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Wang X, Xu H, Zhang Y, Zeng J, Liu C, Luo R, Zhong H, Cai W, Li L, Gu J. Exploring the relationship between illness perception, self-management and quality of life among HIV-positive men who have sex with men. J Adv Nurs 2024. [PMID: 38712981 DOI: 10.1111/jan.16194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/15/2024] [Accepted: 04/06/2024] [Indexed: 05/08/2024]
Abstract
AIMS This study aimed to explore the mediating effect of self-management (SM) on the relationship between illness perception and quality of life (QOL) among Human immunodeficiency virus (HIV)-positive men who have sex with men (MSM). DESIGN A cross-sectional study. METHODS We explored the effect of illness perception and self-management on QOL using the multiple regression model. Moreover, we conducted a simple mediation analysis to examine the role of SM in the relationship between illness perception and QOL. In addition, a parallel mediation analysis was performed to investigate the differences in domains of SM on the relationship between illness perception and QOL. RESULTS Among 300 Chinese HIV-positive MSM, the mean score of SM was 39.9 ± 6.97, with a range of 14.0-54.0. The higher score in SM indicated a higher level of HIV SM. SM was negatively related to illness perception (r = -0.47) while positively related to QOL (r = 0.56). SM partially mediated the relationship between illness perception and QOL, accounting for 25.3% of the total effect. Specifically, both daily self-management health practices and the chronic nature of the self-management domain played a parallel role in mediating the relationship between illness perception and QOL. CONCLUSION Our study demonstrated that SM was a significant factor influencing QOL among HIV-positive MSM. Focusing on daily self-management health practices and the chronic nature of self-management could be the potential key targets for enhancing HIV self-management strategies. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE This study emphasized the role of SM in the well-being of HIV-positive MSM and underscored the importance of developing interventions that integrate SM strategies to improve QOL in this population. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Xu Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - He Xu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yao Zhang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jing Zeng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Cong Liu
- Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Rui Luo
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Haidan Zhong
- Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Weiping Cai
- Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Linghua Li
- Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jing Gu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen University Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, China
- Center for Health Information Research, Sun Yat-sen University, Guangzhou, China
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Yang L, Sun Z. Are All Gay Men at Risk of Developing HIV/AIDS? Why China's Mass HIV Testing Has Majorly Targeted Gay Men in the Era of Biomedicalization. Am J Mens Health 2024; 18:15579883241230165. [PMID: 38321807 PMCID: PMC10851740 DOI: 10.1177/15579883241230165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
Global HIV/AIDS responses have been increasingly biomedically dominated over the past years. In line with this shifting paradigm, China has prioritized mass HIV testing as a practical approach to controlling its HIV/AIDS epidemics among at-risk populations, especially gay men and other men who have sex with men (MSM). This study analyzed why China's mass HIV testing mainly targeted gay men by understanding the perspectives of public health professionals, community-based organization (CBO) workers, and gay men. In addition, this study revealed the tensions and unintended consequences of HIV/AIDS prevention and the representation of gay men in China. The study involved fieldwork conducted in a major city in Eastern China from 2015 to 2019. Semi-structured interviews were held with participants from the three abovementioned groups (N = 25). The study identified four processes concerning why gay men are mainly targeted for HIV testing. Some public health professionals believe that being a gay man is equivalent to having HIV/AIDS risks. In addition, this study particularly noted tensions between public health professionals and gay men, including gay men-identified CBO workers, over whether mass HIV testing should target gay men or anyone who engaged in sexual risk behaviors. This study argued that a particular focus on gay men due to pursuing biomedical advances in HIV/AIDS prevention seems to have unintendedly stereotyped gay men based on the presumptions that they are at risk of developing HIV/AIDS. In addition, this study corresponded to the broader social scientific discussion concerning whether HIV/AIDS intervention should target specific sexual risk practices or sexual identity/population.
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Affiliation(s)
- Lei Yang
- School of Public Administration, Beihang University, Beijing, P.R. China
| | - Zhipeng Sun
- Shanghai Technician School; Higher Vocational and Technical College, Shanghai University of Engineering Science, Shanghai, P.R. China
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Zheng M, Chen W, Qian X, Tao R, Ma L, Zhou F, Zhu Z, Yao Y, Yang G. Awareness of mpox-related knowledge among men who have sex with men in China. BMC Public Health 2023; 23:600. [PMID: 36997990 PMCID: PMC10061892 DOI: 10.1186/s12889-023-15503-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/22/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND With the rapid spread of the mpox epidemic, cases have emerged in multiple countries, mainly among men who have sex with men. Because of the connectedness of today's world, countries have to be prepared to face risks in advance. Therefore, this study aimed to investigate awareness of mpox-related knowledge among men who have sex with men in China. METHODS With the assistance of the social organizations of men who have sex with men, a cross-sectional survey of men who have sex with men in China was conducted through an online questionnaire between July 1 and July 18, 2022. A nationwide sample of Chinese men who have sex with men (N = 3,257) was recruited. RESULTS Only 36.9% of participants had mpox-related knowledge. Awareness of mpox-related knowledge among respondents was positively associated with those in older age groups (33 to 42 years and 51 years or older) (adjusted odds ratio [AOR] = 1.31; 95% confidence interval [CI]: 1.03-1.67, AOR = 1.61; 95% CI: 1.16-2.24; respectively), married (AOR = 1.55; 95% CI: 1.09-2.19), and those with a graduate degree or above (AOR = 2.14; 95% CI: 1.11-4.13), while negatively associated with those living in the western parts of China (AOR = 0.74; 95% CI: 0.60-0.92), and those who were unsure of their history of Human Immunodeficiency Virus (HIV) status (AOR = 0.44; 95% CI: 0.30-0.63). CONCLUSION Mpox-related knowledge is fairly low among men who have sex with men in China. China needs to spread knowledge to the public through multiple channels, especially in key populations (men who have sex with men, HIV-infected, etc.), and take preventive measures to effectively avoid outbreaks of mpox.
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Affiliation(s)
- Min Zheng
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, 550004, Guizhou, China
| | - Wenyan Chen
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, 550025, Guizhou, China
| | - Xiaohan Qian
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, 550004, Guizhou, China
| | - Rui Tao
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, 550004, Guizhou, China
| | - Lin Ma
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, 550004, Guizhou, China
| | - Feng Zhou
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, 550004, Guizhou, China
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, 550025, Guizhou, China
| | - Zhilin Zhu
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, 550004, Guizhou, China
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, 550025, Guizhou, China
| | - Yongming Yao
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, 550004, Guizhou, China.
| | - Guanghong Yang
- Guizhou Provincial Center for Disease Control and Prevention, Guiyang, 550004, Guizhou, China.
- School of Public Health, the Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, 550025, Guizhou, China.
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Ninnoni JP, Agyemang SO, Bennin L, Agyare E, Gyimah L, Senya K, Baddoo NA, Annor F, Obiri-Yeboah D. Coping with loneliness and stigma associated with HIV in a resource-limited setting, making a case for mental health interventions; a sequential mixed methods study. BMC Psychiatry 2023; 23:163. [PMID: 36918875 PMCID: PMC10013231 DOI: 10.1186/s12888-023-04643-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/28/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Challenges such as stigma and loneliness may increase vulnerability to Human Immunodeficiency Virus (HIV) infection and negatively affect the quality of life of people living with HIV (PLHIV) despite the massive investment in access to antiretroviral therapy. This study aims to determine the level of loneliness and stigma and explore the coping resources employed by PLHIV in a resource-constrained setting. METHODS This was a sequential mixed methods study conducted at the Cape Coast Teaching Hospital (CCTH) in Ghana between May and December 2021. A total of 395 adults were selected using a simple random sampling technique. HIV Stigma Scale and UCLA Loneliness Scale were used to collect quantitative data. A purposive sampling technique was applied to recruit 18 participants to saturation using a semi-structured interview guide. SPSS version 21 was used for the statistical analysis of the quantitative data. HIV-related loneliness and stigma levels were estimated, and bivariate and multivariable logistic regression were used to evaluate associated factors using a statistical significance of p-value (p < .05). In general, the thematic analysis approach by Braun and Clark was employed to analyse the qualitative data. Findings were then triangulated. RESULTS The mean age was 46.79 years (± 12.53), 75.4% of the participants were female, with a prevalence of stigma of 99.0% (95%CI = 97.4-99.7) and loneliness of 30.1% (95%CI = 25.6-34.9). Tertiary-level education and instrumental support were associated with lower levels of loneliness. In contrast, comorbidity, personalised stigma, negative self-image, and self-blame were positively related to loneliness. Thematic analyses of the qualitative data produced a range of themes that showed that people living with HIV rely on personal resources, social support networks, and behaviour modification strategies to manage their condition. In particular, some of these strategies include; religiosity and spirituality, family and friends, medication and professional support systems. CONCLUSION The results suggest that PLHIV in the developing world face enormous challenges, socially, psychologically and financially. Although there have been global efforts to make HIV services accessible, the findings suggest a need for integrating mental health services contextually to reduce loneliness and HIV-related stigma to improve quality of life.
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Affiliation(s)
- Jerry Paul Ninnoni
- Department of Mental Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana.
- Department of Mental Health, School of Nursing and Midwifery, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Sampson Opoku Agyemang
- Department of Mental Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Lydia Bennin
- Department of Mental Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Elizabeth Agyare
- Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Leveana Gyimah
- Communicable and Non-Communicable Diseases cluster, World Health Organisation Country Office, Accra, Ghana
| | - Kafui Senya
- Communicable and Non-Communicable Diseases cluster, World Health Organisation Country Office, Accra, Ghana
| | - Nyonuku Akosua Baddoo
- National AIDS/STIs Control Programme, Accra, Ghana
- Department of Community Health, the University of Ghana Medical School, Accra, Ghana
| | - Francis Annor
- Direcctorate of Research, Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
| | - Dorcas Obiri-Yeboah
- Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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Yang Y, Deng H, He H, Fan SF, Li Y, Wu X, Li N, Xi J, Xu J, Xiao J, Liao RP, Xiao W. Lifetime commercial heterosexual behavior among HIV negative elderly men from rural Chengdu, China: a modified knowledge-attitude-practice perspective. BMC Public Health 2021; 21:2095. [PMID: 34781900 PMCID: PMC8594087 DOI: 10.1186/s12889-021-12139-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background China is facing big challenges to achieve the “90–90-90 targets”. The HIV prevalence of elderly (≥50 years) men have been steadily increasing in China, mainly through the sexual transmission route, but sexual behaviors of them are far from well-studied. In 2019, elderly men accounted for 59.2% of HIV/AIDS cases in Sichuan, China. Methods The research design is a cross-sectional study. Face-to-face interviews were conducted among 795 HIV negative elderly men from rural Chengdu, capital City of Sichuan. Bivariate and multivariate logistic regression models were applied to examine factors associated with commercial heterosexual behavior from a modified Knowledge-Attitude-Practice (KAP) perspective. Results 129 (16.23%) respondents admitted high-risk sexual behaviors, including 11.07% commercial heterosexual behavior, 6.16% extramarital, 2.89% casual and 0.25% homosexual behavior, and no one used condom consistently. 427(68.43%) had ever gotten HIV-related Health Education (HRHE), mainly through mass media (70.49%). The HIV-related knowledge awareness rate was only 31.41%. Migration history (AOR =2.46,95% CI = 1.02–5.91), age(≥60 vs. 50–59, OR = 0.41, 95% CI = 0.19–0.91), receiving HRHE from mass media (OR = 0.37, 95%CI = 0.16–0.85), marital status (married vs. never married, OR = 0.04, 95%CI = 0–0.52), and undecided (AOR =0.02, 95%CI = 0.01–0.09) and objection (AOR =0.04, 95%CI = 0.01–0.1) attitude toward commercial sex were related to lifetime commercial heterosexual behavior. Conclusions High-risk sexual behaviors are common among elderly men from rural areas in Chengdu. Receiving HRHE from mass media and undecided and objection attitude toward commercial sex prevent elderly from being involving in commercial heterosexual behavior. According to the results, health facilities should continue to conduct systematic interventions, paying more attention to 50–59 years old group. Sex and condom use need to be talked in public. Working with mass media, health facilities give elderly men education not only focusing on HIV/AIDS, but also on knowledge and skills of condom use.
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Affiliation(s)
- Yi Yang
- Department of Social Medicine and Health Administration, School of Administration, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, 611137, China.
| | - Hua Deng
- Department of Urology, Chengdu Second Peoples' Hospital, 10 Qingyunnan Road, Chengdu, 610017, China
| | - Huan He
- School of Public Administration, Southwestern University of Finance and Economics, 555 Liutai Avenue, Wenjiang District, Chengdu, China
| | - Shuang Feng Fan
- Department of HIV/AIDS prevention, Chengdu Center for Disease Control and Prevention, No.4, Longxiang Road, Wuhou District, Chengdu, 610000, China
| | - Yuan Li
- Department of Epidemiology and Health Statistics, School of Public Health, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, 611137, China
| | - Xia Wu
- Department of HIV/AIDS prevention, Pengzhou Center for Disease Control and Prevention, 331 Longta Road, Pengzhou District, Chengdu, 610000, China
| | - Na Li
- Department of HIV/AIDS prevention, Pengzhou Center for Disease Control and Prevention, 331 Longta Road, Pengzhou District, Chengdu, 610000, China
| | - Jing Xi
- Department of HIV/AIDS prevention, Chengdu Center for Disease Control and Prevention, No.4, Longxiang Road, Wuhou District, Chengdu, 610000, China
| | - Jing Xu
- Department of Social Medicine and Health Administration, School of Administration, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, 611137, China
| | - Jie Xiao
- Department of Social Medicine and Health Administration, School of Administration, Chengdu University of Traditional Chinese Medicine, 1166 Liutai Avenue, Wenjiang District, Chengdu, 611137, China
| | - Rui Ping Liao
- Department of HIV/AIDS prevention, Pengzhou Center for Disease Control and Prevention, 331 Longta Road, Pengzhou District, Chengdu, 610000, China
| | - Wei Xiao
- Department of HIV/AIDS prevention, Pengzhou Center for Disease Control and Prevention, 331 Longta Road, Pengzhou District, Chengdu, 610000, China
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Wu C, Choi EPH, Chau PH. The Holistic Health Status of Chinese Homosexual and Bisexual Adults: A Scoping Review. Front Public Health 2021; 9:710575. [PMID: 34504828 PMCID: PMC8421524 DOI: 10.3389/fpubh.2021.710575] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Same-sex marriage is currently not legalized in China, despite the considerably large number of homosexual and bisexual Chinese populations. At the same time, their holistic health status remains unclear. This is the first scoping review conducted to comprehensively examine all the available literature and map existing evidence on the holistic health of homosexual and bisexual Chinese. Methods: This scoping review used the framework of Arksey and O'Malley and followed the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews (PRISMA-ScR). A comprehensive search strategy was carried out across 20 English (EN) and Chinese (both traditional and simplified) electronic databases from January 1, 2001, to May 31, 2020. Two reviewers conducted the reference screening and study selection independently and consulted a third senior reviewer whenever a consensus must be achieved. Data extraction was conducted using a structured data form based on the Cochrane template, after which a narrative synthesis of the findings was performed. Results: A total of 2,879 references were included in the final analysis, with 2,478 research articles, 167 reviews, and 234 theses. Regarding the study populations, the vast majority of studies centered on men only (96.46%), especially men who have sex with men (MSM). Only 1.32% of the studies targeted female sexual minorities. The geographical distribution of all research sites was uneven, with most of them being conducted in mainland China (95.96%), followed by Hong Kong (2.05%), Taiwan (2.02%), and Macau (0.06%). Regarding the specific study focus in terms of the health domain, around half of the studies (45.93%) focused on sexual health only, and an additional quarter of the studies (24.15%) investigated both sexual health and social well-being. Meanwhile, the studies focusing on mental health only accounted for approximately 15% of the total. Conclusions: This scoping review revealed that previous research focused more on male than female sexual minorities, on disease-centered surveys than person-centered interventions, and investigations on negative health conditions than positive health promotion. Therefore, investigations centered on the female sexual minorities and corresponding person-centered interventions are highly needed. Review Registration: The protocol of this review has been registered within Open Science Framework (https://osf.io/82r7z) on April 27, 2020.
