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Zhang L, Zhang D, Chen W, Zou X, Ling L. High prevalence of HIV, HCV and tuberculosis and associated risk behaviours among new entrants of methadone maintenance treatment clinics in Guangdong Province, China. PLoS One 2013; 8:e76931. [PMID: 24116185 PMCID: PMC3792874 DOI: 10.1371/journal.pone.0076931] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/04/2013] [Indexed: 12/02/2022] Open
Abstract
Background Methadone maintenance treatment (MMT) has been available in Guangdong province, China since 2006. This study aims to estimate the prevalence levels of HIV, Hepatitis C (HCV), Tuberculosis (TB) and their co-infections and associated demographic and risk behaviours among MMT entrants. Method A total of 2296 drug users at the time of their MMT enrolment were recruited from four clinics during 2006-2011. Participants’ demographic characteristics, infection status and self-reported high-risk drug-use and sexual behaviours were surveyed. Log-linear contingency analysis was employed to investigate the demographic and behavioural differences between gender and drug-user type, while multivariate regression analysis was used to identify the associated factors of HIV, HCV and TB infections. Results Female drug users demonstrate significantly higher frequency of daily drug consumption (Log-linear contingency analysis, G2=10.86, p=0.013) and higher proportion of having had sex in the past three months (G2=30.22, p<0.001) than their male counterparts. Among injecting drug users, females also inject (χ2=16.15, p=0.001) and share syringes (χ2=13.24, p=0.004) more frequently than males. Prevalence of HIV, HCV and TB among MMT entrants are 6.3%, 78.7% and 4.4% respectively. Co-infections of HIV/HCV, HIV/TB, HCV/TB and HIV/HCV/TB reportedly infect 5.6%, 0.5%, 3.8% and 0.3% of study participants. Infection risks of HIV, HCV and TB are consistently associated with increasing length of drug use, injecting drugs, financial dependence and reduced sexual activities. Conclusion Injecting drug use is the major contributing factor in prevalence levels of HIV, HCV and TB among MMT entrants. Female drug users are more disadvantaged in their social status and risk-taking in their drug use behaviours than males.
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Affiliation(s)
- Lei Zhang
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, P. R. China
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Di Zhang
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, P. R. China
- School of Public Health, Sun Yat-sen University, Guangzhou, P. R. China
- Office of Medical Science, Sun Yat-sen University, Guangzhou, P. R. China
| | - Wen Chen
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, P. R. China
- School of Public Health, Sun Yat-sen University, Guangzhou, P. R. China
| | - Xia Zou
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, P. R. China
- School of Public Health, Sun Yat-sen University, Guangzhou, P. R. China
| | - Li Ling
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, P. R. China
- School of Public Health, Sun Yat-sen University, Guangzhou, P. R. China
- * E-mail:
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Zhang L, Chow EPF, Jing J, Zhuang X, Li X, He M, Sun H, Li X, Gorgens M, Wilson D, Wang L, Guo W, Li D, Cui Y, Wang L, Wang N, Wu Z, Wilson DP. HIV prevalence in China: integration of surveillance data and a systematic review. THE LANCET. INFECTIOUS DISEASES 2013; 13:955-63. [PMID: 24107261 DOI: 10.1016/s1473-3099(13)70245-7] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Asian HIV epidemics are concentrated among particular behavioural groups, but large variations exist in epidemic types, timing, and geographical spread between countries and within countries, especially in China. We aimed to understand the complexity of HIV epidemics in China by systematically analysing prevalence trends by data source, region, population group, and time period. METHODS We collected HIV prevalence data from official national sentinel surveillance sites at the provincial level from Jan 1, 1995, to Dec 31, 2010. We also searched PubMed, VIP Chinese Journal Database (VIP), China National Knowledge Infrastructure, and Wanfang Data from Jan 1, 1990, to Dec 31, 2012, for independent studies of HIV prevalence. We integrated both sets of data, and used an intraclass correlation coefficient test to assess the similarity of geographical pattern of HIV disease burden across 31 Chinese provinces in 2010. We investigated prevalence trends (and 95% CIs) to infer corresponding incidence by region, population group, and year. FINDINGS Of 6850 articles identified by the search strategy, 821 studies (384,583 drug users, 52,356 injecting drug users, 186,288 female sex workers, and 87,834 men who have sex with men) met the inclusion criteria. Official surveillance data and findings from independent studies showed a very similar geographical distribution and magnitude of HIV epidemics across China. We noted that HIV epidemics among injecting drug users are decreasing in all regions outside southwest China and have stabilised at a high level in northwest China. Compared with injecting drug users, HIV prevalence in female sex workers is much lower and has stabilised at low levels in all regions except in the southwest. In 2010, national HIV prevalence was 9·08% (95% CI 8·04-10·52) in injecting drug users and 0·36% (0·12-0·71) in female sex workers, whereas incidence in both populations stabilised at rates of 0·57 (0·43-0·72) and 0·02 (0·01-0·04) per 100 person-years, respectively. By comparison, HIV prevalence in men who have sex with men increased from 1·77% (1·26-2·57) in 2000, to 5·98% (4·43-8·18) in 2010, with a national incidence of 0·98 (0·70-1·25) per 100 person-years in 2010. We recorded strong associations between HIV prevalence among at-risk populations in each province, supporting the existence of overlap in risk behaviours and mixing among these populations. INTERPRETATION HIV epidemics in China remain concentrated in injecting drug users, female sex workers, and men who have sex with men. HIV prevalence is especially high in southwest China. Sex between men has clearly become the main route of HIV transmission.
