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Wang Y, Yan X, Ai W, Jia Y, Fan C, Hu S, Dai Y, Xue H, Li F, Tang W. Disparities in burden of herpes simplex virus type 2 in China: systematic review, meta-analyses, and meta-regressions. Front Immunol 2024; 15:1369086. [PMID: 39104540 PMCID: PMC11298463 DOI: 10.3389/fimmu.2024.1369086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 07/09/2024] [Indexed: 08/07/2024] Open
Abstract
Background The rising prevalence of herpes simplex type 2 (HSV-2) infection poses a growing global public health challenge. A comprehensive understanding of its epidemiology and burden disparities in China is crucial for informing targeted and effective intervention strategies in the future. Methods We followed Cochrane and PRISMA guidelines for a systematic review and included publications published in Chinese and English bibliographic systems until March 31st, 2024. We synthesized HSV-2 seroprevalence data across different population types. We used random-effects models for meta-analyses and conducted meta-regression to assess the association between population characteristics and seroprevalence. Results Overall, 23,999 articles were identified, and 402 publications (1,203,362 participants) that reported the overall seroprevalence rates (858 stratified measures) were included. Pooled HSV-2 seroprevalence among the general population (lower risk) was 7.7% (95% CI: 6.8-8.7%). Compared to the general population, there is a higher risk of HSV-2 prevalence among intermediate-risk populations (14.8%, 95% CI: 11.0-19.1%), and key populations (31.7%, 95% CI: 27.4-36.1%). Female sexual workers (FSWs) have the highest HSV-2 risk (ARR:1.69, 95% CI: 1.61-1.78). We found northeastern regions had a higher HSV-2 seroprevalence than other regions (17.0%, 95% CI: 4.3-35.6%, ARR: 1.38, 95% CI: 1.26-1.50, Northern China as the reference group). This highlighted the disparity by population risk levels and regions. We also found lower HSV-2 prevalence estimates in publications in Chinese bibliographic databases than those in English databases among key populations (such as MSM and HIV-discordant populations). Conclusion There is a gradient increase in HSV-2 prevalence risk stratification. We also identified region, population, and age disparities and heterogeneities by publication language in the HSV-2 burden. This study provides guidance for future HSV-2 prevention to eliminate disparities of HSV-2 infection and reduce overall HSV-2 burden. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=408108, identifier CRD42023408108.
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Affiliation(s)
- Yehua Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States
| | - Xumeng Yan
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Wei Ai
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Yuanxi Jia
- Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, China
| | - Chengxin Fan
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Siyue Hu
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Yifan Dai
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Huachen Xue
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Feifei Li
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China
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Shi L, Chen L, Liu X, Hu H, Chen Y, Chen Y, Zhang Z, Zhou Y, Lu J, Yang D, Guan W. Evaluating the effect of the plan of national syphilis control in controlling the syphilis epidemic in Jiangsu, China 2010-2020. Front Public Health 2023; 11:1281229. [PMID: 38186690 PMCID: PMC10768032 DOI: 10.3389/fpubh.2023.1281229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
Background Starting in 2010, the Chinese government initiated a 10-year syphilis control plan, called the national syphilis control plan (NSCP), to address the emerging threat of syphilis. We aimed to evaluate the effect of the NSCP plan on syphilis control in Jiangsu, China. Methods The temporal trends of syphilis incidence, prevalence and rate of condom use were estimated by Joinpoint regression with average annual percent change (APC) and average annual percentage (APPC). A Chi-square test was conducted to analyze the outcomes in different subgroups. ArcGIS was used to analyze the spatiotemporal distribution of syphilis incidence. Results Geographically, early and congenital syphilis incidence decreased significantly in all areas of the province during the period of NSCP. Early syphilis incidence decreased from 21.1 to 8.8 (APC: -7.5, 95%CI: -8.6, -6.5, p < 0.001) per 100,000 people, and congenital syphilis decreased from 63.6 to 4.1 (APC: -14.8, 95%CI: -20.8, -8.4, p < 0.01) per 100,000 newborns from 2010 to 2020. Also, syphilis prevalence reduced from 13.4 to 3.8% (APC: -8.7, 95%CI: -12.1, -5.0, p = 0.001) among men who have sex with men, from 5.3 to 1.7% (APC: -7.9, 95%CI: -11.7, -3.8, p = 0.002) among female sex workers and remained under 1.0% with slight variations among pregnant women (APC: 0.3, 95%CI: -4.3, 5.1, p = 0.877) from 2010 to 2020. 0.2% (2,436) of pregnant women who received free syphilis testing during pregnancy were diagnosed with current syphilis infection, and 97.0% (2,555) of newborns in the province were delivered to women diagnosed with syphilis. 91.8% (2,346) of live babies and about 90% of diagnosed patients received complete standard syphilis diagnosis and treatment services. Conclusion Trends of early syphilis incidence and syphilis prevalence show a considerable decreasing trend among almost all the key populations after implementing NSCP. Congenital syphilis has significantly decreased as well and hence, the NSCP program should be sustained and strengthened to control the syphilis epidemic in China further.
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Affiliation(s)
- Lingen Shi
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
- Medical School, Nanjing University, Jiangsu, China
| | - Liping Chen
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Xiaoyan Liu
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Haiyang Hu
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Yuheng Chen
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Yunting Chen
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Zhi Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Ying Zhou
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Jing Lu
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Dandan Yang
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
| | - Wenhui Guan
- Jiangsu Provincial Center for Disease Control and Prevention, Institute for STI and HIV Control and Prevention, Jiangsu, China
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Marley G, Tan RKJ, Wu D, Wang T, Sun M, Sheng Q, Holly ME, Hlatshwako TG, Wang C, Tang W, Ramaswamy R, Yang L, Luo D, Sylvia SS, Gray K, Van Duin D, Zheng H, Tucker JD. Pay-it-forward gonorrhea and chlamydia testing among men who have sex with men and male STD patients in China: the PIONEER pragmatic, cluster randomized controlled trial protocol. BMC Public Health 2023; 23:1182. [PMID: 37337181 PMCID: PMC10280958 DOI: 10.1186/s12889-023-16095-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 06/09/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Gonorrhea and chlamydia are the most common sexually transmitted diseases (STDs) among men who have sex with men (MSM) in China. Previous studies have shown pay-it-forward (PIF) interventions to be associated with a substantial increase in gonorrhea and chlamydia test uptake compared to standard-of-care. We propose a 'pay-it-forward' gonorrhea and chlamydia testing randomized controlled trial (PIONEER). The trial would evaluate the effectiveness of two pay-it-forward strategies in promoting testing uptake compared to the standard of care (in which men pay for their tests out-of-pocket) among MSM and male STD patients in China. METHODS PIONEER will be a three-armed, pragmatic cluster randomized controlled trial (RCT), conducted across 12 clinics (six MSM-led and six public STD clinics) to compare the effectiveness of three implementation strategies. Each facility will be randomized to a standard pay-it-forward intervention of gonorrhea/ chlamydia testing with minimal encouragement for testing, a community-engaged pay-it-forward arm, or a control arm where men pay for their tests out-of-pockets. The primary outcome will be dual gonorrhea/chlamydia test uptake. Secondary outcomes will include syphilis testing, amount donated in pay-it-forward, number of positive gonorrhea and chlamydia tests, and measures of antimicrobial resistance. A sequential transformative mixed methods design will be used to evaluate the implementation process in type 2 effectiveness-implementation hybrid design. Data sources will include survey on acceptability, and feelings and attitudes towards the interventions among participants; testing and treatment uptake data from clinic records, WeChat records, and qualitative data to gain insights into men's perceptions and attitudes towards the pay-it-forward, mechanisms driving uptake, and donating behaviors. Implementers and organizers will be interviewed about fidelity and adherence to protocol, sustainability of pay-it-forward intervention, and barriers and facilitators of implementing the intervention. DISCUSSION PIONEER will substantially increase gonorrhea/chlamydia testing among MSM in China, providing an innovative and new financial mechanism to sustain STD screening among sexual minorities in low- and middle-income countries. This study will answer compelling scientific questions about how best to implement pay-it-forward and the individual and organizational characteristics that moderate it. TRIAL REGISTRATION The study with identification number NCT05723263 has been registered on clinicaltrials.gov/.
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Affiliation(s)
- Gifty Marley
- University of North Carolina Project-China, Guangzhou, China
| | | | - Dan Wu
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Tong Wang
- University of North Carolina Project-China, Guangzhou, China
| | - Murong Sun
- University of North Carolina Project-China, Guangzhou, China
| | - Qilei Sheng
- University of North Carolina Project-China, Guangzhou, China
| | | | | | - Cheng Wang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Weiming Tang
- Department of Medicine, University of North Carolina at Chapel-Hill, Chapel Hill, NC, USA
| | - Rohit Ramaswamy
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ligang Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Danyang Luo
- University of North Carolina Project-China, Guangzhou, China
| | - Sean S Sylvia
- Department of Medicine, University of North Carolina at Chapel-Hill, Chapel Hill, NC, USA
| | - Kurt Gray
- University of North Carolina at Chapel-Hill, Chapel Hill, NC, USA
| | - David Van Duin
- University of North Carolina at Chapel-Hill, Chapel Hill, NC, USA
| | - Heping Zheng
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Joseph D Tucker
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
- Department of Medicine, University of North Carolina at Chapel-Hill, Chapel Hill, NC, USA.
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Li T, Liu Z, Zhang D, Liao Q, Fan S, Hao M, Hong Y, Huang X, Wang H, Xiong Z, Xu H, Xue F, Xue M, Yang X, Zhang J. Prevalence of and risk factors for chlamydia in female outpatients with genital tract infections: a nationwide multi-center, cross-sectional study in China. Front Public Health 2023; 11:1182108. [PMID: 37397732 PMCID: PMC10311204 DOI: 10.3389/fpubh.2023.1182108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/18/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Chlamydia trachomatis is the etiological agent of the commonest sexually transmitted bacterial infection. This study aimed to examine the prevalence of genital chlamydia and associated risk factors in Chinese female outpatients with genital tract infections. Methods A prospective, multicenter epidemiological study of genital chlamydia prevalence in 3008 patients with genital tract infections in 13 hospitals in 12 provinces of China was performed between May 2017 and November 2018. Vaginal secretion specimens were collected for the clinical diagnosis of vaginitis, whereas cervical secretion specimens were tested for Chlamydia trachomatis and Neisseria gonorrhoeae. All patients participated in a one-on-one cross-sectional questionnaire interview. Results Totally 2,908 participants were included. The prevalence rates of chlamydia and gonococcal infections in women with genital tract infections were 6.33% (184/2908) and 0.01% (20/2908), respectively. Multivariate analysis showed high risk factors for chlamydia were premarital sex behavior, first sexual intercourse before the age of 20 and bacterial vaginosis. Discussion Given that most chlamydia cases are asymptomatic and no vaccine is currently available, chlamydia prevention strategies should include behavioral interventions as well as early screening programs to identify and treat individuals with genital tract infections, especially those with the above identified risk factors.
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Affiliation(s)
- Ting Li
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Liu
- Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Beijing Maternal and Child Health Care Hospital, Capital Medical University, Beijing, China
| | - Dai Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Qinping Liao
- Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Shangrong Fan
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Min Hao
- Department of Obstetrics and Gynecology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Ying Hong
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Xiufeng Huang
- Department of Obstetrics and Gynecology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huilan Wang
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhengai Xiong
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hong Xu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fengxia Xue
- Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, Tianjin, China
| | - Min Xue
- Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Xingsheng Yang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Jianqing Zhang
- Department of Obstetrics and Gynecology, Qinghai Red Cross Hospital, Xining, China
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Wang S, Song J. Ethical Dilemmas in the Dermatology Outpatient Department in China. Clin Cosmet Investig Dermatol 2023; 16:1303-1308. [PMID: 37228783 PMCID: PMC10202703 DOI: 10.2147/ccid.s404444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/20/2023] [Indexed: 05/27/2023]
Abstract
Background Recently, sexually transmitted diseases (STDs) remain a sensitive issue within generally healthy environments. Different countries have developed various principle-based approaches to tackle the ethical issues surrounding STDs. Due to lacking any relevant laws or code of conducts to deal with the ethical issue, it has become a notable ethical problem in China. Objective Ethical principles involve a sensitive clinical problem, this paper intends to reflect upon and discuss how nurses as moral agents deal with ethical dilemmas within Chinese culture and provided some orientations for further study. Methods This paper briefly presented the nurses' ethical dilemma related to the issue of confidentiality and disclosure of STD patients' information via a case scenario. Based on Chinese cultural tradition, we focused on how to solve this situation as a clinical nurse with ethical principles and philosophical theories. The process of discussion provided eight steps by the Corey et al model to solve the ethical dilemma. Conclusion The ability to deal with ethical dilemmas is a necessary quality for nurses. On the one hand, nurses should respect patients' autonomy and contribute positively to the relationship between confidentiality and the nurse-patient therapeutic relationship. On the other hand, nurses should combine with the current situation and make a targeted decision where necessary. Of course, professional code supported by related policies is necessary.
