risk. Along with expanded education and social marketing, a welcoming and nonjudgmental environment for HIV testing is needed.
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Xu J, Han X, Reilly KH, Shang H. New features of the HIV epidemic among men who have sex with men in China. Emerg Microbes Infect 2013; 2:e45. [PMID: 26038478 PMCID: PMC3820985 DOI: 10.1038/emi.2013.45] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/13/2013] [Accepted: 06/14/2013] [Indexed: 11/24/2022]
Abstract
Men who have sex with men (MSM) have accounted for an alarmingly increasing proportion of nationally reported human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) cases recently. While the latest HIV epidemic among this population was not well understood, the underlying reasons for the rapid increase of the HIV epidemic were even more rarely evaluated. This study reviewed all published articles and national surveillance data in recent years to analyze the new HIV epidemic among MSM in China, and this study finally concluded that a culture of risky sexual behaviors, low adoption of HIV testing and a high prevalence of syphilis infection were the major risk factors that predominantly facilitate homosexual HIV transmission. Both HIV infection and homosexuality remain highly stigmatized in China, which further exacerbates attempts at HIV prevention and control. A great deal of work still needs to be done for the national policy makers, programming, research and clinical sectors to help curb the HIV epidemic among Chinese MSM.
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Affiliation(s)
- Junjie Xu
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, The First Hospital of China Medical University, Shenyang 110001 , China
| | - Xiaoxu Han
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, The First Hospital of China Medical University, Shenyang 110001 , China
| | | | - Hong Shang
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, The First Hospital of China Medical University, Shenyang 110001 , China
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Zhang L, Zhang D, Yu B, Wang S, Liu Y, Wang J, Li X, Shang X, Li H. Prevalence of HIV infection and associated risk factors among men who have sex with men (MSM) in Harbin, P. R. China. PLoS One 2013; 8:e58440. [PMID: 23516481 PMCID: PMC3596395 DOI: 10.1371/journal.pone.0058440] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 02/04/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the prevalence of HIV infection and characteristically risk of factors which associated with HIV infection among MSM in Harbin, China. METHODS A face-to-face questionnaire interview was conducted among 463 Men Who Have Sex with Men (MSM) who were recruited by the snowball sampling in Harbin from April, 2011 to July, 2011. The questionnaire mainly included demographics, AIDS knowledge, homosexual behavior and the status of intervention in MSM. Blood specimens were obtained and tested for the diagnoses of HIV, syphilis and hepatitis C virus (HCV). Associations between above exposed factors and HIV infection were analyzed using a univariate analysis and forward stepwise logistic regression. RESULTS The prevalence of HIV and syphilis was 9.5 and 14.3%. The awareness rate of AIDS was 86.8%. The rate of unprotected sexual behavior was 57.6% of MSM during the past 6 months. The univariate analysis identified that the age (age ≥ 35 years old), cohabitation, more than 10 years of homosexual behavior and more than 10 homosexual partners were risk factors which associated with the HIV infection, and that protected sex during the past 6 months was a protective factor for the HIV infection. The multivariate analysis identified that the duration of homosexual behavior and commercial sexual behavior were independent risk factors which associated with the HIV infection, and the protected sex during the past 6 months was a protective factor for the HIV infection. CONCLUSION The prevalence of HIV among MSM in Harbin has been rapidly increasing in the past few years. Targeted, tailored, and comprehensive interventions are urgently needed to prevent the HIV infection from MSM.
