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Hodel KVS, Fiuza BSD, Conceição RS, Aleluia ACM, Pitanga TN, Fonseca LMDS, Valente CO, Minafra-Rezende CS, Machado BAS. Pharmacovigilance in Vaccines: Importance, Main Aspects, Perspectives, and Challenges-A Narrative Review. Pharmaceuticals (Basel) 2024; 17:807. [PMID: 38931474 PMCID: PMC11206969 DOI: 10.3390/ph17060807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/29/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Pharmacovigilance plays a central role in safeguarding public health by continuously monitoring the safety of vaccines, being critical in a climate of vaccine hesitancy, where public trust is paramount. Pharmacovigilance strategies employed to gather information on adverse events following immunization (AEFIs) include pre-registration data, media reports, clinical trials, and societal reporting. Early detection of AEFIs during clinical trials is crucial for thorough safety analysis and preventing serious reactions once vaccines are deployed. This review highlights the importance of societal reporting, encompassing contributions from community members, healthcare workers, and pharmaceutical companies. Technological advancements such as quick response (QR) codes can facilitate prompt AEFI reporting. While vaccines are demonstrably safe, the possibility of adverse events necessitates continuous post-marketing surveillance. However, underreporting remains a challenge, underscoring the critical role of public engagement in pharmacovigilance. This narrative review comprehensively examines and synthesizes key aspects of virus vaccine pharmacovigilance, with special considerations for specific population groups. We explore applicable legislation, the spectrum of AEFIs associated with major vaccines, and the unique challenges and perspectives surrounding pharmacovigilance in this domain.
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Affiliation(s)
- Katharine Valéria Saraiva Hodel
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
| | - Bianca Sampaio Dotto Fiuza
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
| | - Rodrigo Souza Conceição
- Department of Medicine, College of Pharmacy, Federal University of Bahia, Salvador 40170-115, Bahia State, Brazil
| | - Augusto Cezar Magalhães Aleluia
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
- Department of Natural Sciences, Southwestern Bahia State University (UESB), Campus Vitória da Conquista, Vitória da Conquista 45031-300, Bahia State, Brazil
| | - Thassila Nogueira Pitanga
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
- Laboratory for Research in Genetics and Translational Hematology, Gonçalo Moniz Institute, FIOCRUZ-BA, Salvador 40296-710, Bahia State, Brazil
| | - Larissa Moraes dos Santos Fonseca
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
| | - Camila Oliveira Valente
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
| | | | - Bruna Aparecida Souza Machado
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), SENAI CIMATEC University Center, Salvador 41650-010, Bahia State, Brazil
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Evans JL, Couture MC, Carrico A, Stein ES, Muth S, Phou M, Aynar L, Song N, Chhit S, Neak Y, Maher L, Page K. Joint effects of alcohol and stimulant use disorders on self-reported sexually transmitted infections in a prospective study of Cambodian female entertainment and sex workers. Int J STD AIDS 2021; 32:304-313. [PMID: 33308090 PMCID: PMC9815469 DOI: 10.1177/0956462420964647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Female entertainment and sex workers (FESW) have high rates of alcohol and amphetamine-type stimulant (ATS) use, increasing risk for HIV/sexually transmitted infections (STI), and other negative outcomes. A prospective cohort of 1,198 FESW in a HIV/ATS use prevention intervention in Cambodia was assessed for alcohol and stimulant use disorders (AUD and SUD) using the Alcohol and Substance Use Involvement (ASSIST) scale. STI history was measured by self-report at baseline and at quarterly follow-up visits. Participants were asked if they had been diagnosed with an STI by a medical provider in the past 3 months. Marginal structural models were used to estimate joint effects of AUD and SUD on recent STI. At baseline, one-in-four screened AUD positive and 7% screened positive for SUD. At 18-months, 26% reported ≥1 recent STI. Accounting for time-varying and other known confounders, the adjusted odds ratio (AOR) for recent STI associated with AUD alone and SUD alone were 2.8 (95% CI:1.5-5.1) and 3.5 (95% CI:1.1-11.3), respectively. The AOR for joint effects of AUD and SUD was 5.7 (95% CI:2.2-15.2). AUD and SUD are independently and jointly associated with greater odds of STI among Cambodian FESW. Further research is critical for understanding how AUD and SUD potentiate biological and behavioural pathways that influence STI acquisition and to inform HIV risk-reduction interventions in FESW.