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Affiliation(s)
- Sisi Wang
- Department of Dermatology, Henan Provincial People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
- Zhengzhou University People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
- Henan University People's Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
| | - Jinghui Song
- Department of Dermatology, Henan Provincial People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
- Zhengzhou University People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
- Henan University People's Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
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Zhang Z, Zong X, Bai H, Fan L, Li T, Liu Z. Prevalence of Mycoplasma genitalium and Chlamydia trachomatis in Chinese female with lower reproductive tract infection: a multicenter epidemiological survey. BMC Infect Dis 2023; 23:2. [PMID: 36604611 PMCID: PMC9814310 DOI: 10.1186/s12879-022-07975-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Chlamydia trachomatis and Mycoplasma infections have been regarded as severe challenges to public health worldwide because their potential risk of leading to serious reproductive complications. C. trachomatis is the most common sexually transmitted bacterial infections and the prevalence has been increasing in recent years. As a newly discovered pathogen, Mycoplasma genitalium has gradually been recognized as important sexually transmitted infection and even been called a "new chlamydia". There are no official epidemiological data of M. genitalium in China especially in women with lower reproductive tract infection. This work aims to understand the prevalence and risk factors of M. genitalium and C. trachomatis in women with lower reproductive tract infections and to provide reference for the formulation of health policy in China. METHODS This study was conducted in the gynecological clinics of 12 hospitals geographically located in different regions in China. Women with purulent cervical secretions or abnormal vaginal microecology were included as the research group, and those with normal vaginal microecology and cervical secretions were included as the control group. A total of 2190 participants were recruited in this project including 1357 of research group and 833 of control group. All participants were required to complete questionnaires, whose vaginal discharge were collected for vaginal microecology test and cervical discharge for detection of M. genitalium and C. trachomatis. RESULTS The prevalence of C. trachomatis and M. genitalium were 7.1% (96/1357) and 3.8% (51/1357), respectively in research group. The prevalence of C. trachomatis and M. genitalium varied in different regions. Infection rates of C. trachomatis and M. genitalium were higher in women with abnormal vaginal microecology (C.t P = 0.038, M.g P = 0.043), especially in women with bacterial vaginosis and mixed vaginitis, of which C. trachomatis showed statistical differences (bacterial vaginosis, P = 0.035; mixed vaginitis, P = 0.0001) and M. genitalium was close to statistical differences (bacterial vaginosis, P = 0.057; mixed vaginitis, P = 0.081). Alcoholism and abnormal vaginal microecology were positively correlated with both C. trachomatis and M. genitalium infection. Increasing age, being married and multi-parity were negatively correlated with C. trachomatis infection. There is a positive correlation between multiple sexual partners, diversed styles of sex and C. trachomatis infection. CONCLUSIONS Women with lower genital dysbiosis have an increased risk of C. trachomatis and M. genitalium. The overall prevalence of M. genitalium is lower than that of C. trachomatis, while they have similarities in the characteristics of infection. Although M. genitalium is not routinely screened as C. trachomatis in young women, attention should be paid to M. genitalium infection in young women with abnormal vaginal microecology or having childbearing needs.
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Affiliation(s)
- Zhan Zhang
- grid.24696.3f0000 0004 0369 153XThe Gynecology Department of Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251 of Yaojiayuan Road, Chaoyang District, Beijing, China
| | - Xiaonan Zong
- grid.24696.3f0000 0004 0369 153XThe Gynecology Department of Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251 of Yaojiayuan Road, Chaoyang District, Beijing, China
| | - Huihui Bai
- grid.24696.3f0000 0004 0369 153XMicroecological Laboratory of Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251 of Yaojiayuan Road, Chaoyang District, Beijing, China
| | - Linyuan Fan
- grid.24696.3f0000 0004 0369 153XThe Gynecology Department of Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251 of Yaojiayuan Road, Chaoyang District, Beijing, China
| | - Ting Li
- grid.24696.3f0000 0004 0369 153XThe Gynecology Department of Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251 of Yaojiayuan Road, Chaoyang District, Beijing, China
| | - Zhaohui Liu
- The Gynecology Department of Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No. 251 of Yaojiayuan Road, Chaoyang District, Beijing, China.
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Zhang Y, Wang C, Liang M. A Latent Class Analysis of Sexual Behavior and Associations with Sex Education, Smoking, Drinking, and Pornography Use Among Chinese Youth. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1351-1361. [PMID: 34750778 DOI: 10.1007/s10508-021-02091-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 02/20/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
The incidence of sexually transmitted diseases has alarmingly increased among Chinese youth in the past decade, and newly diagnosed cases of AIDS have almost doubled between 2010 and 2015. However, little is known about classes of sexual behavior among Chinese youth and associations with their other health behavior or experience of sex education. This study aimed to first identify classes of sexual behavior using latent class analysis and then to examine their associations with sex education, smoking, alcohol drinking, and pornography use. Data were from 13,865 unmarried youth aged 18-24 from the 2009 National Youth Reproductive Health Survey. Six indicators were used: timing of the first sexual intercourse, the number of past-year sexual partners, sex outside of a relationship, incidence of pregnancy, and contraceptive use at the latest and the first sexual intercourse. Four classes were identified: no sex (Class 1, 69%), safer sex (Class 2, 13%), early risk (Class 3, 13%), and multiple risk (Class 4, 5%). Smoking, drinking, and regular pornography use were associated with increased odds of being in the multiple risk class relative to the safer sex class. Sex education, smoking, and pornography use were associated with decreased odds of being in the no sex class relative to the safer sex class. The findings revealed qualitatively different classes of sexual behavior among Chinese youth and important roles of sex education, substance use, and pornography use. Reproductive health service providers can offer individually tailored services to serve youth with different profiles and needs.
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Affiliation(s)
- Yudong Zhang
- Institute of Human Development and Social Change, New York University, 627 Broadway Street, New York, NY, 10012, USA.
| | - Cuntong Wang
- School of Social Development, Central University of Finance and Economics, No. 39, College South Road, Haidian District, 100081, Beijing, People's Republic of China
| | - Mengyuan Liang
- Department of Comparative Human Development, University of Chicago, 1101 E 58th St, Chicago, IL, 60637, USA
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Ye X, Li FR, Pan Q, Li Z, Yu GQ, Liu H, Liu J, Huai PC, Zhang FR. Prevalence and associated factors of sexually transmitted infections among methamphetamine users in Eastern China: a cross-sectional study. BMC Infect Dis 2022; 22:7. [PMID: 34983422 PMCID: PMC8725376 DOI: 10.1186/s12879-021-06987-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The reported incidence of sexually transmitted infections (STIs) in China has been increasing over the last decades, especially among drug users, which has become one of the main burdens of public health in China. This study was conducted to estimate the prevalence and associated factors of STIs among non-injecting methamphetamine (MA) users in Eastern China. METHODS A cross-sectional survey was conducted among 632 MA users in Eastern China in 2017. Demographic characteristics, sexual behaviors, behaviors of MA use and sexual health knowledge were collected through questionnaire. First pass urine specimens were collected and detected for deoxyribonucleic acid (DNA) of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) with Nucleic Acid Amplification Technology (NAAT), while blood specimens were collected and detected for antibodies of Human immunodeficiency virus (HIV), Herpes simplex virus type-2 (HSV-2), and syphilis with enzyme-linked immune sorbent assay (ELISA). RESULTS Among the 632 MA users, 464 (73.42%) were males, 60.92% were < 35 years of age, 546 (86.39%) were Shandong residents. 317 (50.16%, 95% CI 46.26-54.06%) participants were tested positive for at least one kind of STIs, including 242 (38.29%, 95% CI 34.50-42.08%) for HSV-2, 107 (16.93%, 95% CI 14.01-19.85%) for active syphilis, 46 (7.28%, 95% CI 5.25-9.31%) for treated syphilis, 40 (6.33%, 95% CI 4.43-8.23%) for CT, 6 (0.95%, 95% CI 0.19-1.71%) for HIV, and 3 (0.47%, 95% CI 0.06-1.00%) for NG infection. 99 (15.66%, 95% CI 12.83-18.49%) participants were co-infected with two kinds of STIs, including 91 (14.40%, 95% CI 11.66-17.14%) participants were co-infected with HSV-2 and syphilis. 14 (2.22%, 95% CI 1.07-3.37%) participants were co-infected with three kinds of STIs, and 4 HIV positive participants were co-infected with both syphilis and HSV-2. In the multiple logistic regression analysis, the results showed that females (adjusted OR [AOR] = 7.30, 95% CI 4.34-12.30) and individuals ≥ 35 years of age (AOR = 2.97, 95% CI 2.04-4.32) were more likely to test positive for STIs among MA users, whereas participants who acquired sexual health knowledge primarily from the Internet (AOR = 0.57, 95% CI 0.40-0.82) and those whose regular partners did not use drugs (AOR = 0.59, 95% CI 0.37-0.94) were less likely. CONCLUSIONS This study found that the prevalence of HSV-2 and syphilis are alarming high among non-injecting MA users in Shandong Province in Eastern China. The prevention and control intervention of STIs among MA users in Shandong were needed, especially on females and MA users ≥ 35 years of age.
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Affiliation(s)
- Xing Ye
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Fu-Rong Li
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Qing Pan
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Zhen Li
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Gong-Qi Yu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Hong Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Jian Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
| | - Peng-Cheng Huai
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China.
| | - Fu-Ren Zhang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, Shandong, China
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Shui J, Xie D, Zhao J, Ao C, Lin H, Liang Y, Wang H, Dai Y, Tang S. Seroepidemiology of Chlamydia trachomatis Infection in the General Population of Northern China: The Jidong Community Cohort Study. Front Microbiol 2021; 12:729016. [PMID: 34650533 PMCID: PMC8507574 DOI: 10.3389/fmicb.2021.729016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/10/2021] [Indexed: 02/06/2023] Open
Abstract
A longitudinal serological study to investigate the seropositive frequency, incidence, and antibody dynamics of Chlamydia trachomatis infection in the general population of China is urgently needed in order to optimize the strategies for surveillance and precise prevention of C. trachomatis infection. This longitudinal study enrolled 744 subjects aged 18-65 years from Jidong Community of Northern China from 2014 to 2018. Seropositive frequency, incidence, and reinfection of C. trachomatis were determined by detecting antibody against C. trachomatis Pgp3 using "in-house" luciferase immunosorbent assay (LISA). The dynamic of anti-Pgp3 antibody was analyzed using the Generalized Estimating Equation (GEE) model. The overall Pgp3 seropositive frequency among the 18-65-year-old population was 28.1% (95% CI 24.9-31.5), and significantly increased from 12.0% in those aged 18-29 years to 48.6% in the 60-65 years old. The seropositive frequency was slightly higher in women than in men (31.3% vs. 25.4%) without statistical significance. The C. trachomatis incidence and reinfection rate were 11 and 14 per 1,000 person-years, respectively, and showed no significant difference with respect to age, gender, ethnicity, marital status, and education levels. Furthermore, anti-Pgp3 antibody remained detectable in 93.3% (195/209) of the seropositive subjects during the 5 years of follow-up. The overall decay rate for anti-Pgp3 antibody for CT-infected persons was -0.123 Log2 RLU/year, which was dramatically slower than in CT new infection (-3.34 Log2 RLU/year) or reinfection (-1.1 Log2 RLU/year). In conclusion, at least one quarter of the people aged 18-65 years have been infected with C. trachomatis over their lifetime while all age groups are susceptible to C. trachomatis infection in the community of Northern China. Therefore, comprehensive prevention strategies are urgently needed.
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Affiliation(s)
- Jingwei Shui
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Dongjie Xie
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jianhui Zhao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Cailing Ao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Hongqing Lin
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yuanhao Liang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Haiying Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yingchun Dai
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Shixing Tang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China.,Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, China
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10
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Detection-Based Monetary Incentives to Improve Syphilis Screening Uptake: Results of a Pilot Intervention in a High Transmission Setting in Southern China. Sex Transm Dis 2021; 47:187-191. [PMID: 31842086 DOI: 10.1097/olq.0000000000001116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Underscreening of syphilis in clinical settings is a pervasive problem in resource-constrained settings where heavy patient loads and competing health priorities inhibit health providers' ability to meet screening coverage targets. A "detection-based" pay-for-performance (P4P) strategy can incentivize more targeted testing by rewarding providers with a monetary bonus for every confirmed case. METHODS Five clinics in a high transmission setting of China participated in the 6-month pilot intervention. Seropositive proportions during the P4P intervention were compared with those during the preintervention phase using multilevel logistic regression models adjusted for age and sex of clinic attendees. RESULTS There were 8423 patients that sought care at 1 of the 6 clinics over the course of the study. Adjusted odds of a positive syphilis screen were greater during the intervention period compared to the preintervention interval (odds ratio, 1.33; 95% confidence interval, 1.14-1.56). Variability in clinic-level effects was substantial given the small number of sites of this pilot study. CONCLUSIONS Results of this detection-based P4P pilot study demonstrate the feasibility and preliminary effectiveness of this approach for improving syphilis case detection in resource-constrained clinical settings. A fully powered randomized trial is needed to inform the full utility of this approach for improving sexually transmitted disease detection globally.
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Abstract
This paper reviews the current epidemics of human immunodeficiency virus (HIV) infection in China, particularly the globally available prevention strategies developed and implemented. This review focuses on HIV prevention measures in general, such as education, testing, and counseling and in specific responses to transmission modes, such as blood safety, harm reduction for people who inject drugs, and condom promotion to reduce sexual transmission. We also assess newly developed prevention measures, such as prevention treatment, pre-exposure prophylaxis, post-exposure prophylaxis, male circumcision, and promising potential future preventions, including microbicides and vaccines. Based on this assessment, we provide recommendations for their implementation in China. We conclude that there is no magic bullet for HIV prevention, particularly sexual transmission of the disease, but only a combination of these prevention strategies can control the HIV epidemic.
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12
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First Responses to the Symptoms of Sexually Transmitted Infections and Treatment-Seeking Behavior Among Men Who Have Sex With Men in 13 Cities in China. Sex Transm Dis 2020; 47:28-33. [PMID: 31651711 DOI: 10.1097/olq.0000000000001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data are scarce on sexually transmitted infection (STI) treatment-seeking behavior among men who have sex with men (MSM) in China. The purpose of the study was to characterize the first response to STI symptoms, treatment-seeking behavior, and its associated factors among MSM in China. METHODS A cross-sectional study with convenience sampling design was conducted in 13 cities from April to July 2017. Face-to-face interviews were conducted to collect information on demographics, STI symptoms, and treatment-seeking behavior. Logistic regression analysis was conducted to evaluate variables associated with not seeking treatment. RESULTS Among 3925 recruited participants, 628 (16.0%) reported STI symptoms in the past 12 months and were included in the analysis. Upon or after being notified of the symptoms, MSM sought help from various sources or self-tested using rapid testing kits. Only 322(51.3%) went to see a doctor in clinic. In multiple logistic regression analyses, younger age, lower income, less STI knowledge (adjusted odds ratio [AOR], 1.8; 95% confidence interval [CI], 1.2-2.5), not knowing own STI risk (AOR, 1.8; 95% CI, 1.2-2.7), no symptoms of anogenital ulcers (AOR, 2.3; 95% CI, 1.3-3.8) or anogenital warts (AOR, 2.4; 95% CI, 1.6-3.7), no syphilis testing in the past 12 months (AOR, 2.1; 95% CI, 1.5-3.0) were associated with higher probability of not seeking treatment in clinics. CONCLUSIONS We found a high prevalence of STI symptoms among MSM and only half sought treatment. Prevention efforts should promote STI education, testing, and adequate treatment-seeking behavior.