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Affiliation(s)
- Ling Zhang
- Department of Epidemiology, Public Health College, Harbin Medical University, China
- Centers for Disease Control and Prevention, Harbin, China
| | | | - Baowen Yu
- Sanitation Supervision Stations, Harbin, China
| | - Shangbo Wang
- Centers for Disease Control and Prevention, Harbin, China
| | - Yanlin Liu
- Centers for Disease Control and Prevention, Harbin, China
| | - Jian Wang
- Centers for Disease Control and Prevention, Harbin, China
| | - Xin Li
- Department of Epidemiology, Public Health College, Harbin Medical University, China
| | - Xiaoyun Shang
- Department of Epidemiology, Public Health College, Harbin Medical University, China
| | - Hongyuan Li
- Department of Epidemiology, Public Health College, Harbin Medical University, China
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Lau JTF, Wang Z, Kim JH, Lau M, Lai CHY, Mo PKH. Acceptability of HPV vaccines and associations with perceptions related to HPV and HPV vaccines among men who have sex with men in Hong Kong. PLoS One 2013; 8:e57204. [PMID: 23451188 PMCID: PMC3579800 DOI: 10.1371/journal.pone.0057204] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 01/23/2013] [Indexed: 11/18/2022] Open
Abstract
HPV vaccines are available to men but there are few studies investigating the acceptability of HPV vaccines among men who have sex with men (MSM), a high risk group. We assessed the intention to take up HPV vaccines among MSM in Hong Kong and the associated factors related to cognitions on HPV and HPV vaccines, basing on the Health Belief Model (n = 542). The acceptability of HPV vaccines was 20% (unconditional on efficacies and price), 29.2% (conditional on efficacies and market price), 51.7% (conditional on efficacies and discounted price) and 79.1% (conditional on efficacies and free price). Adjusting for background variables, composite scores of perceived susceptibility, perceived severity, perceived barriers and cue to actions were significantly associated with acceptability of HPV vaccines conditional on specific efficacies and the market price. Acceptability of HPV vaccines was highly price sensitive. Future studies need to use conditional measures. Implementation and translational researches are warranted.
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Affiliation(s)
- Joseph T F Lau
- Centre for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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Emergence in Japan of an HIV-1 variant associated with transmission among men who have sex with men (MSM) in China: first indication of the International Dissemination of the Chinese MSM lineage. J Virol 2013; 87:5351-61. [PMID: 23365432 DOI: 10.1128/jvi.02370-12] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A survey of HIV-1 strains circulating in the Tokyo-Kanagawa metropolitan area of Japan during 2004 to 2011 (n = 477) identified six Japanese males (patients 1 to 6), who harbored viruses with genome segments derived from a distinct CRF01_AE variant uniquely found among men who have sex with men (MSM) in China (designated CN.MSM.01-1). These six HIV infections were diagnosed in 2010 and 2011 among MSM (3 of 75) and men with unknown risk factors (3 of 63) and differed from the vast majority of HIV infections among MSM in Japan, which are overwhelmingly characterized by subtype B (239 of 246 [97.2%]). Approximately one-third (91 of 239 [38.1%]) of subtype B strains from MSM in Japan belong to a large monophyletic cluster (designated JP.MSM.B-1). In addition, we identified a smaller subtype B cluster (n = 8) (designated JP.MSM.B-2) that also contains strains from two Chinese MSM living in Japan. Interestingly, patients 5 and 6 were found to be coinfected with CRF01_AE (CN.MSM.01-1) and subtype B (JP.MSM.B-2 or JP.MSM.B-1) variants that are unique to the HIV-1 epidemics among MSM in China and Japan, respectively. Our study demonstrates for the first time the effect of the expanding HIV epidemic among MSM in China on transmission in neighboring countries and shows the ongoing mixing of CRF01_AE and subtype B lineages unique to HIV-1 that cocirculate in MSM populations in East Asia. This finding highlights the importance of strengthening epidemiological surveillance in the region and the need for effective measures to limit transmission among MSM in East Asia.
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Huang ZJ, He N, Nehl EJ, Zheng T, Smith BD, Zhang J, McNabb S, Wong FY. Social network and other correlates of HIV testing: findings from male sex workers and other MSM in Shanghai, China. AIDS Behav 2012; 16:858-71. [PMID: 22223298 PMCID: PMC8080277 DOI: 10.1007/s10461-011-0119-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Although the Chinese government provides free-of-charge voluntary HIV counseling and testing, HIV testing rates among men who have sex with men (MSM) are reported to be extremely low. This study examines the association of structural and psychosocial factors and social network characteristics with HIV testing behaviors among "money boys" and general MSM in Shanghai. Overall, 28.5% of "money boys" and 50.5% of general MSM had never tested for HIV despite high rates of reported HIV risk behaviors. Factors associated with not testing for HIV included: not knowing of a testing site, limited HIV knowledge, low perceived HIV risk, concern about HIV testing confidentiality, being a closeted gay, not using the Internet, and having a small social network or network with few members who had tested for HIV. Future efforts to promote HIV testing should focus on outreach to general MSM, confidentiality protection, decreasing the stigma of homosexuality, and encouraging peer education and support through the Internet and social networks.