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Affiliation(s)
- Jennifer L Evans
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Marie-Claude Couture
- Department of Population Health Sciences, University of San Francisco, San Francisco, CA, USA
| | - Adam Carrico
- Department of Public Health Sciences, University of Miami Health System, Miami, FL, USA
| | - Ellen S Stein
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Maly Phou
- Independent Researcher, Phnom Penh, Cambodia
| | - Len Aynar
- Independent Researcher, Phnom Penh, Cambodia
| | | | | | - Yuthea Neak
- National Authority for Combatting Drugs, Phnom Penh, Cambodia
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Kimberly Page
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
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Wilson A, Wang YY, Chen R, Cen P, Wang Y, Yao X, Wang T, Li S, Yan H. A thematic analysis of experiences of HIV risks among female sex workers in the Yunnan-Vietnam Chinese border region. BMC WOMENS HEALTH 2021; 21:7. [PMID: 33407384 PMCID: PMC7789185 DOI: 10.1186/s12905-020-01143-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/07/2020] [Indexed: 12/29/2022]
Abstract
Background The Yunnan province is located near the “Golden Triangle” border region between China, Myanmar and Thailand, which has the highest HIV/AIDS prevalence in China. Female sex workers (FSWs) in the Yunnan province are highly vulnerable to HIV infection. The objective of this study was to examine the experiences of FSWs in the Yunnan to better understand the risk of infection and the potential for transmission of HIV. Methods Semi-structured interviews were conducted between May 2018 and June 2018 with 20 FSWs recruited in Hekou County, Yunnan Province, China. Thematic analysis was conducted to identify themes that highlighted increased exposure of FSWs to the risk of HIV infection and transmission. Results The findings showed that FSWs’ primary source for HIV information was gynecologists, with few visiting the local HIV charity Red Ribbon. FSWs reported infrequent visits for check-ups with some seeing a gynecologist once a year. FSWs felt that the onus was on them to prevent STI/HIV infection by using a condom during sex, regardless of their ability to negotiate use. FSWs were also reluctant to see a gynecologists for treatment. Instead, they resorted to douching as a way of preventing HIV/STIs and treating vaginal health problems, such as leucorrhea. Most FSWs worked without the influence of alcohol and drugs. A small number of FSWs reported heroin addiction and injecting drug use. Conclusion The findings suggest a need for innovative HIV prevention strategies among FSWs and their clients in the Chinese border region. Governmental agencies should continue to implement practical strategies in terms of HIV prevention education and condom use through tailored interventions that are localized. Such strategies should include localized tailored interventions that dispel myths about douching as a method of HIV/STI prevention and incorporate a mobile outreach approach, similar to the ‘roadside restaurant’ outreach that has been successful in rural China.
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Affiliation(s)
- Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Yuan Yuan Wang
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Runsen Chen
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ping Cen
- Center for Disease Control and Prevention of Nanning, Nanning, China
| | - Yuehui Wang
- School of Health Sciences, Wuhan University, Wuhan, China.,Center for Disease Control and Prevention of Yuzhong District of Chongqing, Chongqing, China
| | - Xing Yao
- Center for Disease Control and Prevention of Wuhan, Wuhan, China
| | - Tang Wang
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Shiyue Li
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Hong Yan
- School of Health Sciences, Wuhan University, Wuhan, China.