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Wang L, Yang B, Tso LS, Zhao P, Ke W, Zhang X, Chen Z, Ren X, Liang C, Liao Y, Chen H, Huang J, Yang L. Prevalence of co-infections with other sexually transmitted infections in patients newly diagnosed with anogenital warts in Guangzhou, China. Int J STD AIDS 2020; 31:1073-1081. [PMID: 32842906 DOI: 10.1177/0956462419890496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prevalence of co-infecting sexually transmitted infections (STIs) among patients newly diagnosed with anogenital warts is under-reported. Our objective is to determine the prevalence of six common STIs, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), genital herpes (herpes simplex virus type 2 [HSV-2]), HIV, and syphilis for patients visiting a sexual health clinic in Guangzhou, China. Demographics, sexual health, and medical histories were collected at patient intake. Patients diagnosed with anogenital warts (N = 200) were invited to participate. We collected urine samples, and urethral, cervical, and rectal swabs to test for CT, NG, and MG, and blood samples for serological detection of HSV-2, syphilis, and HIV. Overall 49 (24.5%) had a co-infection (22.2% of men and 27.7% of women). All six STIs were observed among men: CT (6.8%), NG (3.4%), MG (5.1%), HIV (4.3%), HSV-2 (4.3%), and syphilis (1.7%). Women had fewer STIs, but at higher rates: CT (13.3%), MG (6.0%), and HSV-2 (8.4%). Individual men had up to two co-infections, while women had no more than one co-infection. Chlamydia was the most common STI. Patients aged 18-25 years (35.4%) had the highest prevalence. Although opportunistic screening is often applied for high-risk groups, expansion to patients with anogenital warts in all health-care settings would improve detection of problematic asymptomatic co-infections, thereby increasing China's capacity to contribute toward global surveillance systems.
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Affiliation(s)
- Liuyuan Wang
- Department of Dermatology and Venerology, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Bin Yang
- Department of Dermatology and Venerology, The First Affiliated Hospital, Jinan University, Guangzhou, China.,Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Lai S Tso
- Department of Culture Studies and Oriental Languages, University of Oslo, Oslo, Norway.,Anthropology, Massachusetts Institute of Technology, Cambridge, MA, USA.,Center for Health and Human Development Studies, Sun Yat-sen University, Guangzhou, China
| | - Peizhen Zhao
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Wujian Ke
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Xiaohui Zhang
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Zhengyu Chen
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Xuqi Ren
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Chunmei Liang
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Yuying Liao
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Huiru Chen
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Jinmei Huang
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Ligang Yang
- Department of Venerology, Dermatology Hospital, Southern Medical University, Guangzhou, China
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Yu K, Zheng Y. A Short-Term Longitudinal Investigation of the Perceived Hookup Attitude of Gender-Specific Close Friends and Hookup Behavior. Front Psychol 2020; 11:1410. [PMID: 32765340 PMCID: PMC7381151 DOI: 10.3389/fpsyg.2020.01410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/26/2020] [Indexed: 11/21/2022] Open
Abstract
Research suggests that peer injunctive norms (i.e., perceived attitudes) have an indirect effect on youth’s behavior. Few studies have explored the underlying mechanism of the relationship between the perceived attitude of gender-specific close friends and hookup behavior. Following the social norm approach and the social learning theory, a person’s own hookup attitude and their emotional reaction after a hookup would influence this relationship as mediators. We therefore examined the association between perceived hookup attitudes of students’ same-sex/opposite-sex close friends and the number of hookup partners via mediated variables (i.e., own hookup attitude and affect following a recent hookup) in Chinese college students (N = 314) who completed self-report measures at 6-month intervals. The results of a path analysis showed that students’ own attitudes toward hookups and negative affect following a hookup significantly mediated the association between perceived hookup attitudes of same-sex close friends and the number of hookup partners over 6 months. These findings indicate that same-sex close friends’ injunctive norms were more strongly associated with future hookup behavior, as compared to opposite-sex friends’ injunctive norms. To better understand the relationship between peer norms and hookup behavior, both students’ hookup attitudes and negative emotional responses should be considered.
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Affiliation(s)
- Ke Yu
- Center for Studies of Education and Psychology of Minorities in Southwest China, Southwest University, Chongqing, China.,Sichuan University of Culture and Arts, Mianyang, China
| | - Yong Zheng
- Faculty of Psychology, Southwest University, Chongqing, China
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15
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Li KT, Huang W, Tang W, Wu F, Zhao Y, Wu D, Yang F, Zhang TP, Forastiere L, Alexander M, Kumar N, Tucker JD. A Secondary Mixed Methods Analysis of a Pay-it-Forward Gonorrhea/Chlamydia Testing Program Among Men Who Have Sex With Men in China. Sex Transm Dis 2020; 47:395-401. [PMID: 32149952 PMCID: PMC7230016 DOI: 10.1097/olq.0000000000001161] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gonorrhea and chlamydia are common among Chinese men who have sex with men (MSM), but testing rates are low. We developed a pay-it-forward program where men receive a free gonorrhea/chlamydia test and can then donate toward future participants' tests. This study aims to investigate drivers of testing uptake and donation using a mixed methods approach. METHODS We used a sequential explanatory design to explore drivers of testing uptake and donation unique to pay-it-forward through a quantitative cross-sectional survey and a qualitative thematic analysis of semistructured interviews. We collected data on sociodemographics and perceived benefits of pay-it-forward among men offered the pay-it-forward interventionand analyzed testing uptake and donations using descriptive statistics and logistic regression. We then conducted 30 semistructured interviews with men and coded interview data to identify themes. RESULTS Three hundred and one MSM were offered pay-it-forward and 55% (165/301) received gonorrhea/chlamydia testing. Ninety-one percent (150 of 165) donated any amount with a mean of 58.31 ± 53.39 RMB (US $8.61 ± 7.88), or 39% of the standard price of gonorrhea/chlamydia testing. Getting tested was not associated with income, but donations were higher in the highest income bracket (adjusted odds ratio, 7.12; 95% confidence interval, 1.61-31.52). Fifty-eight percent (94 of 162) selected "more MSM can get tested," and 54% (88 of 162) selected "I can help someone else" as benefits of pay-it-forward. Qualitative themes for drivers of testing and donation included flexible pricing, generosity and reciprocity, and MSM community identity. CONCLUSIONS Quantitative and qualitative results suggest that this pay-it-forward program may increase gonorrhea/chlamydia testing by reducing cost barriers, leveraging generosity and reciprocity, and mobilizing community altruism.
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Affiliation(s)
- Katherine T Li
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Wenting Huang
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Southern Medical University, Guangzhou, China
| | - Feng Wu
- Sun Yat-sen University, Guangzhou, China
| | - Yang Zhao
- School of Social Science, University of Queensland, Brisbane, Australia
| | - Dan Wu
- London School of Hygiene and Tropical Medicine, London, UK
| | - Fan Yang
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
| | - Tiange P Zhang
- Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | | | | | - Navin Kumar
- Sociology Department, Yale University, New Haven, USA
| | - Joseph D Tucker
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- London School of Hygiene and Tropical Medicine, London, UK
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16
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Li KT, Tang W, Wu D, Huang W, Wu F, Lee A, Feng H, Pan SW, Han L, Mak V, Yang L, Tucker JD. Pay-it-forward strategy to enhance uptake of dual gonorrhea and chlamydia testing among men who have sex with men in China: a pragmatic, quasi-experimental study. THE LANCET. INFECTIOUS DISEASES 2020; 19:76-82. [PMID: 30587296 DOI: 10.1016/s1473-3099(18)30556-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/09/2018] [Accepted: 09/04/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chinese men who have sex with men (MSM) rarely receive gonorrhoea and chlamydia testing. The purpose of this pilot study was to evaluate a pay-it-forward strategy to increase uptake of gonorrhoea and chlamydia testing among MSM. METHODS We performed a quasi-experimental pragmatic study to compare a pay-it-forward model with standard of care at two HIV testing sites for MSM in Guangzhou, China: an STD clinic for MSM and a local MSM community-based organisation. All men who arrived at the STD clinic or the community-based organisation were invited to participate. In the pay-it-forward programme, men were offered free gonorrhoea and chlamydia testing and given the option of donating money toward testing for future participants. In the standard-of-care group, men were offered gonorrhoea and chlamydia testing at the standard patient price of ¥150 (about US$21·50). The pay-it-forward programme was implemented for 3 months, after which both sites switched to standard of care offering dual testing for 3 months. The primary outcome for this study was uptake of dual gonorrhoea and chlamydia testing, which we compared using χ2 test and logistic regression, reported as crude odds ratios (cOR) and adjusted odds ratios (aOR), by adjusting for nationality, marital status, income, and site of testing. FINDINGS The pay-it-forward programme took place from Dec 2, 2017, to Feb 3, 2018, and the standard-of-care control took place from March 11, 2018, to May 1, 2018. 408 men were included in this study. 203 men were offered pay-it-forward, and 205 were offered standard of care. Overall, 109 (54%) of 203 men in the pay-it-forward group and 12 (6%) of 205 men in the standard-of-care group received gonorrhoea and chlamydia testing (cOR 18·65, 9·78-35·54; p<0·0001; aOR 19·73, 95% CI 10·02-38·85; p<0·0001). Of all 121 men who tested, this was the first gonorrhoea test for 97 (80%) men and the first chlamydia test for 104 (86%) men. Five (4%) of these 121 men were diagnosed with gonorrhoea and 15 (12%) were diagnosed with chlamydia. 97 (89%) of 109 men who received testing in the pay-it-forward group donated some money toward testing for future participants. INTERPRETATION Pay-it-forward might be a sustainable model for expanding integrated HIV testing services among MSM in China. FUNDING National Institutes of Health, Southern Medical University Dermatology Hospital, Doris Duke Charitable Foundation.
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Affiliation(s)
- Katherine T Li
- Weill Cornell Medical College, New York, NY, USA; University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China; Dermatology Hospital, Southern Medical University, Guangzhou, China; School of Public Health, Southern Medical University, Guangzhou, China; University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dan Wu
- University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China
| | - Wenting Huang
- University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China
| | - Feng Wu
- University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China; Sun Yat-sen University, Guangzhou, China
| | - Amy Lee
- University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China
| | - Henry Feng
- University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China; Duke University, Durham, NC, USA
| | | | - Larry Han
- University of North Carolina Project-China, Guangzhou, China; SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China; University of Cambridge Judge Business School, Cambridge, UK
| | - Vincent Mak
- University of Cambridge Judge Business School, Cambridge, UK
| | - Ligang Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Joseph D Tucker
- SESH (Social Entrepreneurship to Spur Health) Team, Guangzhou, China; University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
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17
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Chimungu B, Fu M, Wu J, Wu J, Huang L, Dai Y, Tang S, Zhang J, Wan C. Prevalence of sexually transmitted infections among foreigners living in Guangzhou, China: a cross-sectional study (2010-2017). BMC Infect Dis 2020; 20:345. [PMID: 32410628 PMCID: PMC7222532 DOI: 10.1186/s12879-020-04995-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/27/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The prevalence of HIV/HCV/HBV/ Treponema pallidum is an essential health issue in China. However, there are few studies focused on foreigners living in China. This study aimed to assess the prevalence and socio-demographic distribution of HIV, HBV, HCV, and T. pallidum among foreigners in Guangzhou in the period of 2010-2017. METHODS A cross-sectional study was conducted to screen serological samples of 40,935 foreigners from 2010 to 2017 at the Guangdong International Travel Health Care Center in Guangzhou. Samples were tested for hepatitis B surface antigen (HBsAg), anti-HCV, syphilis antibody (anti-TPPA) and anti-HIV 1 and 2. We collected secondary data from laboratory records and used multiple logistic regression analyses to verify the association between different factors and the seroprevalence of HIV/HBV/HCV/ T. pallidum. RESULTS The prevalence of HBV/HCV/HIV/ T. pallidum was 2.30, 0.42, 0.02, and 0.60%, respectively, and fluctuated slightly for 7 years. The results of multiple logistic regression showed that males were less susceptible to HBV than females (odds ratio [OR] = 0.77, 95% CI: 0.67-0.89). Participants under the age of 20 had a lower risk of HBV (OR = 0.25, 95% CI: 0.18-0.35), HCV (OR = 0.06, 95% CI: 0.02-0.18), and T. pallidum (OR = 0. 10, 95% CI: 0.05-0.20) than participants over the age of 50. Participants with an education level below high school were more likely to have HBV (OR = 2.98, 95% CI: 1.89-4.70) than others, and businessmen (OR = 3.02, 95% CI: 2.03-4.49), and designers (OR = 3.83, 95% CI: 2.49-5.90) had a higher risk of T. pallidum than others. Co-infection involved 58 (4.20%) total cases, and the highest co-infection rate was observed for HBV and T. pallidum (2.60%). CONCLUSION The prevalence of HBV/HCV/HIV/ T. pallidum was low among foreigners in Guangzhou. Region, gender, age, educational level, and occupation were risk factors for positive infection.
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Affiliation(s)
- Benard Chimungu
- Department of Microbiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Muqing Fu
- Department of Microbiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Jian Wu
- Clinical laboratory, Guangdong International Travel Health Care Center, Guangzhou, 510635, China
| | - Jiali Wu
- Department of Microbiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Liping Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Yingchun Dai
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Shixing Tang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Jianming Zhang
- Clinical laboratory, Guangdong International Travel Health Care Center, Guangzhou, 510635, China.
| | - Chengsong Wan
- Department of Microbiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China. .,Key Laboratory of Tropical Disease Research of Guangdong Province, Southern Medical University, Guangzhou, 510515, China.