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Affiliation(s)
- Z Jennifer Huang
- Department of International Health, Georgetown University School of Nursing and Health Studies, Washington, DC 20057, USA.
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Xue QY, Gao JJ, Song PP, Qu XJ, Xu LZ. Prospects for using pre-exposure prophylaxis to control the prevalence of HIV/AIDS in China. Drug Discov Ther 2012; 5:159-61. [PMID: 22466295 DOI: 10.5582/ddt.2011.v5.4.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although important progress has been achieved in combating HIV/AIDs over the past 30 years, HIV/AIDs is still a serious threat to today's world. In China, figures on the incidence of this disease have painted a less than optimistic outlook. As the prevailing methods of preventing HIV/AIDS are all partially effective, novel and effective preventive interventions are needed in order to control the spread of the disease. Pre-exposure prophylaxis (PrEP) is one of the most promising prevention strategies and has garnered great attention worldwide. Current clinical trials on the efficacy and safety of this strategy have had some favorable results though major challenges around the world remain. Thus, China has taken an active part in the PrEP study to limit the prevalence of HIV/AIDS. This article describes the status of the PrEP study and discusses the opportunities and challenges encountered when implementing this strategy in China.
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Affiliation(s)
- Q Y Xue
- Institute of Social Medicine and Health Services Management, School of Public Health, Shandong University, Ji'nan, Shandong, China
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Han X, Xu J, Chu Z, Dai D, Lu C, Wang X, Zhao L, Zhang C, Ji Y, Zhang H, Shang H. Screening acute HIV infections among Chinese men who have sex with men from voluntary counseling & testing centers. PLoS One 2011; 6:e28792. [PMID: 22194914 PMCID: PMC3237549 DOI: 10.1371/journal.pone.0028792] [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: 09/01/2011] [Accepted: 11/15/2011] [Indexed: 11/30/2022] Open
Abstract
Background Recent studies have shown the public health importance of identifying acute HIV infection (AHI) in the men who have sex with men (MSM) of China, which has a much higher risk of HIV transmission. However, cost-utility analyses to guide policy around AHI screening are lacking. Methodology/Principal Findings An open prospective cohort was recruited among MSM living in Liaoning Province, Northeast China. Blood samples and epidemiological information were collected every 10 weeks. Third-generation ELISA and rapid test were used for HIV antibody screening, western blot assay (WB) served for assay validation. Antibody negative specimens were tested with 24 mini-pool nucleic acid amplification testing (NAAT). Specimens with positive ELISA but negative or indeterminate WB results were tested with NAAT individually without mixing. A cost-utility analysis of NAAT screening was assessed. Among the 5,344 follow-up visits of 1,765 MSM in 22 months, HIV antibody tests detected 114 HIV chronic infections, 24 seroconverters and 21 antibody indeterminate cases. 29 acute HIV infections were detected with NAAT from 21 antibody indeterminate and 1,606 antibody negative cases. The HIV-1 prevalence and incidence density were 6.6% (95% CI: 5.5–7.9) and 7.1 (95% CI: 5.4–9.2)/100 person-years, respectively. With pooled NAAT and individual NAAT strategy, the cost of an HIV transmission averted was $1,480. The addition of NAAT after HIV antibody tests had a cost-utility ratio of $3,366 per gained quality-adjusted life year (QALY). The input-output ratio of NAAT was about 1∶16.9. Conclusions/Significance The HIV infections among MSM continue to rise at alarming rates. Despite the rising cost, adding pooled NAAT to the HIV antibody screening significantly increases the identification of acute HIV infections in MSM. Early treatment and target-oriented publicity and education programs can be strengthened to decrease the risk of HIV transmission and to save medical resources in the long run.
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Affiliation(s)
- Xiaoxu Han
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No.1 Hospital of China Medical University, Shenyang, Liaoning, China
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Sim F, Mackie P. Public Health Sans Frontieres. Public Health 2011; 125:245-6. [PMID: 21658536 DOI: 10.1016/j.puhe.2011.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2011] [Indexed: 10/18/2022]
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50
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Emerging issues, challenges and aspirations in the HIV/AIDS epidemic in China. Public Health 2011; 125:257-9. [DOI: 10.1016/j.puhe.2011.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 01/20/2011] [Indexed: 11/22/2022]
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