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Affiliation(s)
- Lei Zhang
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Comprehensive AIDS Research Center, Tsinghua University, Beijing, China.
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Saktiawati AMI, Worth H, Lazuardi E, Spooner C, Subronto YW, Padmawati RS. I Just Trust Him: The Notion of Consideration as a Barrier to Condom Use amongst Women Who Inject Drugs in Central Java. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wja.2013.34038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Should associations between HIV-related risk perceptions and behaviors or intentions be positive or negative? PLoS One 2012; 7:e52124. [PMID: 23284896 PMCID: PMC3526527 DOI: 10.1371/journal.pone.0052124] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 11/08/2012] [Indexed: 11/24/2022] Open
Abstract
Risk perceptions are important in HIV research and interventions; mixed results were found between HIV-related perceptions and behaviors. We interviewed 377 sexually active injecting drug users in China, finding mixed associations between HIV-related risk perception assessed by two general measures and two previous risk behaviors (syringe sharing: p<.05; unprotected sex: p>.05) – partially supporting the ‘reflective hypothesis’ that reflection on previous behaviors increases risk perceptions. When we use specific measures for risk perceptions (HIV transmission via unprotected sex with specific types of sex partner and via syringe sharing) and use behavioral intention to adopt protective risk behaviors (condom use and avoid syringe sharing totally) as dependent variables, positive significant associations were observed – supporting the motivational hypothesis that risk perceptions motivate one to adopt protective behaviors. The direction and significance of the associations of concern depends on types of measures used. It has important implications on research design, data interpretation and services.
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Peng EYC, Yeh CY, Cheng SH, Morisky DE, Lan YC, Chen YMA, Lyu SY, Malow RM. A Case-control Study of HIV Infection Among Incarcerated Female Drug Users: Impact of Sharing Needles and Having Drug-using Sexual Partners. J Formos Med Assoc 2011; 110:446-53. [DOI: 10.1016/s0929-6646(11)60066-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 04/30/2010] [Accepted: 08/03/2010] [Indexed: 11/26/2022] Open
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Gu J, Lau JT, Chen H, Tsui H, Ling W. Prevalence and factors related to syringe sharing behaviours among female injecting drug users who are also sex workers in China. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2011; 22:26-33. [DOI: 10.1016/j.drugpo.2010.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 06/02/2010] [Accepted: 06/28/2010] [Indexed: 10/19/2022]
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Lau JTF, Tsui HY, Gu J, Zhang J, Zhang L, Zhang Y, Cheng F, Wang N. Sexual mixing and condom use with different types of sex partners among non-institutionalized sexually active female injecting drug users in Sichuan, China. AIDS Behav 2011; 15:86-94. [PMID: 20625925 DOI: 10.1007/s10461-010-9754-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Behavioral surveillance data of 1422 sexually active female injecting drug users (IDU) in Sichuan China were analyzed. The prevalence of syringe-sharing was 43.5%. Respectively, 59.0%, 38.5% and 55.7% had regular, non-regular, and commercial sex-partner (RP, NRP, and CSP); 44.3% had multiple types of sex partners; 23.6 and 36.2% of those with RP had NRP and CSP. The prevalence of unprotected sex (last episode) with RP, NRP and CSP were respectively 75.4%, 50.7% and 39.3%; these three variables were associated with each other and with syringe sharing (univariate OR = 1.58-30.13). About 85% of the participants had attempted quitting drug use; the experience was not associated with condom use. HIV voluntary counseling and testing was associated with lower likelihood of unprotected sex with RP, NRP and CSP (multivariate OR= 0.44-0.60); the coverage was only 40.7%. Potential bridging of HIV transmission from IDU to non-IDU populations is a serious concern.