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18
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Rashidian M, Minichiello V, Knutsen S, Ghamsary M. Western, Asian, and Middle Eastern Societies’ Cultural Attitudes and Barriers Impacting the Management of Sexual Health Care. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/978-3-030-36222-5_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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19
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Ong JJ, Li CC, Fu H, Nie J, Tang W, Chang W, Smith MK, Marks M, Yang B, Wang C, Tucker J. Risk attitudes, risky sexual behaviours and willingness to test negative for syphilis using lottery-based financial incentives among Chinese men who have sex with men. Sex Transm Infect 2019; 96:355-357. [PMID: 31653680 DOI: 10.1136/sextrans-2019-054072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 10/02/2019] [Accepted: 10/06/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Individuals with risk-loving attitudes may be more likely to participate in high-risk sex and gambling. We investigated whether a lottery-based financial incentive to have a negative syphilis test may attract Chinese men who have sex with men (MSM) who practised risky sexual behaviours. METHODS In July 2018, a national online cross-sectional survey was conducted in China. We collected information on willingness to participate in a lottery-based financial incentive where men were eligible if they tested negative for syphilis, and the minimum prize that would attract them to participate. We used a validated risk attitude scale which asked about the willingness to take risks in six domains, ranging from 0 (avoids taking risk) to 10 (fully prepared to take risks). To avoid multicollinearity, we used principal components analysis to create a 'risk attitude index'. Bivariable and multivariable logistic regression explored factors associated with willingness to test negative for syphilis. RESULTS 699 MSM enrolled with a median age of 26 years (IQR: 23-30). 70% self-identified as gay and 52% reported ever testing for syphilis. 64% stated they were likely or very likely to test for syphilis linked with a lottery-based incentive. The median desired amount for the lottery had an expected value of ¥10 (US$1.50, IQR: ¥5-¥30). Men who had greater odds of willingness to participate in the lottery-based incentive were those scoring highest on the risk attitude index (adjusted OR (AOR) 2.6, 95% CI 1.5 to 4.3), those reporting more than one sexual partner in the last 3 months (AOR 1.7, 95% CI 1.2 to 2.4), those who had not used condoms during their last sex (AOR 1.5, 95% CI 1.0 to 2.2) and those who ever had group sex (AOR 1.5, 95% CI 1.0 to 2.2). CONCLUSION Chinese MSM with higher risk attitudes and who reported riskier sexual behaviours indicated greater interest in the concept of a lottery-based incentive for syphilis testing. A lottery-based incentive may be a promising strategy for promoting condom use among risk-loving men.
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Affiliation(s)
- Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Central Clinical School, Monash University, Clayton, Victoria, Australia
| | - Chang Chang Li
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - HongYun Fu
- University of North Carolina Project China, Guangzhou, China.,Community Health and Research Division, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Juan Nie
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - WeiBin Chang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - M Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - Cheng Wang
- Dermatology Hospital of Southern Medical University, Guangzhou, Guangdong, China .,Guangdong Center for Prevention and Treatment of Skin Diseases and STDs, Guangzhou, Guangdong, China
| | - Joseph Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,University of North Carolina Project China, Guangzhou, China
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20
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Wang Z, Yang L, Hao C, Jiang H, Zhu J, Luo Z, Zheng Z, Lau JTF. A Randomized Controlled Trial Evaluating Efficacy of a Brief Setting-Based and Theory-Based Intervention Promoting Voluntary Medical Male Circumcision Among Heterosexual Male Sexually Transmitted Disease Patients in China. AIDS Behav 2019; 23:2453-2466. [PMID: 31321636 DOI: 10.1007/s10461-019-02610-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Voluntary medical male circumcision (VMMC) is an evidence-based biomedical HIV prevention but under-utilized by male sexually transmitted diseases patients (MSTDP) in China. A parallel-group, non-blinded randomized controlled trial was conducted. Participants were uncircumcised heterosexual MSTDP attending four sexually transmitted diseases (STD) clinics in three Chinese cities. A total of 244 MSTDP were randomized 1:1 into the intervention group (n = 108) and the control group (n = 136). In addition to the education booklet received by the control group, the intervention group watched a 10-min video clip and received a brief counseling delivered by clinicians in the STD clinics. The interventions were developed based on the Health Belief Model and the Theory of Planned Behavior. At Month 6, participants in the intervention group reported significantly higher uptake of VMMC (14.8% versus 2.9%; RR 5.03, 95% CI 1.73, 14.62, p = 0.001). The brief STD clinic-based intervention was effective in increasing VMMC uptake among MSTDP in China.Trial registry: This study is registered at ClinicalTrials.gov, number NCT03414710. https://clinicaltrials.gov/ct2/show/NCT03414710 .
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Affiliation(s)
- Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.
| | - Ligang Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Dermatology Hospital, Guangzhou, China
| | - Chun Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hui Jiang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | | | - Zhenzhou Luo
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Zhiwei Zheng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Joseph T F Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.
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21
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Zhang TP, Yang F, Tang W, Alexander M, Forastiere L, Kumar N, Li K, Zou F, Yang L, Mi G, Wang Y, Huang W, Lee A, Zhu W, Vickerman P, Wu D, Yang B, Christakis NA, Tucker JD. Pay-it-forward gonorrhea and chlamydia testing among men who have sex with men in China: a study protocol for a three-arm cluster randomized controlled trial. Infect Dis Poverty 2019; 8:76. [PMID: 31426869 PMCID: PMC6700988 DOI: 10.1186/s40249-019-0581-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/29/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Gonorrhea and chlamydia testing rates are poor among Chinese men who have sex with men (MSM). A quasi-experimental study suggested that a pay-it-forward strategy increased dual gonorrhea/chlamydia testing among MSM. Pay-it-forward offers an individual a gift (e.g., a free test) and then asks the same person if they would like to give a gift to another person. This article reports the protocol of a randomized controlled trial to evaluate dual gonorrhea/chlamydia test uptake and other outcomes among MSM in three arms - a pay-it-forward arm, a pay-what-you-want arm, and a standard of care arm. METHODS Three hundred MSM will be recruited at three HIV testing sites in Guangzhou and Beijing. Testing sites include two hospital-based MSM sexually transmitted diseases clinics and one MSM community-based organization. Eligible participants will be born biologically male, aged 16 years or older, reporting previous anal sex with another man, having never participated in the pay-it-forward program, without previous gonorrhea and chlamydia testing in the past 12 months, and residing in China. Following a cluster randomized design, every cluster of ten participants will be randomly allocated into one of three arms: (1) a pay-it-forward arm in which men are offered free gonorrhea and chlamydia testing and then asked whether they would like to donate ("pay it forward") toward testing for future testers; (2) a pay-what-you-want arm in which men are offered free testing and told to decide how much to pay after receiving the test; (3) a standard of care arm in which men can pay the full price for dual gonorrhoea and chlamydia testing. The primary outcome is dual gonorrhoea/chlamydia testing as verified by administrative records. Secondary outcomes include incremental cost per test, incremental cost per diagnosis, community connectedness, and social cohesion. Primary outcome will be calculated for each arm using intention-to-treat and compared using one-sided 95% confidence intervals with a margin of 20% increase defined as superiority. DISCUSSION This study will examine the pay-it-forward strategy in comparison to the standard of care in improving test uptake for gonorrhea and chlamydia. We will leverage the cluster randomized controlled trial to provide scientific evidence on the potential effect of pay-it-forward. Findings from this study will shed light on novel intervention methods for increasing preventive health service utilization and innovate ways to finance it among communities. TRIAL REGISTRATION ClinicalTrials.gov, NCT03741725 . Registered on 12 November 2018.
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Affiliation(s)
- Tiange P. Zhang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
- Loyola University Chicago Stritch School of Medicine, Maywood, IL USA
| | - Fan Yang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
| | - Weiming Tang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
- Southern Medical University Dermatology Hospital, Guangzhou, China
| | - Marcus Alexander
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT USA
| | - Laura Forastiere
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT USA
| | - Navin Kumar
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT USA
| | | | - Fei Zou
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
| | - Ligang Yang
- Southern Medical University Dermatology Hospital, Guangzhou, China
| | | | - Yehua Wang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
| | - Wenting Huang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
| | - Amy Lee
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
| | - Weizan Zhu
- Zhitong Guangzhou LGBT Center, Guangzhou, China
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Dan Wu
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
| | - Bin Yang
- Southern Medical University Dermatology Hospital, Guangzhou, China
| | | | - Joseph D. Tucker
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Guida J, Hu L, Liu H. Sexual Behavior With Noncommercial Partners: A Concurrent Partnership Study Among Middle-Aged Female Sex Workers in China. JOURNAL OF SEX RESEARCH 2019; 56:670-680. [PMID: 29452001 PMCID: PMC6188845 DOI: 10.1080/00224499.2018.1434115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Female sex workers (FSWs) often engage in concurrent partnerships, meaning they have multiple sexual relationships at the same time. The objective of this study was to investigate sexual concurrency and its associations with condom use and syphilitic infections among FSWs over age 35. Respondent-driven sampling was used to recruit 1,245 FSWs in Nanning, Hefei, and Qingdao, China. FSWs were asked to report whether they had concurrent partners in the past six months. Concurrency was defined as engagement in sex with commercial clients and (1) husbands and boyfriends (n = 167); (2) husbands only (n = 301); or (3) boyfriends only (n = 469). FSWs with only commercial clients were used as the comparison group (n = 308). Across all groups, the percentage of FSWs with prevalent and active syphilis ranged from 19.6% to 25.6% and 9.1% to 11.5%, respectively. Condom use was low with noncommercial sexual partners and was more likely to be used when FSWs' boyfriends had other partners. Three components of the theory of planned behavior were significantly associated with consistent condom use. Concurrent relationships may lead to increased transmission of syphilis at the workplace and family levels. Effective interventions should target concurrency with both commercial and noncommercial partners.
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Affiliation(s)
- Jennifer Guida
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park
| | - Liangyuan Hu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park
| | - Hongjie Liu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park
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23
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Wu D, Li KT, Tang W, Ong JJ, Huang W, Fu H, Lee A, Wei C, Tucker JD. Low Chlamydia and Gonorrhea Testing Rates Among Men Who Have Sex With Men in Guangdong and Shandong Provinces, China. Sex Transm Dis 2019; 46:260-265. [PMID: 30601282 PMCID: PMC8159294 DOI: 10.1097/olq.0000000000000963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although periodic chlamydia and gonorrhea testing is recommended for men who have sex with men (MSM), little is known about testing rates in China. This study examines chlamydia and gonorrhea testing rates and testing correlates among Chinese MSM. METHODS An online survey of MSM was conducted in August 2017. Men 16 years or older who had ever had sex with a man were enrolled through a gay social networking mobile application. We asked men about their sexual behaviors, community engagement in sexual health, and previous testing for chlamydia, gonorrhea, and HIV. Multivariable logistic regressions were used to examine the association of testing with community engagement and recent HIV testing. RESULTS Of 1031 men, 819 (79.5%) were younger than 30 years, and 263 (25.5%) reported condomless sex in the past 3 months. In total, 294 (28.5%) men tested for chlamydia, 315 (30.6%) men tested for gonorrhea, and 817 (79.2%) men tested for HIV. One hundred twenty-five (42.5%) men who received chlamydia testing and 134 (42.5%) men who received gonorrhea testing had substantial community engagement. Compared with men with no/minimal community engagement, men with substantial community engagement had greater odds of chlamydia testing (adjusted odds ratio [AOR], 2.8; 95% confidence interval [CI], 1.9-4.3) and gonorrhea testing (AOR, 2.9; 95% CI, 2.0-4.4). Men with recent HIV testing were more likely to have received chlamydia testing (AOR, 1.5; 95% CI, 1.1-2.0) and gonorrhea testing (AOR, 1.6; 95% CI, 1.2-2.1). CONCLUSIONS Chlamydia and gonorrhea testing levels are low among Chinese MSM. Integrating chlamydia and gonorrhea test promotion strategies into HIV prevention programs that engage MSM communities may help bridge the gap.
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Affiliation(s)
| | | | | | | | | | - Hongyun Fu
- Eastern Virginia Medical School, Norfolk, VA
| | | | - Chongyi Wei
- Department of Social and Behavior Health Sciences, Rutgers School of Public Health, Piscataway, NJ
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24
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Prevalence of Ureaplasma urealyticum, Chlamydia trachomatis, Neisseria gonorrhoeae and herpes simplex virus in Beijing, China. Epidemiol Infect 2018; 147:e59. [PMID: 30501682 PMCID: PMC6518584 DOI: 10.1017/s0950268818003163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The prevalence of sexually transmitted infection (STI) pathogens in Beijing, China, is rarely reported. In this study, 34 911 symptomatic outpatients with suspected genital infections who attended outpatient clinics in a tertiary care hospital were included to investigate the updated prevalence of Ureaplasma urealyticum (UU), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and herpes simplex virus (HSV) from 1 January 2013 to 31 December 2016 in Beijing, China. Results indicated that a decrease trend (UU, CT, NG and HSV) in male and an increase trend (UU, CT and NG) in female were observed during the period. Patients aged 20–39 years old were mostly affected by these pathogens, while the prevalence in patients aged 20–29 years old was the highest, The prevalence of UU in male was significantly lower than in female (31.5% vs. 49.3%, P < 0.05), while the prevalence of NG in male was significantly higher than in female (2.5% vs. 0.8%, P < 0.05). In patients with co-infections, 60.6% of male and 71.4% of female were co-infected by UU + CT. In total, 11.9% and 88.1% of patients with HSV infections were confirmed to be infected by HSV-1 and HSV-2. This study could contribute to a better understanding of the current epidemiological features of UU, NG, CT and HSV among symptomatic patients attending an outpatient clinic in Beijing, China, and thus facilitate to develop more effective intervention, prevention and treatment of STI.