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Affiliation(s)
| | - Edmond Pui Hang Choi
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Xu Y, Towe SL, Causey ST, Meade CS. Using mobile health technologies to test the association of cocaine use with sexual desire and risky sexual behaviors among people with and without HIV who use illicit stimulants. Drug Alcohol Depend 2021; 225:108744. [PMID: 34146909 PMCID: PMC8715517 DOI: 10.1016/j.drugalcdep.2021.108744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cocaine use is broadly associated with risky sexual behavior potentially through elevated sexual desire. Understanding the within-person effects of cocaine on sexual desire and risky sexual behavior and the modification of HIV infection may inform primary and secondary HIV interventions. METHODS We conducted a mobile health (mHealth) study in a community sample of males and females with (n = 28) and without (n = 32) HIV who use illicit stimulant drugs. Participants completed ecological momentary assessments (EMAs) and daily diaries over 28 days. Mixed effects models were employed to examine the within-person association of cocaine use with sexual desire and risky sexual behavior. RESULTS Participants completed 3505 EMA responses, with 36 % involving recent cocaine use, including powder and/or crack cocaine. They completed 1427 daily diary responses, with cocaine use reported on 49 % of these days and sexual behavior on 21 % of these days. Sexual desire was highest in the first hour since cocaine use and gradually decreased with time. Sexual desire was lowest when participants had not used any cocaine in the past 6 h, and it correlated positively with the amount of use. Participants were more likely to have risky sexual behavior on days they used cocaine. These associations were similar for participants with and without HIV. CONCLUSION This study demonstrates the dynamic and proximal effects of cocaine use on sexual desire and risky sexual behavior. Our findings support the development of HIV prevention interventions that utilize mHealth technology to reduce sexual risk behavior among persons who use stimulant drugs.
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Affiliation(s)
- Yunan Xu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Sheri L Towe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Shakiera T Causey
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Christina S Meade
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Liu J, Deng R, Lin B, Pan H, Gao Y, Dai J, Liang H, Huang A, Zhong X. Risk Management on Pre-Exposure Prophylaxis Adherence of Men Who Have Sex with Multiple Men: A Multicenter Prospective Cohort Study. Risk Manag Healthc Policy 2021; 14:1749-1761. [PMID: 33953624 PMCID: PMC8092636 DOI: 10.2147/rmhp.s295114] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Men who have sex with multiple men (MSMM) belong to a high-risk group for HIV infection, and pre-exposure prophylaxis (PrEP) is an effective measure to prevent the infection. However, few studies on PrEP adherence by MSMM in China exist. We aimed to explore the protective motivation-related factors for PrEP adherence in an HIV-negative MSMM population in Western China and to provide a reference for future risk management and effective prevention strategies. Methods Data were collected from a 2-year follow-up cohort study of PrEP in MSM in China. Rogers’ protective motivation theory (PMT) was used to study the PrEP adherence of MSMM, and logistic regression was performed to analyze the influencing factors of PrEP adherence. Results A total of 496 MSMM were included in the study: 299 (60.28%) of them in the good adherence group and 197 (39.72%) in the poor adherence group. The threat assessment scores of the good and poor adherence groups were 2.15 ± 0.59 and 2.06 ± 0.47, respectively, and the response assessment scores were 2.81 ± 0.62 and 2.74 ±0.62, respectively. Poor PrEP adherence was associated with on-demand PrEP medication (OR=0.670), students at school (OR=1.837), occasional condom use (OR=1.621), and good HIV knowledge (OR= 0.659). The higher the threat assessment score, the higher the susceptibility; and the lower the response cost, the stronger the protection motivation and the less likely MSMM were to have poor adherence. Conclusion On-demand PrEP medication is more conducive to adherence. Preventive management should focus on MSMMs who are students at school, those who occasionally use condoms, and those with poor HIV knowledge. Improving threat perception and susceptibility, and controlling and reducing the response cost can effectively improve PrEP adherence, and the subsequent application of PMT during intervention research can provide a reference for HIV prevention in MSMM.
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Affiliation(s)
- Jiaxiu Liu
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, People's Republic of China.,School of Medical Information, Chongqing Medical University, Chongqing, People's Republic of China
| | - Ruibin Deng
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Bing Lin
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Hong Pan
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Yuwen Gao
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Jianghong Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Xinjiang, People's Republic of China
| | - Hao Liang
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangxi Medical University, Nanning, People's Republic of China
| | - Ailong Huang
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, People's Republic of China
| | - Xiaoni Zhong
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, People's Republic of China
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You X, Gilmour S, Cao W, Lau JTF, Hao C, Gu J, Le PM, Peng L, Wei D, Deng Y, Wang X, Zou H, Li J, Hao Y, Li J. HIV incidence and sexual behavioral correlates among 4578 men who have sex with men (MSM) in Chengdu, China: a retrospective cohort study. BMC Public Health 2021; 21:802. [PMID: 33902499 PMCID: PMC8077884 DOI: 10.1186/s12889-021-10835-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 04/13/2021] [Indexed: 01/22/2023] Open
Abstract
Background The prevalence of HIV among men who have sex with men (MSM) in southwest China is still increasing. This study aimed to investigate the trend in HIV incidence and its associated risk factors among MSM in Chengdu, China. Method Incidence data were collected from the largest local non-governmental organization (NGO) serving MSM in Chengdu between 2012 and 2018, while information on sexual behaviors was collected from 2014. All MSM who received voluntary counseling and testing services (VCT) in the collaborating NGO at least twice during the study period were included. We calculated the HIV incidence density among MSM every 2 years and the overall incidence rate. A Cox proportional hazards regression model was employed to identify risk factors for HIV infection. Result A total of 4578 HIV-negative participants were included in the cohort. The total incidence density was 5.95 (95% CI: 5.37–6.56)/100 person-years (PYs) between 2012 and 2018. The segmented incidence density was 9.02 (95% CI: 7.46–10.78), 5.85 (95% CI: 4.86–6.97), 5.43 (95% CI: 4.53–6.46), and 3.09 (95% CI: 2.07–4.41)/100 PYs in 2012–2013, 2014–2015, 2016–2017, and 2018, respectively. After adjusting for sociodemographic characteristics, compared to participants without sexual partners within 6 months, MSM with one fixed partner (Adjusted Hazard Ratio, AHR = 1.18, 95% CI: 0.44–3.19) and more than five partners (AHR = 2.24, 95% CI: 0.81–6.20) had increased risk of HIV infection. MSM who used condom inconsistently had a higher risk of HIV infection (AHR = 1.87, 95% CI: 1.46–2.38) compared to consistent condom users. Conclusion The decreased HIV incidence density among MSM was potentially related to the successful comprehensive HIV prevention strategies in Chengdu. Multiple male sexual partnerships and inconsistent condom use during anal intercourse were risk factors associated with HIV occurrence.
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Affiliation(s)
- Xinyi You
- School of Public Health, Sun Yat-sen University (North Campus), No.74, Zhongshan second road, Guangzhou, China
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Wangnan Cao
- Center for Evidence Synthesis in Health, School of Public Health, Brown University, Providence, RI, USA
| | - Joseph Tak-Fai Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Chun Hao
- School of Public Health, Sun Yat-sen University (North Campus), No.74, Zhongshan second road, Guangzhou, China. .,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China.
| | - Jing Gu
- School of Public Health, Sun Yat-sen University (North Campus), No.74, Zhongshan second road, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Phuong Mai Le
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Liping Peng
- School of Public Health, Sun Yat-sen University (North Campus), No.74, Zhongshan second road, Guangzhou, China
| | - Dannuo Wei
- School of Public Health, Sun Yat-sen University (North Campus), No.74, Zhongshan second road, Guangzhou, China
| | - Yang Deng
- School of Public Health, Sun Yat-sen University (North Campus), No.74, Zhongshan second road, Guangzhou, China
| | - Xiaodong Wang
- Chengdu Tongle Health Consulting Service Center, Chengdu, China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Jibin Li
- Department of Clinical Research, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yuantao Hao
- School of Public Health, Sun Yat-sen University (North Campus), No.74, Zhongshan second road, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Jinghua Li
- School of Public Health, Sun Yat-sen University (North Campus), No.74, Zhongshan second road, Guangzhou, China. .,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China.
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Pan S, Sun S, Li X, Chen J, Xiong Y, He Y, Pachankis JE. A pilot cultural adaptation of LGB-affirmative CBT for young Chinese sexual minority men's mental and sexual health. Psychotherapy (Chic) 2021; 58:12-24. [PMID: 32538644 PMCID: PMC7736310 DOI: 10.1037/pst0000318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Young men who have sex with men (YMSM) represent one of the most at-risk groups for HIV infection and experience sexual minority stress especially in high-stigma settings, which affects their psychological health and increases likelihood of HIV-risk behaviors. The HIV epidemic in China is increasing rapidly among YMSM. However, no evidence-based intervention has specifically targeted Chinese YMSM's minority stress to improve their mental and sexual health. Adaptation of evidence-based interventions to promote the mental and sexual health of YMSM is one promising way to achieve the global target of HIV epidemic control. The current adaptation study followed the Assessment-Decision-Administration-Production-Topical Experts-Integration-Training-Testing model. YMSM (n = 41) and key stakeholders (n = 16) in China provided feedback into the selected intervention, a cognitive-behavioral therapy called Effective Skills to Empower Effective Men, originally developed with efficacy in the United States. An open pilot (n = 8) was also then conducted. Qualitative and quantitative data collected from each adaptation phase were analyzed to form the adapted intervention: "Yi Si Tang ()." Adaptations addressed a cultural context prioritizing family needs, limited support from the health system, as well as YMSM delivery preferences. YMSM and key stakeholders deemed the intervention acceptable and preliminarily feasible for the Chinese context. The pre-post comparison of mental and sexual health outcomes indicated improvement in mental health and sexual health of Chinese YMSM. Outcomes of the small initial pilot suggest future promise for this first-of-its-kind intervention for Chinese YMSM. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Liang S, Liu Z, Wang S, Liu J, Shi L, Mao W, Liu C, Wan J, Zhu L, Huang M, Liu Y, Wang J, Ness P, Shan H, Zeng P, He M. The genotype distribution, infection stage and drug resistance mutation profile of human immunodeficiency virus-1 among the infected blood donors from five Chinese blood centers, 2014-2017. PLoS One 2020; 15:e0243650. [PMID: 33347449 PMCID: PMC7752150 DOI: 10.1371/journal.pone.0243650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022] Open
Abstract
Human immunodeficiency virus-1 (HIV-1) exhibits high diversity and complexity in China, challenging the disease surveillance and antiretroviral therapy. Between July 1, 2014 and January 30, 2017, we investigated the profiles of HIV-1 infection stages, genotype distribution and drug resistance mutations (DRMs) using plasma samples from HIV Western blot (WB) confirmed blood donors from five Chinese blood centers (Chongqing, Guangxi, Luoyang, Mianyang, and Urumqi). HIV pol regions consisted of whole protease and partial reverse transcriptase were genotyped and analyzed for DRMs. Lag-Avidity testing was performed to identify the infection stages. Of the 356 HIV-1 WB positive samples tested by Lag-avidity assay, 19.1% (68/356) were recent infections. Genotyping on 356 amplified sequences presented the subtype distributions as following: CRF07_BC (65.7%), CRF08_BC (7.3%), CRF01_AE (19.1%), B (4.2%), CRF55_01B (3.1%), CRF59_01B (0.3%) and CRF68_01B (0.3%). No significant difference in genotype distribution was observed between recent and long-term infections. 48 DRMs were identified from 43 samples, indicating a drug resistance prevalence of 12.1% (43/356), which include seven protease inhibitors (PIs) accessory DRMs (Q58E, L23I and I84M), two PIs major DRMs (M46I, M46L), seven nucleoside RT inhibitors DRMs (D67N, K70Q, K219R and M184L), and 32 non-nucleoside RT inhibitors DRMs (K103N, V179E, K238N, V179D, E138G, G190E, A98G, Y188D and E138A). In addition, we had also identified CRFs from the 01B subtype including CRF55_01B (3.1%), CRF59_01B (0.3%) and CRF68_01B (0.3%). As an important part of the continuous monitoring of HIV-1 circulating strains among blood donors, our findings were expected to contribute to the comprehensive AIDS control and development of proper diagnostics for HIV-1 in China.
