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Hu J, Li W, Peng Z, Chen Z, Shi Y, Zheng Y, Liang Q, Wu Y, Liu W, Shen W, Dai Q, Zhu L, Bao C, Zhu F, Chen F. Annual incidence and fatality rates of notifiable infectious diseases in southeast China from 1950 to 2022 and relationship to socioeconomic development. J Glob Health 2023; 13:04107. [PMID: 37681663 PMCID: PMC10486175 DOI: 10.7189/jogh.13.04107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
Background Over the past 70 years, China has advanced significantly in the prevention and treatment of infectious diseases while simultaneously undergoing a socioeconomic transformation, making it a useful source of data for analysing relationships between public health policy and the control of infectious diseases. Methods We collected data on the incidence of notifiable infectious diseases and associated fatalities in Jiangsu province in southeast China from the Provincial Center for Disease Control and Prevention, Provincial Institute of Parasitic Diseases, and the Nationwide Notifiable Infectious Diseases Reporting Information System. We compared data from different historical periods using descriptive statistical methods, joinpoint regression, and correlation analysis. Results During 1950-2022, 75 754 008 cases of 46 notifiable infectious diseases were reported in Jiangsu, with an average annual incidence was 1679.49 per 100 000 population and a fatality rate of 1.82 per 1000 persons. The incidence of classes A-B decreased (average annual percent change (AAPC) = -2.1) during the entire study period, while the incidence of class C increased (AAPC = 10.8) after 2004. The incidence of intestinal diseases (AAPC = -4.4) and vector-borne and zoonotic diseases (AAPC = -8.1) decreased rapidly, while the incidence of sexually transmitted and blood-borne diseases (AAPC = 1.8) increased. The number of medical and health institutions and the per capita gross domestic product correlated negatively with the annual incidence of diseases in classes A-B, but not with fatality rates. Conclusions Although the annual incidence of many severe infectious diseases has decreased in Jiangsu since 1950, the incidence of sexually transmitted and blood-borne diseases increased. Socioeconomic growth and sustainable investment in health systems are associated with better control of infectious diseases.
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Affiliation(s)
- Jianli Hu
- School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Acute Infectious Diseases Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
- National Health Commission Key Laboratory of Enteric Pathogenic Microbiology, Nanjing, China
| | - Wei Li
- General office, Jiangsu Institute of Parasitic Diseases, WuXi, China
| | - Zhihang Peng
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ziying Chen
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yingying Shi
- Department of Acute Infectious Diseases Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yanze Zheng
- Department of Acute infectious Diseases Control and Prevention, Lianyungang Municipal Center for Disease Control and Prevention, Lianyungang, China
| | - Qi Liang
- Department of Acute Infectious Diseases Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Ying Wu
- Department of Acute Infectious Diseases Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Wendong Liu
- Department of Acute Infectious Diseases Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Wenqi Shen
- Department of Acute Infectious Diseases Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Qigang Dai
- Department of Acute Infectious Diseases Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
- Jiangsu Province Engineering Research Center of Health Emergency, Nanjing, China
| | - Liguo Zhu
- Department of Acute Infectious Diseases Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
- Jiangsu Province Engineering Research Center of Health Emergency, Nanjing, China
| | - Changjun Bao
- Department of Acute Infectious Diseases Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
- Jiangsu Province Engineering Research Center of Health Emergency, Nanjing, China
| | - Fengcai Zhu
- School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Acute Infectious Diseases Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
- National Health Commission Key Laboratory of Enteric Pathogenic Microbiology, Nanjing, China
| | - Feng Chen
- School of Public Health, Nanjing Medical University, Nanjing, China
- China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China
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Wu Z, McGoogan JM, Detels R. The Enigma of the Human Immunodeficiency Virus (HIV) Epidemic in China. Clin Infect Dis 2021; 72:876-881. [PMID: 32569373 PMCID: PMC7935386 DOI: 10.1093/cid/ciaa835] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/16/2020] [Indexed: 11/22/2022] Open
Abstract
Nearly 17 years ago China launched its National HIV/AIDS Response Program, yet the epidemic still is not slowing. New cases and new deaths increase every year—in 2005, 40 711 people living with human immunodeficiency virus (HIV; PLWH) were diagnosed and 5729 died, whereas in 2019, 148 598 PLWH were diagnosed and 31 522 died. Moreover, the estimated PLWH population in China has risen to >1.25 million. However, epidemic data are worryingly complex and difficult to interpret, presenting challenges to the redirection and refocusing of efforts toward achievement of control. Here we present three “windows” into China’s epidemic data. From these viewpoints, it appears we still do not know how much infection exists, how much transmission is occurring, and in what contexts transmission happens. The enigma that is China’s HIV epidemic must be better understood. A new research agenda must be developed and executed if we are to change the future of HIV in China.
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Affiliation(s)
- Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,University of California, Los Angeles, California, USA
| | - Jennifer M McGoogan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Roger Detels
- University of California, Los Angeles, California, USA
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Xie T, Wang G, Sun Q. Prevalence and Predictors of Syphilis in Female Sex Workers in Eastern China: Findings from Six Consecutive Cross-Sectional Surveys. J Multidiscip Healthc 2021; 14:853-860. [PMID: 33888989 PMCID: PMC8057824 DOI: 10.2147/jmdh.s305492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/30/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose Female sex workers play an important role in transmitting HIV and syphilis from high-risk groups to the general population. However, epidemic trends and risk factors for syphilis in Chinese female sex workers (FSWs) remain unclear. Methods Using convenient sampling methods, 2482 FSWs were interviewed and tested for syphilis from 2014 to 2019, all of them were divided into two groups of high-grade FSWs and low-grade FSWs according to service solicited and clients price there were. Demographic data were collected and logistic regression analysis was used to identify risk factors for syphilis. Results 43.67% of participants have received free condoms, 76.15% of them engaged in peer education of the 2482 FSWs tested for syphilis, 107 (4.31%) were positive. The prevalence of syphilis in high-grade FSWs was significantly lower than that in low-grade FSWs (3.14% and 5.62%, respectively).The overall prevalence of syphilis increased from 3.19% to4.47%. The percentage of FSWs received free condoms and engaged in peer education increased significantly. With upgraded awareness of syphilis, the number of FSWs having protected sex also increased significantly. It is also found that low-grade female sex workers are at greater risk of syphilis than those high-grade ones (odds ratio (OR) = 1.76, 95% CI 1.18–2.63, p < 0.05). Conclusion Great awareness of syphilis and the increased utilization of condom did not reduce the prevalence of syphilis, especially in low-grade FSWs group. More effective integrated interventions should be developed for such populations.
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Affiliation(s)
- Tiansheng Xie
- Zhejiang Sino-German Institute of Life Science and Healthcare, School of Biological and Chemical Engineering, Zhejiang University of Science and Technology, Hangzhou, Zhejiang, 310023, People's Republic of China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Guohua Wang
- Tongxiang Center for Disease Prevention and Control, Jiaxing, Zhejiang, 314500, People's Republic of China
| | - Qiang Sun
- Tongxiang Center for Disease Prevention and Control, Jiaxing, Zhejiang, 314500, People's Republic of China
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Rashidian M, Minichiello V, Knutsen S, Ghamsary M. Western, Asian, and Middle Eastern Societies’ Cultural Attitudes and Barriers Impacting the Management of Sexual Health Care. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/978-3-030-36222-5_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Wu Z, Wang Y, Detels R, Bulterys M, McGoogan JM. The US CDC Global AIDS Program in China. HIV/AIDS IN CHINA 2020. [PMCID: PMC7121485 DOI: 10.1007/978-981-13-8518-6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The China-US Cooperation-Global AIDS Program (GAP) was a strategic technical collaboration program jointly implemented by the US Centers for Disease Control and Prevention and the Chinese Center for Disease Control and Prevention. This program developed, piloted, launched, and evaluated a broad range of projects supporting national and local HIV prevention and control programs; evidence-based decision-making; strengthening systems and capacity at national, provincial, and local levels; prioritizing high-risk geographic areas and populations; developing innovative approaches for scale-up; answering important scientific questions that can be most effectively answered in China but also with global implications for the HIV response; and increasing China’s engagement with the global public health community and sharing critical lessons learned. A productive working relationship with well-conceived models, a results-based activity implementation plan, and proper linkage to the domestic policy process has made a significant contribution to HIV control and prevention in China.
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Affiliation(s)
- Zunyou Wu
- National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Yu Wang
- Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Roger Detels
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA USA
| | - Marc Bulterys
- U.S. Centers for Disease Control and Prevention, Global AIDS Program, China Office, Beijing, China
| | - Jennifer M. McGoogan
- National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
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Ma Y, Dou Z, Guo W, Mao Y, Zhang F, McGoogan JM, Zhao Y, Zhao D, Wu Y, Liu Z, Wu Z. The Human Immunodeficiency Virus Care Continuum in China: 1985-2015. Clin Infect Dis 2019; 66:833-839. [PMID: 29216405 DOI: 10.1093/cid/cix911] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/05/2017] [Indexed: 11/13/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) care continuum attrition is a major global public health challenge. Few studies have examined this problem in resource-limited settings. We aimed to assess cumulative, current, and historical achievement along China's HIV continuum of care. Methods A nationwide, serial cross-sectional study of all individuals with HIV infection diagnosed in China between 1 January 1985 and 31 December 2015 was conducted using data from China's HIV/AIDS information systems. Biennial estimates of the number of persons living with HIV were also used. We defined 7 steps in HIV care continuum as infected (estimated), diagnosed, linked, retained, enrolled, receiving antiretroviral therapy (ART), and virally suppressed. Cumulative, 30-year performance, and biennial performance during the most recent 10 years were examined. Results A total of 573529 persons diagnosed with HIV infection were included. Cumulatively, 94% were linked, 88% were retained, 73% were enrolled, 67% were receiving ART, and 44% were suppressed. Greatest attrition was observed for adolescents, minorities, and those who reported injecting drug use as their route of infection. Improvement was observed from 2005 to 2015. As of the end of 2015, 68% among those infected were diagnosed, 67% among diagnosed were receiving ART, and 65% among those receiving ART were virally suppressed. After adjusting for those without viral load testing, the proportion suppressed increased to 89%. Conclusions Despite dramatic improvements, China faces serious challenges in achieving the Joint United Nations Programme on HIV/AIDS 90-90-90 targets, because of substantial attrition along its continuum of HIV care.
