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Xie L, Mo PKH, Wang Z, Tian X, Lau JTF. Men who have sex with men were more depressed than their counterparts because of lower social support and higher loneliness: A comparative survey among Chinese university students. J Affect Disord 2024; 353:11-18. [PMID: 38373515 DOI: 10.1016/j.jad.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Poor mental health is prevalent among men who have sex with men (MSM), including MSM university students (MSMUS), causing a significant burden on their health and society. The study aimed to compare the difference in levels of depressive symptoms between Chinese MSMUS and non-MSMUS and test the mediating roles of social support and loneliness in the relationship between MSM status and depressive symptoms among male university students. METHODS From June to October 2018, a total of 305 MSMUS and 2447 non-MSMUS from two cities in Sichuan province (China) were investigated using questionnaires. RESULTS The proportion of depression in the MSMUS and non-MSMUS groups was 54.1 % and 36.4 %, respectively. MSM status, social support, and loneliness were all significantly associated with depressive symptoms among Chinese university students. Structural equation modelling showed that the association between MSM status and depressive symptoms was partially mediated by three indirect paths, including 1) via social support (mediated proportion = 19.4 %), 2) via loneliness (mediated proportion = 19.3 %), and 3) via social support and then loneliness (mediated proportion = 16.1 %). CONCLUSIONS Depression was prevalent among university students in China, especially MSMUS. The findings increased our understanding of the mediating roles of social support and loneliness in the link between MSM status and depressive symptoms among Chinese male university students, which have great implications for designing interventions to improve their mental health. LIMITATION The cross-sectional study design limited causal inferences.
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Affiliation(s)
- Luyao Xie
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Phoenix K H Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Xiaobing Tian
- Department of Epidemiology and Biostatistics, School of Public Health, North Sichuan Medical University, Nanchong, China
| | - Joseph T F Lau
- Public Mental Health Center, School of Mental Health, Wenzhou Medical University, Wenzhou, China; Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Wenzhou, China.
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Yang H, Chen M, Hu Y, Xu M, Li Y, Liu L, Yuan D, Yuan F, Li L, Ye L, Zhou C, Zhang Y, Liang S, Su L. An Assessment of Trends in HIV-1 Prevalence and Incidence and Spatio-Temporal Analyses of HIV-1 Recent Infection Among MSM During the Surveillance Period Between 2018 and 2022 in Sichuan, China. HIV AIDS (Auckl) 2024; 16:83-93. [PMID: 38464995 PMCID: PMC10924877 DOI: 10.2147/hiv.s448096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/24/2024] [Indexed: 03/12/2024] Open
Abstract
Background Men who have sex with men (MSM) is one main type of high-risk activities facilitating HIV-1 transmission in Sichuan province. Previous works on HIV-1 incidence and prevalence among MSM only concentrated before 2018, the situation after that is unknown. In addition, the distribution of hot-spots related to current HIV-1 epidemic is also rarely known among MSM in Sichuan. Objective To update trends of HIV-1 prevalence and incidence and to visualize hot-spots of ongoing transmission in Sichuan province during surveillance period among MSM between 2018 and 2022. Methods Limiting Antigen Avidity assay was performed to detect recent infection within new HIV-1 diagnoses founded during surveillance period among MSM. The HIV-1 prevalence and incidence were calculated according to an extrapolation method proposed by publications and guidelines. Trend tests were performed using χ2 tests with linear-by-linear association. The spatial analysis was conducted with ArcGIS 10.7 to figure hot-spots of HIV-1 recent infections among MSM. Results Between 2018 and 2022, 16,697 individuals participated in HIV-1 MSM sentinel surveillance program, of which 449 samples (98.25%) were tested with LAg-Avidity EIA, and 230 samples were classified as recent infection. Respectively, the overall prevalence and incidence were 2.74% and 3.69% (95% CI: 3.21, 4.16) and both had significant declining trends (p < 0.001). Luzhou city had a highest HIV-1 incidence (10.74%, 95% CI: 8.39, 13.10) over the study period and was recognized as a hot-spot for recent HIV-1 infection among MSM. Conclusion During the surveillance period, both HIV-1 prevalence and incidence were declining. However, Luzhou city had an unusually high HIV-1 incidence and became an emerging hot-spot of recent HIV-1 infection among MSM. This finding suggested focused attention, cross-regional intervention strategies, and prevention programs are urgently required to curb the spread of ongoing transmission.