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Zhu J, Hu D, Yin Y, Zhu Z, Wang N, Wang B. HIV prevalence and correlated factors among male clients of female sex workers in a border region of China. PLoS One 2019; 14:e0225072. [PMID: 31697754 PMCID: PMC6837524 DOI: 10.1371/journal.pone.0225072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/27/2019] [Indexed: 11/19/2022] Open
Abstract
Objectives To assess the prevalence of human immunodeficiency virus (HIV) infection and the correlated risk factors among male clients of female sex workers (FSWs) in a Chinese–Vietnamese border region in Yunnan Province, China. Methods A cross-sectional survey was conducted between 2014 and 2015 in Hekou County, Yunnan Province, China. Convenience sampling and snowball sampling methods were used to recruit male clients for a questionnaire survey to collect information on demographics, sexual behavior, and drug use. Blood and urine samples were collected for testing of HIV/sexually transmitted infections (STIs) and drug use. Multivariate logistic regression was used to examine factors correlated with HIV infection. Results Of 776 respondents who participated in the study, 721 (92.91%) were Chinese and 55 (7.09%) were Vietnamese. Overall HIV prevalence in male clients of FSWs was 2.06%, 128 (16.49%) were infected with HSV-2, and five (0.64%) tested syphilis-positive. Two-thirds (68.81%) of respondents reported always using condoms with FSWs, and 89.05% reported condom use in the last episode of commercial sex. Male clients from Vietnam were significantly more likely to take morphine (9.09%) compared with Chinese male clients of FSWs. Age ≥50 years (OR: 8.11, 95%CI: 1.26–52.16) and morphine positivity (OR: 7.35, 95%CI: 1.42–38.06) were associated with HIV infection in the multivariate logistic regression model. Conclusion The relatively high proportion of male clients of FSWs who have numerous sexual partners and use condoms less frequently make them serve as important bridges for HIV transmission from FSWs to the low-risk general population. The positive association between morphine positivity and HIV infection confirmed illegal drug use as another important route for acquiring HIV infection in addition to sexual transmission, indicating that innovative interventions addressing both drug use and risky sexual behaviors are greatly required for male clients. Respondents aged ≥50 years have a higher risk of HIV infection, which emphasizes that older male clients of FSWs should be focused in future HIV prevention interventions in the border regions of China.
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Affiliation(s)
- Jing Zhu
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu, P.R. China
| | - Dan Hu
- Department of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, P.R. China
| | - Yueqi Yin
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu, P.R. China
| | - Zhibin Zhu
- Hekou Center for Disease Control and Prevention, Hekou, Yunnan, P.R. China
| | - Ning Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, P.R. China
| | - Bei Wang
- Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu, P.R. China
- * E-mail:
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Li Y, He C, He Z, Zhong M, Liu D, Liu R, Fan R, Duan Y. AIDS prevention and control in the Yunnan region by T cell subset assessment. PLoS One 2019; 14:e0214800. [PMID: 30998710 PMCID: PMC6472762 DOI: 10.1371/journal.pone.0214800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/20/2019] [Indexed: 11/18/2022] Open
Abstract
Background Prior to being spread throughout broader China, multiple human immunodeficiency virus (HIV)-1 genotypes were originally discovered in the Yunnan Province. As the HIV-1 epidemic continues its spread in Yunnan, knowledge of the influence of gender, age, and ethnicity to instances of HIV reservoirs will benefit monitoring the spread of HIV. Methods The degree to which T cells are depleted during an HIV infection depends on the levels of immune activation. T-cell subsets were assessed in newly-diagnosed HIV/AIDS patients in Yunnan, and the influence of age, gender, and ethnicity were investigated. Patients that were newly diagnosed with the HIV-infection between the years 2015 and 2018 at the First Affiliated Hospital of Kunming Medical College were selected for this study (N = 408). The lymphocyte levels and T cell subsets were retrospectively measured in whole blood samples by FACS analysis. Results The median CD4 count was 224 ± 191 cells/μl. Significantly higher mean frequencies and absolute numbers were observed in CD3+, CD3+CD4+, CD3+CD8+, CD45+, and CD3+CD4+/CD45+ in females compared to males. Han patients showed a higher total number of CD3+T cells and the ratio of CD3+ /CD45+ cells compared to any other ethnic minority (P < 0.001). The numbers of CD3+ T-cells, CD3+CD8+ T cells, and CD45+ T cells were highest in the age group ≥ 60. Significant differences were observed in the counts of CD3+, CD3+CD8+, and CD45+ cells and the ratio of CD3+/CD45+ and CD3+CD4+/CD45+ cells between the ≤ 29 and 30–59 age groups. Conclusion This study has revealed that low levels of CD4+ T cells can be observed in newly-diagnosed HIV/AIDS patients in the Yunnan province. It has also been demonstrated that gender, age, and ethnicity have a significant association with the ratio of T-cell subsets that may contribute to virus progression and disease prognosis in individuals belonging to certain subsets of the population. This study has highlighted the importance of HIV/AIDS screening in at-risk populations to ensure timely and adequate clinical management in Yunnan.