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Affiliation(s)
- Shan Liang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
- Sichuan Blood Safety and Blood Substitute International Science and Technology Cooperation Base, Chengdu, China
| | - Zhiyang Liu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
- Sichuan Blood Safety and Blood Substitute International Science and Technology Cooperation Base, Chengdu, China
| | - Shaoli Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
- Sichuan Blood Safety and Blood Substitute International Science and Technology Cooperation Base, Chengdu, China
| | - Jing Liu
- The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America
| | - Ling Shi
- University of Massachusetts at Boston, Boston, Massachusetts, United States of America
| | - Wei Mao
- Chongqing Blood Center, Chongqing, China
| | - Cunxu Liu
- Guangxi Blood Center, Liuzhou, Guangxi, China
| | - Jianhua Wan
- Urumqi Blood Center, Urumqi, Xinjiang, China
| | - Lili Zhu
- Luoyang Blood Center, Luoyang, Henan, China
| | - Mei Huang
- Mianyang Blood Center, Mianyang, Sichuan, China
| | - Yu Liu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
- Sichuan Blood Safety and Blood Substitute International Science and Technology Cooperation Base, Chengdu, China
| | - Jingxing Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
- Sichuan Blood Safety and Blood Substitute International Science and Technology Cooperation Base, Chengdu, China
| | - Paul Ness
- The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States of America
| | - Hua Shan
- Stanford University, Stanford, California, United States of America
| | - Peibin Zeng
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- * E-mail: (PZ); (MH)
| | - Miao He
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
- Sichuan Blood Safety and Blood Substitute International Science and Technology Cooperation Base, Chengdu, China
- * E-mail: (PZ); (MH)
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12
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Bao Y, Medland NA, Fairley CK, Wu J, Shang X, Chow EPF, Xu X, Ge Z, Zhuang X, Zhang L. Predicting the diagnosis of HIV and sexually transmitted infections among men who have sex with men using machine learning approaches. J Infect 2020; 82:48-59. [PMID: 33189772 DOI: 10.1016/j.jinf.2020.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/30/2020] [Accepted: 11/07/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVES We aimed to develop machine learning models and evaluate their performance in predicting HIV and sexually transmitted infections (STIs) diagnosis based on a cohort of Australian men who have sex with men (MSM). METHODS We collected clinical records of 21,273 Australian MSM during 2011-2017. We compared accuracies for predicting HIV and STIs (syphilis, gonorrhoea, chlamydia) diagnosis using four machine learning approaches against a multivariable logistic regression (MLR) model. RESULTS Machine learning approaches consistently outperformed MLR. Gradient boosting machine (GBM) achieved the highest area under the receiver operator characteristic curve for HIV (76.3%) and STIs (syphilis, 85.8%; gonorrhoea, 75.5%; chlamydia, 68.0%), followed by extreme gradient boosting (71.1%, 82.2%, 70.3%, 66.4%), random forest (72.0%, 81.9%, 67.2%, 64.3%), deep learning (75.8%, 81.0%, 67.5%, 65.4%) and MLR (69.8%, 80.1%, 67.2%, 63.2%). GBM models demonstrated the ten greatest predictors collectively explained 62.7-73.6% of variations in predicting HIV/STIs. STIs symptoms, past syphilis infection, age, time living in Australia, frequency of condom use with casual male sexual partners during receptive anal sex and the number of casual male sexual partners in the past 12 months were most commonly identified predictors. CONCLUSIONS Machine learning approaches are advantageous over multivariable logistic regression models in predicting HIV/STIs diagnosis.
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Affiliation(s)
- Yining Bao
- China Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi 710061, People's Republic of China; Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, No.9 Seyuan Road, Chongchuan District, Nantong, Jiangsu 226019, People's Republic of China; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Nicholas A Medland
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; The Kirby Institute, University of NSW, Sydney, Australia
| | - Christopher K Fairley
- China Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi 710061, People's Republic of China; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Jinrong Wu
- Centre for Eye Research Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia; Centre for Data Analytics and Cognition, College of Arts, Social Sciences and Commerce, The La Trobe University, Melbourne, Australia
| | - Xianwen Shang
- Centre for Eye Research Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Xianglong Xu
- China Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi 710061, People's Republic of China; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Zongyuan Ge
- Monash e-Research Centre, Faculty of Engineering, Airdoc Research, Nvidia AI Technology Research Centre, Monash University, Melbourne, VIC, Australia
| | - Xun Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, No.9 Seyuan Road, Chongchuan District, Nantong, Jiangsu 226019, People's Republic of China.
| | - Lei Zhang
- China Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi 710061, People's Republic of China; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China.
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13
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Do national funding organizations properly address the diseases with the highest burden?: Observations from China and the UK. Scientometrics 2020. [DOI: 10.1007/s11192-020-03572-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Okal J, Lango D, Matheka J, Obare F, Ngunu-Gituathi C, Mugambi M, Sarna A. "It is always better for a man to know his HIV status" - A qualitative study exploring the context, barriers and facilitators of HIV testing among men in Nairobi, Kenya. PLoS One 2020; 15:e0231645. [PMID: 32294124 PMCID: PMC7159816 DOI: 10.1371/journal.pone.0231645] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 03/28/2020] [Indexed: 01/20/2023] Open
Abstract
HIV testing services are an important component of HIV program and provide an entry point for clinical care for persons newly diagnosed with HIV. Although uptake of HIV testing has increased in Kenya, men are still less likely than women to get tested and access services. There is, however, limited understanding of the context, barriers and facilitators of HIV testing among men in the country. Data are from in-depth interviews with 30 men living with HIV and 8 HIV testing counsellors that were conducted to gain insights on motivations and drivers for HIV testing among men in the city of Nairobi. Men were identified retroactively by examining clinical CD4 registers on early and late diagnosis (e.g. CD4 of ≥500 cells/mm, early diagnosis and <500 cells/mm, late diagnosis). Analysis involved identifying broad themes and generating descriptive codes and categories. Timing for early testing is linked with strong social support systems and agency to test, while cost of testing, choice of facility to test and weak social support systems (especially poor inter-partner relations) resulted in late testing. Minimal discussions occurred prior to testing and whenever there was dialogue it happened with partners or other close relatives. Interrelated barriers at individual, health-care system, and interpersonal levels hindered access to testing services. Specifically, barriers to testing included perceived providers attitudes, facility location and set up, wait time/inconvenient clinic times, low perception of risk, limited HIV knowled ge, stigma, discrimination and fear of having a test. High risk perception, severe illness, awareness of partner's status, confidentiality, quality of services and supplies, flexible/extended opening hours, and pre-and post-test counselling were facilitators. Experiences between early and late testers overlapped though there were minor differences. In order to achieve the desired impact nationally and to attain the 90-90-90 targets, multiple interventions addressing both barriers and facilitators to testing are needed to increase uptake of testing and to link the positive to care.
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Affiliation(s)
- Jerry Okal
- Population Council, Nairobi, Kenya
- * E-mail:
| | | | | | | | | | - Mary Mugambi
- National HIV and STI Control Programme (NASCOP), Nairobi, Kenya
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Liu J, Zhong X, Lu Z, Peng B, Zhang Y, Liang H, Dai J, Zhang J, Huang A. Anxiety and Depression Associated with Anal Sexual Practices among HIV-Negative Men Who Have Sex with Men in Western China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020464. [PMID: 31936800 PMCID: PMC7014070 DOI: 10.3390/ijerph17020464] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/13/2022]
Abstract
This study aimed to explore the prevalence and influencing factors of anxiety and depression among human immunodeficiency virus negative (HIV-negative) men who have sex with men (MSM) based on anal sex roles, so as to provide a scientific basis for the management of mental health conditions. Data were obtained from the baseline in a cohort study with a two-year follow-up period in western China. The Self-Rating Anxiety Scale and Center for Epidemiological Studies Depression Scale were used to assess anxiety and depression symptoms, respectively. The prevalence of anxiety and depression in 1771 MSM was 26.03% and 37.83%. Among them, 182 anal sex role “0” MSM who only had receptive anal sex with men reported the highest prevalence of anxiety and depression (31.32% and 46.15%), 467 anal sex role “1” MSM who only had insertive anal sex with men (22.27% and 32.76%), and 1122 anal sex role “0.5” MSM who engaged equally in both insertive and receptive anal sex intercourse with men (26.74% and 38.59%), respectively. Logistic regression analysis revealed that the influencing factors of anxiety include anal sex role “0”/”0.5”, low educational level, female sexual partners, frequently searching partners on the Internet, sexually transmitted diseases (STD) diagnosed by doctors, and no HIV counseling. Anal sex role “0”/”0.5”, rural area, casual male partners, female partners, STD diagnosed by doctors, frequently searching partners on the Internet, no HIV counseling, no condom use, and daily alcohol use were found to be associated with depression. In conclusion, early identification and intervention of anxiety and depression symptoms in HIV-negative MSM should be carried out, especially for anal sex role “0” MSM. Furthermore, key intervention and psychological counseling should be taken into consideration for MSM with a low education level, high-risk behaviors, and high-risk perceptions.
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Affiliation(s)
- Jiaxiu Liu
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Xiaoni Zhong
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
- Correspondence:
| | - Zhuo Lu
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Bin Peng
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Yan Zhang
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Hao Liang
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangxi Medical University, Nanning 520021, China
| | - Jianghong Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Xinjiang 830011, China
| | - Juying Zhang
- Department of Epidemiology and Medical Statistics, School of Public Health, Sichuan University, Chengdu 610041, China
| | - Ailong Huang
- Key Laboratory of Molecular Biology on Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing 400016, China
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Wang L, Santella AJ, Wei X, Zhuang G, Li H, Zhang H, Huang X, Zhang Y, Zheng H, Zhou A. Prevalence and protective factors of HIV and syphilis infection among men who have sex with men in Northwest China. J Med Virol 2019; 92:1141-1147. [PMID: 31696951 DOI: 10.1002/jmv.25622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 10/29/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) continue to be disproportionately impacted by human immunodeficiency virus (HIV) and syphilis in China. Little is known about HIV and syphilis infections among MSM in Xi'an, a developing city in Northwest China. A cross-sectional study with recruitment via snowball sampling was conducted to collect HIV and syphilis infection status and risk factors among MSM in Xi'an between April 2013 to December 2016. Among the 5000 participants, the mean age was 29.0 years (SD 7.7) and the prevalence of HIV, syphilis, and coinfection was 6.5%, 2.2%, and 0.4%, respectively. There was no significant change in HIV prevalence from 2013 to 2016, while the prevalence of syphilis and coinfection showed a downward trend. Multiple logistic regression analyses found that being over 25 years old (OR = 1.647), junior high school/middle school education and below (OR = 3.085), with a sexual role of passive or versatile (OR = 3.300; OR = 2.337), rush poppers use during the last 6 months (OR = 1.660) and syphilis infection (OR = 2.235) were more likely to acquire HIV infection, whereas used condoms in the last episode of anal sex (OR = 0.572) and tested HIV antibody previously (OR = 0.252) were protective factors for HIV infection. HIV prevalence among MSM in Xi'an was stable, whereas the prevalence of syphilis and coinfection showed a downward trend. Interventions to promote HIV and sexually transmitted disease testing and condom use should be strengthened, especially for MSM with low education.
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Affiliation(s)
- Lirong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Anthony J Santella
- Department of Health Professions, Hofstra University, Hempstead, New York
| | - Xiaoli Wei
- Department of Sexually Transmitted Disease Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Guihua Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Hengxin Li
- Department of Sexually Transmitted Disease Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Hailan Zhang
- Department of Sexually Transmitted Disease Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Xiaodan Huang
- Department of Sexually Transmitted Disease Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Yalan Zhang
- Department of Sexually Transmitted Disease Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Haichao Zheng
- Department of Sexually Transmitted Disease Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Anqin Zhou
- Department of HIV Testing Mobilization, Xi'an Center for Marie Stopes International, Xi'an, China
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Wei X, Zhang Y, Santella AJ, Wang L, Zhuang G, Li S, Zhang H. Effect of early highly active antiretroviral therapy on viral suppression among newly diagnosed men who have sex with men living with human immunodeficiency virus in Xi'an, China. J Med Virol 2019; 91:1263-1271. [PMID: 30840771 DOI: 10.1002/jmv.25449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND The number of men who have sex with men (MSM) living with human immunodeficiency virus (HIV) in China has increased rapidly and thus immediate highly active antiretroviral therapy (HAART) after diagnosis was implemented as a strategy to reduce the HIV transmission. METHODS MSM who were diagnosed with HIV and received HAART between 2013 to 2015 in Xi'an were divided into three groups (>350, 200-350, and <200 cell/μL) according to their baseline CD4+ T cell count. The time of follow-up was calculated from the first date of receiving HAART to December 31, 2016. The CD4+ T cell count was detected with 1 week before or after HAART. The plasma viral loads were tested after 1, 2, and 3 years of treatment. RESULTS Of 1442 subjects who received HAART, 690 (47.9%) cases were in >350 cell/μL group, whereas 400 (27.7%) cases and 352 (24.4%) cases were in the 200-350 cell/μL group and <200 cell/μL group, respectively. After 1 year of treatment, the viral suppression rate in the <200 cell/μL group was 91.1%, which was significantly lower than the other two groups. The logistic regression results show that the >350 cell/μL group and 200-350 cell/μL group predicted higher viral suppression rates. CONCLUSIONS Baseline CD4+ T cell count more than 350 cell/μL can improve viral suppression among MSM living with HIV. Furthermore, to reduce the transmission risk, the treatment compliance of people living with HIV with high CD4+ T cell levels should be improved, and their diagnosis to the treatment time should be decreased.
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Affiliation(s)
- Xiaoli Wei
- Department of Sexually Transmitted Diseases Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Yajuan Zhang
- Department of Sexually Transmitted Diseases Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Anthony J Santella
- Department of Health Professions, School of Health Professions and Human Services, Hofstra University, Hempstead, New York
| | - Lirong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Guihua Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Siwen Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Hailan Zhang
- Department of Sexually Transmitted Diseases Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
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Yang G, Long J, Luo D, Xiao S, Kaminga AC. The Characteristics and Quality of Mobile Phone Apps Targeted at Men Who Have Sex With Men in China: A Window of Opportunity for Health Information Dissemination? JMIR Mhealth Uhealth 2019; 7:e12573. [PMID: 30916658 PMCID: PMC6456822 DOI: 10.2196/12573] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/03/2019] [Accepted: 01/20/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A number of mobile phone apps has been developed specifically for men who have sex with men (MSM). We will call these mobile phone apps MSM apps for simplicity. At present, the characteristics and quality and purpose of these MSM apps are unclear. OBJECTIVE The aim of this study was to objectively and comprehensively evaluate the characteristics and quality of the MSM apps to assess whether they disseminated health information among the MSM in China. METHODS We searched 2 dominant mobile phone app stores (Apple Store and Android Market) to obtain MSM apps using the keywords MSM, gay, lesbian, gay, bisexual, and transgender (LGBT), ,,,,, and . Apps were excluded if they did not have a Chinese language interface or if their target population was not MSM. Basic information about the eligible apps for this study, such as app name, app store category, and date of last update was gathered from the specified app stores. The quality of apps was rated by 2 independent raters using Mobile App Rating Scale (MARS). The intraclass correlation coefficient (ICC) between raters was computed as a measure for interrater reliability of the MARS. All analyses were conducted using SPSS version 20.0 (SPSS Inc). RESULTS A total of 575 apps were reviewed between September 15, 2018 and September 30, 2018, out of which, 532 apps were excluded. Finally, 43 apps were included. Of the 43 apps, 16 were from the Apple Store, 10 were from Android Market, and 17 were available in both app stores. In addition, 39 out of 43 apps were for social and sexual networking, whereas 10 contained sexual health information, for example, HIV/sexually transmitted diseases knowledge, HIV test, and condom use. The average rating was 4 stars. The number of downloads for 21 apps exceeded 10,000. A total of 31 apps had acceptable quality (as defined by a MARS score of >3), with functionality as the highest scoring domain, followed by information quality, esthetics, and engagement. Interrater reliability was excellent for the overall mean app quality scores (ICC=.946; 95% CI 0.904-0.970) and the subjective quality scores (ICC=.910; 95% CI 0.841-0.950). CONCLUSIONS By reviewing the available apps, we found that MSM apps are popular. The majority of MSM apps are for dating, whereas few of them contain HIV prevention and health information. The overall quality of the apps is acceptable. The utilization of mobile phone technologies is a promising way for delivering HIV prevention messages to MSM. We recommend that researchers and app developers should work together to disseminate health information for MSM via mobile technologies.