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Affiliation(s)
- Joseph T F Lau
- Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, 5/F., Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
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Hu Y, Liang S, Zhu J, Qin G, Liu Q, Song B, Wang Q, Wei D, Zhang L, Qian HZ, Ruan Y, Shao Y. Factors Associated with Recent Risky Drug Use and Sexual Behaviors among Drug Users in Southwestern China. ACTA ACUST UNITED AC 2011; 2. [PMID: 22180851 DOI: 10.4172/2155-6113.1000120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A cross-sectional survey was conducted in 2007 among 504 drug users who were recruited mainly from detoxification centers in southwest China. About one-third (34.3%) of participants reported recent risky drug use behavior, which was defined as injecting drugs in the past 3 months, and more than one-fifth (21.6%) reported recent risky sexual behavior, or had multiple sexual partners in the past 30 days. Male sex (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.2-3.2) and more episodes of detoxification (OR, 3.7; 95% CI, 2.3-6.0) were associated with higher odds of risky drug use behavior, while unmarried status (OR, 1.7; 95% CI, 1.0-2.9), higher personal annual income (OR, 1.8; 95% CI, 1.1-2.8) and history of sexually transmitted infections (OR, 3.7; 95% CI, 2.1-6.6) were associated with higher odds of having risky sexual behavior. Subgroup analyses showed 15% participants who used drugs in the past 3 months also shared needles, and 77% participants who had multiple sexual partners in the past 30 days did not use condoms during sex with non-primary sexual partners. The study findings are useful for developing HIV risk reduction intervention programs among drug users.
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Affiliation(s)
- Yifei Hu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, P. R. China
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Lau JTF, Yan H, Lin C, Zhang J, Choi KC, Wang Z, Hao C, Huan X, Yang H. How willing are men who have sex with men in China to be circumcised for the sake of protecting his female sex partner? J Sex Med 2010; 9:1904-12. [PMID: 21091875 DOI: 10.1111/j.1743-6109.2010.02050.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The HIV prevalence among men who have sex with men (MSM) is increasing sharply in China. Many MSM have female sexual partners, representing a bridge of transmitting HIV to the general population. Circumcision reduces the risk of HIV prevention via heterosexual intercourse. AIM The study investigated the prevalence and factors related to willingness to undergo circumcision when MSM were informed that circumcision could reduce risk of heterosexual HIV transmission. METHODS An anonymous cross-sectional survey was conducted in Jiangsu, China. A total of 157 MSM with bisexual behaviors in the last six months were recruited using snowball sampling. MAIN OUTCOME MEASURES Self-reported circumcision status and foreskin conditions were recorded. HIV-related knowledge, risk perceptions, risky sexual behaviors, cognitive and behavioral intention factors regarding circumcision were assessed. RESULTS Among all respondents, 5.7% were circumcised. In the uncircumcised subsample, the willingness to be circumcised increased from 8.1% to 35.1% after they were informed about the 50% risk reduction effect of circumcision regarding heterosexual HIV transmission. Risk behaviors, uncertainty about the prevalence of HIV among MSM, perception of overly long foreskin, peer's suggestion, disagreement with the statements "MSM in general are not willing to be circumcised" and "circumcisions are for children, not for adults" and self-efficacy for circumcision were significantly associated with willingness for circumcision given the hypothetical risk reduction effect (OR = 2.37 and 3.11, respectively, P < 0.05). Perception of overly long foreskin, self-efficacy, and having used a condom in the last episode of sex with a woman remained significantly associated with the conditional willingness for circumcision in the multivariate analysis (OR = 3.03, 2.84 and 2.42, respectively, P < 0.05). CONCLUSIONS Interventions promoting circumcision among bisexual MSM, based on the risk reduction effect on heterosexual HIV transmission, are likely to be successful. Such programs should focus on increasing self-efficacy and may consider utilizing a peer educator approach.
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Affiliation(s)
- Joseph T F Lau
- Centre for Health Behaviours Research, School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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