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Affiliation(s)
- Hong Yang
- Department of AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Maogang Chen
- Department of Microbiology, Liangshan Yi Autonomous Prefecture Center for Disease Control and Prevention, Xichang, People’s Republic of China
| | - Ying Hu
- Department of AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Mengjiao Xu
- Department of AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Yiping Li
- Department of AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Lunhao Liu
- Department of AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Dan Yuan
- Department of AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Fengshun Yuan
- Department of AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Ling Li
- Department of AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Li Ye
- Department of AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Chang Zhou
- Department of AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Yan Zhang
- Department of AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Shu Liang
- Department of AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Ling Su
- Department of AIDS/STD Control and Prevention, Sichuan Center for Disease Control and Prevention, Chengdu, People’s Republic of China
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Fu J, Dai Z, Wang H, Si M, Chen X, Wu Y, Xiao W, Huang Y, Yu F, Mi G, Su X. Willingness to use long-acting injectable PrEP among HIV-negative/unknown men who have sex with men in mainland China: A cross-sectional online survey. PLoS One 2023; 18:e0293297. [PMID: 37856527 PMCID: PMC10586652 DOI: 10.1371/journal.pone.0293297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are at high risk of HIV acquisition. Long-acting injectable-pre-exposure prophylaxis (LAI-PrEP), requiring less frequent dosing, is being studied as an alternative method to daily oral HIV PrEP. With the addition of this potential new prevention method, it expands the scope for a wider user choice and is expected to increase the acceptability and uptake of HIV prevention measures. The aim of our study was to explore the willingness to use LAI-PrEP and associated influential factors. METHODS Participants were recruited from December 2020 to March 2021 through banner advertisements on web- and mobile app-based platforms on Blued, a large gay Chinese social media platform. MSM in our cross-sectional study was HIV-negative and currently lived in mainland China. Participants were asked about their willingness to use LAI-PrEP and reasons why they might be or not be willing to use LAI-PrEP. Multivariable logistic regression was used to analyze the factors associated with the willingness to use LAI-PrEP. RESULTS In total, 969 participants met the inclusion criteria and finished the survey. Nearly twenty percent (19.5%) of participants had never tested for HIV; 66.8% of MSM had multiple male partners; and 51.6% of MSM engaged in condomless sex with their partner. About three-fifths (66.3%) of MSM were aware of PrEP, and only 3.9% of MSM had used PrEP before. The willingness to use LAI-PrEP among MSM was 74.0% (95% CI: 71.4%-76.6%). MSM with higher education levels were less likely to show a willingness to use LAI-PrEP (AOR = 0.56, 95%CI: 0.38-0.84). Participants who had a history of HIV test (AOR = 1.68, 95%CI: 1.11-2.55), were willing to use daily oral PrEP (AOR = 10.64, 95%CI:7.43-15.21), had multiple male sexual partners (AOR = 1.33, 95%CI:0.93-1.90), who used rush popper(AOR = 1.49, 95%CI:1.05-2.13), and who were aware of PEP (AOR = 1.66, 95%CI: 1.02-2.70) were more likely to show willingness to use LAI-PrEP. CONCLUSIONS In our study, MSM had quite high awareness but low uptake of PrEP. As LAI-PrEP is expected to be approved for use in China in the future, our study of MSM highlights the need for key population-focused education programs about PrEP and healthy sexual behavior. This study also provides some evidence for LAI-PrEP use among the Chinese MSM population in the future.