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Affiliation(s)
- Guoli Yang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jian Long
- Department of Emergency, 3rd Xiangya Hospital, Central South University, Changsha, China
| | - Dan Luo
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Atipatsa Chiwanda Kaminga
- Department of Mathematics and Statistics, Mzuzu University, Mzuzu, Malawi.,Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
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19
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Wu D, Tang W, Lu H, Zhang TP, Cao B, Ong JJ, Lee A, Liu C, Huang W, Fu R, Li K, Pan SW, Zhang Y, Fu H, Wei C, Tucker JD. Leading by Example: Web-Based Sexual Health Influencers Among Men Who Have Sex With Men Have Higher HIV and Syphilis Testing Rates in China. J Med Internet Res 2019; 21:e10171. [PMID: 30664490 PMCID: PMC6360381 DOI: 10.2196/10171] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 01/14/2023] Open
Abstract
Background The spread of healthy behaviors through social networks may be accelerated by influential individuals. Previous studies have used lay health influencers to prevent sexually transmitted infections (STIs) among internet-using men who have sex with men (MSM). However, there is a lack of understanding of the characteristics of this key subset of MSM. Objective This study aimed to examine sociodemographic characteristics, HIV and syphilis testing, and sexual behaviors of Web-based MSM sexual health influencers (SHIs) in China, defined as individuals with relatively stronger influence on spreading HIV and STI information online. Methods A Web-based survey of MSM was conducted in August 2017 as a final follow-up of a randomized controlled trial promoting HIV testing in 8 Chinese cities. Men were recruited through a gay social networking mobile phone app and were included if they were born biologically male, aged 16 years and above, ever had sex with another man, and HIV negative or with unknown HIV status. Information regarding sociodemographic characteristics, sexual behaviors, and HIV and syphilis testing was obtained. We assessed men’s Web-based sexual health influence using a standardized 6-item opinion leadership scale focused on HIV and STI information. Influencers were defined as those whose mean score ranked within the top 13% (a higher score means greater influence). We used multivariable linear and logistic regression models to measure Web-based sexual health influence’s association with HIV and syphilis testing, controlling for intervention trial effects, age, education, income, and marital status. Results Overall, 1031 men completed the survey. Most men were younger than 30 years (819/1031, 79.43%) and had at least college education (667/1031, 64.69%). Influencers were more likely to get tested for HIV (73/132, 55.3% vs 337/899, 37.5%; P<.001) and syphilis (35/132, 26.5% vs 137/899, 15.2%; P=.001) in the last 3 months compared with noninfluencers. There were no significant differences in condomless sex with male partners (26/132, 19.7% vs 203/899, 22.6%; P=.46), mean number of male sex partners (1.32 vs 1.11; P=.16) in the last 3 months, and mainly meeting male sex partners online in the last 12 months (97/132, 73.5% vs 669/899, 74.4%; P=.82) between influencers and noninfluencers. Regression analyses showed that influencers had higher odds of HIV testing (adjusted odds ratio, AOR 2.16, 95% CI 1.48-3.17) and syphilis testing (AOR 1.99, 95% CI 1.28-3.10) in the last 3 months. Conclusions We identified Web-based SHIs who might be more likely to help promote healthy HIV and syphilis testing behaviors through MSM populations. Leveraging existing influencers may help improve HIV and syphilis testing among their networks.
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Affiliation(s)
- Dan Wu
- University North Carolina at Chapel Hill, Project-China, Guangzhou, China.,Social Entrepreneurship to Spur Health Global, Guangzhou, China.,Dermatology Hospital of Southern Medical University, Guangzhou, China.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Weiming Tang
- University North Carolina at Chapel Hill, Project-China, Guangzhou, China.,Social Entrepreneurship to Spur Health Global, Guangzhou, China.,Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Haidong Lu
- University North Carolina at Chapel Hill, Project-China, Guangzhou, China.,Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, United States
| | - Tiange P Zhang
- University North Carolina at Chapel Hill, Project-China, Guangzhou, China.,Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Bolin Cao
- School of Media and Communication, Shenzhen University, Shenzhen, China
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Central Clinical School, Monash University, Monash, Australia
| | - Amy Lee
- University North Carolina at Chapel Hill, Project-China, Guangzhou, China.,Social Entrepreneurship to Spur Health Global, Guangzhou, China
| | - Chuncheng Liu
- Department of Sociology, University of California, San Diego, CA, United States
| | - Wenting Huang
- University North Carolina at Chapel Hill, Project-China, Guangzhou, China.,Social Entrepreneurship to Spur Health Global, Guangzhou, China
| | - Rong Fu
- Social Entrepreneurship to Spur Health Global, Guangzhou, China
| | - Katherine Li
- Weill Cornell Medical College, New York, NY, United States
| | - Stephen W Pan
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Ye Zhang
- University North Carolina at Chapel Hill, Project-China, Guangzhou, China.,Social Entrepreneurship to Spur Health Global, Guangzhou, China.,Kirby Institute, University of New South Wales, Sydney, Australia
| | - Hongyun Fu
- Eastern Virginia Medical School, Norfolk, VA, United States
| | - Chongyi Wei
- Department of Social and Behavior Health Sciences, Rutgers School of Public Health, Piscataway, NJ, United States
| | - Joseph D Tucker
- University North Carolina at Chapel Hill, Project-China, Guangzhou, China.,Social Entrepreneurship to Spur Health Global, Guangzhou, China.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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20
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Zhang W, Wang P. Quality of life among men who have sex with men in China measured using the 36-item Short-Form Health Survey: A cross-sectional study. Medicine (Baltimore) 2018; 97:e11310. [PMID: 29979401 PMCID: PMC6076159 DOI: 10.1097/md.0000000000011310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The present study was conducted to assess the quality of life (QOL) of Chinese men who have sex with men (MSM) and to explore possible factors associated with QOL among them.A cross-sectional study of 370 MSM in Dalian and Huludao city was conducted to evaluate QOL in MSM using the Chinese version of the 36-item Short-Form Health Survey (SF-36). A t test was used to compare the QOL score of our sample with the Chinese norm. ANOVA, t test, and multivariate linear regression analysis were used to assess the association of QOL with basic characteristics.The QOL score of MSM was lower than the Chinese norm (P < .05). Multivariate analysis showed that marital status and monthly income were factors associated with physical component summary (PCS) and mental component summary (MCS) among MSM population (P < .05). Married MSM had poorer QOL, and respondents with higher income levels had better QOL.The government may need to develop more effective prevention strategies to improve the mental component of QOL in the Chinese MSM population, especially the married MSM population.
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21
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Yin L, Zhao Y, Peratikos MB, Song L, Zhang X, Xin R, Sun Z, Xu Y, Zhang L, Hu Y, Hao C, Ruan Y, Shao Y, Vermund SH, Qian HZ. Risk Prediction Score for HIV Infection: Development and Internal Validation with Cross-Sectional Data from Men Who Have Sex with Men in China. AIDS Behav 2018; 22:2267-2276. [PMID: 29786768 DOI: 10.1007/s10461-018-2129-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Receptive anal intercourse, multiple partners, condomless sex, sexually transmitted infections (STIs), and drug/alcohol addiction are familiar factors that correlate with increased human immunodeficiency virus (HIV) risk among men who have sex with men (MSM). To improve estimation to HIV acquisition, we created a composite score using questions from routine survey of 3588 MSM in Beijing, China. The HIV prevalence was 13.4%. A risk scoring tool using penalized maximum likelihood multivariable logistic regression modeling was developed, deploying backward step-down variable selection to obtain a reduced-form model. The full penalized model included 19 sexual predictors, while the reduced-form model had 12 predictors. Both models calibrated well; bootstrap-corrected c-indices were 0.70 (full model) and 0.71 (reduced-form model). Non-Beijing residence, short-term living in Beijing, illegal drug use, multiple male sexual partners, receptive anal sex, inconsistent condom use, alcohol consumption before sex, and syphilis infection were the strongest predictors of HIV infection. Discriminating higher-risk MSM for targeted HIV prevention programming using a validated risk score could improve the efficiency of resource deployment for educational and risk reduction programs. A valid risk score can also identify higher risk persons into prevention and vaccine clinical trials, which would improve trial cost-efficiency.
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Affiliation(s)
- Lu Yin
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuejuan Zhao
- Beijing Municipal Center for Disease Control and Prevention & Centers for Preventive Medical Research, Beijing, China
| | | | - Liang Song
- Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Xiangjun Zhang
- Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Ruolei Xin
- Beijing Municipal Center for Disease Control and Prevention & Centers for Preventive Medical Research, Beijing, China
| | - Zheya Sun
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunan Xu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Li Zhang
- Beijing Municipal Center for Disease Control and Prevention & Centers for Preventive Medical Research, Beijing, China
| | - Yifei Hu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Child, Adolescent Health and Maternal Health, School of Public Health, Capital Medical University, Beijing, China
| | - Chun Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.
- Yale School of Public Health, Yale University, New Haven, CT, USA.
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Yale School of Public Health, Yale University, New Haven, CT, USA
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22
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Liu J, Yi Z, Zhao Y, Qu B, Zhu Y. The psychological health and associated factors of men who have sex with men in China: A cross-sectional survey. PLoS One 2018; 13:e0197481. [PMID: 29813076 PMCID: PMC5973584 DOI: 10.1371/journal.pone.0197481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/03/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives The psychological health of men who have sex with men (MSM) has received increased attention in recent years. We thus investigated the psychological status and associated factors among MSM in China. Methods A cross-sectional survey of 248 MSM was conducted from April to September 2015 using Symptom Checklist 90 (SCL-90) in Huludao and Zhengzhou, China. Statistical analyses utilized SPSS version 19.0 for Windows. Results All Cronbach’s α coefficients of the SCL-90 subscales exceeded 0.7, suggesting acceptable reliability. The coefficient range of the collective validity for all the subscales was >0.4. For the divisional validity, each item correlated better with the hypothetical subscale than with other subscales. Collective validity and divisional validity were both acceptable. The four most frequent types of psychological distress among MSM were depression, obsessive-compulsive behavior, interpersonal sensitivity, and anxiety. Results of the univariate analysis revealed that the following groups had significantly higher SCL-90 scores (P < 0.05): peasantry, married MSM, respondents who reported condomless anal intercourse and a greater number of male partners, and respondents who had not undergone psychosocial counseling and whose family or friends did not know about their sexual identity. In a multivariate logistic regression model, the following parameters were independently associated with higher SCL-90 scores: being married (AOR [adjusted odds ratio] = 3.19; 95% CI [confidence interval]: 1.96 to 5.93), condomless anal intercourse (AOR = 1.16; 95% CI: 1.02 to 1.31), number of male partners (AOR = 1.66 and 1.81; 95% CI: 1.08 to 2.34 and 1.32 to 2.69), family or friends not knowing about sexual identity (AOR = 2.13; 95% CI: 1.17 to 4.92), and lack of psychosocial counseling (AOR = 2.09; 95% CI: 1.06 to 4.09). Conclusions Our results indicate that psychological health problems among MSM in China are of concern. It is thus necessary to strengthen intervention efforts, with more emphasis on intervention programs to improve psychological health among Chinese MSM.
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Affiliation(s)
- Jie Liu
- Department of Health Statistics, School of public health, China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Zhe Yi
- Department of Prothodontics, School of Stomatology, China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Yang Zhao
- Department of Health Statistics, School of public health, China Medical University, Shenyang, Liaoning Province, P.R. China
| | - Bo Qu
- Department of Health Statistics, School of public health, China Medical University, Shenyang, Liaoning Province, P.R. China
- * E-mail:
| | - Yaxin Zhu
- Department of Health Statistics, School of public health, China Medical University, Shenyang, Liaoning Province, P.R. China
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23
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Liu Y, Vermund SH, Ruan Y, Liu H, Rivet Amico K, Simoni JM, Shepherd BE, Shao Y, Qian H. Peer counselling versus standard-of-care on reducing high-risk behaviours among newly diagnosed HIV-positive men who have sex with men in Beijing, China: a randomized intervention study. J Int AIDS Soc 2018; 21:e25079. [PMID: 29430845 PMCID: PMC5808102 DOI: 10.1002/jia2.25079] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/29/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Reducing high-risk behaviours (i.e. multiple partnership, condomless anal/vaginal sex, alcohol use before sex, illicit drug use) after HIV diagnosis is critical for curtailing HIV transmission. We designed an intervention to explore peer- counselling in reducing high-risk behaviours among newly diagnosed HIV-positive Chinese men who have sex with men (MSM). METHODS We randomized 367 newly diagnosed HIV-positive men to either standard-of-care (SOC; n = 183) or peer-counselling intervention (n = 184), and followed them for 12 months (visit at 0-, 3-, 6-, 9- and 12-month). SOC participants received counselling on high-risk behaviour reduction by clinic staff. Intervention participants received both SOC and peer counselling. A generalized estimating equation was used to compare pre-post diagnosis high-risk behaviour change; logistic regression was used to assess the likelihood of practicing high-risk behaviours between intervention and SOC participants. Both intent-to-treat and per-protocol (full-dosage) approaches were used for the analyses. RESULTS For pre- and post-diagnosis comparisons, multiple partnership fell from 50% to 16% (p < 0.001), alcohol use before sex from 23% to 9% (p = 0.001), illicit drug use from 33% to 6% (p < 0.001), condomless anal sex from 47% to 4% (insertive from 23% to 2%; receptive from 36% to 3%; p < 0.001). In the intent-to-treat analysis accounting for repeated measures, peer counselling was more likely to reduce insertive anal sex (AOR = 0.65; 95% CI: 0.45 to 0.94), condomless anal sex (AOR = 0.27; 95% CI: 0.10 to 0.64) and illicit drug use (AOR = 0.32; 95% CI: 0.16 to 0.64). In the per-protocol analysis, peer counselling was associated with a lower likelihood of using illicit drug (OR = 0.23; 95% CI: 0.07 to 0.81) and having condomless vaginal sex with women (OR = 0.12; 95% CI: 0.07 to 0.98). CONCLUSIONS We observed a 14 to 43% decrease in the prevalence of selected high-risk behaviours after HIV diagnosis. Peer counselling had a greater impact in reducing condomless anal sex with men, illicit drug use and condomless vaginal sex with women over time. Future studies with exclusive peer-counselling arm are necessary to test its efficacy and effectiveness among Chinese MSM. Clinical Trial Number: NCT01904877.
