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Kumar N, Forastiere L, Janmohamed K, Zhang TP, Sha Y, Yu F, Yang L, Tucker JD, Tang W, Alexander M. Blocking and being blocked on gay dating apps among MSM attending a sexual health clinic: an observational study. BMC Public Health 2021; 21:2127. [PMID: 34798857 PMCID: PMC8605500 DOI: 10.1186/s12889-021-12182-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background There are limited studies on blocking and men who have sex with men (MSM) health outcomes. We need such data in China, to better understand the relationship between Chinese MSM gay app use and health outcomes, thus providing insight on risky sexual behaviors and HIV transmission among Chinese MSM - one of the world’s largest MSM communities. Blocking someone is when users select a function on an app to prevent another user from contacting them and being blocked is when someone is prevented from contacting another user. We studied the correlates of blocking on the world’s largest gay dating app among Chinese MSM (N = 208). Methods We conducted a cross-sectional survey as part of an HIV testing intervention in Guangzhou, China, May–December 2019. Using logistic regression models, we estimated the correlates of blocking (e.g. sociodemographic characteristics, sexual behavior, HIV testing history, social network data). Results MSM had a mean age of 27.9 years (SD = 7.1) and median of one sexual partner in the last 3 months. About 62% had blocked someone in their lifetime and 46% had been blocked in their lifetime. Each additional male partner was associated with an 87% (aOR = 1.87, 95%CI = 1.03, 3.40) increased chance of being blocked. Reporting a versatile sexual role was related with a 90% (aOR = 0.10, 95%CI = 0.02, 0.45) decreased likelihood of blocking behavior and an 86% (aOR = 0.14, 95%CI = 0.04, 0.46) reduced chance of being blocked. Conclusions Number of male partners may be associated with blocking behavior, with implications for the design of online sexual health interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12182-w.
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Affiliation(s)
- Navin Kumar
- Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Laura Forastiere
- Yale School of Medicine, Yale University, New Haven, CT, USA.,Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | | | - Tiange P Zhang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095, China.,Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Yongjie Sha
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095, China
| | - Fei Yu
- Blued.com, Beijing, China
| | - Ligang Yang
- Southern Medical University Dermatology Hospital, Guangzhou, China
| | - Joseph D Tucker
- 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, USA.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Weiming Tang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095, China.,Southern Medical University Dermatology Hospital, Guangzhou, China.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Hessou SPH, Glele-Ahanhanzo Y, Adekpedjou R, Ahoussinou C, Djade CD, Biaou A, Johnson CR, Boko M, Alary M. HIV incidence and risk contributing factors among men who have sex with men in Benin: A prospective cohort study. PLoS One 2020; 15:e0233624. [PMID: 32516307 PMCID: PMC7282649 DOI: 10.1371/journal.pone.0233624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 05/08/2020] [Indexed: 12/18/2022] Open
Abstract
Men who have sex with Men (MSM) are a key population in the transmission of Human Immunodeficiency Virus (HIV) infection. In Benin, there is a lack of strategic information to offer appropriate interventions for these populations who live hidden due to their stigmatization and discrimination. The objective is to identify contributing factors that affect HIV incidence in the MSM population. Study of a prospective cohort of 358 HIV-negative MSM, aged 18 years and over, reporting having had at least one oral or anal relationship with another man during the last 12 months, prior to recruitment. The monitoring lasted 30 months with a follow-up visit every six months. Univariate analyses and a Cox proportional hazards multivariate regression were used to examine the association between bio-behavioral, socio-demographic and knowledge-related characteristics with HIV incidence. The retention rate for the follow-up of the 358 participants was 94.5%. On the 813.5 person-years of follow-up, 48 seroconversions with an HIV incidence of 5.91 per 100 person-years were observed (95% CI: 4.46–7.85). Factors associated with the high risk of HIV were age (HR = 0.4; 95% CI: 0.2–0.8), living in couple (HR = 0.5 95% CI: 0.2–0.96) and the lack of condom systematic use with a male partner during high-risk sex (HR = 3.9; 95% CI: 1.4–11.1). HIV incidence is high within MSM population and particularly among young people. Targeted, suitable and cost-effective interventions for the delivery of the combination prevention package in an environment free of stigma and discrimination are necessary and vital for reaching the 90x90x90 target.