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25
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Cao WT, Li R, Ying JY, Chi XL, Yu XD. Spatiotemporal distribution and determinants of gonorrhea infections in mainland China: a panel data analysis. Public Health 2018; 162:82-90. [PMID: 29990616 DOI: 10.1016/j.puhe.2018.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 05/03/2018] [Accepted: 05/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Gonorrhea remains a major public health concern worldwide. This study aims to explore the spatiotemporal distribution and sociodemographic determinants of gonorrhea rates during 2004-2014 in mainland China. STUDY DESIGN Space-time scan statistics and spatial panel regression model. METHODS The gonorrhea infection data and sociodemographic data during 2004-2014 at the provincial level in mainland China were extracted from the China Public Health Science Data Center and China Statistical Yearbooks, respectively. The space-time scan statistics were used to identify the high-risk clusters of gonorrhea, and the spatial panel regression model was adopted to examine the sociodemographic determinants. RESULTS One most likely and five secondary high-risk clusters of gonorrhea rates were identified, which were mainly located in southern and eastern China. The regions with higher GDP per capita, larger floating population, less access to healthcare, higher male-female ratio, and higher divorce rate were more likely to become high-risk areas of gonorrhea. CONCLUSIONS Gonorrhea rates were distributed unevenly through space and time and affected by various sociodemographic variables. The space-time scan statistics and spatial panel regression are viable tools for identifying clusters and examining determinants of gonorrhea rates. The findings provide valuable implications for developing targeted prevention and control programs in public health practice.
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Affiliation(s)
- Wen-Ting Cao
- School of Earth Sciences, Zhejiang University, Hangzhou 310027, Zhejiang, China.
| | - Rui Li
- School of Earth Sciences, Zhejiang University, Hangzhou 310027, Zhejiang, China.
| | - Ju-Ying Ying
- ZheJiang Economic & Trade Polytechnic, Xiasha, Hangzhou 310018, Zhejiang, China.
| | - Xiao-Li Chi
- Institute of Meteorology, Free University of Berlin, Carl-Heinrich-Becker Weg 6-10, 12165 Berlin, Germany.
| | - Xiao-Dong Yu
- School of Earth Sciences, Zhejiang University, Hangzhou 310027, Zhejiang, China.
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26
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Cao Y, Su X, Wang Q, Xue H, Zhu X, Zhang C, Jiang J, Qi S, Gong X, Zhu X, Pan M, Ren H, Hu W, Wei Z, Tian M, Liu W. A Multicenter Study Evaluating Ceftriaxone and Benzathine Penicillin G as Treatment Agents for Early Syphilis in Jiangsu, China. Clin Infect Dis 2018; 65:1683-1688. [PMID: 29020150 DOI: 10.1093/cid/cix611] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 07/14/2017] [Indexed: 11/14/2022] Open
Abstract
Background The aim of this study was to assess the efficacy of ceftriaxone and benzathine penicillin G (BPG) in nonpregnant, immunocompetent adults with early syphilis because there is a lack of clinical evidence supporting ceftriaxone as an alternative treatment for early syphilis without an human immunodeficiency virus coinfection. Methods A randomized, open-label controlled study evaluating the efficacy of ceftriaxone and BPG was conducted in 4 hospitals in Jiangsu Province. Treatment comprised either ceftriaxone (1.0 g, given intravenously, once daily for 10 days) or BPG (2.4 million units, given intramuscularly, once weekly for 2 weeks). A serological response was defined as a ≥4-fold decline in the rapid plasma reagin (RPR) titer. Results In all, 301 patients with early syphilis were enrolled in this study; 230 subjects completed the follow-ups. The serological response at 6 months of follow up was observed in 90.2% in ceftriaxone group and 78.0% in BPG group (P = .01). There was no significant difference between treatment groups in patients with primary or early latent syphilis, but among patients with secondary syphilis the difference was highly significant (95.8% vs 76.2%; P < .01). Moreover, patients exhibiting a Jarisch-Herxheimer reaction after treatment might have a shorter period before a serological response (P = .03). Conclusions In this study, ceftriaxone regimen was noninferior to the BPG regimen in nonpregnant, immunocompetent patients with early syphilis. Clinical Trials Registration ChiCTR-TQR-13003624.
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Affiliation(s)
- Yuping Cao
- Institute of Dermatology and Skin Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing
| | - Xiaohong Su
- Institute of Dermatology and Skin Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing
| | - Qianqiu Wang
- Institute of Dermatology and Skin Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing
| | - Huazhong Xue
- Institute of Dermatology and Skin Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing
| | - Xiaofeng Zhu
- Institute of Dermatology and Skin Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing
| | - Chuanfu Zhang
- Institute of Dermatology and Skin Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing
| | - Juan Jiang
- Institute of Dermatology and Skin Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing
| | - Shuzhen Qi
- Institute of Dermatology and Skin Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing
| | - Xiangdong Gong
- Institute of Dermatology and Skin Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing
| | - Xiaofang Zhu
- Department of Dermatology, Northern Jiangsu People's Hospital, Yangzhou
| | - Min Pan
- Department of Dermatology, Northern Jiangsu People's Hospital, Yangzhou
| | - Hong Ren
- Department of Dermatology, The First People's Hospital of Lianyungang
| | - Wenlong Hu
- Department of Dermatology, The First People's Hospital of Lianyungang
| | - Zhiping Wei
- Department of Dermatology, Affiliated Hospital of Xuzhou Medical University, China
| | - Meihua Tian
- Department of Dermatology, Affiliated Hospital of Xuzhou Medical University, China
| | - Weida Liu
- Institute of Dermatology and Skin Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing
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27
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Chang RC, Hail-Jares K, Zheng H, He N, Bouey JZH. Mitigating circumstances: A model-based analysis of associations between risk environment and infrequent condom use among Chinese street-based sex workers. PLoS One 2018; 13:e0195982. [PMID: 29763416 PMCID: PMC5953488 DOI: 10.1371/journal.pone.0195982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/03/2018] [Indexed: 12/01/2022] Open
Abstract
Background Little is known about how freelance street-based sex workers navigate condom use while soliciting. Traditional behavioural model may fail to account for the complex risk environment that most street-based sex workers work within. We examine first the association of self-efficacy and the infrequent condom use, then we investigated the roles of clients and venues frequented on this association. Method Using a purposive chain-referral sampling method, we surveyed 248 street-based sex workers in Shanghai. The survey focused on sex workers HIV risk factors, sex work patterns, HIV knowledge, and related HIV self-efficacy. Clients types and behaviours, and characteristics of the venues frequented by these commercial sex workers were also collected. We conducted a series of multiple logistic regression models to explore how the association between a sex worker’s self-efficacy with infrequent condom use change as client and venue characteristics were added to the models. Results We find that within the basic model, low self-efficacy was marginally associated with infrequent condom use (54.9% vs. 45.1%, AOR = 1.70, 95% CI = 0.95–3.03). As client- and venue- characteristics were added, the associations between self-efficacy and condom use were strengthened (AOR = 2.10 95% CI = 1.12–3.91 and 2.54 95% CI = 1.24–5.19 respectively). Those who reported middle-tiered income were more likely to report infrequent condom use compared to their peers of high income (AOR = 3.92 95% CI = 1.32–11.70) whereas such difference was not found between low income and high income sex workers. Visiting multiple venues and having migrant workers as clients were also associated with infrequent condom use. Conclusion Our findings suggest sex worker’s self-efficacy matters in their HIV risk behaviours only when environment characteristics were adjusted. Risk environment for street-based sex workers are complex. Programming addressing behavioural changes among female sex workers should adopt holistic, multilevel models with the consideration of risk environments.
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Affiliation(s)
- Ruth C. Chang
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington DC, United States of America
| | - Katie Hail-Jares
- Griffith Criminology Institute, Griffith University, Mt. Gravatt, Queensland, Australia
| | - Huang Zheng
- Shanghai CSW&MSM Center, Xinjian St., Shanghai, China
| | - Na He
- Department of Epidemiology, Fudan University, Wu Jiao Chang, Yang Pu Qu, Shanghai, China
| | - Jennifer Z. H. Bouey
- Department of International Health, School of Nursing and Health Studies, Georgetown University, Washington DC, United States of America
- * E-mail:
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Zhou YH, Ma HX, Yang Y, Gu WM. Prevalence and antimicrobial resistance of Ureaplasma spp. and Mycoplasma hominis isolated from semen samples of infertile men in Shanghai, China from 2011 to 2016. Eur J Clin Microbiol Infect Dis 2018; 37:729-734. [PMID: 29313203 DOI: 10.1007/s10096-017-3167-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/14/2017] [Indexed: 02/07/2023]
Abstract
This study was conducted to estimate the prevalence and antimicrobial resistance rate of Ureaplasma spp. and Mycoplasma hominis that were isolated from the semen samples of infertile males in Shanghai, China from 2011 to 2016. A total of 5016 infertile males and 412 healthy male controls were examined. The cultivation, identification, and antimicrobial susceptibilities of Ureaplasma spp. and M. hominis were assessed by using a Mycoplasma IST kit that was performed in parallel to selective solid agar cultivation. The positive rate of genital Mycoplasma infections in infertile men from 2011 to 2016 was 30-55%, which initially decreased during the first four years and then increased in the last two. Two distinct high-risk age ranges of Mycoplasma infections were observed: 26-30 years (37.8%) and 31-35 years (30.7%). Semisynthetic tetracyclines and macrolide antibiotics were the most effective agents against Ureaplasma spp. Among the fluoroquinolones, sparfloxacin and levofloxacin were also effective. Antibiotic resistance of Ureaplasma spp. against tetracyclines and macrolide antibiotics in the last six years did not vary significantly. However, the rate of resistance to fluoroquinolones (except norfloxacin) and spectinomycin decreased in the last two years. The rate of genital Mycoplasma presence in infertile patients between the ages of 26 and 35 years in Shanghai was high. The prevalence of genital Mycoplasma decreased during the first four years and then increased, with a peak in 2016. Doxycycline, minocycline, josamycin, and sparfloxacin can be recommended for first-line empirical treatment of Mycoplasma infections in infertile men in Shanghai, China.
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Affiliation(s)
- Y-H Zhou
- Department of Clinical Laboratory, Shanghai Crops Hospital of Chinese People's Armed Police, Shanghai, China
| | - H-X Ma
- Department of Health Management Medicine, Shanghai East Hospital, Tongji University, Shanghai, China.
| | - Y Yang
- Department of Clinical Laboratory, Shanghai Dermatology Hospital, Shanghai, China
| | - W-M Gu
- Department of Clinical Laboratory, Shanghai Dermatology Hospital, Shanghai, China
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Li M, Zhang X, Huang K, Qiu H, Zhang J, Kang Y, Wang C. Presence of Chlamydia trachomatis and Mycoplasma spp., but not Neisseria gonorrhoeae and Treponema pallidum, in women undergoing an infertility evaluation: high prevalence of tetracycline resistance gene tet(M). AMB Express 2017; 7:206. [PMID: 29150724 PMCID: PMC5691826 DOI: 10.1186/s13568-017-0510-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/11/2017] [Indexed: 01/07/2023] Open
Abstract
Chlamydia trachomatis, Mycoplasma spp., Neisseria gonorrhoeae and Treponema pallidum are sexually transmitted pathogens that threaten reproductive health worldwide. In this study, vaginal swabs obtained from women (n = 133) that attended an infertility clinic in China were tested with qPCRs for C. trachomatis, Mycoplasma spp., N. gonorrhoeae, T. pallidum and tetracycline resistance genes. While none of vaginal swabs were positive for N. gonorrhoeae and T. pallidum, 18.8% (25/133) of the swabs were positive for Chlamydia spp. and 17.3% of the swabs (23/133) were positive for Mycoplasma species. All swabs tested were positive for tetracycline resistance gene tet(M) which is the most effective antibiotic for bacterial sexually transmitted infections. The qPCRs determined that the gene copy number per swab for tet(M) was 7.6 times as high as that of C. trachomatis 23S rRNA, and 14.7 times of Mycoplasma spp. 16S rRNA. In China, most hospitals do not detect C. trachomatis and Mycoplasma spp. in women with sexually transmitted infections and fertility problems. This study strongly suggests that C. trachomatis and Mycoplasma spp. should be routinely tested in women with sexually transmitted infections and infertility in China, and that antimicrobial resistance of these organisms should be monitored. Further studies are warranted to determine the prevalences in different regions and associated risk factors.
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Liu Y, Vermund SH, Ruan Y, Liu H, Zhang C, Yin L, Shao Y, Qian HZ. HIV testing and sexual risks among migrant men who have sex with men: findings from a large cross-sectional study in Beijing, China. AIDS Care 2017; 30:86-94. [PMID: 28944685 DOI: 10.1080/09540121.2017.1381331] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Despite the exacerbating HIV transmission among migrant men who have sex with men (MSM) in China, few epidemiological studies explore their HIV testing/risk profiles. We sought to explore sociodemographic/behavioral correlates of HIV/syphilis and HIV testing among migrant MSM. A study was conducted among 3,588 HIV-uninfected MSM. Participants were recruited via short message services, peer referral, web-advertisement and community outreach. HIV/syphilis infections were lab-confirmed. Migrant MSM were more likely to be HIV-infected compared to local MSM. Among 2,699 migrant MSM, HIV testing was associated with older age, living longer in Beijing, having ≥10 lifetime male sexual partners (LMSPs), having insertive anal sex; while being unemployed/retired and having condomless receptive anal sex (CRAS) were associated with a lower odds of HIV testing. Being married, living longer in Beijing, ever testing for HIV and having sex with women were associated with lower HIV odds; while being unemployed/retired, having higher HIV perception, having ≥ 10 LMSPs and having CRAS were associated a higher HIV odds. Increased likelihood of syphilis was associated with older age, being employed, higher HIV perception, having ≥10 LMSPs and having CRAS. Our study provides implications for targeted interventions to tackle HIV/STI risks and improve HIV testing among migrant Chinese MSM.