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Affiliation(s)
- Ya Li
- Yunnan Key Laboratory of Laboratory Medicine, Kunming, Yunan, China
- Yunnan Institute of Laboratory Diagnosis, Kunming, Yunan, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Chenglu He
- Yunnan Key Laboratory of Laboratory Medicine, Kunming, Yunan, China
- Yunnan Institute of Laboratory Diagnosis, Kunming, Yunan, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Zengpin He
- Yunnan Key Laboratory of Laboratory Medicine, Kunming, Yunan, China
- Yunnan Institute of Laboratory Diagnosis, Kunming, Yunan, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Min Zhong
- Yunnan Key Laboratory of Laboratory Medicine, Kunming, Yunan, China
- Yunnan Institute of Laboratory Diagnosis, Kunming, Yunan, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Dajin Liu
- Department of Medical Records and Statistics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Ruiyang Liu
- Department of Standardized Training, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Ruixuan Fan
- Department of Infectious Diseases, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
| | - Yong Duan
- Yunnan Key Laboratory of Laboratory Medicine, Kunming, Yunan, China
- Yunnan Institute of Laboratory Diagnosis, Kunming, Yunan, China
- Department of Clinical Laboratory, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunan, China
- * E-mail:
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Zhu J, Yuan R, Hu D, Zhu Z, Wang N, Wang B. HIV prevalence and correlated factors of female sex workers and male clients in a border region of Yunnan Province, China. Int J STD AIDS 2017; 29:424-434. [PMID: 28901213 DOI: 10.1177/0956462417730258] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Female sex workers (FSWs) and their male clients are vulnerable to HIV infection and serve as a bridge in HIV transmission from the high-risk population to the general, low-risk population. To examine the factors of FSWs and male clients that correlate with the prevalence of HIV infection in the Chinese-Vietnamese border region, a cross-sectional survey was conducted in 2014 in the Hekou county of the Yunnan province of China. We performed a questionnaire survey to collect data on demographics, sexual behavior, and drug use. Blood and urine samples were collected for testing of HIV/sexually transmitted infections and drug use. We found that the prevalence of HIV infection among FSWs was 2.74%, and 15 male clients (2.62%) were HIV-positive. Multivariate logistic regression analysis revealed that herpes simplex virus type 2 infection was a risk factor for HIV infection in FSWs and male clients, suggesting the increased role of sexual transmission in the HIV epidemic in the Chinese-Vietnamese border region. Positive urinalysis result for amphetamine-type stimulants was observed in FSWs with HIV infection. History of drug use was correlated with HIV infection, which increased the HIV infection risk of male clients, confirming that drug use is an important target in future interventions for HIV prevention.