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Affiliation(s)
- Yu Liu
- Department of Public Health SciencesUniversity of Rochester School of Medicine and DentistryRochesterNYUSA
| | | | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID)Collaborative Innovation Center for Diagnosis and Treatment of Infectious DiseasesChinese Center for Disease Control and PreventionBeijingChina
| | - Hongjie Liu
- Department of Epidemiology and BiostatisticsSchool of Public HealthUniversity of MarylandCollege ParkMDUSA
| | - K Rivet Amico
- Department of Health Behavior and Health EducationUniversity of MichiganAnn ArborMIUSA
| | - Jane M Simoni
- Department of PsychologyUniversity of Washington SeattleSeattleWAUSA
| | - Bryan E Shepherd
- Department of BiostatisticsVanderbilt University School of MedicineNashvilleTNUSA
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID)Collaborative Innovation Center for Diagnosis and Treatment of Infectious DiseasesChinese Center for Disease Control and PreventionBeijingChina
| | - Han‐Zhu Qian
- School of Public HealthYale UniversityNew HavenCTUSA
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24
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Frequent implementation of interventions may increase HIV infections among MSM in China. Sci Rep 2018; 8:451. [PMID: 29323225 PMCID: PMC5765000 DOI: 10.1038/s41598-017-18743-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/12/2017] [Indexed: 12/21/2022] Open
Abstract
Intervention measures among men who have sex with men (MSM) are usually designed to reduce the frequency of high risk behaviors (within-community level), but unfortunately may change the contact network and consequently increase the opportunity for them to have sex with new partners (between-community level). A multi-community periodic model on complex network is proposed to study the two-side effects of interventions on HIV transmission among MSM in China, in which the wanning process of the impacts of interventions are modelled. The basic reproduction number for the multi-community periodic system is defined and calculated numerically. Based on the number of annual reported HIV/AIDS cases among MSM in China, the unknown parameters are estimated by using MCMC method and the basic reproduction number is estimated as 3.56 (95%CI [3.556, 3.568]). Our results show that strong randomness of the community-connection networks leads to more new infections and more HIV/AIDS cases. Moreover, main conclusion indicates that implementation of interventions may induce more new infections, depending on relative level of between- and within-community impacts, and the frequency of implementation of interventions. The findings can help to guide the policy maker to choose the appropriate intervention measures, and to implement the interventions with proper frequency.
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25
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Tucker JD. Crowdsourcing to promote HIV testing among MSM in China: study protocol for a stepped wedge randomized controlled trial. Trials 2017; 18:447. [PMID: 28969702 PMCID: PMC5625620 DOI: 10.1186/s13063-017-2183-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 09/08/2017] [Indexed: 11/13/2022] Open
Abstract
Background HIV testing for marginalized populations is critical to controlling the HIV epidemic. However, the HIV testing rate among men who have sex with men (MSM) in China remains low. Crowdsourcing, the process of shifting individual tasks to a group, has been increasingly adopted in public health programs and may be a useful tool for spurring innovation in HIV testing campaigns. We designed a multi-site study to develop a crowdsourced HIV test promotion campaign and evaluate its effectiveness against conventional campaigns among MSM in China. Methods This study will use an adaptation of the stepped wedge, randomized controlled trial design. A total of eight major metropolitan cities in China will be randomized to sequentially initiate interventions at 3-month intervals. The intervention uses crowdsourcing at multiple steps to sustain crowd contribution. Approximately 1280 MSM, who are 16 years of age or over, live in the intervention city, have not been tested for HIV in the past 3 months, and are not living with HIV, will be recruited. Recruitment will take place through banner advertisements on a large gay dating app along with other social media platforms. Participants will complete one follow-up survey every 3 months for 12 months to evaluate their HIV testing uptake in the past 3 months and secondary outcomes including syphilis testing, sex without condoms, community engagement, testing stigma, and other related outcomes. Discussion MSM HIV testing rates remain poor in China. Innovative methods to promote HIV testing are urgently needed. With a large-scale, stepped wedge, randomized controlled trial our study can improve understanding of crowdsourcing’s long-term effectiveness in public health campaigns, expand HIV testing coverage among a key population, and inform intervention design in related public health fields. Trial Registration ClinicalTrials.gov, NCT02796963. Registered on 23 May 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2183-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Joseph D Tucker
- University of North Carolina Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095, China.
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Changing Epidemic of HIV and Syphilis Among Resident and Migrant Men Who Have Sex with Men in Jiangsu, China. Sci Rep 2017; 7:9478. [PMID: 28842553 PMCID: PMC5573352 DOI: 10.1038/s41598-017-08671-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 07/12/2017] [Indexed: 11/08/2022] Open
Abstract
Men who have sex with men (MSM) in China face high rates of HIV and syphilis infection exacerbated by internal migration. Studies on the differences of HIV and syphilis epidemics changing trends in high-risk behaviors and geographic distribution between resident and migrant MSM in Jiangsu, China were conducted. MSM were recruited from 14 surveillance sites in the serial cross-sectional study. Data on demographics, sexual behaviors, HIV and syphilis prevalence were collected. Participants were classified as residents or migrants based on household registration. During 2010–2014, 19,750 MSM were investigated. Engaged in anal sex (76.3% to 80.2%, P < 0.01) as well as received HIV-related services (72.1% to 79.2%, P < 0.01) were increasing. In contrast, engaged in commercial anal sex with males (7.4% to 5.0%, P < 0.01) and drug use (1.6% to 0.8%, P < 0.01) were decreasing. HIV prevalence ranged between 8.6% to 9.6%, while syphilis prevalence decreased over time (13.4–6.8%, P < 0.01). Further, we found that migrant MSM were more likely to engage in condomless anal sex, also had a higher HIV and syphilis prevalence than resident. During the study period, while syphilis prevalence decreased, higher rates of risk behaviors among migrant MSM called for targeted intervention strategies to reduce the HIV transmission.
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Community engagement in sexual health and uptake of HIV testing and syphilis testing among MSM in China: a cross-sectional online survey. J Int AIDS Soc 2017. [PMID: 28406270 PMCID: PMC5515028 DOI: 10.7448/ias.20.01/21372] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION HIV and syphilis testing rates remain low among men who have sex with men (MSM) in low- and middle-income countries (LMICs). Community engagement has been increasingly used to promote HIV testing among key populations in high-income countries, often in settings with stronger civil society. This study aimed to assess socio-demographic, behavioural, and community engagement factors associated with HIV and syphilis testing among MSM in China. METHODS MSM ≥16 years old who had condomless sex in the past three months were recruited nationwide to complete a cross-sectional online survey in November 2015. Data were collected on socio-demographics, sexual behaviours, HIV testing, syphilis testing, and community engagement in sexual health. We defined community engagement in sexual health using six items assessing awareness and advocacy of sexual health programmes. The underlying factor structure of a 6-item community engagement scale was determined through exploratory factor analysis. Univariate and multivariable logistic regressions identified correlates of HIV and syphilis testing. RESULTS 1189 MSM were recruited. 54% (647/1189) of men had ever tested for HIV and 30% (354/1189) had ever tested for syphilis. Factor analysis suggested three levels of community engagement (minimal, moderate, and substantial) and this model explained 79.5% of observed variance. A quarter (26%, 312/1189) reported none to minimal engagement, over one half (54%, 644/1189) reported moderate engagement, and a fifth (20%, 233/1189) reported substantial engagement. Multivariable logistic regression showed that MSM with greater community engagement in sexual health were more likely to have ever tested for HIV (substantial vs. no engagement: aOR 7.91, 95% CI 4.98-12.57) and for syphilis (substantial vs. no engagement: aOR 5.35, 95% CI 3.16-9.04). CONCLUSION HIV and syphilis testing are suboptimal among MSM in China. Community engagement may be useful for promoting testing in China and should be considered in intervention development and delivery. Further research is needed to better understand the role of LMIC community engagement in HIV interventions.
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Community engagement in sexual health and uptake of HIV testing and syphilis testing among MSM in China: a cross-sectional online survey. J Int AIDS Soc 2017; 20:21372. [PMID: 28406270 DOI: 10.7448/ias.20.01.21372] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION HIV and syphilis testing rates remain low among men who have sex with men (MSM) in low- and middle-income countries (LMICs). Community engagement has been increasingly used to promote HIV testing among key populations in high-income countries, often in settings with stronger civil society. This study aimed to assess socio-demographic, behavioural, and community engagement factors associated with HIV and syphilis testing among MSM in China. METHODS MSM ≥16 years old who had condomless sex in the past three months were recruited nationwide to complete a cross-sectional online survey in November 2015. Data were collected on socio-demographics, sexual behaviours, HIV testing, syphilis testing, and community engagement in sexual health. We defined community engagement in sexual health using six items assessing awareness and advocacy of sexual health programmes. The underlying factor structure of a 6-item community engagement scale was determined through exploratory factor analysis. Univariate and multivariable logistic regressions identified correlates of HIV and syphilis testing. RESULTS 1189 MSM were recruited. 54% (647/1189) of men had ever tested for HIV and 30% (354/1189) had ever tested for syphilis. Factor analysis suggested three levels of community engagement (minimal, moderate, and substantial) and this model explained 79.5% of observed variance. A quarter (26%, 312/1189) reported none to minimal engagement, over one half (54%, 644/1189) reported moderate engagement, and a fifth (20%, 233/1189) reported substantial engagement. Multivariable logistic regression showed that MSM with greater community engagement in sexual health were more likely to have ever tested for HIV (substantial vs. no engagement: aOR 7.91, 95% CI 4.98-12.57) and for syphilis (substantial vs. no engagement: aOR 5.35, 95% CI 3.16-9.04). CONCLUSION HIV and syphilis testing are suboptimal among MSM in China. Community engagement may be useful for promoting testing in China and should be considered in intervention development and delivery. Further research is needed to better understand the role of LMIC community engagement in HIV interventions.
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He H, Lv F, Zhang NN, Wu Z, Liao Q, Chang Z, Li Y, Xu H, OuYang L, Huan X, Yang J. Look into the HIV Epidemic of Gay Community with a Socio-Cultural Perspective: A Qualitative Study in China, 2015-2016. PLoS One 2017; 12:e0170457. [PMID: 28107523 PMCID: PMC5249147 DOI: 10.1371/journal.pone.0170457] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/05/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Current Chinese studies continue to view male homosexuality through a disease focused lens which pays limited attention to socio-cultural aspects of sexual behavior and HIV transmission. This qualitative study aimed to investigate how socio-cultural factors influence gay men's sexual beliefs and behaviors in contemporary China, and their implications for HIV epidemic. METHODS AND FINDINGS Qualitative methodology was used in this study. During 2015-2016, in-depth interviews were conducted with 61 self identified gay men in Jiangxi, Henan, Heilongjiang, Guangdong, Jiangsu provinces and Chongqing municipality of China. Our study revealed that: 1) influenced by Chinese traditional culture, gay men have conflicts on self-identity, which led to low self-acceptance and negative attitude on sex, and huge socio-psychological stress; 2) a generational differences within gay community was observed, reflected in varied sexual attitudes and practices as well as way for approaching new friends, both of which have implications and challenges on HIV control and prevention; 3) socio-cultural barriers, including open minds towards casual sex and nonmonogamous relationship, and low priority of health demands were widely observed and led to negative coping with AIDS among gay community. CONCLUSIONS It is essential to take a holistic view into gay men's HIV epidemic in China. Socio-cultural barriers for HIV control and prevention found in this study call for serious and imperative consideration on integrated measures, including targeted efforts towards effective sex education and further inclusion of socio-cultural perspectives in HIV/AIDS interventions for gay men.
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Affiliation(s)
- Huijing He
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fan Lv
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail:
| | - Nanci Nanyi Zhang
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zunyou Wu
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qinghua Liao
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Zhanjun Chang
- Zhengzhou Center for Disease Control and Prevention, Zhengzhou, Henan Province, China
| | - Yi Li
- Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, Heilongjiang Province, China
| | - Huifang Xu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong Province, China
| | - Lin OuYang
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Xiping Huan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China
| | - Juan Yang
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Zheng C, Xu JJ, Hu QH, Yu YQ, Chu ZX, Zhang J, Han XX, Lu L, Wang Z, Fu JH, Chen X, Yan HJ, Jiang YJ, Geng WQ, Vermund SH, Qian HZ, Shang H. Commercial sex and risk of HIV, syphilis, and herpes simplex virus-2 among men who have sex with men in six Chinese cities. BMC Infect Dis 2016; 16:765. [PMID: 28003032 PMCID: PMC5178086 DOI: 10.1186/s12879-016-2130-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 10/15/2016] [Indexed: 11/25/2022] Open
Abstract
Background Men who have sex with men (MSM) are at high risk of HIV and sexually transmitted infections (STIs) in China and globally. Engaging in commercial sex put them at even greater risk. This study estimated the prevalence of HIV/STIs among three subgroups of MSM: MSM who sold sex (MSM-selling), MSM who bought sex (MSM-buying), and non-commercial MSM (NC-MSM) and evaluated the relationship between commercial sex and HIV/STIs. Methods We conducted a cross-sectional survey among MSM in six Chinese cities (Shenyang, Ji’nan, Changsha, Zhengzhou, Nanjing, and Kunming) from 2012 to 2013. Data on socio-demographics and sexual behaviors were collected. Serological tests were conducted to detect HIV, syphilis, and human simplex virus type 2 (HSV-2). Results Of 3717 MSM, 6.8% were engaged in commercial sex. The overall prevalence of HIV, syphilis and HSV-2 infections was 11.1, 8.8 and 12.1%, respectively. MSM-selling had higher prevalence of HIV (13.4%), syphilis (12.1%) and HSV-2 (17.9%) than NC-MSM (10.9, 8.7 and 11.9% for HIV, syphilis and HSV-2, respectively), though the differences are not statistically significant. Among MSM-selling, HIV prevalence was significantly higher for those who found sex partners via Internet than those did not (19.4% vs. 8.1%, P = 0.04). Compared to NC-MSM, MSM-selling were more likely to use recreation drugs (59.3% vs. 26.3%), have unprotected anal intercourse (77.9% vs. 61.7%), and have ≥10 male sex partners (46.2% vs. 6.2%) in the past 6 months (each P < 0.05). Conclusions All three subgroups of MSM in six large Chinese cities have high prevalence of HIV/STIs. Those who sell sex only have a particularly high risk of acquiring and transmitting disease, and therefore, they should be considered as a priority group in HIV/STIs surveillance and intervention programs. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2130-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cunge Zheng
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jun-Jie Xu
- Department of Laboratory Medicine, Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Qing-Hai Hu
- Department of Laboratory Medicine, Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yan-Qiu Yu
- Department of Laboratory Medicine, Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zhen-Xing Chu
- Department of Laboratory Medicine, Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Jing Zhang
- Department of Laboratory Medicine, Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xiao-Xu Han
- Department of Laboratory Medicine, Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Lin Lu
- Yunnan Provincial Centers for Disease Control and Prevention, Kunming, Yunnan, China
| | - Zhe Wang
- Henan Provincial Centers for Disease Control and Prevention, Zhengzhou, Henan, China
| | - Ji-Hua Fu
- Shandong Provincial Centers for Disease Control and Prevention, Ji'nan, Shandong, China
| | - Xi Chen
- Hunan Provincial Centers for Disease Control and Prevention, Changsha, Hunan, China
| | - Hong-Jing Yan
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Yong-Jun Jiang
- Department of Laboratory Medicine, Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Wen-Qing Geng
- Department of Laboratory Medicine, Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.,Departments of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA. .,Department of Laboratory Medicine, Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China. .,Division of Epidemiology, Departments of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Hong Shang
- Department of Laboratory Medicine, Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, The First Affiliated Hospital, China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
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Zhang C, Qian HZ, Yin L, Liu Y, Strauss SM, Ruan Y, Shao Y, Lu H, Vermund SH. Sexual Behaviors Linked to Drug and Alcohol Use Among Men Who Have Sex With Men in China. Subst Use Misuse 2016; 51:1821-30. [PMID: 27608264 PMCID: PMC5423713 DOI: 10.1080/10826084.2016.1197264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND High-risk sexual behaviors drive the HIV epidemic among men who have sex with men (MSM). Alcohol consumption and use of club drugs may increase sexual risk behaviors. We evaluated effects of drug and alcohol use on sexual behaviors with both their male and female partners as well as on HIV and syphilis infections among MSM in China. METHODS As the part of a community randomized clinical trial that conducted among MSM in Beijing from 2013 to 2015, we recruited a total of 3,680 participants cross-sectionally. A self-administered questionnaire was employed to collect information regarding demographics, sexual behaviors, and a history of alcohol and drug use. Blood sample was collected for HIV and syphilis testing. RESULTS A total of 3,588 MSM completed the survey and were included in the data analysis. The mean age was 29.9 with 97.3% of Han-ethnicity and 85.0% unmarried. The HIV and syphilis prevalence was 12.7% and 7.4%, respectively. Drug use was significantly associated with higher odds of HIV infection (aOR = 1.3, 95% Confidence Interval [CI] = 1.0,1.6), but not associated with syphilis. A higher level of alcohol consumption was similarly associated with higher odds of HIV risks with both male (e.g., condomless sex acts) and female partners (e.g., numbers of sexual partners). CONCLUSION The association between drug and alcohol use and high-risk behaviors is notable among MSM in China. Integrated HIV interventions that target substance use among MSM may be more effective than programs that only target HIV alone.