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Affiliation(s)
- Septime P. H. Hessou
- National Reference Centre for AIDS Research and Care (CNRRPEC-CNHU/Bénin), Cotonou, Bénin
- Population Health and Best Practices in Health Axis Quebec City University Hospital Research Center Laval University, Hôpital du Saint-Sacrement, Québec, Canada
- Inter-faculty Centre for Training and Research in Environment for Development (CIFRED), Abomey-Calavi University (UAC), Calavi, Bénin
- * E-mail:
| | - Yolaine Glele-Ahanhanzo
- Regional Institute of Public Health (IRSP), University of Abomey-Calavi (UAC), Ouidah, Bénin
| | - Rhéda Adekpedjou
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Université de Montréal, Quebec, Canada
| | - Clement Ahoussinou
- Institute for the Analysis of Communication and Social Groups, Missereté, Bénin
| | - Codjo D. Djade
- Population Health and Best Practices in Health Axis Quebec City University Hospital Research Center Laval University, Hôpital du Saint-Sacrement, Québec, Canada
| | | | - Christian R. Johnson
- Inter-faculty Centre for Training and Research in Environment for Development (CIFRED), Abomey-Calavi University (UAC), Calavi, Bénin
| | - Michel Boko
- Inter-faculty Centre for Training and Research in Environment for Development (CIFRED), Abomey-Calavi University (UAC), Calavi, Bénin
| | - Michel Alary
- Population Health and Best Practices in Health Axis Quebec City University Hospital Research Center Laval University, Hôpital du Saint-Sacrement, Québec, Canada
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Abstract
In recent years, men who have sex with men (MSM) constitute a major group of HIV transmission in China. High primary drug-resistance (PDR) rate in MSM also represents a serious challenge for the Chinese antiretroviral therapy (ART) program. To assess the efficiency of ART in controlling HIV/AIDS infection among MSM, we developed a compartmental model for the annually reported HIV/AIDS MSM from 2007 to 2019 in the Zhejiang Province of China. R0 was 2.3946 (95% CI (2.2961–2.4881)). We predict that 90% of diagnosed HIV/AIDS individuals will have received treatment till 2020, while the proportion of the diagnosed remains as low as 40%. Even when the proportion of the diagnosed reaches 90%, R0 is still larger than the level of AIDS epidemic elimination. ART can effectively control the spread of HIV, even in the presence of drug resistance. The 90-90-90 strategy alone may not eliminate the HIV epidemic in Chinese MSM. Behavioural and biologic interventions are the most effective interventions to control the HIV/AIDS epidemic among MSM.
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Thienkrua W, Todd CS, Chaikummao S, Sukwicha W, Yafant S, Tippanont N, Varangrat A, Khlaimanee P, Sirivongrangson P, Holtz TH. Lubricant Use Among Men Who Have Sex With Men Reporting Anal Intercourse in Bangkok, Thailand: Impact of HIV Status and Implications for Prevention. JOURNAL OF HOMOSEXUALITY 2015; 63:507-21. [PMID: 26322804 DOI: 10.1080/00918369.2015.1088319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This analysis measures prevalence and correlates of consistent lubricant use among a cohort of Thai men who have sex with men (MSM). Lubricant use was queried at the 12-month follow-up visit. Consistent lubricant use was evaluated with logistic regression. Consistent lubricant use was reported by 77.0% of men and was associated with consistent condom use with casual partners, while binge drinking, payment for sex, and inconsistent condom use with casual, and steady, partners were negatively associated. Though consistent lubricant use is common among this Thai MSM cohort, further promotion is needed with MSM engaging in risky sexual practices.