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Affiliation(s)
- Jing Zhu
- 1 Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, 12579 Southeast University , Nanjing City, China
| | - Rui Yuan
- 1 Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, 12579 Southeast University , Nanjing City, China
| | - Dan Hu
- 2 Department of Health Policy and Management, 12461 Nanjing Medical University , Nanjing City, China
| | - Zhibin Zhu
- 3 Hekou Center for Disease Control and Prevention, Hekou, China
| | - Ning Wang
- 4 National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing City, China
| | - Bei Wang
- 1 Key Laboratory of Environmental Medicine and Engineering, Ministry of Education, Department of Epidemiology and Medical Statistics, School of Public Health, 12579 Southeast University , Nanjing City, China
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Sun Y, Guo W, Li G, He S, Lu H. Increased synthetic drug abuse and trends in HIV and syphilis prevalence among female drug users from 2010-2014 from Beijing, China. Int J STD AIDS 2017; 29:30-37. [PMID: 28697679 DOI: 10.1177/0956462417715174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to monitor the trend of addiction drug use and its relationship with sexually transmitted infections (STIs) among female drug users (FDUs). Serial cross-sectional surveys were conducted during 2010-2014 among FDUs in Beijing to collect information on addiction drug usage, sexual behaviors, and STI prevalence. Characteristics were analyzed and compared between traditional and synthetic drug users among FDUs by logistic regression method. A total of 3859 FDUs were surveyed during 2010-2014, with the median age being 32.7 years old. The proportion of synthetic drug users among FDUs increased from 43.7% in 2010 to 70.7% in 2014. Compared with traditional drug users, synthetic drug users were younger (P < 0.001), lacked education (P < 0.001), were unmarried (P < 0.001), and were non-local residents (P < 0.001). No significant difference was found with condom usage during sexual activity between traditional and synthetic drug FDUs. However, the engagement of commercial sexual activities (P < 0.001) and syphilis prevalence (P < 0.001) among synthetic drug users were significantly higher than traditional drug users. Synthetic drug abuse appears to be correlated with commercial sex behavior and higher syphilis prevalence among FDUs. Tailored strategies on health education to curb the prevalence of synthetic drug abuse are urgently needed in Beijing.
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Affiliation(s)
- Yanming Sun
- 1 Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Wei Guo
- 2 Division of Epidemiology, 196543 National Center for AIDS/STD Control and Prevention , Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guiying Li
- 1 Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Shufang He
- 1 Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Hongyan Lu
- 1 Beijing Center for Diseases Prevention and Control, Beijing, China
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Zhang L, Chow EPF, Su S, Yiu WL, Zhang X, Iu KI, Tung K, Zhao R, Sun P, Sun X, Yuan L, Muessig KE, Tucker JD, Jing J. A systematic review and meta-analysis of the prevalence, trends, and geographical distribution of HIV among Chinese female sex workers (2000-2011): implications for preventing sexually transmitted HIV. Int J Infect Dis 2015; 39:76-86. [PMID: 26358859 DOI: 10.1016/j.ijid.2015.08.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 08/19/2015] [Accepted: 08/28/2015] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The aim of this meta-analysis was to investigate temporal and geographical trends in the HIV epidemic among female sex workers (FSWs) recruited from various venues in China. METHODS Chinese and English peer-reviewed articles published between January 2000 and February 2013 were systematically searched. Standard meta-analysis methods were used to calculate the pooled HIV prevalence, in accordance with the PRISMA guidelines. RESULTS The national HIV prevalence among FSWs declined from 0.74% (95% confidence interval (CI) 0.37-1.49%) in 2000-2002 to 0.40% (95% CI 0.31-0.53%) in 2009-2011. All Chinese regions demonstrated significant declines in HIV prevalence, apart from the East and South Central regions, in which the epidemics stabilized at low/moderate levels. Despite a significant decline from 1.92% (95% CI 0.86-4.24%) to 0.87% (95% CI 0.65-1.18%) during 2000-2011, Southwest China still bore the greatest HIV disease burden. Nationwide, FSWs recruited from detention centres had the highest HIV prevalence (0.92%, 95% CI 0.46-1.88%), followed by voluntary counselling and testing sites (0.80%, 95% CI 0.46-1.67%) and entertainment venues (0.61%, 95% CI 0.47-0.79%). The prevalences among FSWs in high-, middle-, and low-tier entertainment venues were 0.59% (95% CI 0.32-1.45%), 0.92% (95% CI 0.50-1.77%), and 1.10% (95% CI 0.71-2.16%), respectively. High- and middle-tier FSWs had a significantly lower risk of HIV infection than lower-tier FSWs (high/low: odds ratio (OR) 0.48, 95% CI 0.40-0.59; middle/low: OR 0.49, 95% CI 0.37-0.66). CONCLUSIONS The HIV epidemic has shown a gradual declining or stabilizing trend among Chinese FSWs. Intervention efforts should be diverted to high-risk subgroups of FSWs, such as drug-using and low-tier FSWs.