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Affiliation(s)
- Chen Zhang
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Han-Zhu Qian
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA.,b Division of Epidemiology , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Lu Yin
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Yu Liu
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Shiela M Strauss
- c College of Nursing , New York University , New York , New York , USA
| | - Yuhua Ruan
- d State Key Laboratory of Infectious Disease Prevention and Control (SKLID) , Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Beijing , China
| | - Yiming Shao
- d State Key Laboratory of Infectious Disease Prevention and Control (SKLID) , Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Beijing , China
| | - Hongyan Lu
- e Beijing Center for Disease Control and Prevention , Beijing , China
| | - Sten H Vermund
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA.,f Department of Pediatrics , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
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Hidru TH, Wang F, Lolokote S, Jia Y, Chen M, Tong W, Li XF. Associated factors of self-reported psychopathology and health related quality of life among men who have sex with men (MSM) with HIV/AIDS in Dalian, China: a pilot study. Infect Dis Poverty 2016; 5:108. [PMID: 27903303 PMCID: PMC5131411 DOI: 10.1186/s40249-016-0204-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 10/24/2016] [Indexed: 01/25/2023] Open
Abstract
Background Despite the availability of Anti-Retroviral Therapy (ART), the health-related quality of life (HRQoL) among HIV-positive men who have sex with men (HIVMSM) in China remains poor. This study aimed to explore the relationship between self-reported psychopathology and HRQoL among HIVMSM in Dalian, China. Methods A cross-sectional study was conducted in 112 HIVMSM. Symptom check list 90 (SCL 90): a measure of psychopathology and World Health Organization quality of life in HIV infection (WHOQOL-HIV-Bref): a measure of HRQoL were used. Correlation and multiple regression analysis were employed to explore the association between self-reported psychopathology and HRQoL in HIVMSM. Results Out of the total 112 HIVMSM cases, 9 (8 %) cases were homosexuals and 103 (92 %) ones were bisexuals. The participants who had low family income (P = 0.001), perceived discrimination (P = 0.001) and lack of regular attendance in medical follow-ups (P = 0.014) reported poorer HRQoL than their counterparts. Somatization, obsession, depression, phobia and overall SCL 90 scores in self-reported psycholpathology had a negative impact on the domains of HRQoL among HIVMSM. Conclusions Total quality of life was predicted by family income, perceived discrimination, and medical follow-up attendance. Self-reported psychopathology was negatively correlated with HRQoL in HIVMSM. The Strategies that target MSM focusing on linking and engaging HIV-positive patients in medical care is the key step to improve their HRQoL. More emphasis is needed on the newly diagnosed HIVMSM in Dalian in order to develop a more targeted intervention to prevent perceived discrimination and lack of proper medical follow-up services. Trial registration The trial registration number does not require for this manuscript. The study is cross-sectional design that do not involve intervention at all, it is not a clinical trial. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0204-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tesfaldet Habtemariam Hidru
- Department of Epidemiology and Biostatistics, Dalian Medical University, Dalian, Liaoning, 116044, People's Republic of China
| | - Feng Wang
- Department of Epidemiology and Biostatistics, Dalian Medical University, Dalian, Liaoning, 116044, People's Republic of China
| | - Sainyugu Lolokote
- Department of Epidemiology and Biostatistics, Dalian Medical University, Dalian, Liaoning, 116044, People's Republic of China
| | - Yong Jia
- School of Public Health, Dalian Medical University, Dalian, Liaoning, 116044, People's Republic of China
| | - Min Chen
- School of Public Health, Dalian Medical University, Dalian, Liaoning, 116044, People's Republic of China
| | - Wei Tong
- Department of HIV/AIDS, Dalian Center for Disease Control and Prevention, Dalian, 116023, Liaoning, People's Republic of China
| | - Xiao-Feng Li
- Department of Epidemiology and Biostatistics, Dalian Medical University, Dalian, Liaoning, 116044, People's Republic of China.
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Zang X, Tang H, Min JE, Gu D, Montaner JSG, Wu Z, Nosyk B. Cost-Effectiveness of the 'One4All' HIV Linkage Intervention in Guangxi Zhuang Autonomous Region, China. PLoS One 2016; 11:e0167308. [PMID: 27893864 PMCID: PMC5125690 DOI: 10.1371/journal.pone.0167308] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/13/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In Guangxi Zhuang Autonomous Region, China, an estimated 80% of newly-identified antiretroviral therapy (ART)-eligible patients are not engaged in ART. Delayed ART uptake ultimately translates into high rates of HIV morbidity, mortality, and transmission. To enhance HIV testing receipt and subsequent treatment uptake in Guangxi, the Chinese Center for Disease Control and Prevention (CDC) executed a cluster-randomized trial to assess the effectiveness and cost-effectiveness of a streamlined HIV testing algorithm (the One4All intervention) in 12 county-level hospitals. OBJECTIVE To determine the incremental cost-effectiveness of the One4All intervention delivered at county hospitals in Guangxi, China, compared to the current standard of care (SOC). PERSPECTIVE Health System. TIME HORIZON 1-, 5-and 25-years. METHODS We adapted a dynamic, compartmental HIV transmission model to simulate HIV transmission and progression in Guangxi, China and identify the economic impact and health benefits of implementing the One4All intervention in all Guangxi hospitals. The One4All intervention algorithm entails rapid point-of-care HIV screening, CD4 and viral load testing of individuals presenting for HIV screening, with same-day results and linkage to counselling. We populated the model with data from the One4All trial (CTN-0056), China CDC HIV registry and published reports. Model outcomes were HIV incidence, mortality, costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) of the One4All intervention compared to SOC. RESULTS The One4All testing intervention was more costly than SOC (CNY 2,182 vs. CNY 846), but facilitated earlier ART access, resulting in delayed disease progression and mortality. Over a 25-year time horizon, we estimated that introducing One4All in Guangxi would result in 802 averted HIV cases and 1629 averted deaths at an ICER of CNY 11,678 per QALY gained. Sensitivity analysis revealed that One4All remained cost-effective at even minimal levels of effectiveness. Results were robust to changes to a range of parameters characterizing the HIV epidemic over time. CONCLUSIONS The One4All HIV testing strategy was highly cost-effective by WHO standards, and should be prioritized for widespread implementation in Guangxi, China. Integrating the intervention within a broader combination prevention strategy would enhance the public health response to HIV/AIDS in Guangxi.
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Affiliation(s)
- Xiao Zang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Houlin Tang
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jeong Eun Min
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Diane Gu
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Julio S. G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zunyou Wu
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- * E-mail:
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Sargin F, Goktas S. HIV prevalence among men who have sex with men in Istanbul. Int J Infect Dis 2016; 54:58-61. [PMID: 27894981 DOI: 10.1016/j.ijid.2016.11.406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/12/2016] [Accepted: 11/20/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The re-emergence of the HIV epidemic among men who have sex with men (MSM) represents a serious health issue. This study aimed to assess the HIV prevalence among MSM in a very low prevalence population of a large city. METHODS A public campaign to raise awareness of HIV infection and to provide access to anonymous testing was conducted in places frequented by MSM and through a mobile phone application. No identity information was requested from individuals contacting the call centre, and anonymous and free HIV testing was offered proactively. Those who agreed to have a test were provided a code number, which was used in blood sampling procedures. RESULTS Of 1200 subjects who contacted the call centre, 197 consented to undergo HIV testing and visited the laboratory to give a blood sample. Twenty-five subjects were found to have a reactive ELISA result on two different occasions plus a positive Western blot test result. Thus, the HIV prevalence in this group of MSM was 12.7%. CONCLUSIONS MSM remain a high risk group for HIV infection in a low prevalence setting, and thus represent a key target population for diagnostic and therapeutic interventions.
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Affiliation(s)
- Fatma Sargin
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.
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Yi S, Tuot S, Chhoun P, Pal K, Ngin C, Choub SC, Brody C. Improving prevention and care for HIV and sexually transmitted infections among men who have sex with men in Cambodia: the sustainable action against HIV and AIDS in communities (SAHACOM). BMC Health Serv Res 2016; 16:599. [PMID: 27769237 PMCID: PMC5073448 DOI: 10.1186/s12913-016-1857-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of HIV and sexually transmitted infections (STIs) among key populations in Cambodia continues to rise. To address this issue, KHANA, the largest national HIV organization in the country developed and implemented the Sustainable Action against HIV and AIDS in Communities (SAHACOM) project. This study aims to determine the impacts of the SAHACOM on sexual behaviors and the uptake of HIV/STI services among men who have sex with men (MSM) in Cambodia. METHODS We compared outcome indicators at midterm (n = 352) and endline (n = 394). Surveys were conducted in 2012 and 2014 in Battambang and Siem Reap provinces. A two-stage cluster sampling method was employed to select the study sample for structured interviews. RESULTS The midterm and endline samples were similar. The average number of sexual partners in the past three months decreased significantly from 6.2 to 4.0 (p = 0.03). The proportion of MSM who reported paying for sex with men in the past three months also decreased significantly from 19.0 % to 9.7 % (OR = 2.0, 95 % CI = 1.3-3.0). No significant change was found in condom and lubricant use in all types of relationships. Regarding STIs, 28.1 % of MSM at midterm reported having at least one STI symptom in the past three months compared to 6.1 % at endline (OR = 4.6, 95 % CI = 2.9-7.4); out of them, 14.1 % of MSM at midterm sought treatment compared to 20.7 % at endline (OR = 2.6, 95 % CI = 1.1-6.9). The proportion of MSM who reported using illicit drugs in the past three months also decreased significantly from 12.2 % to 5.1 % (OR = 2.4, 95 % CI = 1.4-4.2). However, the proportion of MSM who reported having been tested for HIV in the past six months decreased significantly from 94.1 % to 77.1 % (OR = 2.9, 95 % CI = 1.8-3.6). CONCLUSIONS Findings from this study indicate that the SAHACOM was effective in improving sexual behaviors and related health outcomes among MSM under the project. However, it could not increase condom use and HIV testing rates among this key population. Tailored intervention programs are needed to improve condom use and HIV testing among MSM in Cambodia.
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Affiliation(s)
- Siyan Yi
- KHANA Center Population Health Research, No. 33, Street 71, Tonle Bassac, Chamkar Mon, Phnom Penh, Cambodia
- Center for Global Health Research, Public Health Program, Touro University California, 1310, Club Drive, Vallejo, CA94592 USA
| | - Sovannary Tuot
- KHANA Center Population Health Research, No. 33, Street 71, Tonle Bassac, Chamkar Mon, Phnom Penh, Cambodia
| | - Pheak Chhoun
- KHANA Center Population Health Research, No. 33, Street 71, Tonle Bassac, Chamkar Mon, Phnom Penh, Cambodia
| | - Khuondyla Pal
- KHANA Center Population Health Research, No. 33, Street 71, Tonle Bassac, Chamkar Mon, Phnom Penh, Cambodia
| | - Chanrith Ngin
- KHANA Center Population Health Research, No. 33, Street 71, Tonle Bassac, Chamkar Mon, Phnom Penh, Cambodia
| | - Sok Chamreun Choub
- KHANA Center Population Health Research, No. 33, Street 71, Tonle Bassac, Chamkar Mon, Phnom Penh, Cambodia
| | - Carinne Brody
- Center for Global Health Research, Public Health Program, Touro University California, 1310, Club Drive, Vallejo, CA94592 USA
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Li X, Li W, Zhong P, Fang K, Zhu K, Musa TH, Song Y, Du G, Gao R, Guo Y, Yan W, Xuan Y, Wei P. Nationwide Trends in Molecular Epidemiology of HIV-1 in China. AIDS Res Hum Retroviruses 2016; 32:851-9. [PMID: 27080587 DOI: 10.1089/aid.2016.0029] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To estimate the nationwide and regional distribution of HIV-1 genotypes in China in the past three decades, province-specific HIV-1 molecular epidemiology data were derived from 260 independent studies of HIV molecular prevalence through searching PubMed, VIP Chinese Journal Database (VIP), China National Knowledge Infrastructure, and Wanfang Data from January 1981 to December 2015. The nationwide and regional distribution of HIV-1 genotypes was estimated by weighting the genotype distribution from each province- and risk-specific subpopulation with the number of reported cases in the corresponding subgroups in the relevant periods. A sharp transition of HIV-1 subtypes and recombinant distribution was observed in various risk groups and regions over time. CRF01_AE has rapidly surged among almost all risk groups and in all areas, and it has become dominant among men who have sex with men and heterosexuals. A wide variety of new circulating recombinant forms (CRFs) and unique recombinant forms (URFs) were rapidly appearing in several risk groups and regions. After 2007, CRF01_AE was the most prevalent strain, accounting for 42.5% of all national infections, followed by CRF07_BC (28.9%), subtype B'/B (10.9%), CRF08_BC (10.0%), and subtype C (2.8%). URFs and other CRFs were responsible for 2.6% and fewer than 1% of infections nationwide, respectively. The nationwide and regional distributions of HIV-1 subtypes and recombinants were sharply shifting in China. CRF01_AE and new CRFs played an increasing role in the nationwide or regional HIV pandemic. The nationwide diversity of HIV-1 poses a formidable challenge to HIV vaccine development and disease prevention.