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Affiliation(s)
- Jiaqi Fu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhenwei Dai
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hao Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mingyu Si
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xu Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yijin Wu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Weijun Xiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yiman Huang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fei Yu
- Danlan Public Welfare, Beijing, China
| | | | - Xiaoyou Su
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Dai Z, Mi G, Yu F, Chen G, Wang X, He Q. Using a Geosocial Networking App to Investigate New HIV Infections and Related Risk Factors Among Student and Nonstudent Men Who Have Sex With Men in Chengdu, China: Open Cohort Study. J Med Internet Res 2023; 25:e43493. [PMID: 37505891 PMCID: PMC10422168 DOI: 10.2196/43493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/26/2022] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND In China, condomless sex among men who have sex with men (MSM) is the primary route of HIV infection in young people. Chengdu is a hotspot for reported HIV cases among young people nationwide. Extensive use of geosocial networking (GSN) smartphone apps has dramatically changed the pattern of sexual behavior among young MSM (YMSM). However, data on HIV incidence and the risk behavior of YMSM using the GSN app are still obscure. OBJECTIVE This study aims to analyze and understand the HIV incidence and its risk factors among YMSM using GSN apps in Chengdu, China. METHODS An open cohort study was conducted among YMSM aged 18-24 years through a gay GSN smartphone app in Chengdu, China, from July 2018 to December 2020. Every participant completed a web-based questionnaire on sociodemographic characteristics, sexual behaviors, and other related statuses; made a reservation for a web-based HIV testing; and then voluntarily got tested at the designated testing site. At least one additional HIV test was taken via the app during the study period, and participants were evaluated at the end of the study or at the time of HIV seroconversion. By dividing the sum of the observed HIV seroconversions by the observed person-years, HIV incidence was calculated and compared between the student and nonstudent MSM. Univariate and multivariate (Cox proportional hazards regression) analyses were used to discuss the risk factors for new HIV infections. RESULTS In the study cohort, 24 seroconversions occurred among 625 YMSM who took at least two HIV tests through the app during the study period, contributing to 505 observed person-years. The HIV incidence rate per 100 person-years was 4.75 (95% CI 2.89-6.61) among all MSM, 3.60 (95% CI 1.27-5.93) among student MSM, and 5.88 (95% CI 2.97-8.79) among nonstudent MSM. In addition, the HIV incidence per 100 person-years was 11.11 (95% CI 4.49-17.73) among those who had resided in the area for 6 months or less and 7.14 (95% CI 1.52-12.77) among those with senior high school or less education. Two or more sexual partners (adjusted hazards ratio [HR] 3.63, 95% CI 1.08-12.23) in the preceding 6 months was a risk factor for new HIV infections. Consistent condom use for anal sex (adjusted HR 0.38, 95% CI 0.16-0.88) and insertive anal sex only (adjusted HR 0.10, 95% CI 0.01-0.75) in the preceding 6 months were protective factors for new HIV infections. CONCLUSIONS The rate of new HIV infections among YMSM who actively used GSN smartphone apps was high, especially among migrant nonstudent MSM. Targeted interventions on GSN smartphone apps should be implemented to provide demand-adapted prevention and services to reduce the threat of HIV.