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Affiliation(s)
- Warunee Thienkrua
- a HIV/STD Research Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration , Nonthaburi , Thailand
| | - Catherine S Todd
- a HIV/STD Research Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration , Nonthaburi , Thailand
- b FHI360 Asia-Pacific Regional Office , Bangkok , Thailand
| | - Supaporn Chaikummao
- a HIV/STD Research Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration , Nonthaburi , Thailand
| | - Wichuda Sukwicha
- a HIV/STD Research Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration , Nonthaburi , Thailand
| | - Somsak Yafant
- a HIV/STD Research Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration , Nonthaburi , Thailand
| | - Narongritt Tippanont
- a HIV/STD Research Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration , Nonthaburi , Thailand
| | - Anchalee Varangrat
- a HIV/STD Research Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration , Nonthaburi , Thailand
| | - Pechpailin Khlaimanee
- a HIV/STD Research Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration , Nonthaburi , Thailand
| | | | - Timothy H Holtz
- a HIV/STD Research Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration , Nonthaburi , Thailand
- d Division of HIV/AIDS Prevention , Centers for Disease Control and Prevention , Atlanta , Georgia , USA
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HIV incidence and risk factors in Chinese young men who have sex with men--a prospective cohort study. PLoS One 2014; 9:e97527. [PMID: 24878586 PMCID: PMC4039446 DOI: 10.1371/journal.pone.0097527] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 04/21/2014] [Indexed: 11/19/2022] Open
Abstract
Objectives To assess HIV incidence and its associated risk factors among young men who have sex with men (YMSM) in urban areas, China. Design The study used a prospective cohort study design and standard diagnostic tests. Methods A twelve-month prospective cohort study was conducted among YMSM (18–25 years old) in 8 large cities in China. The participants were recruited via snowball sampling. A total of 1102 HIV-negative YMSM completed baseline assessment, 878 YMSM participants completed 6-month follow-up, and 902 completed 12-month follow-up. HIV was screened by an enzyme-linked immunosorbent assay and confirmed with Western Blot. Syphilis was screened via rapid plasma reagent and confirmed by treponema pallidum particle agglutination assay. Results 78 HIV seroconversions were identified within 1168.4 person-year observations yielding an incidence rate of 6.7 per 100 person-years. HIV seroconversion was associated with non-student status (RR = 2.61, 90% CI = 1.3–5.26), low HIV transmission knowledge (RR = 8.87, 90% CI = 2.16–36.43), and syphilis infection (RR = 5.04, 90% CI = 2.57–9.90). Conclusions Incidence of HIV among YMSM is high in urban areas of China. Interventions measures are required to contain the HIV epidemic within this population.
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Thienkrua W, Todd CS, Chaikummao S, Sukwicha W, Yafant S, Tippanont N, Varangrat A, Khlaimanee P, Holtz TH. Prevalence and correlates of willingness to participate in a rectal microbicide trial among men who have sex with men in Bangkok. AIDS Care 2014; 26:1359-69. [PMID: 24797186 DOI: 10.1080/09540121.2014.913763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Rectal microbicides (RMs) hold promise as a HIV prevention method to reduce transmission among men who have sex with men (MSM). To assess RM trial feasibility in Bangkok, we measured prevalence and correlates of willingness to participate among Thai MSM observational cohort participants. Between April 2006 and December 2010, 1744 MSM enrolled in the Bangkok MSM Cohort Study; at 12 months, RM trial participation willingness was measured. We evaluated correlates of RM trial participation willingness using logistic regression analysis. Participants completing the 12-month visit (81.4%, n = 1419) had a mean age of 27.3 years (SD = 6.1), and 65.5% and 86.1% reported having a steady partner or anal intercourse (AI) in the past four months, respectively. Most (79.1%, n = 1123) participants reported willingness to participate in an RM trial, which, in multivariable analysis, was independently associated with insertive only (adjusted odds ratio [AOR] = 3.25, 95% CI: 1.82-5.81) or receptive/versatile role AI (AOR = 3.07, 95% CI: 1.88-5.01), and being paid for sex (AOR = 12.15, 95% CI: 1.67-88.21) in the past four months, and believing that people with AIDS look sick (AOR = 1.92, 95% CI: 1.23-2.98). Of hypothetical RM trial features to increase enrollment likelihood, the most (91.1%) compelling was that the study be approved by the Thai ethics committee, followed by the study site offering evening hours (88.9%). Reasons not to participate were not wanting a rectal examination (29.5%) or fluid collected from the penis or anus (24.6%) and not wanting the placebo (23.0%). RM trial participation willingness was high, particularly for those with greater HIV acquisition risk, within this Thai MSM cohort, suggesting feasibility of an RM trial. Addressing potential barriers to trial entry may be useful in educational materials to optimize recruitment.