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Affiliation(s)
- Xiaoshan Li
- Teaching and Research Office of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Wei Li
- Department of Infectious Disease Prevention and School Health, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Ping Zhong
- Department of AIDS and STD, Shanghai Municipal Center for Disease Control and Prevention, Shanghai Municipal Institutes for Preventive Medicine, Shanghai, China
| | - Kun Fang
- Teaching and Research Office of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Kexin Zhu
- School of Public Health, Nantong University, Nantong, China
| | - Taha Hussein Musa
- Teaching and Research Office of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Yue Song
- Teaching and Research Office of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Guoping Du
- Teaching and Research Office of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Rong Gao
- Teaching and Research Office of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Yan Guo
- Teaching and Research Office of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Wenjuan Yan
- Teaching and Research Office of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Yang Xuan
- Teaching and Research Office of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Pingmin Wei
- Teaching and Research Office of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
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Chen J, Li X, Xiong Y, Fennie KP, Wang H, Williams AB. Reducing the risk of HIV transmission among men who have sex with men: A feasibility study of the motivational interviewing counseling method. Nurs Health Sci 2016; 18:400-7. [PMID: 27291137 DOI: 10.1111/nhs.12287] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 11/27/2022]
Abstract
HIV prevalence among Chinese men who have sex with men has rapidly increased in recent years. In this randomized, controlled study, we tested the feasibility and efficacy of motivational interviewing to reduce high-risk sexual behaviors among this population in Changsha, China. Eighty men who have sex with men were randomly assigned to either the intervention group, in which participants received a three-session motivational interviewing intervention over 4 weeks, or the control group, in which participants received usual counseling from peer educators. High-risk behavior indicators and HIV knowledge level were evaluated at baseline and 3 months after the intervention. Motivational interviewing significantly improved consistent anal condom use. However, there was no significant change in consistent condom use for oral sex or in the number of sexual partners over time. HIV knowledge scores improved equally in both groups. This study demonstrated that an intervention using motivational interviewing is feasible and results in increased condom use during anal sex for Chinese men who have sex with men. However, further work must be done to increase the use of condoms during oral sexual encounters.
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Affiliation(s)
- Jia Chen
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Xianhong Li
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Yang Xiong
- Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Kristopher P Fennie
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Honghong Wang
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
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Sargin F, Yildiz D, Aydin OA, Mete B, Gunduz A, Karaosmanoglu HK, Yemisen M, Yazici S, Bolukcu S, Durdu B, Senates E, Ozaras R, Dokmetas I, Tabak F. Changes in HIV demographic patterns in a low prevalence population: no evidence of a shift towards men who have sex with men. Int J Infect Dis 2016; 48:52-6. [PMID: 27173075 DOI: 10.1016/j.ijid.2016.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aimed to examine the changes in HIV demographics over time in an exceptionally low prevalence population, with particular emphasis on men who have sex with men (MSM). METHODS A total of 1292 newly diagnosed HIV-positive patients registered in the ACTHIV-IST Study Group database between 2000 and 2014 were included. The changes occurring over time in the characteristics of patients at the time of initial admission were examined retrospectively. RESULTS A gradual increase in the total number of newly diagnosed patients was evident during the study period; however, it was not possible to show an increase in the proportion of MSM within the study population (p=0.63). There was a male predominance throughout the study (85% vs. 15%), with further increases in the proportion of males in recent years. The mean age was lower at the end of the study (p<0.05) and there was an increase in the number of unmarried patients (p<0.05). CONCLUSIONS Sexual preference patterns of HIV patients in extremely low prevalence populations may be different, possibly due to an early phase of the epidemic. Nevertheless, MSM still represent a target subgroup for interventions, since they account for a substantial proportion of cases and a resurgent epidemic may be expected among this group in later phases of the epidemic.
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Affiliation(s)
- Fatma Sargin
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.
| | - Dilek Yildiz
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ozlem Altuntas Aydin
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Bilgul Mete
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - Alper Gunduz
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Hayat Kumbasar Karaosmanoglu
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Mucahit Yemisen
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - Saadet Yazici
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Sibel Bolukcu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Bulent Durdu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ebubekir Senates
- Department of Gastroenterology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Resat Ozaras
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - Ilyas Dokmetas
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
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Mi G, Ma B, Kleinman N, Li Z, Fuller S, Bulterys M, Hladik W, Wu Z. Hidden and Mobile: A Web-based Study of Migration Patterns of Men Who Have Sex With Men in China. Clin Infect Dis 2016; 62:1443-7. [PMID: 27129466 DOI: 10.1093/cid/ciw167] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 01/11/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are highly vulnerable to human immunodeficiency virus (HIV) infection and more likely to migrate due to widespread stigma and discrimination in China. Their mobility complicates estimation of local MSM population sizes and the provision of HIV services, and may also contribute to the spread of HIV. METHODS Between 1 January 2008 and 31 December 2012, the visits of all individuals to the largest Chinese MSM dating website were recorded. After a predesigned de-identification procedure by the website, we analyzed Internet Protocol addresses for migration patterns. Migrants were defined as individuals who were away from their registered residence for >6 months in the last 12 months. RESULTS The website contained data on 794 912 MSM eligible for the study, of which 34.5% were migrants. The median age was 26 years (range, 18-61 years), and 85.5% were unmarried. Compared with nonmigrant MSM, migrants were less likely to be married to a woman (8.6% vs 13.5%; P < .001). The 5 provinces with the highest migrant inflow ratios were Guangdong, Shanghai, Beijing, Tianjin, and Zhejiang. Eastern coastal cities were the primary destination of MSM from southwestern China. CONCLUSIONS Preferential MSM migration may influence MSM population sizes in both originating and destination provinces, particularly for provinces with uneven inflow and outflow. MSM migration from southwestern China, which has the highest HIV prevalence in this population, to coastal cities with lower prevalence may have implications for the spread of the HIV epidemic as well as HIV care services.
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Affiliation(s)
- Guodong Mi
- Global AIDS Program, China Office, US Centers for Disease Control and Prevention (CDC) National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention
| | | | - Nora Kleinman
- Global AIDS Program, China Office, US Centers for Disease Control and Prevention (CDC) Association of Schools of Public Health, Washington D.C
| | - Zhijun Li
- Global AIDS Program, China Office, US Centers for Disease Control and Prevention (CDC)
| | - Serena Fuller
- Global AIDS Program, China Office, US Centers for Disease Control and Prevention (CDC) Association of Schools of Public Health, Washington D.C
| | - Marc Bulterys
- Global AIDS Program, China Office, US Centers for Disease Control and Prevention (CDC) Naval Health Research Center, San Diego, California
| | - Wolfgang Hladik
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention
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Estimating HIV incidence among key affected populations in China from serial cross-sectional surveys in 2010-2014. J Int AIDS Soc 2016; 19:20609. [PMID: 26989062 PMCID: PMC4796775 DOI: 10.7448/ias.19.1.20609] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 11/13/2015] [Accepted: 02/05/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction HIV incidence is an important measure for monitoring the development of the epidemic, but it is difficult to ascertain. We combined serial HIV prevalence and mortality data to estimate HIV incidence among key affected populations (KAPs) in China. Methods Serial cross-sectional surveys were conducted among KAPs from 2010 to 2014. Trends in HIV prevalence were assessed by the Cochran-Armitage test, adjusted by risk group. HIV incidence was estimated from a mathematical model that describes the relationship between changes in HIV incidence with HIV prevalence and mortality. Results The crude HIV prevalence for the survey samples remained stable at 1.1 to 1.2% from 2010 to 2014. Among drug users (DUs), HIV prevalence declined from 4.48 to 3.29% (p<0.0001), and among men who have sex with men (MSM), HIV prevalence increased from 5.73 to 7.75% (p<0.0001). Changes in HIV prevalence among female sex workers (FSWs) and male patients of sexually transmitted disease clinics were more modest but remained statistically significant (all p<0.0001). The MSM population had the highest incidence estimates at 0.74% in 2011, 0.59% in 2012, 0.57% in 2013 and 0.53% in 2014. Estimates of the annual incidence for DUs and FSWs were very low and may not be reliable. Conclusions Serial cross-sectional prevalence data from representative samples may be another approach to construct approximate estimates of national HIV incidence among key populations. We observed that the MSM population had the highest incidence for HIV among high-risk groups in China, and we suggest that interventions targeting MSM are urgently needed to curb the growing HIV epidemic.
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Fan W, Lu R, Wu G, Yousuf MA, Feng L, Li X, Xiao Y, Shao Y, Ruan Y. Alcohol drinking and HIV-related risk among men who have sex with men in Chongqing, China. Alcohol 2016; 50:1-7. [PMID: 26632032 DOI: 10.1016/j.alcohol.2015.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 09/23/2015] [Accepted: 09/23/2015] [Indexed: 12/28/2022]
Abstract
To estimate the prevalence of any alcohol use and heavy alcohol drinking using the Alcohol Use Disorders Identification Test (AUDIT) and its correlates among men who have sex with men (MSM), a cross-sectional study was conducted among 391 MSM in Chongqing, China to collect data about sociodemographic characteristics, alcohol use, sexual behaviors, and other related factors through a computer-assisted self-administered questionnaire. Heavy alcohol drinking in the past 12 months was defined as an AUDIT-C score ≥ 4. Blood was collected from each potential participant to test for HIV and syphilis status. Twenty three percent of MSM had consumed a drink containing alcohol in the previous year. 7.2% had an AUDIT-C score ≥ 4, defined as heavy alcohol drinkers. 23.5% were unmarried, but planning to marry, who were more likely to report any alcohol drinking (adjusted odds ratio [AOR], 2.38; 95% confidence interval [CI], 1.40-4.06) and to have AUDIT-C scores ≥ 4 (AOR, 3.58; 95% CI, 1.60-8.00). MSM who had used any alcohol in the previous year, and MSM who were heavy alcohol drinkers, were more likely to have had anal sex with male casual partners in the previous 6 months, to have been tested for HIV, and to have decreased scores on the scales of general self-efficacy, increased scores on the scales of stigma and discrimination. Our findings provided further evidence of the associations of any alcohol use and heavy alcohol consumption with HIV-risky behaviors, lowered sense of general self-efficacy, and higher sense of HIV/AIDS-related stigma and discrimination among MSM in the city with the highest HIV epidemic among MSM in China.
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Affiliation(s)
- Wensheng Fan
- Department of Public Health, Western Kentucky University, Bowling Green, KY 42101, USA
| | - Rongrong Lu
- Chongqing Center for Disease Control and Prevention, Chongqing, PR China
| | - Guohui Wu
- Chongqing Center for Disease Control and Prevention, Chongqing, PR China
| | - Mohammed Adnan Yousuf
- Department of Public Health, Western Kentucky University, Bowling Green, KY 42101, USA
| | - Liangui Feng
- Chongqing Center for Disease Control and Prevention, Chongqing, PR China
| | - Xuefeng Li
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, PR China; Karamay Center for Disease Control and Prevention, Karamay, PR China
| | - Yan Xiao
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, PR China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, PR China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, PR China.
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Phanuphak N, Lo YR, Shao Y, Solomon SS, O'Connell RJ, Tovanabutra S, Chang D, Kim JH, Excler JL. HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials. AIDS Res Hum Retroviruses 2015; 31:1060-76. [PMID: 26107771 DOI: 10.1089/aid.2015.0049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process.
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Affiliation(s)
| | - Ying-Ru Lo
- HIV, Hepatitis, and STI Unit, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Yiming Shao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sunil Suhas Solomon
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | - Robert J. O'Connell
- Department of Retrovirology, U.S. Army Medical Component, Armed Forces Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Sodsai Tovanabutra
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - David Chang
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jerome H. Kim
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jean Louis Excler
- U.S. Military HIV Research Program, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
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Liu G, Lu H, Wang J, Xia D, Sun Y, Mi G, Wang L. Incidence of HIV and Syphilis among Men Who Have Sex with Men (MSM) in Beijing: An Open Cohort Study. PLoS One 2015; 10:e0138232. [PMID: 26426271 PMCID: PMC4591335 DOI: 10.1371/journal.pone.0138232] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 08/26/2015] [Indexed: 12/31/2022] Open
Abstract
Background This study investigated HIV and syphilis incidence among men who have sex with men (MSM) in Beijing, China. Methods An open cohort was established from September 2009 to April 2012. Participants were followed up with every three to four months after recruitment and for thirty-one months in total. Chi-square tests were used to compare demographic and behavioral characteristics between participants who were followed up with and those lost to follow up. Univariate and multivariate Cox proportional hazards regression analyses were used to examine demographic and behavioral associations with HIV and syphilis incidence. Results 69.7% (699/1,003) of the participants finished at least two follow-up surveys during the study period. Variables which corresponded to increased loss to follow-up included younger age, less education, non-identification of homosexual identity, and migrant status. A total of 1,045 person-years (PYs) and 1,016.4 PYs were followed up for HIV and syphilis incidence estimation, respectively. The HIV incidence was 5.9 per 100 PYs and 7.8 per 100 PYs for syphilis. The predictors for the high HIV incidence included unsafe anal sex, sex after drinking alcohol and STI infection. Conclusion HIV incidence increased rapidly within the cohort, but syphilis incidence remained stable and decreased. More research is needed to provide multi-pronged HIV prevention interventions among MSM in order to reduce the increasing burden of HIV and sexually transmitted infections (STIs) in China.
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Affiliation(s)
- Guowu Liu
- Beijing Municipality Center for Disease Control and Prevention, Beijing, China
| | - Hongyan Lu
- Beijing Municipality Center for Disease Control and Prevention, Beijing, China
| | - Juan Wang
- Beijing Municipality Center for Disease Control and Prevention, Beijing, China
| | - Dongyan Xia
- Beijing Municipality Center for Disease Control and Prevention, Beijing, China
| | - Yanming Sun
- Beijing Municipality Center for Disease Control and Prevention, Beijing, China
| | - Guodong Mi
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (GDM); (LMW)
| | - Liming Wang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
- * E-mail: (GDM); (LMW)
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Liu Y, Sun X, Qian HZ, Yin L, Yan Z, Wang L, Jiang S, Lu H, Ruan Y, Shao Y, Vermund SH, Amico KR. Qualitative Assessment of Barriers and Facilitators of Access to HIV Testing Among Men Who Have Sex with Men in China. AIDS Patient Care STDS 2015; 29:481-9. [PMID: 26186029 DOI: 10.1089/apc.2015.0083] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Diagnosis of HIV is the entry point into the continuum of HIV care; a well-recognized necessary condition for the ultimate prevention of onward transmission. In China, HIV testing rates among men who have sex with men (MSM) are low compared to other high risk subgroups, yet experiences with HIV testing among MSM in China are not well understood. To address this gap and prepare for intervention development to promote HIV testing and rapid linkage to treatment, six focus groups (FGs) were conducted with MSM in Beijing (40 HIV-positive MSM participated in one of four FGs and 20 HIV-negative or status unknown MSM participated in one of two FGs). Major themes reported as challenges to HIV testing included stigma and discrimination related to HIV and homosexuality, limited HIV knowledge, inconvenient clinic times, not knowing where to get a free test, fear of positive diagnosis or nosocomial infection, perceived low service quality, and concerns/doubts about HIV services. Key facilitators included compensation, peer support, professionalism, comfortable testing locations, rapid testing, referral and support after diagnosis, heightened sense of risk through engagement in high-risk behaviors, sense of responsibility to protect self, family and partner support, and publicity via social media. Themes and recommendations were generally consistent across HIV-positive and negative/status unknown groups, although examples of enacted stigma were more prevalent in the HIV-positive groups. Findings from our study provide policy suggestions for how to bolster current HIV prevention intervention efforts to enhance 'test-and-treat' strategies for Chinese MSM.