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Affiliation(s)
- Lei Zhang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Eric P F Chow
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia; The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Shu Su
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Wai Lok Yiu
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Xiaohu Zhang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Ka I Iu
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Keith Tung
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rui Zhao
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Peng Sun
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Xiaoshu Sun
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Lei Yuan
- The School of Sociology and Population Studies, Remin University of China, Beijing, China
| | - Kathryn E Muessig
- The University of North Carolina Project-China, Guangzhou, China; Department of Health Behavior, Gillings School of Global Public Health at the University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joseph D Tucker
- The University of North Carolina Project-China, Guangzhou, China; London School of Hygiene and Tropical Medicine, London, UK
| | - Jun Jing
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China; The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
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Le LVN, Nguyen TA, Tran HV, Gupta N, Duong TC, Tran HTT, Nadol P, Sabin K, Maher L, Kaldor JM. Correlates of HIV infection among female sex workers in Vietnam: injection drug use remains a key risk factor. Drug Alcohol Depend 2015; 150:46-53. [PMID: 25765480 PMCID: PMC10774074 DOI: 10.1016/j.drugalcdep.2015.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 02/03/2015] [Accepted: 02/03/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Women who sell sex and use drugs have dual risks for HIV infection. Despite increasing reports of drug use among female sex workers (FSW) in Vietnam, FSW HIV interventions remain focused mainly on sexual risk reduction. We assessed the impact of drug use and inconsistent condom use on HIV infection among FSW in Vietnam, which few studies have quantified. METHODS We surveyed 5298 women aged ≥18 years who had sold sex in the past month from ten geographically dispersed provinces. We performed multivariate logistic regression on data from provinces with high (≥10%) or low (<10%) HIV prevalence among FSW. RESULTS Compared to FSW who never used illicit drugs, the odds of HIV infection among FSW who had ever injected drugs and those who reported non-injection drug use were 3.44 (CI 2.32-5.09) and 1.76 (CI 1.14-2.71), respectively, in high-prevalence provinces. FSW who always used condoms with clients had lower odds of HIV infection than those who did not (AOR=0.71; CI 0.52-0.98). In low-prevalence provinces lifetime injection drug use (AOR 22.05, CI 12.00-40.49), but not non-injecting drug use or inconsistent condom use, was significantly associated with HIV infection. CONCLUSIONS Because injection drug use and inconsistent condom use were key risk factors for HIV infection in high-prevalence provinces, drug injection risk reduction should be as much a focus of HIV prevention as sexual risk reduction. Where HIV prevalence remains low in FSW, a more general emphasis on harm reduction for all drug users will benefit FSW.
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Affiliation(s)
- Linh-Vi N Le
- U.S. Centers for Disease Control and Prevention, Vietnam; Kirby Institute for Infection and Immunity, UNSW, Australia.