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Affiliation(s)
- Yu Liu
- a Department of Public Health Sciences, School of Medicine and Dentistry , University of Rochester , Rochester , NY , USA
| | - Sten H Vermund
- b School of Public Health , Yale University , New Haven , CT , USA
| | - Yuhua Ruan
- c State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Chinese Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Hongjie Liu
- d Department of Epidemiology and Biostatistics, School of Public Health , University of Maryland , College Park , MD , USA
| | - Chen Zhang
- e School of Nursing , University of Rochester , Rochester , NY , USA
| | - Lu Yin
- f Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Yiming Shao
- c State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Chinese Center for Disease Control and Prevention , Beijing , People's Republic of China
| | - Han-Zhu Qian
- g Division of Global HIV and TB , Centers for Disease Control and Prevention (CDC) , Atlanta , GA , USA
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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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Liu D, Jiang Z, Xiu C, Li Z, Song Q, Wang Z. Sexually transmitted infection prevalence and related risk factors among heterosexual male methamphetamine users in China. Int J STD AIDS 2017; 28:1208-1214. [PMID: 28178893 DOI: 10.1177/0956462417693165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Few studies have examined the association between methamphetamine (MA) abuse and sexually transmitted infection (STI) risk among heterosexual male MA users in China. A total of 288 heterosexual male MA users who met our inclusion criteria were recruited from nightclubs, KTVs, bars, bath centres and an STI clinic. STIs were screened among the participants, and the risk factors related to STIs were analysed by multivariate logistic regression in SPSS 11.0. Among the 288 heterosexual male MA users, 51 (17.7%) had syphilis, 36 (12.5%) had genital warts, 2 (0.7%) had genital herpes, 3 (1.0%) had HIV infection and 41 (14.2%) had urethritis. STIs were associated with the following variates: 'MA has the function of anti-inebriation' (OR = 2.522, 95%CI = 1.337-4.756), 'I am addicted to MA' (OR = 4.030, 95%CI = 2.194-7.401), 'It occurred to me to abstain from MA' (OR = 2.939, 95%CI = 1.246-6.934), 'Years of MA abuse' (OR = 2.622, 95%CI = 1.318-5.215), 'Times of MA abuse per week' (OR = 5.275, 95%CI = 1.988-14.002), 'Number of persons using MA together' (OR = 2.579, 95%CI = 1.246-5.340) and 'Number of female sex workers as sex partners per MA abuse' (OR = 4.004, 95%CI = 1.526-10.508). Our findings show that MA users belong to the high-risk group for STI in China. STIs, except for HIV, have spread widely among heterosexual male MA users. Thus, specific interventions must be conducted to prevent the spread of STIs in this population in China.
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Affiliation(s)
- Dianchang Liu
- 1 Department of STD and Leprosy Prevention and Control, Shandong Provincial Institute of Dermatology and Venereology, Shandong, China
| | - Zhenxia Jiang
- 2 Department of HIV/STD Prevention and Control, Qingdao Centers for Disease Control and Prevention, Qingdao, China
| | - Cuizhen Xiu
- 2 Department of HIV/STD Prevention and Control, Qingdao Centers for Disease Control and Prevention, Qingdao, China
| | - Zhizhi Li
- 3 Department of HIV/STD Prevention and Control, Chengyang Centers for Disease Control and Prevention, Qingdao, China
| | - Qing Song
- 3 Department of HIV/STD Prevention and Control, Chengyang Centers for Disease Control and Prevention, Qingdao, China
| | - Zhenhong Wang
- 4 Department of Dermatology, The Third hospital of Chengyang, Qingdao, China
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Chen G, Cao Y, Yao Y, Li M, Tang W, Li J, Babu GR, Jia Y, Huan X, Xu G, Yang H, Fu G, Li L. Syphilis incidence among men who have sex with men in China: results from a meta-analysis. Int J STD AIDS 2017; 28:170-178. [PMID: 26992411 PMCID: PMC5026914 DOI: 10.1177/0956462416638224] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/03/2016] [Indexed: 11/17/2022]
Abstract
The recent upsurge of syphilis infections among men who have sex with men (MSM) is one of the major challenges facing China. However, the overall burden is still not clear. This study aims to summarize the incidence of syphilis among MSM in China by using meta-analysis. We comprehensively searched PubMed-MEDLINE, China National Knowledge Infrastructure and Chinese Wanfang databases. Articles published between December 2009 and March 2015 that met the inclusion criteria were considerably involved in this meta-analysis. Two reviewers performed a quality assessment of the studies and extracted data for estimating the overall syphilis incidence. STATA 12.0 was used to summarize the overall incidence of syphilis. In all, 14 studies from 13 papers were included in this study. Follow-up duration of these studies ranged from six to 36 months, while drop-out rates ranged from 11.9% to 83.6%. The individual incidence rates of the included studies varied from 3.1/100 person-years (95% CI, 0.8-5.3/100 person-years) to 38.5/100 person-years (95% CI, 28.9-48.1/100 person-years), with a pooled incidence of 9.6/100 person-years (95% CI, 7.0-12.2/100 person-years). The subgroup meta-analysis revealed that incidence estimates were 38.5/100 person-years (95% CI, 28.9-48.1/100 person-years), 12.1/100 person-years (95% CI, 7.0-17.2/100 person-years), 11.2/100 person-years (95% CI, 0.7-23.1/100 person-years), 8.9/100 person-years (95% CI, 6.5-11.2/100 person-years), 5.7/100 person-years (95% CI, 3.4-8.0/100 person-years) and 3.1/100 person-years (95% CI, 0.8-5.3/100 person-years) in Northeast, North, Southwest, East, South and Northwest China, respectively. Syphilis incidence among Chinese MSM is high, and this may increase the spread of other sexually transmitted infections, including human immunodeficiency virus. It is essential to integrate syphilis control programs with HIV control programs. This can be achieved by establishing public health response systems to monitor and control the epidemic of syphilis and HIV together in China.
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Affiliation(s)
- Guohong Chen
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Ya Cao
- Department of Biological Science and Technology and State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Yuan Yao
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Ming Li
- Department of Biological Science and Technology and State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
| | - Jianjun Li
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Giridhara R Babu
- Public Health Foundation of India, IIPH-H, Bangalore Campus, Bangalore, India
| | - Yue Jia
- School of Life Science, Xiamen University, Xiamen, China
| | - Xiping Huan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Genxing Xu
- Department of Biological Science and Technology and State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Haitao Yang
- Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | - Gengfeng Fu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Lei Li
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
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Xu JJ, Yu YQ, Hu QH, Yan HJ, Wang Z, Lu L, Zhuang MH, Chen X, Fu JH, Tang WM, Geng WQ, Jiang YJ, Shang H. Treatment-seeking behaviour and barriers to service access for sexually transmitted diseases among men who have sex with men in China: a multicentre cross-sectional survey. Infect Dis Poverty 2017; 6:15. [PMID: 28095879 PMCID: PMC5242014 DOI: 10.1186/s40249-016-0219-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 12/07/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Delayed or inappropriate treatment for sexually transmitted diseases (STDs) increases the risk of HIV acquisition and may cause other harmful outcomes. However, studies on STD treatment-seeking behaviour and correlated factors in men who have sex with men (MSM) are scarce. This information is crucial for the promotion of STD treatment-seeking behaviour and reduction of HIV transmission among Chinese MSM. METHODS During 2012-2013, a multicentre cross-sectional study was conducted in 7 Chinese cities. Participants completed an interview-questionnaire and gave venous blood samples, which were then tested for antibodies to HIV, syphilis, and herpes simplex virus-2 (HSV-2). MSM who tested positive for syphilis/HSV-2 or had obvious STD-related symptoms within the last 12 months were defined as suspected STD-infected MSM. RESULTS Of the 4 496 eligible MSM who completed this survey, 24.4% (1 096/4 496) were categorized as suspected STD-infected MSM. 35.7% (391/1 096) of these MSM with suspected STD infections sought STD treatment in clinics within the last 12 months. Among MSM who did not attend STD clinics for treatment, the prevalence of syphilis and HSV-2 was significantly higher; the HIV prevalence and incidence within this subpopulation reached as high as 14.5% and 12.2/100 person-years, respectively. Multivariate logistic regression analysis indicated that having 7-12 years of education (vs. ≤6 years; aOR, 2.5; 95%CI, 1.0-6.1), ≥13 years of education (vs. ≤6 years: aOR, 2.8; 95%CI, 1.2-7.0), monthly income >500 USD (vs. ≤500 USD: aOR, 1.5; 95%CI, 1.1-2.1), obvious STD-related symptoms within last 12 months (aOR, 5.3; 95%CI, 3.7-7.5), being HIV infected (aOR, 1.7; 95%CI, 1.1-2.6), currently syphilis infected (aOR, 0.6; 95%CI, 0.4-0.9) and HSV-2 infected (aOR, 0.6; 95%CI, 0.5-0.9) were independent correlates with seeking STD treatment in clinics among Chinese MSM. CONCLUSIONS The high prevalence of STD infection coupled with a low proportion of individuals who exhibit appropriate treatment-seeking behaviour create a high risk of a growing HIV epidemic among Chinese MSM. Models that prioritize better screening for and education about STDs should be urgently implemented, especially among low-income MSM.
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Affiliation(s)
- Jun-Jie Xu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yan-Qiu Yu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Qing-Hai Hu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong-Jing Yan
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, China
| | - Zhe Wang
- He’nan Provincial Centers for Disease Control and Prevention, Zhengzhou, China
| | - Lin Lu
- Yunnan Provincial Centers for Disease Control and Prevention, Kunming, China
| | - Ming-Hua Zhuang
- Shanghai Municipal Centers for Disease Control and Prevention, Shanghai, China
| | - Xi Chen
- Hu’nan Provincial Centers for Disease Control and Prevention, Changsha, China
| | - Ji-Hua Fu
- Shandong Provincial Centers for Disease Control and Prevention, Jinan, China
| | - Wei-Ming Tang
- University of North Carolina Project-China, Guangzhou, China
| | - Wen-Qing Geng
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yong-Jun Jiang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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Guida J, Fukunaga A, Liu H. Biomarker validation of self-reported sex among middle-aged female sex workers in China. Ann Epidemiol 2017; 27:181-186.e1. [PMID: 28185717 DOI: 10.1016/j.annepidem.2017.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 12/05/2016] [Accepted: 01/08/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The objective of this study was to examine information bias arising from self-reported sexual activity and its association with syphilitic infections among female sex workers (FSWs) aged 35 years and older in China. METHODS A questionnaire was administered to 1245 middle-aged FSWs. Respondents self-reported sexual intercourse in the past 48 hours. The prostate-specific antigen test was used to verify self-reported sexual activity. FSWs were considered discordant if they indicated no sexual intercourse in the past 48 hours on the questionnaire and had a positive prostate-specific antigen test. Logistic regression was used to assess the associations between discordance and syphilis. RESULTS Three hundred twenty FSWs self-reported no engagement in sexual intercourse in the past 48 hours. One-fourth of respondents (25%) were discordant. Twenty-two percent and 35.8% of discordant FSWs tested positive for active and prevalent syphilis, respectively. After adjusting for confounders, discordant FSWs had 3.8 times the odds of active syphilis (95% confidence interval: 1.52-9.30) and 2.6 times the odds of prevalent syphilis (95% confidence interval: 1.37-5.02), compared with concordant FSWs. CONCLUSIONS FSWs who had active or prevalent syphilis were more likely to be discordant. Data collected via self-reported questionnaire may not be a valid tool to assess sexual behavior.
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Affiliation(s)
- Jennifer Guida
- School of Public Health, University of Maryland, College Park.
| | - Ami Fukunaga
- School of Public Health, University of Maryland, College Park
| | - Hongjie Liu
- School of Public Health, University of Maryland, College Park
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Zhu Y, Yin B, Wu T, Ye L, Chen C, Zeng Y, Zhang Y. Comparative study in infertile couples with and without Chlamydia trachomatis genital infection. Reprod Health 2017; 14:5. [PMID: 28086915 PMCID: PMC5237126 DOI: 10.1186/s12978-016-0271-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 12/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chlamydia, caused by the bacterium Chlamydia trachomatis(C. trachomatis), is the most common sexually transmitted disease. The incidence is not clear due to the asymptomatic nature of early stage of infections. The incidence of Chlamydia has not been fully investigated in the Chinese Han population. Since chronic infection with can C. trachomatis can lead to infertility in males and females, it is important to determine the impact of infection on clinical outcomes. The aim of this study is to explore the epidemiology of C. trachomatis in subfertile couples and to determine whether infections will adversely affect clinical outcomes after assisted reproduction technique (ART) treatment. METHODS Subfertile patients (n = 30760) were screened in the research for C. trachomatis in our center from January 2010 to December 2014. C. trachomatis-specific DNA was detected by Taq-man PCR from semen or swabs from the urethral, endocervix or vaginal. The control group consisted of 1140 subfertile patients without C. trachomatis infection. The prevalence and characteristics of C. trachomatis were identified for subfertile couples and clinical outcomes were collected and analyzed. A retrospective study was performed. RESULTS Nine hundred and seventy patients were diagnosed with C. trachomatis infection, and the overall prevalence was 3.15% in the most recent five years, with a yearly increasing. The incidence was a higher in the second half of the year (3.40%) compared to the first half (2.69%). The age group with the highest-risk of infection with C. trachomatis was between 26 to 35 years old, and in about one third of the couples, both partners were infected. The basic parameters and clinical outcomes were not statistically significant between different the groups (P > 0.05), even though some minor data were different (P < 0.05). CONCLUSIONS C. trachomatis is a common infection in subfertile people and it is essential to test for this organism in ART couples' screening. This study identified no adverse on clinical outcomes after successful treatment of C. trachomatis infection, regardless of gender, age and number of C. trachomatis copies.
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Affiliation(s)
- Yuanchang Zhu
- School of Life Sciences, Tsinghua University, Beijing, 100000, China.,Key Lab in Healthy Science and Technology, Division of Life Science, Graduate School at Shenzhen, Tsinghua University, Shenzhen, 518000, China
| | - Biao Yin
- Central South University, the State Key Laboratory of Medical Genetics of China, Changsha, 410000, China
| | - Tonghua Wu
- Shenzhen Key Laboratory for Reproductive Immunology of Preimplantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, 518000, China
| | - Lijun Ye
- Shenzhen Key Laboratory for Reproductive Immunology of Preimplantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, 518000, China
| | - Chunmei Chen
- Shenzhen Key Laboratory for Reproductive Immunology of Preimplantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, 518000, China
| | - Yong Zeng
- Shenzhen Key Laboratory for Reproductive Immunology of Preimplantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, 518000, China
| | - Yaou Zhang
- Key Lab in Healthy Science and Technology, Division of Life Science, Graduate School at Shenzhen, Tsinghua University, Shenzhen, 518000, China.
