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Yuan T, Gao Y, Wang Z, Huang R, Wang J, Li P, Meng X, Zhang K, Wang G, Zhou Y, Luo D, Cai Y, Fan S, Ouyang L, Zhao J, Yu M, Qian HZ, Wu G, Zou H. Acceptability of male circumcision for HIV prevention among men who have sex with men in China: a short report. AIDS Care 2021; 34:371-378. [PMID: 33908841 DOI: 10.1080/09540121.2021.1917759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Recent evidence shows that circumcision is associated with lower HIV prevalence among MSM. We assessed the acceptability of circumcision for preventing HIV and that of Shang Ring circumcision (SRC) among men who have sex with men (MSM) in China. 538 adult MSM were recruited from six cities in China between January and March 2019. Participants were surveyed by an online, self-administered questionnaire. The acceptability of circumcision was assessed before and after the potential protective effect of circumcision against HIV was informed, and subsequently men's willingness to undergo SRC was assessed. The level of circumcision was 16.4%. Of 450 uncircumcised MSM, their willingness to be circumcised in the following six months increased significantly from 32.2% to 55.6% after the information session. Three quarters of men who were willing to undergo circumcision accepted SRC. MSM who perceived that circumcision could maintain genital hygiene were more likely to accept circumcision after the information session, whereas those who regarded circumcision as an embarrassing surgery were disinclined to be circumcised. The low circumcision rate, along with its high acceptability in Chinese MSM, suggests a great potential benefit of circumcision intervention if proved effective. SRC might be a popular circumcision procedure in this population.
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Affiliation(s)
- Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Yanxiao Gao
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Zhenyu Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ruonan Huang
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Junfeng Wang
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peiyang Li
- School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaojun Meng
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi, People's Republic of China
| | - Kechun Zhang
- Shenzhen Longhua District Center for Disease Control and Prevention, Shenzhen, People's Republic of China
| | - Guanghui Wang
- Qingdao Qingtong AIDS Prevention Volunteer Service Center, Qingdao, People's Republic of China
| | - Yepeng Zhou
- Foshan Friends Care Center for AIDS/HIV Control, Foshan, People's Republic of China
| | - Danyang Luo
- Zhitong LGBT Service Center, Guangzhou, People's Republic of China
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Song Fan
- School of Public Health, Southwest Medical University, Luzhou, People's Republic of China
| | - Lin Ouyang
- Department of AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, People's Republic of China
| | - Jin Zhao
- Department of AIDS/STD Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, People's Republic of China
| | - Maohe Yu
- Department of AIDS/STD Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin, People's Republic of China
| | - Han-Zhu Qian
- School of Public Health, Yale University, New Haven, CT, USA
| | - Guohui Wu
- Department of AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, People's Republic of China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China.,Kirby Institute, University of New South Wales, Sydney, Australia
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Zhang X, Wang N, Vermund SH, Zou H, Li X, Zhang F, Qian HZ. Interventions to improve the HIV continuum of care in China. Curr HIV/AIDS Rep 2019; 16:448-457. [PMID: 31776975 PMCID: PMC10767704 DOI: 10.1007/s11904-019-00469-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW To describe HIV epidemic and interventions for improving HIV continuum of care in China. RECENT FINDINGS The reported HIV epidemic has been continuously increasing, partially due to the expansion of active HIV testing campaign. Public health intervention programs have been effective in containing HIV spread among former plasma donors and people who inject drugs (PWID), but more infections occur among heterosexual men and women and young men who have sex with men. Of 1.25 million Chinese people are living with HIV, one-third do not know their status. About two-thirds of diagnosed individuals have used antiretroviral therapy (ART) and two-thirds of those on ART have achieved viral suppression, but some risk groups such as PWID have lower rates. The national free ART program has reduced adult and pediatric mortality and reduced heterosexual transmission. China faces great challenges to reduce HIV sexual transmission, improve the HIV continuum of care, and close the gaps to the UNAIDS Three "90" Targets.
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Affiliation(s)
- Xiangjun Zhang
- School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
| | - Na Wang
- School of Public Health, Guilin Medical University, Guilin, China
| | | | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, China
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Fujie Zhang
- Clinical and Research Center of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Clinical Center for HIV/AIDS, Capital Medical University, Beijing, China
| | - Han-Zhu Qian
- Yale School of Public Health, New Haven, CT, USA.
- SJTU-Yale Joint Center for Biostatistics and Data Science, Shanghai Jiao Tong University, Shanghai, China.