| | - Tuan A Nguyen
- National Institute of Hygiene and Epidemiology, Vietnam
| | | | - Nisha Gupta
- U.S. Centers for Disease Control and Prevention, Vietnam
| | - Thanh C Duong
- National Institute of Hygiene and Epidemiology, Vietnam
| | | | - Patrick Nadol
- U.S. Centers for Disease Control and Prevention, Vietnam
| | - Keith Sabin
- World Health Organization, Vietnam, currently UN Joint Programme on HIV/AIDS, Switzerland
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, UNSW, Australia
| | - John M Kaldor
- Kirby Institute for Infection and Immunity, UNSW, Australia
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Chow EPF, Muessig KE, Yuan L, Wang Y, Zhang X, Zhao R, Sun P, Sun X, Tucker JD, Jing J, Zhang L. Risk behaviours among female sex workers in China: a systematic review and data synthesis. PLoS One 2015; 10:e0120595. [PMID: 25815481 PMCID: PMC4376708 DOI: 10.1371/journal.pone.0120595] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/05/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Commercial sex is one of the major modes of HIV transmission in China. Understanding HIV risk behaviours in female sex workers (FSW) is of great importance for prevention. This study aims to assess the magnitude and temporal changes of risk behaviours in Chinese FSW. METHOD Five electronic databases were searched to identify peer-reviewed English and Chinese language articles published between January 2000 and December 2012 that reported risk behaviours among FSW in China, including condom use, HIV testing, and drug use. Linear regression and Spearman's rank correlation were used to examine temporal trends in these risk factors. The study followed PRISMA guidelines for meta-analyses and was registered in the PROSPERO database for systematic reviews. RESULTS A total of 583 articles (44 English, 539 Chinese) investigating 594,583 Chinese FSW were included in this review. At last sex, condom use was highest with commercial partners (clients), increasing from 53.7% in 2000 to 84.9% in 2011. During this same time period, condom use increased with regular partners from 15.2% to 40.4% and with unspecified partners from 38.6% to 82.5%. Increasing trends were also found in the proportion of sampled FSW who reported testing for HIV in the past 12 months (from 3.2% in 2000 to 48.0% in 2011), while drug use behaviours decreased significantly from 10.9% to 2.6%. CONCLUSION During the first decade of 2000, Chinese FSWs' self-reported risk behaviours have decreased significantly while HIV testing has increased. Further outreach and intervention efforts are needed to encourage condom use with regular partners, continue promotion of HIV testing, and provide resources for the most vulnerable FSW, particularly low tier FSW, who may have limited access to sexual health and prevention programs.
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Affiliation(s)
- Eric P. F. Chow
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Kathryn E. Muessig
- The University of North Carolina Project-China, Guangzhou, China
- Department of Health Behavior, Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Institute for Global Health and Infectious Diseases, UNC Chapel Hill, Chapel Hill, North Carolina, United States of America,
| | - Lei Yuan
- The School of Sociology and Population Studies, Remin University of China, Beijing, China
| | - Yanjie Wang
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Xiaohu Zhang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Rui Zhao
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Peng Sun
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Xiaoshu Sun
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Joseph D. Tucker
- The University of North Carolina Project-China, Guangzhou, China
- Institute for Global Health and Infectious Diseases, UNC Chapel Hill, Chapel Hill, North Carolina, United States of America,
| | - Jun Jing
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Lei Zhang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
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11
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Zhou C, Rou K, Dong WM, Wang Y, Dong W, Zhou Y, Chen X, Jia M, Liu W, Zheng J, Ma Y, Li Y, Wu Z. High prevalence of HIV and syphilis and associated factors among low-fee female sex workers in mainland China: a cross-sectional study. BMC Infect Dis 2014; 14:225. [PMID: 24767104 PMCID: PMC4026051 DOI: 10.1186/1471-2334-14-225] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 03/19/2014] [Indexed: 11/24/2022] Open
Abstract
Background The prevalence of HIV and syphilis among middle and high-fee female sex workers (FSWs) has been widely reported but little is known among low-fee FSWs. This study aims to determine the prevalence and associated factors of HIV and syphilis among low-fee FSWs in China. Methods A cross-sectional study design was used. A convenience sample of low-fee FSWs was recruited from venues by outreach workers in 12 cities. Structured questionnaire interviews and blood sampling for HIV and syphilis were carried out. Univariate and multivariate logistic regression were used for assessing potential associated factors. Results This study enrolled 781 low-fee FSWs. There were 37 (4.7%) HIV positive participants and 117 (15.0%) participants were infected with syphilis. Final multivariate analysis identified five factors associated with HIV infection: older age (OR:2.6, 95% CI:1.1-6.1), local household registration (OR:3.3, 95% CI:1.5-6.9), employed in Yunnan province (OR:2.7, 95% CI:1.1-6.7), soliciting in self-rented rooms and “market day” buildings (OR:3.9, 95% CI:1.5-10.0), injection drug use in the past 6 months (OR:13.5, 95% CI:4.5-40.1); and four factors associated with syphilis infection: older age (OR:1.8, 95% CI:1.2-2.9), employed in Yunnan province (OR:2.1, 95% CI:1.2-3.6), soliciting in self-rented rooms and “market day” buildings (OR:2.3, 95% CI:1.4-3.7) , and no consistent condom use with clients in the past 30 days (OR:1.6, 95% CI:1.0-2.6). Conclusions A high prevalence of HIV and syphilis were found among low-fee FSWs. Those soliciting in self-rented rooms and “market day” buildings with the lowest income, and injection drug users (IDUs) in this population should take priority in further intervention strategies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Beijing, Changping District 102206, China.