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Affiliation(s)
- Ye Ma
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Zhihui Dou
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Wei Guo
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Yurong Mao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Fujie Zhang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China.,Beijing Ditan Hospital, Capital Medical University, China
| | - Jennifer M McGoogan
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Yan Zhao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Decai Zhao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Yasong Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Zhongfu Liu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, China.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California
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Weng RX, Hong FC, Yu WY, Cai YM. Compare HIV/syphilis infections between age groups and explore associated factors of HIV/syphilis co-infections among men who have sex with men in Shenzhen, China, from 2009 to 2017. PLoS One 2019; 14:e0223377. [PMID: 31581277 PMCID: PMC6776337 DOI: 10.1371/journal.pone.0223377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/19/2019] [Indexed: 12/16/2022] Open
Abstract
The aim of this study is to assess the HIV/syphilis epidemic among men who have sex with men (MSM) aged <50 years and ≥50 years in Shenzhen, and explore the associated factors of HIV/syphilis co-infections among MSM in Shenzhen, in order to help prevention and intervention programs determine their target sub-group. A serial cross-sectional study was conducted on MSM in Shenzhen city, China from 2009 to 2017. A questionnaire was used to collect demographic characteristics, history of HIV testing, history of blood donation and sexual behaviors. 5 ml of venous blood were collected for syphilis and HIV tests. The overall prevalence of HIV, syphilis, HIV/syphilis co-infection was 9.40%, 18.97%, and 4.91%, respectively. The prevalence of HIV (15.26%), syphilis (27.71%), HIV/syphilis co-infection (9.24%) in aged ≥50 years MSM was significantly higher than aged <50 years MSM (9.15%, 18.59% and 4.72%, respectively). The following factors were found to be significantly associated with HIV/syphilis co-infections (P<0.05): age≥50 years (OR = 1.78, 95% CI = 1.10–2.87), high school or lower (OR = 1.49, 95% CI = 1.10–2.01), monthly income ≤436.2 USD (OR = 1.74, 95% CI = 1.25–2.42), monthly income 436.4–727.2 USD (OR = 1.46, 95% CI = 1.05–2.03), ≥2 anal sex partners in the past 6 months (OR = 1.59, 95% CI = 1.02–2.49), ≥2 oral sex partners in the past 6 months (OR = 1.60, 95% CI = 1.08–2.36), inconsistent condom use during anal sex in the past 6 months (OR = 1.50, 95% CI = 1.11–2.03). We found that aged <50 years and ≥50 years MSM in Shenzhen had a high prevalence of HIV/syphilis infection in a period from 2009 to 2017. Age-specific sexually transmitted diseases education, prevention, and intervention programs for aged ≥50 years MSM should be implemented urgently and integrated interventions of both HIV and syphilis infections on MSM are needed in the future.
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Affiliation(s)
- Rong-Xing Weng
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong Province, China
| | - Fu-Chang Hong
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong Province, China
| | - Wei-Ye Yu
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong Province, China
| | - Yu-Mao Cai
- Department of STD Control and Prevention, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong Province, China
- * E-mail:
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8
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Chen Q, Sun Y, Sun W, Hao M, Li G, Su X, Xin R, Lu H. Trends of HIV incidence and prevalence among men who have sex with men in Beijing, China: Nine consecutive cross-sectional surveys, 2008-2016. PLoS One 2018; 13:e0201953. [PMID: 30092072 PMCID: PMC6084969 DOI: 10.1371/journal.pone.0201953] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 07/13/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sexual transmission of HIV among men who have sex with men (MSM) increased markedly in China during the past decade. HIV incidence is a critical indicator in HIV surveillance and we use a HIV-1 BED-capture-enzyme immunoassay (BED-CEIA) to examine the incidence among MSM in Beijing from 2008 to 2016. Risk factors related to recent HIV infection were also assessed. METHODS Consecutive cross-sectional surveys on MSM were conducted yearly from 2008 through 2016. Demographic and behaviors data were collected. HIV status was determined and HIV positive specimens were tested for recent infection using BED-CEIA. Specimens with ODn values≤0.8 were considered recently infected, HIV incidence rates and prevalence were then calculated. Risk factors associated with recent HIV infection were assessed by univariate and multivariable logistic regression. RESULTS From 2008 to 2016, the numbers of eligible participants in the nine consecutive years ranged from 472 to 616. All the 261 eligible HIV-positive specimens were subjected to recent HIV infection testing. HIV prevalence ranged from 5.0% (3.3%-6.8%) to 10.2% (7.8%-12.7%), and incidence ranged from 1.57% (0.19%-2.95%) to 6.63% (3.65%-9.61%). MSM who never or sometimes used condoms during anal sex with men in the past 6 months (aOR = 1.515, 95%CI: 1.016-2.257, p = 0.041), or having syphilis infection (aOR = 1.561, 95%CI: 0.946-2.575, p = 0.081) were more likely to be recently infected with HIV. Being a Beijing resident (aOR = 0.409, 95%CI: 0.212-0.790, p = 0.008), or having only one male anal sex partner in the past 6 months (aOR = 0.467, 95%CI: 0.220-0.994, p = 0.048) were associated with a lower risk for recent HIV infection. CONCLUSIONS The HIV incidence fluctuated among MSM in Beijing. Unprotected anal sex, having multiple sex partners, being a non-registered Beijing resident and having a syphilis infection play important roles in the recent HIV infection. Effective intervention measures for HIV and syphilis control and prevention should be continuously strengthened.
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Affiliation(s)
- Qiang Chen
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing Center for Preventive Medical Research, Beijing, China
| | - Yanming Sun
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing Center for Preventive Medical Research, Beijing, China
| | - Weidong Sun
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing Center for Preventive Medical Research, Beijing, China
| | - Mingqiang Hao
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing Center for Preventive Medical Research, Beijing, China
| | - Guiying Li
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing Center for Preventive Medical Research, Beijing, China
| | - Xueli Su
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing Center for Preventive Medical Research, Beijing, China
| | - Ruolei Xin
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing Center for Preventive Medical Research, Beijing, China
| | - Hongyan Lu
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing Center for Preventive Medical Research, Beijing, China
- * E-mail:
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Zou H, Meng X, Grulich A, Huang S, Jia T, Zhang X, Luo Z, Ding Y, Yang L, Han J, Chen W, Zheng H, Yang B. A randomised controlled trial to evaluate the impact of sexual health clinic based automated text message reminders on testing of HIV and other sexually transmitted infections in men who have sex with men in China: protocol for the T2T Study. BMJ Open 2017; 7:e015787. [PMID: 28698334 PMCID: PMC5541733 DOI: 10.1136/bmjopen-2016-015787] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 05/16/2017] [Accepted: 05/22/2017] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION The frequency of screening for HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) is still low in China. METHODS AND ANALYSIS A sexual health clinic based randomised controlled trial will be conducted in Guangzhou, Wuxi and Shenzhen, China, enrolling 600 MSM. Eligibility will be judged by the pre-programed iPad based questionnaire: (1) age ≥18 years and (2) have had two or more male anal sex partners, or condomless anal sex with a casual male sex partner, or an STI history, in the past 6 months, and (3) provides a valid mobile phone number. Eligible men will be randomly allocated 1:1 to the intervention arm (with monthly text messages reminding them to test for HIV/STIs) or to the control arm (with no reminders). Men in both arms will complete a questionnaire onsite at enrolment and after 12 months, and another questionnaire online at 6 months. Men in both arms will be tested for HIV, syphilis, anal gonorrhoea/chlamydia and penile gonorrhoea/chlamydia at enrolment and at 12 months. The primary outcome is the rate and frequency of HIV testing within the 12 months after enrolment. The secondary outcome is the rate of unprotected anal intercourse. An assessment of the cost effectiveness of this intervention is also planned. ETHICS AND DISSEMINATION The study has been approved by the ethical review committees of the University of New South Wales, Australia (HC16803), the Guangdong Provincial Centre for Skin Disease and STI Control (GDDHLS-20160926) and the Wuxi Centre for Disease Control and Prevention (WXCDC2016009), China. Study findings will be submitted to academic journals and disseminated to local health authorities. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry at: http://www.chictr.org.cn/showprojen.aspx?proj=15752 and WHO International Clinical Trials Registry Platform at: http://apps.who.int/trialsearch/Trial2.aspx?TrialID=ChiCTR-IOR-16009304.
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Affiliation(s)
- Huachun Zou
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Xiaojun Meng
- Department of Infectious Disease Control, Wuxi Municipal Centre for Disease Control and Prevention, Wuxi, China
| | - Andrew Grulich
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Shujie Huang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Dermatology Hospital, Guangzhou, China
| | - Tianjian Jia
- Department of Infectious Disease Control, Wuxi Municipal Centre for Disease Control and Prevention, Wuxi, China
| | - Xuan Zhang
- Department of Infectious Disease Control, Wuxi Municipal Centre for Disease Control and Prevention, Wuxi, China
| | - Zhenzhou Luo
- Nanshan District Centre for Chronic Disease Control and Prevention, Shenzhen, China
| | - Yi Ding
- Nanshan District Centre for Chronic Disease Control and Prevention, Shenzhen, China
| | - Ligang Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Dermatology Hospital, Guangzhou, China
| | - Jinmei Han
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Dermatology Hospital, Guangzhou, China
| | - Weiying Chen
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Dermatology Hospital, Guangzhou, China
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Dermatology Hospital, Guangzhou, China
| | - Bin Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Dermatology Hospital, Guangzhou, China
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Dejman M, Vameghi M, Roshanfekr P, Dejman F, Rafiey H, Forouzan AS, Assari S, Bass J, Johnson RM. Drug Use among Street Children in Tehran, Iran: A Qualitative Study. Front Public Health 2015; 3:279. [PMID: 26779469 PMCID: PMC4688369 DOI: 10.3389/fpubh.2015.00279] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/10/2015] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Globally, children who work and live on the streets are at higher risk of undesired behavioral health outcomes, including increased drug use and abuse. Considering the rapid growth of this population in Iran and the lack of program planning that is partly due to a scarcity of research-based information, this study was conducted in 2013 to investigate drug use among street children in Tehran. 1METHOD With a qualitative design, we conducted a Rapid Assessment and Response Survey of street children in Tehran, 2012-2013. Data were also obtained from 10 focus group discussions with street children using semi-structured questionnaires and 27 in-depth interviews with key informants in governmental, non-governmental, and international organizations. RESULTS The variation in age at first use, type of drugs, and pattern of drug use were found based on ethnicity. Consuming of Alcohol was reported to be more among an ethnic group. Drug use problems were commonly described among families of street children. Children whose parents had drug-use problems described using drugs earlier than other children. Informants reported that families with drug-related problems used children for procurement of drugs. Children themselves described using drugs to cope with stress, and to reduce physical and psychological stressors and problems, such as fatigue, sadness, and pressure, resulting from frequent failures in life. CONCLUSION These results suggest that intervention and prevention programs dealing with drug use of street children in Iran should include family and peers when addressing drug use by street children.