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Morris BJ, Moreton S, Krieger JN. Critical evaluation of arguments opposing male circumcision: A systematic review. J Evid Based Med 2019; 12:263-290. [PMID: 31496128 PMCID: PMC6899915 DOI: 10.1111/jebm.12361] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/03/2019] [Accepted: 05/12/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To systematically evaluate evidence against male circumcision (MC). METHODS We searched PubMed, Google Scholar, EMBASE and Cochrane databases. RESULTS Database searches retrieved 297 publications for inclusion. Bibliographies of these yielded 101 more. After evaluation we found: Claims that MC carries high risk were contradicted by low frequency of adverse events that were virtually all minor and easily treated with complete resolution. Claims that MC causes psychological harm were contradicted by studies finding no such harm. Claims that MC impairs sexual function and pleasure were contradicted by high-quality studies finding no adverse effect. Claims disputing the medical benefits of MC were contradicted by a large body of high-quality evidence indicating protection against a wide range of infections, dermatological conditions, and genital cancers in males and the female sexual partners of men. Risk-benefit analyses reported that benefits exceed risks by 100-200 to 1. To maximize benefits and minimize risks, the evidence supported early infant MC rather than arguments that the procedure should be delayed until males are old enough to decide for themselves. Claims that MC of minors is unethical were contradicted by balanced evaluations of ethical issues supporting the rights of children to be provided with low-risk, high-benefit interventions such as MC for better health. Expert evaluations of case-law supported the legality of MC of minors. Other data demonstrated that early infant MC is cost-saving to health systems. CONCLUSIONS Arguments opposing MC are supported mostly by low-quality evidence and opinion, and are contradicted by strong scientific evidence.
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Affiliation(s)
- Brian J Morris
- School of Medical SciencesUniversity of SydneySydneyNew South WalesAustralia
| | | | - John N Krieger
- Department of UrologyUniversity of Washington School of MedicineSeattleWashington
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Zhang C, Webb GF, Lou J, Shepherd BE, Qian HZ, Liu Y, Vermund SH. Predicting the long-term impact of voluntary medical male circumcision on HIV incidence among men who have sex with men in Beijing, China. AIDS Care 2019; 32:343-353. [PMID: 31619058 DOI: 10.1080/09540121.2019.1679704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Using a deterministic compartmental modeling procedure to fit prevalence from 2005-2015, we projected new HIV cases during 2016-2026 under different coverage rates ranging from 0.0001 (at baseline) to 0.15 (an optimistic assumption) with simulations on varying transmission rates, model calibration to match historical data, and sensitivity analyses for different assumptions. Compared with the baseline (λ = 0.0001), we found the new HIV cases would reduce with the increase of coverage rates of the voluntary medical male circumcision (VMMC) among men who have sex wtih men (MSM). The higher the coverage rate, the lower the new HIV incidence would be. As one of the first studies to model the potential impact of VMMC among MSM in China, our model suggested a modest to the significant public health impact of VMMC. Even at just 15% VMMC annual uptake rate, the reduction in new infections is substantial. Therefore, there is a strong need to determine the efficacy of VMMC among MSM, to improve the evidence base for its potential use among MSM in low circumcision settings. Only then can policymakers decide whether to incorporate VMMC into a package of HIV prevention interventions targeting MSM.
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Affiliation(s)
- Chen Zhang
- School of Nursing, University of Rochester Medical Center, Rochester, NY, USA
| | - Glenn F Webb
- Departments of Mathematics, Vanderbilt University, Nashville, TN, USA
| | - Jie Lou
- Department of Mathematics, Shanghai University, Shanghai, People's Republic of China
| | - Brian E Shepherd
- Departments of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Han-Zhu Qian
- School of Public Health, Yale University, New Haven, CT, USA
| | - Yu Liu
- Department of Public Health Science, University of Rochester Medical Center, Rochester, NY, USA
| | - Sten H Vermund
- School of Public Health, Yale University, New Haven, CT, USA
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Zhang C, Qian HZ, Liu Y, Vermund SH. Voluntary medical male circumcision and HIV infection among men who have sex with men: Implications from a systematic review. SAGE Open Med 2019; 7:2050312119869110. [PMID: 31448119 PMCID: PMC6689924 DOI: 10.1177/2050312119869110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/21/2019] [Indexed: 01/05/2023] Open
Abstract
Background: With the rapidly-increased HIV epidemic among men who have sex with men worldwide, the effectiveness of voluntary medical male circumcision as the tool of HIV prevention still remains undetermined. Purpose: In the current study, we conducted a systematic review and meta-analysis to assess the association between voluntary medical male circumcision and HIV risk among men who have sex with men. Methods and Conclusion: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, we conducted a comprehensive literature search through multiple databases. A total of 37 articles/abstracts were included in the analysis. We employed random-effects models and subgroup analyses based upon key study characteristics derived from empirical studies. A total of 117,293 men who have sex with men were included in the meta-analysis, and no randomized control trials have been identified. The odds of being HIV positive were 7% lower among men who have sex with men who were circumcised than among men who have sex with men who were uncircumcised (adjusted odds ratio, 0.93; 95% confidence interval, 0.88–0.99). The evidence for the potential protective effect of voluntary medical male circumcision was stronger among men who have sex with men in Asia and Africa (adjusted odds ratio, 0.62; 95% confidence interval, 0.53–0.73). Our meta-analyses may suggest a protective effect of voluntary medical male circumcision against HIV infection among men who have sex with men, especially in settings like Asia/Africa.
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Affiliation(s)
- Chen Zhang
- School of Nursing, University of Rochester Medical Center, Rochester, NY, USA
| | - Han-Zhu Qian
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Yu Liu
- Division of Epidemiology, Department of Public Health Science, University of Rochester Medical Center, Rochester, NY, USA
| | - Sten H Vermund
- Yale School of Public Health, Yale University, New Haven, CT, USA
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