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Affiliation(s)
- Zhen Dai
- Department of Sexually Transmitted Disease, AIDS Prevention and Control, Chengdu Center for Disease Control and Prevention, Chengdu, China
| | | | - Fei Yu
- BlueCity Holdings, Beijing, China
| | - Guodong Chen
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Xiaodong Wang
- Chengdu Tongle Social Work Service Center, Chengdu, China
| | - Qinying He
- Department of Sexually Transmitted Disease, AIDS Prevention and Control, Chengdu Center for Disease Control and Prevention, Chengdu, China
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Li J, Gilmour S, Wang Y, Gu J, Lau JTF. Time to consider elimination of HIV in China. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 24:100497. [PMID: 35677147 PMCID: PMC9168685 DOI: 10.1016/j.lanwpc.2022.100497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Jinghua Li
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Yijing Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jing Gu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China
| | - Joseph Tak-fai Lau
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
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Xu Y, Wu S, Fu X, Ding J, Xu W, Li X, Shi H, Qiao M, Zhu Z. Trends in HIV Prevalence and HIV-Related Risk Behaviors Among Male Students Who Have Sex With Men From 2016 to 2020 in Nanjing, China: Consecutive Cross-Sectional Surveys. Front Public Health 2022; 10:806600. [PMID: 35570976 PMCID: PMC9091556 DOI: 10.3389/fpubh.2022.806600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background The growing HIV epidemic among student men who have sex with men (MSM) necessitates immediate attention from public health. In China, male students who have sex with men (SMSM) were also at an increasing risk of HIV transmission. The aim of this study was to investigate the trends in HIV prevalence, HIV-related risk behaviors, and HIV testing, as well as analyze the factors associated with HIV infection among SMSM in Nanjing. Methods Data were collected through face-to-face questionnaire interviews and laboratory testing in Nanjing. The participants were recruited among SMSM by snowball sampling and internet-recruited convenience sampling annually from 2016 to 2020. The self-report data primarily included demographics, HIV knowledge, HIV-related behaviors, and HIV testing, while the laboratory test results of HIV and syphilis were collected. Linear-by-linear chi-square test was used to analyze the trends of HIV/syphilis prevalence and its risk behaviors. The binary logistic regression model was used to explore the factors associated with HIV infection. Results During the 5 years from 2016 to 2020, a total of 775 SMSM were recruited in our survey (220, 112, 171, 142, and 120, respectively). The HIV prevalence was 5.2, 6.3, 5.3, 7.0, and 8.3%, without a significant increasing trend (P = 0.277). Syphilis prevalence fluctuated from 5.7% in 2016 to 4.2% in 2020, without a significant decreasing trend (P = 0.318). The proportion of consistent condom use in anal intercourse (48.5 to 56.2%, P < 0.05), and HIV testing in the past 12 months (51.0 to 59.2%, P < 0.05) were increasing. A remarkable growing trend has been reported in the percentage of MSM with more than one male sex partner (46.2 to 59.2%, P < 0.05). Multivariate analysis showed that HIV testing in the past 12 months was a protective factor against HIV infection. MSM who had unprotected anal intercourse (UAI) in the past 6 months, recreational drug use, and currently syphilis infection were risk factors for HIV infection. Conclusions We observed stable HIV/ syphilis prevalence, increasing consistent condom use, increasing HIV testing rate, and increasing multiple male sex partners dramatically among SMSM in China. The original comprehensive intervention measures should be continuously strengthened for the subgroup. To satisfy the current HIV prevention requirements, new biological interventions should be introduced and carried out as major components of combination prevention programs.