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12
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Zhang L, Zhang D, Chen W, Zou X, Ling L. High prevalence of HIV, HCV and tuberculosis and associated risk behaviours among new entrants of methadone maintenance treatment clinics in Guangdong Province, China. PLoS One 2013; 8:e76931. [PMID: 24116185 PMCID: PMC3792874 DOI: 10.1371/journal.pone.0076931] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/04/2013] [Indexed: 12/02/2022] Open
Abstract
Background Methadone maintenance treatment (MMT) has been available in Guangdong province, China since 2006. This study aims to estimate the prevalence levels of HIV, Hepatitis C (HCV), Tuberculosis (TB) and their co-infections and associated demographic and risk behaviours among MMT entrants. Method A total of 2296 drug users at the time of their MMT enrolment were recruited from four clinics during 2006-2011. Participants’ demographic characteristics, infection status and self-reported high-risk drug-use and sexual behaviours were surveyed. Log-linear contingency analysis was employed to investigate the demographic and behavioural differences between gender and drug-user type, while multivariate regression analysis was used to identify the associated factors of HIV, HCV and TB infections. Results Female drug users demonstrate significantly higher frequency of daily drug consumption (Log-linear contingency analysis, G2=10.86, p=0.013) and higher proportion of having had sex in the past three months (G2=30.22, p<0.001) than their male counterparts. Among injecting drug users, females also inject (χ2=16.15, p=0.001) and share syringes (χ2=13.24, p=0.004) more frequently than males. Prevalence of HIV, HCV and TB among MMT entrants are 6.3%, 78.7% and 4.4% respectively. Co-infections of HIV/HCV, HIV/TB, HCV/TB and HIV/HCV/TB reportedly infect 5.6%, 0.5%, 3.8% and 0.3% of study participants. Infection risks of HIV, HCV and TB are consistently associated with increasing length of drug use, injecting drugs, financial dependence and reduced sexual activities. Conclusion Injecting drug use is the major contributing factor in prevalence levels of HIV, HCV and TB among MMT entrants. Female drug users are more disadvantaged in their social status and risk-taking in their drug use behaviours than males.
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Affiliation(s)
- Lei Zhang
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, P. R. China
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Di Zhang
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, P. R. China
- School of Public Health, Sun Yat-sen University, Guangzhou, P. R. China
- Office of Medical Science, Sun Yat-sen University, Guangzhou, P. R. China
| | - Wen Chen
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, P. R. China
- School of Public Health, Sun Yat-sen University, Guangzhou, P. R. China
| | - Xia Zou
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, P. R. China
- School of Public Health, Sun Yat-sen University, Guangzhou, P. R. China
| | - Li Ling
- Sun Yat-sen Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, P. R. China
- School of Public Health, Sun Yat-sen University, Guangzhou, P. R. China
- * E-mail:
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13
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Willis B. The global public health burden of sex work: a call for research. LANCET GLOBAL HEALTH 2013; 1:e68. [PMID: 25104153 DOI: 10.1016/s2214-109x(13)70011-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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