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Affiliation(s)
- Masoumeh Dejman
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Meroe Vameghi
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Payam Roshanfekr
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fatemeh Dejman
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hassan Rafiey
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ameneh Setareh Forouzan
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Shervin Assari
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Judith Bass
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Renee M. Johnson
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Xiao Z, Li X, Lin D, Tam CC. Mass Media and HIV/AIDS Prevention Among Female Sex Workers in Beijing, China. JOURNAL OF HEALTH COMMUNICATION 2015; 20:1095-1106. [PMID: 25950448 PMCID: PMC6277979 DOI: 10.1080/10810730.2015.1018575] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The current study aimed to identify the sources of HIV prevention information for female sex workers in Beijing and assess the associations between levels of mass media exposure of HIV/AIDS prevention information and HIV/AIDS knowledge as well as condom use-related attitudes, beliefs, and behaviors. Cross-sectional data were collected from 359 female sex workers in Beijing, China. Chi-square tests and one-way ANOVA tests were employed. Female sex workers sampled in Beijing were more likely to obtain HIV/AIDS prevention information from television and street posters than radio and the Internet. However, a higher level of exposure to and a lasting impression on online information were significantly associated with a higher level of condom use self-efficacy and more consistent condom use among the participants. Exposure to HIV/AIDS prevention information delivered by radio, street posters, and the Internet was found to be associated with sexual communication about HIV or condom use with sexual partners. Overall, this study provides preliminary evidence of the utility of various mass media outlets in delivering HIV/AIDS prevention information among female sex workers in China. Future studies are needed to systematically examine the effectiveness of mass media-based prevention education on HIV/AIDS related attitudes and behaviors among female sex workers and other populations in China.
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Affiliation(s)
- Zhiwen Xiao
- a Valenti School of Communication , University of Houston , Houston , Texas , USA
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12
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Liu J, Calzavara L, Mendelsohn JB, O'Leary A, Kang L, Pan Q, Myers T, Ren J, Cha Y, Shi G, Liu X, Tian X, Fan H, Ni Y, Remis RS. Impact evaluation of a community-based intervention to reduce risky sexual behaviour among female sex workers in Shanghai, China. BMC Public Health 2015; 15:147. [PMID: 25880416 PMCID: PMC4377073 DOI: 10.1186/s12889-015-1439-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 01/15/2015] [Indexed: 11/30/2022] Open
Abstract
Background Female sex workers (FSWs) are at risk for sexually transmitted infections (STIs), including HIV. We implemented an HIV/STI preventive intervention among FSWs in Shanghai that aimed to increase condom use, improve HIV knowledge, and reduce STI and HIV incidence. Methods From six districts in Shanghai, 750 randomly selected venue-based FSWs were allocated to either a behavioural intervention or control group. In the intervention and control groups, 221 and 278 participants, respectively, had at least one follow-up at three or six months. In analysis, we randomly selected 57 lost to follow-up cases in the intervention group and imputed baseline values to equalize the arms at n = 278 (74.1% follow-up rate in each group). The impacts of the intervention on condom use, HIV/STI risk perception and knowledge, and STI incidence were assessed using either a logistic or linear model, adjusting for the baseline measure of the outcome and venue type. Results The intervention improved consistent condom use with any partner type in the previous month (AOR = 2.09, 95% CI, 1.43-3.04, p = 0.0001). Consistent condom use with clients in the three most recent sex acts increased in both arms, and with primary partners in the intervention arm, but there was no difference between groups after adjusting for baseline condom use and venue type. There were no differences in cumulative incidence of any STI (i.e., chlamydia, gonorrhoea, syphilis) between groups. HIV transmission knowledge (p = 0.0001), condom use skill (p = 0.0421), and self-efficacy for using condoms (p = 0.0071) were improved by the intervention. HIV-related stigma declined (p = 0.0119) and HIV and STI risk perception were improved (4.6 to 13.9%, and 9.4 to 20.0%, respectively). The intervention was associated with these improvements after adjusting for the baseline measure and venue type. Conclusion Following a preventive intervention among Shanghai FSWs, our findings demonstrate that a simple, community-based educational intervention improved overall condom use, HIV and STI knowledge, and attitudes in relation to HIV/AIDS. The intervention should be implemented widely after tailoring educational materials regarding condom negotiation with different partner types (i.e., commercial sex clients and primary partners). Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1439-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juan Liu
- Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada.
| | - Liviana Calzavara
- Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada.
| | - Joshua B Mendelsohn
- Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada.
| | - Ann O'Leary
- US Centres for Disease Control, Atlanta, GA, USA.
| | - Laiyi Kang
- Shanghai Centre for Disease Control and Prevention, Shanghai, China.
| | - Qichao Pan
- Shanghai Centre for Disease Control and Prevention, Shanghai, China.
| | - Ted Myers
- Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada.
| | - Jinma Ren
- Shanghai Centre for Disease Control and Prevention, Shanghai, China. .,Centre for Outcomes Research, University of Illinois, College of Medicine, Peoria, IL, USA.
| | - Yanfeng Cha
- Songjiang District Centre for Disease Control and Prevention, Shanghai, China.
| | - Guozheng Shi
- Jiading District Centre for Disease Control and Prevention, Shanghai, China.
| | - Xiaofeng Liu
- Baoshan District Centre for Disease Control and Prevention, Shanghai, China.
| | - Xiuhong Tian
- Minhang District Centre for Disease Control and Prevention, Shanghai, China.
| | - Huili Fan
- Luwan District Centre for Disease Control and Prevention, Shanghai, China.
| | - Yinqing Ni
- Changning District Centre for Disease Control and Prevention, Shanghai, China.
| | - Robert S Remis
- Dalla Lana School of Public Health, University of Toronto, Health Science Building, 155 College Street, Room 518, Toronto, ON, M5T 3M7, Canada.
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13
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Zhang L, Li X, Zhou Y, Lin D, Su S, Zhang C, Stanton B. Predictors of consistent condom use among Chinese female sex workers: an application of the protection motivation theory. Health Care Women Int 2014; 36:816-33. [PMID: 25061932 DOI: 10.1080/07399332.2014.942902] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We utilized Protection Motivation Theory to assess predictors of intention and behavior of consistent condom use among Chinese female sex workers (FSWs). A self-administered questionnaire was used in a cross-sectional survey among 700 FSWs in Guangxi, China. Multivariate logistic regression analysis indicated that extrinsic and intrinsic rewards, self-efficacy, and response costs predicted consistent condom use intention and behavior among FSWs. Sexually transmitted infection/ HIV prevention programs need to reduce FSWs' perceptions of positive extrinsic rewards and intrinsic rewards for engaging in consistent condom use, reduce FSWs' perception of response costs for using a condom, and increase condom use self-efficacy among FSWs.
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Affiliation(s)
- Liying Zhang
- a Pediatric Prevention Research Center, Department of Pediatrics, Wayne State University School of Medicine , Detroit , Michigan , USA
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14
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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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15
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Wang L, Tang W, Wang L, Qian S, Li YG, Xing J, Li D, Ding Z, Babu GR, Wang N. The HIV, syphilis, and HCV epidemics among female sex workers in china: results from a serial cross-sectional study between 2008 and 2012. Clin Infect Dis 2014; 59:e1-9. [PMID: 24723287 PMCID: PMC4305149 DOI: 10.1093/cid/ciu245] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies on the transmission of human immunodeficiency virus (HIV) and sexually transmitted diseases in female sex workers (FSWs) have been limited primarily to inferences drawn by focusing on defined geographical areas. METHODS AND FINDINGS This serial cross-sectional study was conducted in mainland China from 2008 through 2012. Data for 827 079 participants was analyzed. We classified venues such as karaoke bars and hotels as high tier and venues such as hair salons and barbershops, massage parlors, and other public outdoor venues as low tier based on the participants' socioeconomic status. FSWs who worked at the venues and those who were present on the days of the survey were recruited. The prevalence of HIV decreased from 0.6% in 2008 to 0.3% in 2012, the syphilis prevalence ranged from 2.4% to 3.2% between 2008 and 2012, and hepatitis C virus (HCV) prevalence decreased from 0.9% in 2008 to 0.8% in 2012. Further, we found that HIV, syphilis, and HCV prevalence proportions were high in FSWs from low tiers. CONCLUSIONS HIV, syphilis, and HCV prevalence among FSWs in our study decreased during the study period. Comprehensive intervention strategies, particularly those that focus on low-tier and older FSWs, are needed in order to decrease the disease burden in this population.