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Affiliation(s)
- Yuanyuan Xu
- Department of AIDS/STD Control and Prevention, Nanjing Center for Disease Control and Prevention, Nanjing, China
| | - Sushu Wu
- Department of AIDS/STD Control and Prevention, Nanjing Center for Disease Control and Prevention, Nanjing, China
| | - Xuezhen Fu
- International Department of Nanjing No.13 Middle School, Nanjing, China
| | - Jie Ding
- Department of Office, Nanjing Center for Disease Control and Prevention, Nanjing, China
| | - Wenjiong Xu
- Department of Microbiology Laboratory, Nanjing Center for Disease Control and Prevention, Nanjing, China
| | - Xin Li
- Department of AIDS/STD Control and Prevention, Nanjing Center for Disease Control and Prevention, Nanjing, China
| | - Hongjie Shi
- Department of AIDS/STD Control and Prevention, Nanjing Center for Disease Control and Prevention, Nanjing, China
| | - Mengkai Qiao
- Department of Microbiology Laboratory, Nanjing Center for Disease Control and Prevention, Nanjing, China
| | - Zhengping Zhu
- Department of AIDS/STD Control and Prevention, Nanjing Center for Disease Control and Prevention, Nanjing, China
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Zhu Y, Hou F, Chen C, Wei D, Peng L, You X, Gu J, Hao C, Hao Y, Li J. Moderating effect of self-efficacy on the association of intimate partner violence with risky sexual behaviors among men who have sex with men in China. BMC Infect Dis 2021; 21:895. [PMID: 34470607 PMCID: PMC8408951 DOI: 10.1186/s12879-021-06618-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background In China, men who have sex with men (MSM) face a high risk of HIV infection. Intimate partner violence (IPV) is common in this population and leads to various adverse consequences, including risky sexual behaviors, substance abuse, and poor mental health, which pose huge challenges to HIV prevention and control. Methods An anonymous cross-sectional study was conducted to investigate the lifetime prevalence of IPV and prevalence of risky sexual behaviors during the previous 6 months in a convenience sample of 578 MSM from 15 cities covering seven geographical divisions in mainland China. The associations between IPV and risky sexual behaviors and the moderating effect of self-efficacy on these associations were explored through univariate and multivariate regression analyses. Results The prevalence rates of IPV perpetration and victimization were 32.5% and 32.7%, respectively. The proportions of participants who reported inconsistent condom use with regular or casual partners and multiple regular or casual sexual partners were 25.8%, 8.3%, 22.2%, and 37.4%, respectively. Multiple IPV experiences were positively associated with risky sexual behaviors; for example, any IPV victimization was positively associated with multiple regular partners, adjusted odds ratio (ORa) = 1.54, 95% CI [1.02,2.32], and multiple casual partners, ORa = 1.93, 95% CI [1.33, 2.80]. Any IPV perpetration was positively associated with inconsistent condom use with regular partners, ORa = 1.58, 95% CI [1.04, 2.40], and multiple casual partners, ORa = 2.11, 95% CI [1.45, 3.06]. Self-efficacy was identified as a significant moderator of the association between multiple casual sexual partnership and emotional IPV. Conclusions In conclusion, given the high prevalence of both IPV and risky sexual behaviors among Chinese MSM in this study, the inclusion of self-efficacy in interventions targeting IPV and risky sexual behaviors should be considered.
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Affiliation(s)
- Yang Zhu
- School of Public Health, Sun Yat-Sen University, North Campus, 74# Zhongshan 2nd Road, Guangzhou, 510000, China
| | - Fengsu Hou
- Department of Public Mental Health, Shenzhen Kangning Hospital, Shenzhen, China.,Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Chun Chen
- Department of Mechanical and Automation Engineering, Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong, China
| | - Dannuo Wei
- School of Public Health, Sun Yat-Sen University, North Campus, 74# Zhongshan 2nd Road, Guangzhou, 510000, China
| | - Liping Peng
- School of Public Health, Sun Yat-Sen University, North Campus, 74# Zhongshan 2nd Road, Guangzhou, 510000, China
| | - Xinyi You
- School of Public Health, Sun Yat-Sen University, North Campus, 74# Zhongshan 2nd Road, Guangzhou, 510000, China
| | - Jing Gu
- School of Public Health, Sun Yat-Sen University, North Campus, 74# Zhongshan 2nd Road, Guangzhou, 510000, China.,Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Chun Hao
- School of Public Health, Sun Yat-Sen University, North Campus, 74# Zhongshan 2nd Road, Guangzhou, 510000, China.,Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Yuantao Hao
- School of Public Health, Sun Yat-Sen University, North Campus, 74# Zhongshan 2nd Road, Guangzhou, 510000, China
| | - Jinghua Li
- School of Public Health, Sun Yat-Sen University, North Campus, 74# Zhongshan 2nd Road, Guangzhou, 510000, China. .,Sun Yat-Sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China.
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