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Affiliation(s)
- Yu Liu
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Xiaoyun Sun
- Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Medicine (Division of Epidemiology), Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Lu Yin
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Zheng Yan
- Xicheng District Center for Disease Control and Prevention, Beijing, China
| | - Lijuan Wang
- Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Shulin Jiang
- Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Hongyan Lu
- Beijing City Center for Disease Control and Prevention, Beijing, China
| | - Yuhua Ruan
- 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
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yiming Shao
- 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
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Sten H. Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Pediatrics (Division of Infectious Diseases), Vanderbilt University School of Medicine, Nashville, Tennessee
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
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Chow EPF, Chen X, Zhao J, Zhuang X, Jing J, Zhang L. Factors associated with self-reported unprotected anal intercourse among men who have sex with men in Changsha city of Hunan province, China. AIDS Care 2015; 27:1332-42. [PMID: 26272244 DOI: 10.1080/09540121.2015.1058892] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Men who have sex with men (MSM) in China are highly susceptible to HIV infection and HIV prevalence among Chinese MSM is rapidly increasing in recent years. Unprotected anal intercourse (UAI) is a major contributing factor of HIV transmission. This study aims to identify factors associated with UAI among MSM in Changsha city, China. A cross-sectional survey was conducted among 642 MSM in Changsha city from July 2009 to June 2011 via a venue-based sampling method. Data on socio-demographic characteristics, sexual behaviours and utilisation of HIV/AIDS services were collected to determine the associates of UAI in MSM. Among the 642 MSM, 184 (28.7%) reported having UAI with male partners at the last sexual episode. UAI was associated with the venues where MSM met other MSM, and having unprotected sex with female partners at last the sexual episode and in the past six months. In addition, UAI was significant associated with not being exposed to HIV interventions, including free condom, lubricant, HIV testing and counselling, and peer education. MSM who have UAI practice are more likely to have unprotected sex with female; hence, potentially bridging HIV to the general female population. Specific harm-reduction programmes are shown to have significant impacts in reducing UAI and should be scaled up among MSM in China.
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Affiliation(s)
- Eric P F Chow
- a Melbourne Sexual Health Centre , Alfred Health , Melbourne , VIC , Australia.,b Central Clinical School, Faculty of Medicine, Nursing and Health Sciences , Monash University , Melbourne , VIC , Australia
| | - Xi Chen
- c Division of HIV/AIDS and STI control, Hunan Provincial Centers for Disease Control and Prevention , Hunan , China
| | - Junshi Zhao
- c Division of HIV/AIDS and STI control, Hunan Provincial Centers for Disease Control and Prevention , Hunan , China
| | - Xun Zhuang
- d School of Public Health , Nantong University , Jiangsu , China
| | - Jun Jing
- e Comprehensive AIDS Research Center, School of Medicine , Tsinghua University , Beijing , China
| | - Lei Zhang
- e Comprehensive AIDS Research Center, School of Medicine , Tsinghua University , Beijing , China.,f The Kirby Institute, Faculty of Medicine , University of New South Wales , Sydney , NSW , Australia
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Chen X, Yu B, Zhou D, Zhou W, Gong J, Li S, Stanton B. A Comparison of the Number of Men Who Have Sex with Men among Rural-To-Urban Migrants with Non-Migrant Rural and Urban Residents in Wuhan, China: A GIS/GPS-Assisted Random Sample Survey Study. PLoS One 2015; 10:e0134712. [PMID: 26241900 PMCID: PMC4524597 DOI: 10.1371/journal.pone.0134712] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/13/2015] [Indexed: 11/23/2022] Open
Abstract
Background Mobile populations and men who have sex with men (MSM) play an increasing role in the current HIV epidemic in China and across the globe. While considerable research has addressed both of these at-risk populations, more effective HIV control requires accurate data on the number of MSM at the population level, particularly MSM among migrant populations. Methods Survey data from a random sample of male rural-to-urban migrants (aged 18-45, n=572) in Wuhan, China were analyzed and compared with those of randomly selected non-migrant urban (n=566) and rural counterparts (580). The GIS/GPS technologies were used for sampling and the survey estimation method was used for data analysis. Results HIV-related risk behaviors among rural-to-urban migrants were similar to those among the two comparison groups. The estimated proportion of MSM among migrants [95% CI] was 5.8% [4.7, 6.8], higher than 2.8% [1.2, 4.5] for rural residents and 1.0% [0.0, 2.4] for urban residents, respectively. Among these migrants, the MSM were more likely than non-MSM to be older in age, married, and migrated to more cities. They were also more likely to co-habit with others in rental properties located in new town and neighborhoods with fewer old acquaintances and more entertainment establishments. In addition, they were more likely to engage in commercial sex and less likely to consistently use condoms. Conclusion Findings of this study indicate that compared to rural and urban populations, the migrant population in Wuhan consists of a higher proportion of MSM who also exhibit higher levels of HIV-related risk behaviors. More effective interventions should target this population with a focus on neighborhood factors, social capital and collective efficacy for risk reduction.
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Affiliation(s)
- Xinguang Chen
- Department of Epidemiology, University of Florida, Gainesville, Florida, United States of America
- Wuhan Centers for Disease Prevention and Control, Wuhan, China
- School of Public Health, Wuhan University, Wuhan, China
- Pediatric Prevention Research Center, Wayne State University, Detroit, Michigan, United States of America
- * E-mail:
| | - Bin Yu
- Department of Epidemiology, University of Florida, Gainesville, Florida, United States of America
| | - Dunjin Zhou
- Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Wang Zhou
- Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Jie Gong
- Wuhan Centers for Disease Prevention and Control, Wuhan, China
| | - Shiyue Li
- School of Public Health, Wuhan University, Wuhan, China
| | - Bonita Stanton
- Pediatric Prevention Research Center, Wayne State University, Detroit, Michigan, United States of America
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Lin H, Ding Y, Liu X, Wu Q, Shen W, He N. High Prevalence of HIV Infection and Bisexual Networks among a Sample of Men Who Have Sex with Men in Eastern China. PLoS One 2015; 10:e0129300. [PMID: 26053179 PMCID: PMC4459882 DOI: 10.1371/journal.pone.0129300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 05/08/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine homosexual and heterosexual behaviors, behavioral networks and HIV infection among men who have sex with men (MSM) in Eastern China. METHODS A cross-sectional survey was conducted among MSM in 2013 in a rural prefecture of Zhejiang province. Participants were interviewed for their sexual behaviors and sexual networks and were tested for HIV infection. RESULTS A total of 620 MSM from gay bath houses and bars participated in the survey. Of them, 58.2% aged 18 to 39 years and 49.5% were currently married with a female. The age of first homosexual contact was 26.7 years on average, ranging from 12 to 66 years. 91.0% had multiple male sex partners and 86.1% also had female sex partners in lifetime. 70 (11.3%) of the participants were tested HIV-positive. A total of 620 independent egocentric sexual networks involving 620 study participants and 1,971 reported sexual partners in the past 12 months were constructed, including 70 networks for the 70 HIV-positive participants with their 221 sexual partners and 550 networks for the 550 HIV-negative participants with their 1,750 sexual partners. The median network degree was 3 (IQR 2-4) overall and was not different between HIV-positive participants (Median: 3; IQR: 2-4) and HIV-negative participants (Median: 3; IQR: 2-4) (Mann-Whitney test, Z=-0.015, P=0.998). The proportion of networks with a multiple male sexual partnership was 63.7% overall, 62.8% for HIV-positive participants and 63.8% for HIV-negative participants (χ2=0.025, P=0.875). The proportion of networks with both male and female sexual partners was 44.8% overall, 47.1% for HIV-positive participants and 44.5% for HIV-negative participants (χ2=0.169, P=0.681). Consistent condom use and knowledge of HIV infection status were rare within the network partners. CONCLUSIONS The currently high HIV prevalence and complicated bisexual networks among MSM in the study area provides enhanced evidence for developing tailored prevention strategies for HIV transmission among and beyond the MSM population.
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Affiliation(s)
- Haijiang Lin
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
- Taizhou City Center for Disease Control and Prevention, Taizhou city of Zhejiang Province, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Xing Liu
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Qionghai Wu
- Taizhou City Center for Disease Control and Prevention, Taizhou city of Zhejiang Province, China
| | - Weiwei Shen
- Taizhou City Center for Disease Control and Prevention, Taizhou city of Zhejiang Province, China
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai, China
- * E-mail:
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48
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Chow EP, Gao L, Chen L, Jing J, Zhang L. Shifting Patterns of the HIV Epidemic in Southwest China: A Case Study Based on Sentinel Surveillance, 1995-2012. AIDS Patient Care STDS 2015; 29:314-20. [PMID: 25928866 DOI: 10.1089/apc.2014.0307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The HIV epidemic is experiencing a rapid shift in transmission profile in China. This study aims to examine the changes in magnitude, transmission pattern, and trend of the HIV epidemic in a typical Southwest Chinese prefecture over the period of 1995-2012. HIV surveillance data from the web-based reporting system were analyzed during this period. We investigated the temporal trends in the changing characteristics of HIV transmission, the HIV disease burden in key affected populations, and assessed the impacts on HIV disease progression due to scale-up of antiretroviral treatment. A total of 3556 HIV/AIDS cases were reported in Yuxi prefecture, Yunnan, over the study period. The number of HIV tests conducted has dramatically increased from 1041 in 1995 to 247,859 in 2012, resulting in a substantial increase in HIV diagnoses from 11 cases to 327 cases over the same period. Since 2005, cumulatively 1250 eligible people living with HIV (PLHIV) have received combination antiretroviral therapy which reduced AIDS disease progression from 9.0% (95% CI: 6.7-11.4%) in 1995 to 0.1% (0-0.3%) in 2012 (ptrend=0.0002). The primary mode of HIV transmission has been shifted from injection sharing (71.9% diagnoses in 1995-2004) to unsafe sexual contacts (82.6% diagnoses in 2012). Yuxi prefecture is experiencing a concentrated but shifting HIV epidemic. Scale-up of HIV testing is essential to effective sentinel surveillance and enhancing early diagnosis and treatment in PLHIV.
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Affiliation(s)
- Eric P.F. Chow
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- The Kirby Institute, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Liangmin Gao
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Liang Chen
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Jun Jing
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Lei Zhang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- The Kirby Institute, University of New South Wales Australia, Sydney, New South Wales, Australia
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49
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Yang F, Shi X, He W, Wu S, Wang J, Zhao K, Yuan H, Martin K, Zhang H. Factors of the HIV Transmission in Men Who Have Sex with Men in Suizhou City from 2009 to 2013. Sex Med 2015; 3:24-31. [PMID: 25844172 PMCID: PMC4380911 DOI: 10.1002/sm2.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction The primary transmission of human immunodeficiency virus (HIV) has been recently changing worldwide. In China, HIV transmission through heterosexual contact remains the predominant mode, but the prevalence of men who have sex with men (MSM) has been increasing. Aim This article investigated the overall epidemic trend and associated high-risk behavior among MSM in Suizhou City and explored the government's responses to the epidemic. Methods We conducted yearly cross-sectional behavioral surveillance surveys among MSM in Suizhou City from 2009 to 2013. Participation was anonymous and self-completed. Recruitment methods were consistently applied in each survey. Main Outcome Measures Semi-structured questionnaire surveys and yearly work summaries were conducted. Results Most of the MSM groups in Suizhou City were young adults (P < 0.05), well educated (P < 0.05), and married (P < 0.05). Two years after our interventions, we found an increasing trend of condom use during anal sex (P < 0.05), as well as commercial sex trade (P < 0.05). Conclusions HIV continues to spread rapidly among MSM in Suizhou City. The high-risk behavior among MSM remains a hindrance to HIV prevention. Innovative intervention approaches are essential for HIV surveillance and prevention among MSM in Suizhou City. Yang F, Shi X, He W, Wu S, Wang J, Zhao K, Yuan H, Martin K, and Zhang H. Factors of the HIV transmission in men who have sex with men in Suizhou City from 2009 to 2013. Sex Med 2015;3:24–31.
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Affiliation(s)
- Fan Yang
- Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China
| | - Xiuye Shi
- Centers for Disease Control and Prevention Suizhou, Hubei, China
| | - Weihua He
- Centers for Disease Control and Prevention Suizhou, Hubei, China
| | - Songjie Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China
| | - Jiaojiao Wang
- Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China
| | - Kai Zhao
- Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China
| | - Hongfang Yuan
- Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China
| | - Kuete Martin
- Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China
| | - Huiping Zhang
- Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei, China
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50
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Zhang H, Lu H, Pan SW, Xia D, Zhao Y, Xiao Y, He X, Yue H, Sun Z, Xu Y, Ruan Y, Shao Y. Correlates of unprotected anal intercourse: the influence of anal sex position among men who have sex with men in Beijing, china. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:375-387. [PMID: 25548064 DOI: 10.1007/s10508-014-0396-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/13/2014] [Accepted: 08/18/2014] [Indexed: 06/04/2023]
Abstract
Understanding barriers to consistent condom use among men who have sex with men (MSM) requires consideration of the context in which risk behaviors occur. Anal sex position is one such context. This pooled cross-sectional study used survey data from 1,230 MSM and their 2,618 reported male sexual partnerships. Overall, nearly half of the participants engaged in unprotected anal intercourse (UAI) with at least one of upto three partners in the past 6 months. "Insertive" men engaged in less UAI (39 %) than "receptive" (53 %) or "versatile" (51 %) men. Regardless of sexual position, UAI was associated with cohabiting with a male or female partner and perceiving great or moderate risk of HIV from male contact at the individual level, and steady (vs. casual) partnership at the dyad level. However, early MSM anal sex debut, high number of male partners, alcohol use, receiving and buying condoms, HIV testing, and MSM sex-seeking venues were found to be only statistically significantly correlated with UAI among some but not all sexual positions, implying that interventions to increase condom use should take into account how anal sex position may influence willingness and ability to engage in safer sex. Dyad level data appear to provide additional insight into the influence of sexual positions, and should be used to complement individual data for future intervention designs.
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Affiliation(s)
- Heng Zhang
- Epidemiology and Biostatistics Branch of Division of Virology and Immunology, State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, 155 Changbai Road, Changping District, Beijing, 102206, People's Republic of China
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