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Affiliation(s)
- Lu Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - Lan Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shasha Qian
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yin-Ge Li
- School of Public Health, Harvard School of Public Health
| | - Jiannan Xing
- 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
| | - Zhengwei Ding
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Giridhara R Babu
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Ning Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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16
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Xu JJ, Smith MK, Chu J, Ding GW, Chang DF, Sharp GB, Qian HZ, Lu L, Bi AM, Wang N. Dynamics of the HIV epidemic in southern China: sexual and drug-using behaviours among female sex workers and male clients in Yunnan. Int J STD AIDS 2013; 23:670-5. [PMID: 23033525 DOI: 10.1258/ijsa.2009.009128] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To examine the HIV/sexually transmitted infection (STI)-related risk behaviours among community-based female sex workers (FSWs) and their clients in Yunnan Province, China, we performed a cross-sectional study of 705 FSWs and 100 male clients. We found that HIV seroprevalence among FSWs was 13.0% and the most prevalent STI was herpes simplex virus type 2 (HSV-2) (71.1%), followed by Chlamydia trachomatis (18.1%) and syphilis (8.8%). The 20% of FSWs who reported injection drug use also reported needle-sharing behaviours in the last three months. Drug-using FSWs had substantially higher HIV and HSV-2 prevalence, serviced more clients and had a longer history of sex work than non-using FSWs. In total, 57.0% of male clients did not consistently use condoms with FSWs, 2.0% reported illicit drug use and 17.0% had STI symptoms in the last year. The dual risk behaviours of drug-using FSWs and clients place them at greater risk of HIV infection. Intervention programmes must adopt comprehensive methods.
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Affiliation(s)
- J J Xu
- Key Laboratory of Immunology, 1st Hospital of China Medical University, Shenyang, Liaoning Province
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17
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Zhang L, Gray RT, Wilson DP. Modelling the epidemiological impact of scaling up HIV testing and antiretroviral treatment in China. Sex Health 2012; 9:261-71. [PMID: 22697144 DOI: 10.1071/sh11104] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 08/02/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND The HIV epidemic in China has been increasing. In response, a 5-year action plan in China has prioritised the scale-up of HIV testing and treatment. METHODS We use a mathematical model to reproduce HIV epidemic trends in China and to forecast epidemic trends according to current conditions or increases in the rate of HIV testing or roll-out of antiretroviral therapy. RESULTS We show that the epidemic in China could be expected to experience a 2.5-fold expansion over the next 5 years such that ~1.8 million people will be infected with HIV in China by 2015. However, increasing testing and treatment rates can have substantial epidemiological benefits. For example, a four-fold increase in testing rates may avert more than 42000 HIV infections and 11000 deaths over the next 5 years. A 10-fold increase in the treatment rate could decrease the number of HIV-related deaths by 58% and the number of new infections by one-quarter by 2015. CONCLUSIONS Increasing HIV testing and treatment are important public health strategies for prevention.
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Affiliation(s)
- Lei Zhang
- The Kirby Institute, University of New South Wales, Darlinghurst, Sydney, NSW 2010, Australia
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18
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Chen XS, Wang QQ, Yin YP, Liang GJ, Jiang N, Yang LG, Liu Q, Zhou YJ, Huan XP, Wei WH, Wang B. Prevalence of syphilis infection in different tiers of female sex workers in China: implications for surveillance and interventions. BMC Infect Dis 2012; 12:84. [PMID: 22475187 PMCID: PMC3352076 DOI: 10.1186/1471-2334-12-84] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 04/04/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Syphilis has made a dramatic resurgence in China during the past two decades and become the third most prevalent notifiable infectious disease in China. Female sex workers (FSWs) have become one of key populations for the epidemic. In order to investigate syphilis infection among different tiers of FSWs, a cross-sectional study was conducted in 8 sites in China. METHODS Serum specimens (n = 7,118) were collected to test for syphilis and questionnaire interviews were conducted to obtain socio-demographic and behavioral information among FSWs recruited from different types of venues. FSWs were categorized into three tiers (high-, middle- and low-tier FSWs) based on the venues where they solicited clients. Serum specimens were screened with enzyme-linked immunosorbent assay (ELISA) for treponemal antibody followed by confirmation with non-treponemal toluidine red unheated serum test (TRUST) for positive ELISA specimens to determine syphilis infection. A logistic regression model was used to determine factors associated with syphilis infection. RESULTS Overall syphilis prevalence was 5.0% (95%CI, 4.5-5.5%). Low-tier FSWs had the highest prevalence (9.7%; 95%CI, 8.3-11.1%), followed by middle-tier (4.3%; 95%CI, 3.6-5.0%, P < 0.001) and high-tier FSWs (2.2%; 95%CI, 1.6-2.9%, P < 0.001). Factors independently associated with syphilis infection included older age, lower education level, geographic location, lower tier of typology, and injection drug use. CONCLUSIONS This multi-site survey showed a high prevalence of syphilis infection among FSWs and substantial disparities in syphilis prevalence by the tier of FSWs. The difference in syphilis prevalence is substantial between different tiers of FSWs, with the highest rate among low-tier FSWs. Thus, current surveillance and intervention activities, which have low coverage in low-tier FSWs in China, should be further examined.
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Affiliation(s)
- Xiang-Sheng Chen
- National Center for STD Control, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, 12 Jiangwangmiao Street, Nanjing 210042, China.
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19
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Zhou F, Gao L, Li S, Li D, Zhang L, Fan W, Yang X, Yu M, Xiao D, Yan L, Zhang Z, Shi W, Luo F, Ruan Y, Jin Q. Willingness to accept HIV pre-exposure prophylaxis among Chinese men who have sex with men. PLoS One 2012; 7:e32329. [PMID: 22479320 PMCID: PMC3316531 DOI: 10.1371/journal.pone.0032329] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 01/25/2012] [Indexed: 11/19/2022] Open
Abstract
Objective We investigated the awareness and acceptability of pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and potential predicting factors. Methods This study was conducted among MSM in Beijing, China. Study participants, randomly selected from an MSM cohort, completed a structured questionnaire, and provided their blood samples to test for HIV infection and syphilis. Univariate logistic regression analyses were performed to evaluate the factors associated with willingness to accept (WTA) PrEP. Factors independently associated with willingness to accept were identified by entering variables into stepwise logistic regression analysis. Results A total of 152 MSM completed the survey; 11.2% had ever heard of PrEP and 67.8% were willing to accept it. Univariate analysis showed that age, years of education, consistent condom use in the past 6 months, heterosexual behavior in the past 6 months, having ever heard of PrEP and the side effects of antiretroviral drugs, and worry about antiretroviral drugs cost were significantly associated with willingness to accept PrEP. In the multivariate logistic regression model, only consistent condom use in the past 6 months (odds ratio [OR]: 0.31; 95% confidence interval [CI]: 0.13–0.70) and having ever heard of the side effects of antiretroviral drugs (OR: 0.30; 95% CI: 0.14–0.67) were independently associated with willingness to accept PrEP. Conclusions The awareness of PrEP in the MSM population was low. Sexual behavioral characteristics and knowledge about ART drugs may have effects on willingness to accept PrEP. Comprehensive prevention strategies should be recommended in the MSM community.
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Affiliation(s)
- Feng Zhou
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lei Gao
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shuming Li
- Beijing Chaoyang Center for Disease Control and Prevention, Beijing, China
| | - Dongliang Li
- Beijing Chaoyang Center for Disease Control and Prevention, Beijing, China
| | - Lifen Zhang
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academic of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Wensheng Fan
- Department of Public Health, College of Health and Human Service, Western Kentucky University, Bowling Green, Kentucky, United States of America
| | - Xueying Yang
- Beijing Chaoyang Center for Disease Control and Prevention, Beijing, China
| | - Mingrun Yu
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dong Xiao
- Chaoyang Chinese AIDS Volunteer Group, Beijing, China
| | - Li Yan
- Beijing Jingcheng Skin Diseases Hospital, Beijing, China
| | - Zheng Zhang
- Beijing Chaoyang Center for Disease Control and Prevention, Beijing, China
| | - Wei Shi
- Beijing Chaoyang Health Bureau, Beijing, China
| | - Fengji Luo
- Beijing Chaoyang Center for Disease Control and Prevention, Beijing, China
- * E-mail: (FL); (YR)
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (FL); (YR)
| | - Qi Jin
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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20
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Lin C, Li L, Wan D, Wu Z, Yan Z. Empathy and avoidance in treating patients living with HIV/AIDS (PLWHA) among service providers in China. AIDS Care 2012; 24:1341-8. [PMID: 22292939 DOI: 10.1080/09540121.2011.648602] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study aims to investigate health care providers' empathy levels and its association with avoidance in providing service to patients living with HIV/AIDS (PLWHA) in China. A total of 1760 health service providers were randomly sampled from 40 county hospitals in two provinces of China. Using a self-administered questionnaire, participants' demographic characteristics, work history, empathy level, and avoidance attitudes toward PLWHA were collected in a cross-sectional survey. Empathy was higher among participants aged 31-40 years, those who had an associated medical degree, and those who had served in the medical profession for less than 20 years. Nurses, younger providers, and providers with lower education tended to avoid contact with PLWHA. Multiple linear regression model showed that a higher level of empathic attitude toward patients was significantly negatively associated with avoidance attitude toward PLWHA. Service providers' empathy level plays an important role in providing quality care to HIV-infected patients. Future stigma reduction interventions should cultivate empathy as a platform for understanding, effective communication, and trusting provider-patient relationships. PLWHA could potentially benefit from attitudinal change in medical settings.
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Affiliation(s)
- Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, USA
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21
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Tucker JD, Yin YP, Wang B, Chen XS, Cohen MS. An expanding syphilis epidemic in China: epidemiology, behavioural risk and control strategies with a focus on low-tier female sex workers and men who have sex with men. Sex Transm Infect 2012; 87 Suppl 2:ii16-8. [PMID: 22110145 PMCID: PMC3306605 DOI: 10.1136/sti.2010.048314] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Joseph D Tucker
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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22
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Chen XS, Peeling RW, Yin YP, Mabey DC. The epidemic of sexually transmitted infections in China: implications for control and future perspectives. BMC Med 2011; 9:111. [PMID: 21975019 PMCID: PMC3203037 DOI: 10.1186/1741-7015-9-111] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 10/06/2011] [Indexed: 11/10/2022] Open
Abstract
China has experienced an increasing epidemic of sexually transmitted infections (STIs), including HIV. High risk groups likely to be infected include female sex workers (FSWs) and their clients, men who have sex with men (MSM), drug users and migrant workers. Prevention can be achieved through education of the population, condom promotion, early detection of symptomatic and asymptomatic people, and effective diagnosis and treatment of these patients and their partners. This article aims to describe the profile of the epidemic in high-risk groups in China as well as to detail the contributing factors and the implications for control. Programmes for the control of STIs should be immediate priorities in China, and primary and secondary prevention strategies are vital to this process.