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Affiliation(s)
- Warunee Thienkrua
- a Thailand MOPH - US CDC Collaboration (TUC) , HIV/STD Research Program , Nonthaburi , Thailand
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Xiao Z, Li X, Mehrotra P. HIV/sexual risk reduction interventions in China: a meta-analysis. AIDS Patient Care STDS 2012; 26:597-613. [PMID: 22989271 DOI: 10.1089/apc.2012.0151] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The current study was a meta-analysis of the efficacy of educational, psychosocial or behavioral interventions that were conducted in China to promote HIV/sexual risk reduction. A total of 26 intervention studies qualified for the meta-analysis. Outcome variables for which effect sizes were calculated included condom use with different types of sexual partners, HIV/AIDS knowledge, condom use knowledge, intentions of condom use, condom use self-efficacy, and others. Mean weighted effect sizes were calculated for each outcome measure across reviewed studies; effect size for each outcome measure was weighted by their inverse variance; fixed effects and random effects meta-analytic procedures were used. The Q statistic was used to examine whether the effect sizes were homogeneous in nature and moderating analysis (i.e., the Q(b) statistic) was used to compare the effect sizes of intervention studies that were different in a number of categorical variables. The reviewed interventions were successful in improving HIV knowledge (d=0.706), condom use knowledge (d=0.620), attitudes toward people living with HIV/AIDS (PLWHA; d=0.625) and in increasing condom use with regular partners (d=0.477), condom use with casual partners (d=0.444), general condom use (d=0.408), and condom use self-efficacy (d=0.584) among target audiences. In addition, moderating analyses on three most examined variables, including HIV knowledge, condom use, and attitudes toward PLWHA, demonstrated that interventions that reported the conduction of formative research and process evaluation, that were peer-led, and that included only one follow-up were more likely to report a positive impact on condom use behavior among target audiences (p<0.001), HIV knowledge (p<0.001), or attitudes toward PLWHA (p<0.001).
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Affiliation(s)
- Zhiwen Xiao
- Valenti School of Communication, University of Houston, Houston, Texas
| | - Xiaoming Li
- School of Medicine, Wayne State University, Detroit, Michigan
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Zhang L, Ding X, Lu R, Feng L, Li X, Xiao Y, Ruan Y, Vermund SH, Shao Y, Qian HZ. Predictors of HIV and syphilis among men who have sex with men in a Chinese metropolitan city: comparison of risks among students and non-students. PLoS One 2012; 7:e37211. [PMID: 22623994 PMCID: PMC3356386 DOI: 10.1371/journal.pone.0037211] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 04/17/2012] [Indexed: 12/18/2022] Open
Abstract
Background Men who have sex with men (MSM) are at a substantial risk of HIV, given rising HIV prevalence in urban China. Adolescent and adult students often take HIV-related risk as part of sexual exploration. We compared the risks of HIV and syphilis infections and risky sexual behaviors between student and non-student among urban MSM. Methods Respondent driven sampling approach was used to recruit men who were self-identified as MSM in Chongqing Metropolitan City in southwestern China in 2009. Each participant completed a computer-assisted self-interview which collected demographic and behavioral data, and provided blood specimens for HIV and syphilis testing. Multivariable logistic regression analyses identified predictors for HIV and syphilis infections while comparing student and non-student MSM. Results Among 503 MSM participants, 36.4% were students, of whom 84.2% were in college. The adjusted prevalence of HIV infection was 5.5% (95% confidence interval [CI]: 2.1%–10.2%) in students and 20.9% (95% CI: 13.7%–27.5%) in non-students; the adjusted prevalence of syphilis was 4.4% (95% CI: 0.7%–9.0%) in students and 7.9% (95% CI: 3.6%–12.9%) in non-students (P = 0.12). Two groups had similar risky sexual behaviors such as number of sexual partners and exchanging sex for money. Multivariate analysis showed that students had lower HIV prevalence than non-students (adjusted odds ratio [AOR]: 0.3; 95% CI: 0.1–0.8) adjusting for age, ethnicity and other variables. Conclusion Student MSM have lower HIV and similar syphilis prevalence compared with non-student MSM. However, due to a shorter duration of sexual experience and high prevalence of at-risk sexual behaviors among student MSM, HIV risk might be quite high in students as in non-students.