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Needs Assessment and Theory-Based Promotion of Voluntary Medical Male Circumcision (VMMC) Among Male Sexually Transmitted Diseases Patients (MSTDP) in China. AIDS Behav 2016; 20:2489-2502. [PMID: 25801474 DOI: 10.1007/s10461-015-1040-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Voluntary medical male circumcision (VMMC) is an evidence-based biomedical HIV prevention method. It is under-utilized in countries outside Africa, including China. The present single-arm, non-blinded test-of-concept trial was designed to promote VMMC among 179 male sexually transmitted diseases patients (MSTDP) in Shenzhen, China. It was based on behavioral health theories and results of a formative survey. At month 4, 45.5 % of the MSTDP responded positively to the intervention (19.9 % had taken up VMMC and 25.6 % intended to do so in the next 6 months). Adjusted analysis showed that cognitive variables measured at baseline (perceived self-efficacy, subjective norm and behavioral intention) significantly predicted adoption of VMMC during the 4-month follow-up period. Process evaluation involving clinicians of the STD clinics was positive. At month 6, 36.0 % of the circumcised participants used condom less frequently with their regular sex partner. We recommend scaling up the intervention, taking prevention of risk compensation into account.
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Abstract
PURPOSE OF REVIEW Sexually transmitted infections (STIs) continue to exert a substantial public health burden globally but surveillance remains a challenge, especially in the developing world. We reviewed STI surveillance systems in various regions globally and used available data to provide an overview of recent trends in STI epidemiology. RECENT FINDINGS STI surveillance systems in the developing world are often limited and restricted to ad hoc cross-sectional surveys; however, available data suggest that these areas are disproportionately affected by STIs, with a higher burden in marginalized groups such as sex workers. Developed countries typically have established surveillance systems. Recent reports suggest many of these countries are experiencing rising diagnoses of STIs in men who have sex with men (MSM) and an increasing contribution of HIV-positive MSM to STI epidemics. SUMMARY There is considerable variability in the surveillance for STIs globally, ranging from active or passive, to sentinel, laboratory or clinic-based systems. Given different levels of resources and patterns of healthcare provision, it is difficult to compare surveillance data across regions; however, available data suggest that considerable inequality in STI burden exists. In resource-limited settings, syndromic surveillance with periodic laboratory assessments is recommended to monitor trends in STIs.
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Qin X, Zheng H, Xue Y, Ren X, Yang B, Huang J, Huang S, Wu X, Zeng W, Ou J, Lan Y, Tang S. Prevalence of Chlamydia trachomatis Genotypes in Men Who Have Sex with Men and Men Who Have Sex with Women Using Multilocus VNTR Analysis-ompA Typing in Guangzhou, China. PLoS One 2016; 11:e0159658. [PMID: 27434536 PMCID: PMC4951006 DOI: 10.1371/journal.pone.0159658] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 07/06/2016] [Indexed: 12/18/2022] Open
Abstract
Background Chlamydia trachomatis is one of the most prevalent bacterial sexually transmitted infection in China. Although C. trachomatis genotypes can be discriminated by outer membrane protein gene (ompA) sequencing, currently available methods have limited resolutions. This study used a high-resolution genotyping method, namely, multilocus variable number tandem-repeat analysis with ompA sequencing (MLVA)-ompA, to investigate the local epidemiology of C. trachomatis infections among men who have sex with men (MSM) and men who have sex with women (MSW) attending a sexually transmitted diseases (STD) clinic in Guangzhou, China. Methods Rectal specimens from MSM and urethral specimens from MSW were collected between January 2013 and July 2014 at the Guangdong Provincial Center STD clinic. The specimens were sent to the laboratory for analyses. All specimens that were tested positive for C. trachomatis by the commercial nucleic acid amplification tests were genotyped by MLVA-ompA. Results Fifty-one rectal specimens from MSM and 96 urethral specimens from MSW were identified with C. trachomatis. One hundred and forty-four of the 147 specimens were fully genotyped by MLVA-ompA. Rectal specimens from MSM were divided into four ompA genotypes and urethral specimens from MSW into nine genotypes. No mixed infections were found among all specimens. The most frequent genotypes were D, G, J, E and F. All specimens were further divided into 46 types after ompA genotyping was combined with MLVA. Genotypes D-8.7.1 and G-3.4a.3 were the most frequent among MSM, whereas genotypes D-3.4a.4, E-8.5.1, F-8.5.1, and J-3.4a.2 were the most frequent subtypes among MSW. The discriminatory index D was 0.90 for MLVA, 0.85 for ompA, and 0.95 for MLVA-ompA. Conclusions The most prevalent MLVA-ompA genotypes were significantly different between MSM and MSW from Guangzhou, China. Moreover, MLVA-ompA represented a more favorable degree of discrimination than ompA and could be a reliable complement for ompA for the routine subtypes of C. trachomatis.
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Affiliation(s)
- Xiaolin Qin
- Guangdong Provincial Center for Skin Diseases and STIs Control and Prevention, Guangzhou, Guangdong, China
| | - Heping Zheng
- Guangdong Provincial Center for Skin Diseases and STIs Control and Prevention, Guangzhou, Guangdong, China
- * E-mail:
| | - Yaohua Xue
- Guangdong Provincial Center for Skin Diseases and STIs Control and Prevention, Guangzhou, Guangdong, China
- Department of Laboratory Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Xuqi Ren
- Guangdong Provincial Center for Skin Diseases and STIs Control and Prevention, Guangzhou, Guangdong, China
| | - Bin Yang
- Guangdong Provincial Center for Skin Diseases and STIs Control and Prevention, Guangzhou, Guangdong, China
| | - Jinmei Huang
- Guangdong Provincial Center for Skin Diseases and STIs Control and Prevention, Guangzhou, Guangdong, China
| | - Shujie Huang
- Guangdong Provincial Center for Skin Diseases and STIs Control and Prevention, Guangzhou, Guangdong, China
| | - Xingzhong Wu
- Guangdong Provincial Center for Skin Diseases and STIs Control and Prevention, Guangzhou, Guangdong, China
| | - Weiying Zeng
- Guangdong Provincial Center for Skin Diseases and STIs Control and Prevention, Guangzhou, Guangdong, China
| | - Jiangli Ou
- Guangdong Provincial Center for Skin Diseases and STIs Control and Prevention, Guangzhou, Guangdong, China
| | - Yinyuan Lan
- Guangdong Provincial Center for Skin Diseases and STIs Control and Prevention, Guangzhou, Guangdong, China
| | - Sanmei Tang
- Guangdong Provincial Center for Skin Diseases and STIs Control and Prevention, Guangzhou, Guangdong, China
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Stamm LV. Syphilis: Re-emergence of an old foe. MICROBIAL CELL (GRAZ, AUSTRIA) 2016; 3:363-370. [PMID: 28357375 PMCID: PMC5354565 DOI: 10.15698/mic2016.09.523] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/11/2016] [Indexed: 11/13/2022]
Abstract
Syphilis is caused by infection with Treponema pallidum subsp. pallidum, a not-yet-cultivable spiral-shaped bacterium that is usually transmitted by sexual contact with an infected partner or by an infected pregnant woman to her fetus. There is no vaccine to prevent syphilis. Diagnosis and treatment of infected individuals and their contacts is key to syphilis control programs that also include sex education and promotion of condom use to prevent infection. Untreated syphilis can progress through four stages: primary (chancre, regional lymphadenopathy), secondary (disseminated skin eruptions, generalized lymphadenopathy), latent (decreased re-occurrence of secondary stage manifestations, absence of symptoms), and tertiary (gummas, cardiovascular syphilis and late neurological symptoms). The primary and secondary stages are the most infectious. WHO estimates that each year 11 million new cases of syphilis occur globally among adults aged 15-49 years. Syphilis has re-emerged in several regions including North America, Western Europe, China and Australia. Host-associated factors that drive the re-emergence and spread of syphilis include high-risk sexual activity, migration and travel, and economic and social changes that limit access to health care. Early, uncomplicated syphilis is curable with a single intramuscular injection of benzathine penicillin G (BPG), the first line drug for all stages of syphilis. Emergence of macrolide-resistant T. pallidum has essentially precluded the empirical use of azithromycin as a second-line drug for treatment of syphilis. Virulence attributes of T. pallidum are poorly understood. Genomic and proteomic studies have provided some new information concerning how this spirochete may evade host defense mechanisms to persist for long periods in the host.
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Affiliation(s)
- Lola V. Stamm
- Department of Epidemiology, Gillings School of Global Public Health,
University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7435
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He M, Xie Y, Zhang R, Gao S, Xu G, Zhang L, Liu P, Li Y, Wu S. Prevalence and antimicrobial resistance of Mycoplasmas and Chlamydiae in patients with genital tract infections in Shanghai, China. J Infect Chemother 2016; 22:548-52. [PMID: 27324895 DOI: 10.1016/j.jiac.2016.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/30/2016] [Accepted: 05/26/2016] [Indexed: 11/25/2022]
Abstract
The infections of Mycoplasmas and Chlamydiae are still severe in patients with genital tract diseases and antimicrobial resistance for these organisms has been changing in recent years. In this study, we reported the prevalence status of Ureaplasma urealyticum, Mycoplasma hominis and Chlamydia trachomatis in 965 patients with genital tract infection in Shanghai from January 2011 to December 2014 and analyzed the antimicrobial resistance of U. urealyticum and M. hominis to 12 kinds of antimicrobial drugs by using commercial kits and SPSS13.0 software. Here, we found the infection of U. urealyticum was the most frequent among these three organisms. The total infection rate for containing any organisms of them was 49.5%, and it has been increasing in recent 4 years. Positive rate in female (53.3%) was higher than male's (34.8%), and the high risk population was 20-39 years old (56.7%). Besides, U. urealyticum and M. hominis displayed relative lower resistance rates to minocycline, doxycycline, josamycin and gatifloxacin (6.5%, 7.2%, 13.5% and 8.6%, respectively). However, for erythromycin, roxithromycin, thiamphenicol and clindamycin, the resistance rates were relatively high (41.9%, 47.2%, 62.3% and 74.9%, respectively). U. urealyticum and M. hominis displayed a declined trend of the antimicrobial resistance to 12 kinds of drugs detected in this study. In total, these preliminary data showed the prevalence of Mycoplasmas and Chlamydiae in patients and the antimicrobial resistance status of Mycoplasmas, which has use for reference on both prevention and treatment of diseases caused by them.
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Affiliation(s)
- Meiling He
- Department of Microbiology, Medical College of Soochow University, No. 199, Ren Ai Road, Suzhou, Jiangsu, 215123, PR China
| | - Yanping Xie
- Fengcheng Hospital of Shanghai, No. 9983, Chuan Nan Feng Road, Fengxian, Shanghai, 201411, PR China
| | - Ruixia Zhang
- Fengcheng Hospital of Shanghai, No. 9983, Chuan Nan Feng Road, Fengxian, Shanghai, 201411, PR China
| | - Song Gao
- Department of Microbiology, Medical College of Soochow University, No. 199, Ren Ai Road, Suzhou, Jiangsu, 215123, PR China
| | - Guangmei Xu
- Department of Microbiology, Medical College of Soochow University, No. 199, Ren Ai Road, Suzhou, Jiangsu, 215123, PR China
| | - Lei Zhang
- Department of Microbiology, Medical College of Soochow University, No. 199, Ren Ai Road, Suzhou, Jiangsu, 215123, PR China
| | - Peipei Liu
- Department of Microbiology, Medical College of Soochow University, No. 199, Ren Ai Road, Suzhou, Jiangsu, 215123, PR China
| | - Yuanyuan Li
- Department of Microbiology, Medical College of Soochow University, No. 199, Ren Ai Road, Suzhou, Jiangsu, 215123, PR China
| | - Shuyan Wu
- Department of Microbiology, Medical College of Soochow University, No. 199, Ren Ai Road, Suzhou, Jiangsu, 215123, PR China.
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Giorgio M, Townsend L, Zembe Y, Guttmacher S, Kapadia F, Cheyip M, Mathews C. Social Support, Sexual Violence, and Transactional Sex Among Female Transnational Migrants to South Africa. Am J Public Health 2016; 106:1123-1129. [PMID: 29417089 DOI: 10.2105/ajph.2016.303107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives To examine the relationship between sexual violence and transactional sex and assess the impact of social support on this relationship among female transnational migrants in Cape Town, South Africa. Methods In 2012 we administered a behavioral risk factor survey using respondent-driven sampling to transnational migrant women aged between 16 and 39 years, born outside South Africa, living in Cape Town, and speaking English, Shona, Swahili, Lingala, Kirundi, Kinyarwanda, French, or Somali. Results Controlling for study covariates, travel-phase sexual violence was positively associated with engagement in transactional sex (adjusted prevalence ratio [APR] = 1.38; 95% confidence interval [CI] = 1.07, 1.77), and social support was shown to be a protective factor (APR = 0.84; 95% CI = 0.75, 0.95). The interaction of experienced sexual violence during migration and social support score was APR = 0.85 (95% CI = 0.66, 1.10). In the stratified analysis, we found an increased risk of transactional sex among the low social support group (APR = 1.56; 95% CI = 1.22, 2.00). This relationship was not statistically significant among the moderate or high social support group (APR = 1.04; 95% CI = 0.58, 1.87). Conclusions Programs designed to strengthen social support may reduce transactional sex among migrant women after they have settled in their receiving communities.