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Affiliation(s)
- Xiang-Sheng Chen
- National Center for STD Control, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, Nanjing, China.
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Zhong F, Lin P, Xu H, Wang Y, Wang M, He Q, Fan L, Li Y, Wen F, Liang Y, Raymond HF, Zhao J. Possible increase in HIV and syphilis prevalence among men who have sex with men in Guangzhou, China: results from a respondent-driven sampling survey. AIDS Behav 2011; 15:1058-66. [PMID: 19826942 DOI: 10.1007/s10461-009-9619-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A respondent-driven sampling survey was conducted to investigate HIV related serological and behavioral characteristics of men who have sex with men (MSM) in Guangzhou, China, and to identify associated factors potentially driving the epidemic. Respondent-Driven Sampling Analysis Tool and SPSS were used to generate adjusted estimates and to explore associated factors. Three hundred seventy-nine eligible participants were recruited. The adjusted prevalence of HIV and current syphilis infection are 5.2% and 17.5% respectively. 60.3% have unprotected anal sex in the past 6 months. Unprotected anal sex, having receptive anal sex and current syphilis infection are significant factors associated with HIV infection. The potential for a rapid rise of HIV and syphilis infections among MSM in Guangzhou exists. Targeted interventions with voluntary counseling and testing (VCT) and sexually transmitted infection (STI) services are needed to address the epidemic, with a focus on such subgroups as those of with current syphilis, and non-official Guangzhou residence status.
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Affiliation(s)
- Fei Zhong
- Guangzhou Municipal Center for Disease Control and Prevention, 510080, Guangzhou, China
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24
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Zhang L, Yap L, Xun Z, Wu Z, Wilson DP. Needle and syringe programs in Yunnan, China yield health and financial return. BMC Public Health 2011; 11:250. [PMID: 21507267 PMCID: PMC3102626 DOI: 10.1186/1471-2458-11-250] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 04/21/2011] [Indexed: 11/10/2022] Open
Abstract
Background As a harm reduction strategy in response to HIV epidemics needle and syringes programs (NSPs) were initiated throughout China in 2002. The effectiveness of NSPs in reducing the spread of infection in such an established epidemic is unknown. In this study we use data from Yunnan province, the province most affected by HIV in China, to (1) estimate the population benefits in terms of infections prevented due to the programs; (2) calculate the cost-effectiveness of NSPs. Methods We developed a mathematical transmission model, informed by detailed behavioral and program data, which accurately reflected the unique HIV epidemiology among Yunnan injecting drug users (IDUs) in the presence of NSPs. We then used the model to estimate the likely epidemiological and clinical outcomes without NSPs and conducted a health economics analysis to determine the cost-effectiveness of the program. Results It is estimated that NSPs in Yunnan have averted approximately 16-20% (5,200-7,500 infections) of the expected HIV cases since 2002 and led to gains of 1,300-1,900 DALYs. The total $1.04 million spending on NSPs from 2002 to 2008 has resulted in an estimated cost-saving over this period of $1.38-$1.97 million due to the prevention of HIV and the associated costs of care and management. Conclusion NSPs are not only cost-effective but cost-saving in Yunnan. Significant scale-up of NSPs interventions across China and removal of the societal and political barriers that compromise the effects of NSPs should be a health priority of the Chinese government.
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Affiliation(s)
- Lei Zhang
- National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, Australia.
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Wang N, Wang L, Wu Z, Guo W, Sun X, Poundstone K, Wang Y. Estimating the number of people living with HIV/AIDS in China: 2003-09. Int J Epidemiol 2011; 39 Suppl 2:ii21-8. [PMID: 21113033 PMCID: PMC2992614 DOI: 10.1093/ije/dyq209] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Before 2003, little was known about the scale of China’s HIV/AIDS epidemic. In 2003, the Chinese government produced national estimates with support from the Joint United Nations Programme on HIV/AIDS, the World Health Organization and the United States Centers for Disease Control and Prevention. Subsequent national estimation exercises were carried out in 2005, 2007 and 2009. We describe these estimation processes and present the results of China’s HIV/AIDS estimation exercises from 2003 to 2009. Methods The Workbook Method was used to generate national HIV/AIDS estimates. Data from the provincial level were used in 2003, data from the prefecture level were used in 2005 and data from the county level were used in 2007 and 2009. Data at the lowest level of aggregation were used to estimate risk group population size and HIV prevalence. Data from lower levels were combined into national estimates. Results At the end of 2003, 2005, 2007 and 2009, there were an estimated 0.84, 0.65, 0.70 and 0.74 million people living with HIV/AIDS in China, respectively, with an overall HIV prevalence of 0.05–0.06%. The number of new HIV infections decreased from 70 000 in 2005, to 50 000 in 2007, to 48 000 in 2009. Data quality improvements have increased the precision of China’s HIV estimates. Conclusion Repeated estimates have improved understanding of the HIV/AIDS epidemic in China. HIV estimates are a valuable tool for guiding national AIDS policies evaluating HIV prevention and control programmes.
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Affiliation(s)
- Ning Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China, Division of AIDS/STD, Bureau of Disease Control and Prevention, Ministry of Health, Beijing, China and Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lu Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China, Division of AIDS/STD, Bureau of Disease Control and Prevention, Ministry of Health, Beijing, China and Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China, Division of AIDS/STD, Bureau of Disease Control and Prevention, Ministry of Health, Beijing, China and 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, Division of AIDS/STD, Bureau of Disease Control and Prevention, Ministry of Health, Beijing, China and Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xinhua Sun
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China, Division of AIDS/STD, Bureau of Disease Control and Prevention, Ministry of Health, Beijing, China and Chinese Center for Disease Control and Prevention, Beijing, China
| | - Katharine Poundstone
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China, Division of AIDS/STD, Bureau of Disease Control and Prevention, Ministry of Health, Beijing, China and Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yu Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China, Division of AIDS/STD, Bureau of Disease Control and Prevention, Ministry of Health, Beijing, China and Chinese Center for Disease Control and Prevention, Beijing, China
- *Corresponding author. Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, China. E-mail:
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Brown T, Bao L, Raftery AE, Salomon JA, Baggaley RF, Stover J, Gerland P. Modelling HIV epidemics in the antiretroviral era: the UNAIDS Estimation and Projection package 2009. Sex Transm Infect 2010; 86 Suppl 2:ii3-10. [PMID: 20929855 PMCID: PMC3173807 DOI: 10.1136/sti.2010.044784] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The UNAIDS Estimation and Projection Package (EPP) is a tool for country-level estimation and short-term projection of HIV/AIDS epidemics based on fitting observed HIV surveillance data on prevalence. This paper describes the adaptations made in EPP 2009, the latest version of this tool, as new issues have arisen in the global response, in particular the global expansion of antiretroviral therapy (ART). Results By December 2008 over 4 million people globally were receiving ART, substantially improving their survival. EPP 2009 required modifications to correctly adjust for the effects of ART on incidence and the resulting increases in HIV prevalence in populations with high ART coverage. Because changing incidence is a better indicator of program impact, the 2009 series of UNAIDS tools also focuses on calculating incidence alongside prevalence. Other changes made in EPP 2009 include: an improved procedure, incremental mixture importance sampling, for efficiently generating more accurate uncertainty estimates; provisions to vary the urban/rural population ratios in generalised epidemics over time; introduction of a modified epidemic model that accommodates behaviour change in low incidence settings; and improved procedures for calibrating models. This paper describes these changes in detail, and discusses anticipated future changes in the next version of EPP.
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Affiliation(s)
- Tim Brown
- Population and Health Studies, East-West Center, 1601 East-West Road, Honolulu, HI 96848, USA.
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Cao H, He N, Jiang Q, Yang M, Liu Z, Gao M, Ding P, Chen L, Detels R. Stigma against HIV-infected persons among migrant women living in Shanghai, China. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2010; 22:445-454. [PMID: 20973664 PMCID: PMC3022510 DOI: 10.1521/aeap.2010.22.5.445] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We examined the characteristics of 601 female migrants in Shanghai regarding stigmatizing attitudes toward people living with HIV/AIDS (PLWHA). A community-based cross-sectional study was conducted July and August 2008, using an anonymous questionnaire. Most participants (88%) were married, 9.2% reported multiple sexual partners, 19.1% knew about voluntary counseling and testing clinics, and 3.7% had been tested for HIV. About half (56.4%) agreed that people who acquire HIV/AIDS through sex or drug use deserve it. About 80% admitted that they were afraid of PLWHA. Low knowledge of HIV/AIDS, being older, low levels of education, and longer duration in Shanghai were correlates for having stigmatizing attitudes, while having premarital sex and/or multiple sex partners correlated with less stigma. HIV-related stigma among female migrants in Shanghai is common. Future stigma reduction prevention and intervention programs among female migrants should target those who are older, less educated, and have lived in Shanghai relatively longer.
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Affiliation(s)
- Haijun Cao
- Department of Epidemiology, University of California, Los Angeles, 90095–1772, USA
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HIV-1 and STIs prevalence and risk factors of miners in mining districts of Yunnan, China. J Acquir Immune Defic Syndr 2010; 53 Suppl 1:S54-60. [PMID: 20104111 DOI: 10.1097/qai.0b013e3181c7d8d2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess HIV/sexually transmitted infection (STI) prevalence and associated risk factors among miners in Yunnan, China. METHODS A cross-sectional study was conducted among 1798 miners in 2 townships of Gejiu City, Yunnan, from March to May 2006. Standardized interviewer-administered questionnaires were completed and specimens collected for HIV/STI testing. RESULTS The prevalence of HIV, Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, herpes simplex virus-2, and any STIs among all miners was 0.7%, 4.8%, 0.8%, 1.8%, 9.6%, and 14.9%, respectively. One fifth of miners reported patronizing female sex workers (FSWs) at least once, and of these, 72% never used a condom with a FSW. Miners who visited FSWs had a higher prevalence of HIV (1.8% vs. 0.5%) and any STI (23.2% vs. 4.3%), including C. trachomatis (6.9% vs. 4.3%), N. gonorrhoeae (2.1% vs. 0.5%), and herpes simplex virus-2 (14.9% vs. 8.4%), and higher rates of illegal drug use compared with miners who visited no FSWs. CONCLUSIONS High prevalence of HIV/STIs among miners in Gejiu warrants special attention to this population, and vigorous interventions should address both sexual and drug use-related risk.