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Affiliation(s)
- Lan Zhang
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | - Xianbin Ding
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Rongrong Lu
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Liangui Feng
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Xuefeng Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | - Yan Xiao
- China Office of the Joint United Nations Program on HIV/AIDS, Beijing, China
- * E-mail: (HZQ); (YX); (YR)
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control, Beijing, China
- * E-mail: (HZQ); (YX); (YR)
| | - Sten H. Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Yiming Shao
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control, Beijing, China
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- * E-mail: (HZQ); (YX); (YR)
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Fan S, Lu H, Ma X, Sun Y, He X, Li C, Raymond H, McFarland W, Sun J, Ma W, Jia Y, Xiao Y, Shao Y, Ruan Y. Behavioral and serologic survey of men who have sex with men in Beijing, China: implication for HIV intervention. AIDS Patient Care STDS 2012; 26:148-55. [PMID: 22248333 DOI: 10.1089/apc.2011.0277] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We assessed HIV prevalence and associated behaviors and risk factors among men who have sex with men (MSM) in Beijing, China. Five hundred MSM were recruited for a biological and behavioral survey using respondent-driven sampling (RDS) in 2009. Serologic specimens were tested for markers of HIV and syphilis infection. A computer-assisted personal interview (CAPI) administered questionnaire gathered information including demographic characteristics, sexual behaviors, HIV testing, and social norms concerning condom use. The adjusted HIV prevalence was 8.0%, syphilis 22.0%. HIV testing and disclosure was low; only 39.3% had HIV tested in the past 12 months, 49.7% knew their own HIV status and 22.8% knew their last male partner's HIV status. HIV infection was associated with syphilis, ever having sex with a woman, not knowing the HIV status of the most recent male partner, and never buying condoms in the past 12 months. Stronger endorsement of positive social norms around condom use strongly and predicted lower prevalence of HIV infection. Compared to surveys of similar design in the recent past, HIV continues to spread rapidly among Beijing's MSM. Our results identify points of intervention that, if addressed in time, may still alter the course of the epidemic including the promotion of HIV testing and partner disclosure, syphilis control and particularly changing social norms around condom use.
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Affiliation(s)
- Song Fan
- 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, P. R. China
| | - Hongyan Lu
- Beijing Center for Disease Control and Prevention, Beijing, P. R. China
| | - Xiaoyan Ma
- Beijing Center for Disease Control and Prevention, Beijing, P. R. China
| | - Yanming Sun
- Beijing Center for Disease Control and Prevention, Beijing, P. R. China
| | - Xiong He
- Beijing Center for Disease Control and Prevention, Beijing, P. R. China
| | - Chunmei Li
- 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, P. R. China
| | - H.F. Raymond
- San Francisco Department of Public Health, San Francisco, California
| | - Willi McFarland
- San Francisco Department of Public Health, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Jiangping Sun
- 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, P. R. China
| | - Wei Ma
- 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, P. R. China
| | - Yujiang Jia
- Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Yan Xiao
- 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, P. R. China
| | - Yiming Shao
- 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, P. R. China
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, P. R. China
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