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Affiliation(s)
| | - Loraine Townsend
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Yanga Zembe
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | | | - Mireille Cheyip
- Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Wu X, Hong F, Lan L, Zhang C, Feng T, Yang Y. Poor awareness of syphilis prevention and treatment knowledge among six different populations in south China. BMC Public Health 2016; 16:287. [PMID: 27020405 PMCID: PMC4810517 DOI: 10.1186/s12889-016-2966-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 03/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China is facing an emerging epidemic of syphilis, and the cities in south China are most affected. Knowledge is a key factor in the prevention of syphilis infection, however, little is reported about how much people know about syphilis. This study was aimed at assessing peoples' awareness status in a city located in south China. METHODS Six populations were recruited for this study, including urban residents, factory workers, college students, pregnant women, female sex workers (FSWs), and men who have sex with men (MSM). A questionnaire designed by the National Center for Disease Control and Prevention was used to assess participants' awareness of syphilis knowledge. About 5% of participants were randomly selected to conduct a telephone survey for confirming the validity of fieldwork. RESULTS The study recruited 3470 participants, and 61.2% of participants were assigned to the awareness group. College students had the smallest percentage of awareness at 51.7% (371/718), followed by FSWs at 53.9% (200/371), factory workers at 56.0% (381/679), urban residents at 65.4% (435/665), pregnant women at 66.0% (451/683), and MSM at 81.1% (287/354). Multivariate logistic regression analysis showed that MSM and FSWs-but not factory workers and pregnant women-had more awareness of syphilis knowledge when comparing with urban residents; however, college students presented less awareness of syphilis knowledge than urban residents. Participants of younger age, of female gender, with lower education levels and without Shenzhen hukou possessed less awareness of syphilis knowledge than those of older age, of male gender, with higher education levels and with Shenzhen hukou respectively. CONCLUSIONS The percentages of awareness on syphilis knowledge found in this study are far from the benchmark set in the national 10-year plan. Tailored interventions for different subgroups to increase syphilis awareness are urgently warranted.
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Affiliation(s)
- Xiaobing Wu
- Department of STD control and prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, P.R. China
| | - Fuchang Hong
- Department of STD control and prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, P.R. China.
| | - Lina Lan
- Department of STD control and prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, P.R. China
| | - Chunlai Zhang
- Department of STD control and prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, P.R. China
| | - Tiejian Feng
- Department of STD control and prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, P.R. China
| | - Yingzhou Yang
- Department of STD control and prevention, Shenzhen Center for Chronic Disease Control, No. 2021, Buxin Road, Luohu District, Shenzhen City, Guangdong Province, P.R. China
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Cheng Z, Luo SX, Sun X, Sun S, Wang Z, Jiang Y, An Z, Wang Q. Surgical treatment of syphilitic superficial femoral artery aneurysm: a rare case report. BMC Infect Dis 2015; 15:540. [PMID: 26589681 PMCID: PMC4654907 DOI: 10.1186/s12879-015-1239-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/21/2015] [Indexed: 11/16/2022] Open
Abstract
Background Arterial aneurysm is a known complication of syphilis, but the occurrence of femoral artery aneurysm secondary to the syphilitic disease has never been reported. Case presentation The present study described a 60-year-old Chinese male who presented with two aneurysms in the middle and lower segment of the right superficial femoral artery causing the symptoms of pain, coldness and numbness in the right lower limb. This case was diagnosed with syphilitic superficial femoral aneurysm because of positive syphilitic testing and the inflammatory cell infiltration around the adventitial vasa vasorum under the pathological examination. Anti-syphilis treatment, stent graft implantation and open surgery were attempted to eliminate the syphilis and aneurysm, which was ultimately successful, with no symptoms after a follow-up of 3 months. Conclusion Combined open and endovascular repair may be effective and safe for treatment of syphilitic femoral artery aneurysms.
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Affiliation(s)
- Zhihua Cheng
- Department of Vascular Surgery, the First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin Province, China.
| | - Sean X Luo
- Department of Vascular Surgery, the First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin Province, China.
| | - Xiwei Sun
- Department of Vascular Surgery, the First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin Province, China.
| | - Siqiao Sun
- Department of Vascular Surgery, the First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin Province, China.
| | - Zhongying Wang
- Department of Vascular Surgery, the First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin Province, China.
| | - Yuzhu Jiang
- Department of Vascular Surgery, Panshi City Hospital, Panshi, 132300, Jilin Province, China.
| | - Zhiyuan An
- Department of Vascular Surgery, Panshi City Hospital, Panshi, 132300, Jilin Province, China.
| | - Qi Wang
- Department of Vascular Surgery, the First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin Province, China.
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Huang C, Long X, Jing S, Fan L, Xu K, Wang S, Zhu W. Ureaplasma urealyticum and Mycoplasma hominis infections and semen quality in 19,098 infertile men in China. World J Urol 2015; 34:1039-44. [DOI: 10.1007/s00345-015-1724-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/28/2015] [Indexed: 11/25/2022] Open
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Zhao Y, Luo T, Tucker JD, Wong WCW. Risk Factors of HIV and Other Sexually Transmitted Infections in China: A Systematic Review of Reviews. PLoS One 2015; 10:e0140426. [PMID: 26468650 PMCID: PMC4607362 DOI: 10.1371/journal.pone.0140426] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/26/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Sexually Transmitted Infections (STIs) are a global challenge. China, once said to have eradicated STIs, is now facing a rapid rise in the prevalence of HIV/STIs. This review of reviews aims to map HIV/STI risk factors among the Chinese population, with the objective of identifying risk factors to inform the formulation of effective prevention strategies. METHODS A systematic search using key terms related to HIV/STIs, risk factors and the Chinese population in both English and Chinese databases (PubMed, PsycINFO, the Cochrane Library; Wanfang data, CNKI, VIP and SINOMED) was conducted, and peer-reviewed systematic reviews on the topic from 1991 to 2014 were selected. Identified risk factors were grouped into different level determinants based on the HIV Social Epidemiology Model, and then evaluated and reported based on the PRISMA checklist. FINDINGS Of the twenty-eight reviews included, the majority were focused on well-established, individual level risk factors within key populations, with some highlighting the complexity of interacting factors (e.g., alcohol use and higher income in male migrants). While twenty-two reviews covered individual factors, only ten mentioned social factors and five had contents on structural factors. There are gaps in the evidence on social and structural level impacts of HIV/STIs, such as on stigma, discrimination, health policy, access to care, and illicit drug control policies. Migration and social expectation appear to pose a significant threat in aggravating the HIV/STI situation in China; for example, incarceration patterns indicated a significant risk of HIV/STIs for female sex workers. CONCLUSIONS Since international guidelines recommend an integrated and multi-level approach to HIV/STI prevention, a comprehensive approach targeting interventions at all levels along the continuum of care is needed to effectively curtail HIV/STI transmission in China. More research is needed to better understand the impact of socio-political interventions within a Chinese context.
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Affiliation(s)
- Yanping Zhao
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong S.A.R., China
| | - Tongyong Luo
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong S.A.R., China
| | - Joseph D. Tucker
- University of North Carolina Project-China, Guangzhou, Guangdong Province, China
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - William Chi Wai Wong
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong S.A.R., China
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Verdery AM, Merli MG, Moody J, Smith J, Fisher JC. Brief Report: Respondent-driven Sampling Estimators Under Real and Theoretical Recruitment Conditions of Female Sex Workers in China. Epidemiology 2015; 26:661-5. [PMID: 26214337 PMCID: PMC4617539 DOI: 10.1097/ede.0000000000000335] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We compare the performance of multiple respondent-driven sampling estimators under different sample recruitment conditions in hidden populations of female sex workers in the midst of China's ongoing epidemic of sexually transmitted infections. We first examine empirically calibrated simulations grounded in survey data to evaluate the relative performance of each estimator under ideal sampling conditions consistent with respondent-driven sampling assumptions and under conditions that mimic observed respondent-driven sampling recruitment processes. One estimator, which incorporates respondents' reports on their network of contacts, substantially out-performs the others under all conditions. We then apply the estimators to empirical samples of female sex workers collected in two Chinese cities that include unique data on respondents' networks. These empirical results are consistent with the simulation results, suggesting that traditional respondent-driven sampling estimators overestimate the proportion of female sex workers working in low tiers of sex work and are likely to overstate the sexually transmitted infection risk profiles of these populations.
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Affiliation(s)
- Ashton M. Verdery
- Department of Sociology and Criminology, Population Research Institute, The Pennsylvania State University, University Park, Pennsylvania
| | - M. Giovanna Merli
- Duke Population Research Institute, Sanford School of Public Policy, Department of Sociology, and Duke Global Health Institute, Duke University, Durham, NC
| | - James Moody
- Duke Population Research Institute, Department of Sociology, Duke University, Durham, NC
- King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jeffrey Smith
- Department of Sociology, University of Nebraska, Lincoln, NE
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Huang C, Zhu H, Xu K, Wang S, Fan L, Zhu W. Mycoplasma and ureaplasma infection and male infertility: a systematic review and meta-analysis. Andrology 2015; 3:809-16. [PMID: 26311339 DOI: 10.1111/andr.12078] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/14/2015] [Accepted: 06/22/2015] [Indexed: 12/26/2022]
Affiliation(s)
- C. Huang
- Institute of Reproductive & Stem Cell Engineering; Central South University; Changsha China
| | - H.L. Zhu
- Institute of Reproductive & Stem Cell Engineering; Central South University; Changsha China
| | - K.R. Xu
- Institute of Reproductive & Stem Cell Engineering; Central South University; Changsha China
| | - S.Y. Wang
- Institute of Reproductive & Stem Cell Engineering; Central South University; Changsha China
| | - L.Q. Fan
- Institute of Reproductive & Stem Cell Engineering; Central South University; Changsha China
- Reproductive & Genetic Hospital of CITIC-XIANGYA; Changsha China
| | - W.B. Zhu
- Institute of Reproductive & Stem Cell Engineering; Central South University; Changsha China
- Reproductive & Genetic Hospital of CITIC-XIANGYA; Changsha China
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Wang J, Liu S, Cao Y, Yang L, Chen Y, Minhas V, Wood C, Zhang T. Prevalence of Kaposi's sarcoma associated herpesvirus among men attending sexually transmitted infections clinics in Anhui, China. J Med Virol 2015; 88:304-11. [PMID: 26147809 DOI: 10.1002/jmv.24321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2015] [Indexed: 11/06/2022]
Abstract
Kaposi's sarcoma-associated herpesvirus (KSHV) may be transmitted via sexual contacts, but limited information is available on KSHV infection status among sexually transmitted infection (STI) patients in China. The main objective of the present study was to determine the KSHV seroprevalence and its risk factors among male STI patients. A cross-sectional survey was conducted in three prefectures of Anhui province, China, between June and September 2013. A total of 1,600 male patients who visited an STI clinic were invited, and 1,372 participated in the study. Data were abstracted from the medical records for all the patients. Blood samples were collected and tested for antibodies to KSHV, HIV, HCV, and syphilis. Factors associated with KSHV seropositivity were examined using multivariable logistic regression analysis. The overall prevalence of KSHV, HIV, HCV, and syphilis was 13.3%, 0.7%, 0.6%, and 12.5%, respectively. After adjusting for potential confounders, KSHV infection was significantly associated with ever having anal sex with men (19 out of 30 males, OR: 8.64, 95%CI: 1.92-38.79) and HIV infection (six out of nine HIV-positive individuals, OR: 8.39, 95%CI: 1.80-39.04). There were no significant associations of KSHV infection with drug use, heterosexual sex behaviors, syphilis, and HCV. Our finding has shown that a relatively moderate prevalence of KSHV was found among male STI patients. While an increased risk for KSHV infection was observed among participants with homosexual contacts. Routine KSHV testing is recommended for male individuals attending STI clinics.
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Affiliation(s)
- Jun Wang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China
| | - Shuying Liu
- Anhui Provincial Institute of Dermatology and Venereology, Hefei, Anhui, China
| | - Yifei Cao
- School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Lei Yang
- School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yue Chen
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
| | - Veenu Minhas
- Nebraska Center of Virology, School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Charles Wood
- Nebraska Center of Virology, School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Tiejun Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China
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Muessig KE, Bien CH, Wei C, Lo EJ, Yang M, Tucker JD, Yang L, Meng G, Hightow-Weidman LB. A mixed-methods study on the acceptability of using eHealth for HIV prevention and sexual health care among men who have sex with men in China. J Med Internet Res 2015; 17:e100. [PMID: 25900881 PMCID: PMC4420841 DOI: 10.2196/jmir.3370] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 12/19/2014] [Accepted: 02/05/2015] [Indexed: 01/16/2023] Open
Abstract
Background Human immunodeficiency virus (HIV) infection disproportionately affects men who have sex with men (MSM). Over half of all HIV-positive MSM in China may not know their HIV status. Mobile phones and Web interventions (eHealth) are underutilized resources that show promise for supporting HIV education, testing, and linkage to care. Objective This mixed-methods study among MSM in China assessed technology utilization and eHealth acceptability for sexual health care. Methods We conducted in-depth interviews and an online survey. Qualitative analyses informed the development of the Internet survey, which was administered through two popular MSM websites. Bivariate and multivariate analysis assessed characteristics of MSM interested in eHealth for sexual health care. Results The qualitative sample included MSM across a range of ages, education, marital status, sexuality, and HIV testing experience. Qualitative findings included the importance of the Internet as the primary source of information about sexual health, HIV and other sexually transmitted diseases (STDs), use of the Internet to enable HIV testing opportunities by facilitating connections with both the gay community and health care providers, and mixed perceptions regarding the confidentiality of eHealth tools for sexual health. Among the Internet sample (N=1342), the average age was 30.6 years old, 82.81% (1098/1342) were single, and 53.42% (711/1331) had completed college. In the past 3 months, 38.66% (382/988) had condomless sex and 60.53% (805/1330) self-reported having ever tested for HIV. The majority of men owned computers (94.14%, 1220/1296) and mobile phones (92.32%, 1239/1342), which many had used to search for HIV/STD information and testing sites. In multivariate analysis, interest in using computers or mobile phones to support their sexual health care was associated with being a student, prior use of computers or mobile phones to search for general health information, prior use of computers or mobile phones to search for HIV/STD information, and confidentiality concerns. Conclusions MSM in this sample had high utilization of technology and interest in eHealth despite confidentiality concerns. Future eHealth interventions can thoughtfully and creatively address these concerns as a priority for successful implementation.
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Affiliation(s)
- Kathryn E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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