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Liu H, Feng T, Liu H, Feng H, Cai Y, Rhodes AG, Grusky O. Egocentric networks of Chinese men who have sex with men: network components, condom use norms, and safer sex. AIDS Patient Care STDS 2009; 23:885-93. [PMID: 19803695 DOI: 10.1089/apc.2009.0043] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Research on risk behaviors among men who have sex with men (MSM) is often based on individualistic models of health behavior, but sexual behavior is inherently social in nature and often determined by constituents of social networks. The objective of this study was to examine relationships among social networks, network norms of condom use, and safer sex. A respondent-driven sampling study recruited 350 MSM in the Shenzhen region of China between November and December 2007 and collected information on network components (relations, structures, and functions) and HIV risk behavior among egos (those interviewed) and their network alters. A total of 2385 alters were nominated by the 350 egos. Egos reported an average of 4 nonsexual relation alters and 2 sexual-partner alters. Egos perceived receiving more tangible and emotional support from nonsexual relation alters than from sexual-partner alters. Two thirds (69%) of egos consistently used condoms. Sixty-seven percent of egos reported having 1 or more alters who always encouraged egos to use condoms, 84% had 1 or more alters who consistently used condoms, and 55% had 1 or more alters who insisted on condom use. Both subjective and descriptive norms were positively associated with consistent condom use. Network components were associated with the levels of the two norms. These findings suggest that social network components may activate or strengthen condom use norms within networks, which, in turn, determine consistent condom use among MSM. HIV behavioral interventions need to target the promotion of safer sex practices through enhancing peer norms of condom use within networks.
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Affiliation(s)
- Hongjie Liu
- Department of Epidemiology and Community Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Tiejian Feng
- Shenzhen Center for Chronic Disease Control and Prevention, Shenzhen, China
| | - Hui Liu
- China Center for HIV/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, China
| | - Hucang Feng
- Shenzhen Center for Chronic Disease Control and Prevention, Shenzhen, China
| | - Yumao Cai
- Shenzhen Center for Chronic Disease Control and Prevention, Shenzhen, China
| | - Anne G. Rhodes
- Department of Epidemiology and Community Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Oscar Grusky
- Department of Sociology, University of California, Los Angeles, California
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Ruan Y, Luo F, Jia Y, Li X, Li Q, Liang H, Zhang X, Li D, Shi W, Freeman JM, Vermund SH, Shao Y. Risk factors for syphilis and prevalence of HIV, hepatitis B and C among men who have sex with men in Beijing, China: implications for HIV prevention. AIDS Behav 2009; 13:663-70. [PMID: 19082879 DOI: 10.1007/s10461-008-9503-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 11/28/2008] [Indexed: 01/02/2023]
Abstract
To examine the correlates for syphilis and the prevalence for HIV, hepatitis B, hepatitis C among men-who-have-sex-with-men (MSM) in Beijing, China. A total of 541 MSM was recruited using peer-referral, community outreach, and Internet. Questionnaire-based interviews provided information including, demographics, sexual and other risk behaviors. HIV prevalence was 4.8%, syphilis 19.8%, HCV 0.4% and HBsAg 6.5%. The median number of lifetime male sex partners was ten. In the past 3 months, 20.7% drank alcohol > or =1 times per week. In the past month, 21.3 and 14.6% had unprotected anal intercourse with regular and casual male sex partners, respectively. Syphilis infection was associated with less education, alcohol use, finding male sex partners through bathhouses/public washrooms/parks, and diagnoses of sexual transmitted diseases (STDs). Syphilis is now epidemic among Beijing's MSM. Prevention efforts are urgent as HIV prevalence is already near 5%. Education, condom promotion, STD control, and alcohol-related intervention are needed urgently.
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Affiliation(s)
- Yuhua Ruan
- Epidemiology and Biostatistics Branch, Division of Virology and Immunology, State Key Laboratory for Infectious Disease Prevention and Control, NCAIDS, Chinese CDC, Beijing 100050, People's Republic of China.
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Yin L, Qin G, Ruan Y, Qian HZ, Hao C, Xie L, Chen K, Zhang Y, Xia Y, Wu J, Lai S, Shao Y. Nonfatal Overdose Among Heroin Users in Southwestern China. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 33:505-16. [PMID: 17668336 DOI: 10.1080/00952990701407223] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the prevalence of and risk factors for nonfatal overdose among heroin users in southwestern China. METHODS In 2005, 731 heroin users in Sichuan Province, China were interviewed for overdose experiences in the past 12 months. Factors hypothesized to be associated with overdose were evaluated with logistic regression models. RESULTS Eighty-eight (12%) drug users experienced at least one overdose, with a range from 1 to 20; 45 (51%) experienced 2 or more overdoses. Over half of participants with experience of overdose were recently released from prison (52%), and 56% used benzodiazepines before overdose. Longer methadone treatment in the past year (>or=180 vs. 0 days; OR, .3; 95% CI, .1-.8; P = .02), longer duration of using drugs (>or=7 vs. <7 years; OR, 2.2; 95% CI, 1.3-3.6; P = .002), and more frequency of injecting drugs in the past 3 months (>or=7 vs. <7 times/week; OR, 5.4; 95% CI, 3.2-9.0; P < .001) were independently associated with increased risk of nonfatal heroin overdose. CONCLUSIONS Nonfatal heroin overdoses are common among Chinese heroin users. Drug users should be encouraged to participate and remain in methadone treatment to prevent overdose and be educated about proper response to overdose to reduce risk of overdose death.
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Affiliation(s)
- Lu Yin
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, and State Key Laboratory for Infectious Disease Prevention and Control, Beijing, China
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Tao XH, Wang QQ, Zheng AM, Shi DQ, Ma L. Is the service of HIV counselling and testing satisfied in Hangzhou, China? Int J STD AIDS 2009; 20:367-8. [PMID: 19386981 DOI: 10.1258/ijsa.2009.009064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Wang D, Operario D, Hong Q, Zhang H, Coates TJ. Intervention to train physicians in rural China on HIV/STI knowledge and risk reduction counseling: preliminary findings. AIDS Care 2009; 21:468-72. [PMID: 19266406 DOI: 10.1080/09540120802290357] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We evaluated an intervention to train physicians in rural China on knowledge of HIV/STI prevention, diagnosis, treatment options, and HIV/STI behavioral risk reduction counseling. This paper reports preliminary findings related to feasibility and acceptability of the program. Using a pre-post design, 69 physicians were recruited from rural county hospitals and participated in a 10-day group training program, followed by two months of clinical fieldwork and two additional weeks of training. Physicians completed baseline and six-month assessments. Patients' cohorts, recruited from clinic waiting areas of participating physicians, completed baseline and six-month HIV/STI risk assessments. Physicians reported increased knowledge of HIV biology and pathology, epidemiology, host immune response, opportunisitic infection and syndromic management, antiretroviral therapy, risk reduction counseling, and stigma reduction following the training. Patients reported improved knowledge of HIV, reduced HIV stigma, higher rates of HIV testing, and improved condom use at follow-up. The findings suggest that training physicians on HIV/STI-related knowledge and risk reduction counseling is a promising strategy for reducing HIV/STI epidemics in rural China.
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Affiliation(s)
- Debin Wang
- Anhui Medical University, Hefei, People's Republic of China
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The 2007 Estimates for People at Risk for and Living With HIV in China: Progress and Challenges. J Acquir Immune Defic Syndr 2009; 50:414-8. [PMID: 19214116 DOI: 10.1097/qai.0b013e3181958530] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To present the methods used for the 2007 estimates for the number of people at risk for and infected with HIV. DESIGN : Estimation work took place throughout 2007, led by the National Center for AIDS and Sexually Transmitted Disease Control and Prevention in collaboration with United Nations AIDS and the World Health Organization. METHODS The workbook method was used to process prefecture and county-level surveillance data to generate HIV prevalence by risk group for each prefecture, which was in turn imported into the spectrum model to generate estimates of new infections and HIV-related deaths. RESULTS The working group estimated that as of 2007, there were 700,000 people living with HIV/AIDS in China, with 50,000 new infections and 20,000 HIV-related deaths in that year. Injection drug use and sexual contact are still primary modes of HIV transmission, with heterosexual contact quickly becoming the dominant route, making up 44.7% of new infections in 2007. The HIV/AIDS epidemic is still highly concentrated in certain areas, with wide variation in prevalence across regions. CONCLUSIONS The 2007 estimates are based on the most accurate and local-level data available to date, including case reports, sentinel surveillance data, results from mass screening of key target groups, and special epidemiological studies.
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Lu F, Jia Y, Sun X, Wang L, Liu W, Xiao Y, Zeng G, Li C, Liu J, Cassell H, Chen HT, Vermund SH. Prevalence of HIV infection and predictors for syphilis infection among female sex workers in southern China. THE SOUTHEAST ASIAN JOURNAL OF TROPICAL MEDICINE AND PUBLIC HEALTH 2009; 40:263-72. [PMID: 19323011 PMCID: PMC2745968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The purpose of this study was to assess the prevalence and risk factors for syphilis infection among female sex workers (FSWs) in Liuzhou City, Guangxi Zhuang Autonomous Region, southern China. A cross-sectional study recruited FSWs using a venue-based method and subsequent snowball sampling with mapping strategies. Questionnaire-based interviews were conducted to collect demographic and behavioral information. Blood was tested for syphilis (RPR with TPPA confirmation) and HIV (EIA with Western blot confirmation) infections. Of the 362 eligible participants, 81.7% were non-local residents (60.5% from other parts of Guangxi and 21.2% were non-Guangxi residents); 58.0% belonged to non-Han minority ethnic groups; 37.5% reported inconsistent condom use with their clients and 71.2% reported inconsistent condom use with their regular sex partners during the past month. Nearly 10% reported having had sex with drug users. The prevalence rates for HIV and syphilis infections were 2.3% and 11.0%, respectively. Almost half (46.6%) of participants reported having had STD symptoms. Inconsistent condom use with clients in the past month (AOR = 5.0; 95% CI = 1.8-13.8), less education (OR = 2.6; 95% CI = 1.1-7.4), and HIV infection (AOR = 8.1; 95% CI = 1.1-68.5) were independently associated with syphilis infection.
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Affiliation(s)
- Fan Lu
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing, PR China.
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Hong FC, Feng TJ, Cai YM, Wen LZ, Pan P, Lan LN, Lai YH, Zhou H, Liu XL, Lin SP, Chen G, Chen XS. Burden of syphilis infections in Shenzhen, China: a preliminary estimation. Int J STD AIDS 2009; 20:115-8. [DOI: 10.1258/ijsa.2008.008252] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Information on the prevalence and incidence of sexually transmitted infections is important for developing prevention and control strategies and allocating human and financial resources. However, there are no available estimates of such information for many areas in China. In this study, we used the existing data to make a preliminary estimation of syphilis infections in Shenzhen city, in south-eastern China. Data on prevalence rates of syphilis infections among different populations were obtained from the local HIV/sexually transmitted disease second-generation surveillance programme, and the sizes of different populations were estimated based on the most recently available figures. It was estimated that 83,760 (range 77,490–90,020) people are currently infected with syphilis, giving a prevalence of 0.71–0.82% (0.76% on average) in Shenzhen. Around 18% of these syphilis infections occur among men who have sex with men and another 15.8% and 8.7% occur among female sex workers and their clients, respectively. These estimates suggest that a combination of unprotected paid sex and sex between men may be sustaining the epidemic of syphilis in the study area. The preliminary estimates will assist the government in planning and improving its comprehensive intervention programmes for the future control and prevention of syphilis.
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Affiliation(s)
- F-C Hong
- Shenzhen Institute of Dermatology, Shenzhen Center for Chronic Disease Control, Shenzhen
| | - T-J Feng
- Shenzhen Institute of Dermatology, Shenzhen Center for Chronic Disease Control, Shenzhen
| | - Y-M Cai
- Shenzhen Institute of Dermatology, Shenzhen Center for Chronic Disease Control, Shenzhen
| | - L-Z Wen
- Shenzhen Institute of Dermatology, Shenzhen Center for Chronic Disease Control, Shenzhen
| | - P Pan
- Shenzhen Institute of Dermatology, Shenzhen Center for Chronic Disease Control, Shenzhen
| | - L-N Lan
- Shenzhen Institute of Dermatology, Shenzhen Center for Chronic Disease Control, Shenzhen
| | - Y-H Lai
- Shenzhen Institute of Dermatology, Shenzhen Center for Chronic Disease Control, Shenzhen
| | - H Zhou
- Baoan District Hospital of Maternal and Child Health, Shenzhen
| | - X-L Liu
- Shenzhen Institute of Dermatology, Shenzhen Center for Chronic Disease Control, Shenzhen
| | - S-P Lin
- Shenzhen Institute of Dermatology, Shenzhen Center for Chronic Disease Control, Shenzhen
| | - G Chen
- Shenzhen Institute of Dermatology, Shenzhen Center for Chronic Disease Control, Shenzhen
| | - X-S Chen
- National Center for STD Control, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Institute of Dermatology, Nanjing, Peoples Republic of China
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Li L, Lin C, Ji G, Sun S, Rotheram-Borus MJ, Ji G. Parents Living with HIV in China: Family Functioning and Quality of Life. JOURNAL OF CHILD AND FAMILY STUDIES 2009; 18:93-101. [PMID: 19890449 PMCID: PMC2772148 DOI: 10.1007/s10826-008-9210-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In China, HIV shifts the lifestyle of not only parents living with HIV/AIDS, but also their children, partners, and extended families. We examined factors related to the quality of life of parents living with HIV and the relation between family functioning and individual quality of life. Interviews were conducted with a total of 116 parents living with HIV/AIDS. Analyses of variance, Pearson correlations, and multiple regression analyses were performed to examine the relation between family functioning and quality of life. We found a significant association between family functioning and individual quality of life for parents living with HIV. In particular, family sociability had a strong relationship with the quality of life of parents living with HIV. Parents living with HIV from families where both parents are HIV-positive reported a lower level of family sociability than those from families with only one HIV-positive parent. HIV disclosure, family sociability, and number of children per family were found to be significant predictors of overall quality of life for the population. Study findings underscore the importance of developing interventions that improve family functioning for people living with HIV/AIDS in China.
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Affiliation(s)
- Li Li
- UCLA Semel Institute for Neuroscience & Human Behavior Center for Community Health, University of California, Los Angeles, CA 90024, USA
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Sun S, Li L, Ji G, Lin C, Semaan A. Child behaviour and parenting in HIV/AIDS-affected families in China. VULNERABLE CHILDREN AND YOUTH STUDIES 2008; 3:192-202. [PMID: 19960110 PMCID: PMC2786209 DOI: 10.1080/17450120802241997] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) among families in China poses many challenges for caregivers and their children. A total of 154 caregivers of HIV/AIDS-affected children were interviewed to examine child behaviour in HIV/AIDS-affected families. Parenting skills were found to be correlated with child delinquency, and this correlation was influenced by the number of children in the family and the child's age. Illiterate caregivers were more likely to have delinquent children, and parenting skills had less of an association with child delinquency among illiterate caregivers. Study findings underscore the necessity of emphasizing good parenting skills in interventions with caregivers of HIV/AIDS-affected children in China in order to improve child behaviour and overall family well-being.
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Affiliation(s)
- Stephanie Sun
- Center for Community Health, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Li Li
- Center for Community Health, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Corresponding author.
| | - Guoping Ji
- Anhui Center for Disease Control and Prevention, Hefei, China
| | - Chunqing Lin
- Center for Community Health, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Alan Semaan
- Center for Community Health, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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Jia Y, Sun J, Fan L, Song D, Tian S, Yang Y, Jia M, Lu L, Sun X, Zhang S, Kulczycki A, Vermund SH. Estimates of HIV prevalence in a highly endemic area of China: Dehong Prefecture, Yunnan Province. Int J Epidemiol 2008; 37:1287-96. [PMID: 18922804 DOI: 10.1093/ije/dyn196] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dehong Prefecture in Yunnan Province, China, borders Myanmar. Its proximity to the 'Golden Triangle', one of the world's largest illicit drug production and distribution centre, contributes to drug trafficking and ready availability of heroin. Dehong's 1.1 million people confront a serious HIV problem fuelled by injection drug use. The aim of this study is to improve the 2005 estimates of the true status of the HIV/AIDS epidemic in Dehong Prefecture. METHODS We estimated the HIV prevalence by synthesizing the results from several data sources (HIV/AIDS case reports, surveys, surveillance activities and epidemiological studies). We applied three different statistical procedures for estimations: (i) The Workbook method, adapted to meet the estimation needs in Dehong Prefecture; (ii) An estimate based on antenatal clinical data; and (iii) a dynamic model based on the local epidemic pattern. RESULTS We estimated that the population prevalence for HIV infections in Dehong Prefecture is 1.3% (likely range from low/high of three estimates: 0.9-1.7%) such that 13 500 people were living with HIV/AIDS in Dehong Prefecture (likely range: 8,200-18,300) in 2005. Infections remain concentrated among injection drug users, female sex workers and their clients with an uneven geographical distribution of estimated cases. CONCLUSION More reliable estimates of HIV prevalence can be made by synthesizing multiple data sources using several procedures. Current HIV prevention, care and treatment challenges are judged substantial in Dehong Prefecture, regardless of what modelling strategy is used.
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Affiliation(s)
- Yujiang Jia
- Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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Jia Y, Lu F, Zeng G, Sun X, Xiao Y, Lu L, Liu W, Ni M, Qu S, Li C, Liu J, Wu P, Vermund SH. Predictors of HIV infection and prevalence for syphilis infection among injection drug users in China: community-based surveys along major drug trafficking routes. Harm Reduct J 2008; 5:29. [PMID: 18724872 PMCID: PMC2556669 DOI: 10.1186/1477-7517-5-29] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 08/25/2008] [Indexed: 11/15/2022] Open
Abstract
Objective To assess the predictors and prevalence of HIV infection among injection drug users in highly endemic regions along major drug trafficking routes in three Chinese provinces. Methods We enrolled participants using community outreach and peer referrals. uestionnaire-based interviews provided demographic, drug use, and sexual behavior information. HIV was tested via ELISA and syphilis by RPR. Results Of the 689 participants, 51.8% were HIV-infected, with persons living in Guangxi having significantly lower prevalence (16.4%) than those from Xinjiang and Yunnan (66.8% and 67.1%, respectively). Syphilis seropositivity was noted in 5.4%. Longer duration of IDU, greater awareness of HIV transmission routes, and living in Xinjiang or Yunnan were associated with HIV seropositivity on multivariable analysis. Independent risk factors differed between sites. In Guangxi, being male and having a longer duration of IDU were independent risk factors for HIV infection; in Xinjiang, older age and sharing needles and/or syringes were independent factors; in Yunnan, more frequent drug injection, greater awareness of HIV transmission routes, and higher income were independent predictors of HIV seropositivity. Conclusion Prevalence rates of HIV among IDUs in China are more than two out of three in some venues. Risk factors include longer duration of IDU and needle sharing. Also associated with HIV were factors that may indicate some success in education in higher risk persons, such as higher knowledge. A systemic community-level intervention with respect to evidenced-based, population-level interventions to stem the spread of HIV from IDU in China should include needle exchange, opiate agonist-based drug treatment, condom distribution along with promotion, and advocacy for community-based VCT with bridges to HIV preventive services and care.
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Affiliation(s)
- Yujiang Jia
- Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
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Hesketh T, Ye XJ, Zhu WX. Syphilis in China: the great comeback. EMERGING HEALTH THREATS JOURNAL 2008; 1:e6. [PMID: 22460215 PMCID: PMC3167587 DOI: 10.3134/ehtj.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 12/11/2007] [Accepted: 01/14/2008] [Indexed: 11/18/2022]
Abstract
China is currently witnessing a major resurgence of syphilis from the elimination of the disease in the 1960s to 5.3 per 100,000 people incidence in 2000-2005. The reasons for the elimination and subsequent resurgence of syphilis in China lie at the heart of much public health debate, highlighting both the relationship between politics and public health, and the role of government in controlling disease. Were the Draconian measures to control syphilis during the early Mao years a price worth paying for the effective control? Is the recent resurgence of syphilis an inevitable consequence of economic development and greater freedom for the individual, which will ultimately lead to better health for the majority of the population? Could tougher control measures such as those of the early Mao years be re-introduced in the current social and economic climate in China? In this review, we briefly chart the history of the syphilis epidemic in China, its elimination in the 1960s, and its gradual resurgence in the past two decades. We explore the reasons for this resurgence, and we conclude with a discussion on the options for control.
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Affiliation(s)
- T Hesketh
- UCL Centre for International Health and Development, Institute of Child Health, University College London, London, UK
| | - XJ Ye
- Institute of Family and Social Medicine, Zhejiang University, Hangzhou, PR China
| | - WX Zhu
- School of Law and Public Policy, Zhejiang Normal University, Jinhua, PR China
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Qian HZ, Hao C, Ruan Y, Cassell HM, Chen K, Qin G, Yin L, Schumacher JE, Liang S, Shao Y. Impact of methadone on drug use and risky sex in China. J Subst Abuse Treat 2008; 34:391-7. [PMID: 17869049 DOI: 10.1016/j.jsat.2007.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 06/08/2007] [Accepted: 07/01/2007] [Indexed: 10/22/2022]
Abstract
This study examined the impact of methadone on drug-using and risky sexual behaviors among 557 heroin injection drug users in one of the first methadone programs in China. Structured questionnaires were administered to collect data on methadone utilization, drug use, and risky sexual behaviors. Blood samples were tested for blood-borne infections. Multivariate logistic analyses revealed that, among opioid-addicted individuals, methadone participants were less likely to use or inject drugs and share needles than nonparticipants. They also were less likely to have multiple sexual partners or have unprotected sex. Those currently enrolled in methadone maintenance had lower risk of using and injecting drugs than those who were no longer receiving methadone. Data suggest positive, short-term impact on these important behaviors, but further studies are needed to examine the long-term impact of methadone treatment on disease rates.
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Affiliation(s)
- Han-Zhu Qian
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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Lin C, Li L, Ji G, Wu S, Semaan A. Children's body mass index and nutrition intake in HIV/AIDS. VULNERABLE CHILDREN AND YOUTH STUDIES 2008; 3:16-23. [PMID: 19946458 PMCID: PMC2783584 DOI: 10.1080/17450120701660602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
HIV/AIDS in China poses many challenges for caregivers and their children. A total of 154 caregivers of HIV/AIDS-affected families were interviewed to examine the children's nutrition intake and body mass index (BMI) in the context of HIV/AIDS in the family. The results showed that 25% of children in HIV/AIDS-affected families were underweight or at risk of being underweight according to US criteria. More than half the children reported that their consumption of protein such as meat, eggs or milk ranged from not at all to two times during the past month. About 40% of the children sometimes or often went hungry due to insufficient food. The study findings underscore the need to improve the nutrition and general health of children of people living with HIV/AIDS.
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Affiliation(s)
- Chinqing Lin
- Department of Epidemiology, University of California at Los Angeles (UCLA), CA, USA
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Zhang L, Zhu J, Rui B, Zhang Y, Zhang L, Yin L, Ruan Y, Qian HZ, Shao Y. High HIV risk among Uigur minority ethnic drug users in northwestern China. Trop Med Int Health 2008; 13:814-7. [PMID: 18363583 DOI: 10.1111/j.1365-3156.2008.02071.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
OBJECTIVE To assess differences of HIV risk between ethnicities in northwestern China. METHOD Cross-sectional serosurvey and structured questionnaire interview of 383 injection drug users of either Han or Uigur ethnicity in Urumqi, Xinjiang. RESULTS Both Uigur minority ethnicity and residence in a Uigur or mixed Uigur/Han community were independently associated with higher HIV risk. CONCLUSION HIV prevention programs should give special focus on minority ethnic drug users and their communities.
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Affiliation(s)
- Li Zhang
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Zhongdan C, Schilling RF, Shanbo W, Caiyan C, Wang Z, Jianguo S. The 100% Condom Use Program: a demonstration in Wuhan, China. EVALUATION AND PROGRAM PLANNING 2008; 31:10-21. [PMID: 17976720 DOI: 10.1016/j.evalprogplan.2007.09.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The 100% Condom Use Program (100% CUP) was evaluated in Wuhan, China. The program sought to increase knowledge of STI/HIV transmission, increase condom use rates, and reduce the prevalence of sexually transmitted infections (STIs) among sex workers (commercial sex workers (CSWs)), via condom availability and use policies in entertainment establishments and STI services including education and counseling. Entertainment establishment owners and CSWs participated in educational sessions and multiple community sectors were involved in the program. At baseline, 170 female CSWs were assessed, and 102 CSWs were assessed at the final 21-month follow-up. At 6-month follow-up, 95% of entertainment establishments were in compliance with 100% CUP policies. At 15 months, condoms were readily available in retail outlets, and condom use rates rose by 94.5%. Refractive rates of chlamydia and methodological limitations of the evaluation leave unanswered questions about the effectiveness of the program. Nonetheless, outcomes suggest that the 100% CUP may be a promising approach to HIV prevention in China.
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Affiliation(s)
- Chen Zhongdan
- China Global Fund AIDS Program (Round 3), No. 42, Dongjing Road, Beijing 100050, China
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Yin L, Zhang Y, Qian HZ, Rui B, Zhang L, Zhu J, Guan Y, Wang Y, Li Q, Ruan Y, Shao Y. Willingness of Chinese injection drug users to participate in HIV vaccine trials. Vaccine 2007; 26:762-8. [PMID: 18191881 DOI: 10.1016/j.vaccine.2007.11.091] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 11/30/2007] [Accepted: 11/30/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chinese injection drug users (IDUs) may be a proper candidate population for HIV vaccine trials. OBJECTIVE To evaluate willingness to participate (WTP) in HIV vaccine trials among Chinese IDUs. METHODS Questionnaire interviews were completed among 401 IDUs in Urumqi City in northwestern China in 2005. RESULTS Overall 74.3% of participants said that they would be definitely willing to participate in HIV vaccine trials, 17.7% were probably willing, 6.2% were probably not willing, and remaining 1.8% were definitely not willing to join. Multivariate logistic regression analysis demonstrated that WTP was positively associated with having ever had sex with a drug use partner (adjusted odds ratio [AOR]: 1.8; 95% confidence interval [CI]: 1.04, 3.2), sharing needle and syringe with a new drug use partner in the past 3 months (AOR: 3.8; 95% CI: 1.2, 11.7), perceived family support for participation (AOR: 7.4; 95% CI: 4.3, 12.7), and perceived vaccine protection against HIV infection (AOR: 16.1; 95% CI: 3.7, 70.8), and was negatively associated with perceived risk of social stigma and isolation for participation (AOR: 0.3; 95% CI: 0.2, 0.5). CONCLUSIONS The stated WTP in hypothetical HIV vaccine trials was high among Chinese IDUs. Further studies are needed to evaluate actual enrollment into the trials.
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Affiliation(s)
- Lu Yin
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), 27 Nanwei Road, Xuanwu District, Beijing 100050, China
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Abstract
OBJECTIVE The goal of the study was to understand the needs of families and children affected by HIV/AIDS. DESIGN This study used a mixed method combining qualitative and quantitative approaches. METHODS Focus groups were conducted with local health workers, local schoolteachers, village leaders, persons living with HIV/AIDS, and caregivers for children affected by HIV/AIDS in Anhui, China. Face-to-face interviews were conducted with 154 caregivers of HIV-affected children. RESULTS The majority of the caregivers interviewed in the quantitative study were parents (84%), 80% were HIV-positive, and 58% were female. About 54% of the caregivers rated quality of life as poor and 85% reported frequent negative feelings. The annual income per person for HIV/AIDS affected families was much lower than the provincial average. HIV also impacted family relations and family economic situation. The impact of HIV on children was reflected in children's school performance. Children's nutrition and health were also compromised. CONCLUSIONS Interventions that address the challenges that families face, build families' coping skills, and form supportive local community networks, are needed.
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Jia Y, Lu F, Sun X, Vermund SH. Sources of data for improved surveillance of HIV/AIDS in China. THE SOUTHEAST ASIAN JOURNAL OF TROPICAL MEDICINE AND PUBLIC HEALTH 2007; 38:1041-52. [PMID: 18613545 PMCID: PMC2730767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The objective of this paper is to describe the evolution of human immunodeficiency virus/acquired immunodeficiency syndrome surveillance in mainland China, with a focus on reviewing the sources of data being used for improved surveillance of HIV/AIDS. We review the development of HIV/AIDS surveillance and its multiple data sources to monitor the dynamics of HIV/AIDS in China. The surveillance system for HIV/AIDS in China was initiated in 1986. It has evolved in three stages: (1) passive surveillance, (2) HIV sentinel surveillance with coexisting active surveillance and passive surveillance, and (3) comprehensive surveillance. In parallel with the evolution of the surveillance system itself, the HIV epidemic in China has gone through increasing stages of complexity, through an Introduction Phase, a Spreading Phase, and a Rapidy Spreading Phase. More reliable data from improved surveillance suggest that the HIV/AIDS epidemic is expanding in China. HIV infections among 2005 estimates remain concentrated among injection drug users (IDUs), those buying and selling sex, and men who have sex with men. Better HIV/AIDS surveillance synthesizes multiple data sources to provide a more accurate picture of the dynamics of specific HIV/AIDS circumstances in different areas of China. Improved surveillance is meaningful insofar as data are used to implement more effective HIV prevention programs in China. Support for surveillance and strategic analyses can enable policy decision makers to make more effective program choices and mobilize adequate resources to contain HIV.
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Affiliation(s)
- Yujiang Jia
- Institute for Global Health, Vanderbilt University, Nashville, TN, USA
- Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Fan Lu
- National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, Beijing
| | - Xinhua Sun
- Bureau of Disease Control, China Ministry of Health, Beijing, PR China
| | - Sten H Vermund
- Institute for Global Health, Vanderbilt University, Nashville, TN, USA
- Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, TN, USA
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