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Ravalihasy A, Ante-Testard PA, Kardas-Sloma L, Yazdanpanah Y, De Allegri M, Ridde V. Quantitative Methods Used to Evaluate Impact of Combination HIV Prevention Intervention: A Methodological Systematic Review. AIDS Behav 2023:10.1007/s10461-023-04000-8. [PMID: 36705772 PMCID: PMC9881517 DOI: 10.1007/s10461-023-04000-8] [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] [Accepted: 01/18/2023] [Indexed: 01/28/2023]
Abstract
Combination HIV prevention aims to provide the right mix of biomedical, behavioral and structural interventions, and is considered the best approach to curb the HIV pandemic. The impact evaluation of combined HIV prevention intervention (CHPI) provides critical information for decision making. We conducted a systematic review of the literature to map the designs and methods used in these studies. We searched original articles indexed in Web of Science, Scopus and PubMed. Fifty-eight studies assessing the impact of CHPI on HIV transmission were included. Most of the studies took place in Asia or sub-Saharan Africa and were published from 2000 onward. We identified 36 (62.1%) quasi-experimental studies (posttest, pretest-posttest and nonequivalent group designs) and 22 (37.9%) experimental studies (randomized designs). The findings suggest that diverse methods are already rooted in CHPI impact evaluation practices as recommended but should be better reported. CHPI impact evaluation would benefit from more comprehensive approaches.
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Affiliation(s)
- Andrainolo Ravalihasy
- Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD) et Université Paris Cité, Inserm ERL 1244, 45 Rue Des Saints-Pères, 75006 Paris, France ,French Collaborative Institute On Migrations, CNRS, Aubervilliers, France ,UMR 1137, Inserm, Université Paris Cité, IAME, Paris, France
| | - Pearl Anne Ante-Testard
- MESuRS and Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France ,Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA USA
| | | | | | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Valéry Ridde
- Centre Population et Développement (Ceped), Institut de Recherche pour le Développement (IRD) et Université Paris Cité, Inserm ERL 1244, 45 Rue Des Saints-Pères, 75006 Paris, France ,French Collaborative Institute On Migrations, CNRS, Aubervilliers, France
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Wu C, Choi EPH, Chau PH. The Holistic Health Status of Chinese Homosexual and Bisexual Adults: A Scoping Review. Front Public Health 2021; 9:710575. [PMID: 34504828 PMCID: PMC8421524 DOI: 10.3389/fpubh.2021.710575] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Same-sex marriage is currently not legalized in China, despite the considerably large number of homosexual and bisexual Chinese populations. At the same time, their holistic health status remains unclear. This is the first scoping review conducted to comprehensively examine all the available literature and map existing evidence on the holistic health of homosexual and bisexual Chinese. Methods: This scoping review used the framework of Arksey and O'Malley and followed the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews (PRISMA-ScR). A comprehensive search strategy was carried out across 20 English (EN) and Chinese (both traditional and simplified) electronic databases from January 1, 2001, to May 31, 2020. Two reviewers conducted the reference screening and study selection independently and consulted a third senior reviewer whenever a consensus must be achieved. Data extraction was conducted using a structured data form based on the Cochrane template, after which a narrative synthesis of the findings was performed. Results: A total of 2,879 references were included in the final analysis, with 2,478 research articles, 167 reviews, and 234 theses. Regarding the study populations, the vast majority of studies centered on men only (96.46%), especially men who have sex with men (MSM). Only 1.32% of the studies targeted female sexual minorities. The geographical distribution of all research sites was uneven, with most of them being conducted in mainland China (95.96%), followed by Hong Kong (2.05%), Taiwan (2.02%), and Macau (0.06%). Regarding the specific study focus in terms of the health domain, around half of the studies (45.93%) focused on sexual health only, and an additional quarter of the studies (24.15%) investigated both sexual health and social well-being. Meanwhile, the studies focusing on mental health only accounted for approximately 15% of the total. Conclusions: This scoping review revealed that previous research focused more on male than female sexual minorities, on disease-centered surveys than person-centered interventions, and investigations on negative health conditions than positive health promotion. Therefore, investigations centered on the female sexual minorities and corresponding person-centered interventions are highly needed. Review Registration: The protocol of this review has been registered within Open Science Framework (https://osf.io/82r7z) on April 27, 2020.
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Affiliation(s)
| | - Edmond Pui Hang Choi
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Jin X, Cheng J, Lou J. Infer HIV transmission dynamics from gene sequences among young men who have sex with men in China. Infect Dis Model 2021; 6:832-838. [PMID: 34322646 PMCID: PMC8286960 DOI: 10.1016/j.idm.2021.06.003] [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: 04/25/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
To investigate the transmission dynamics and temporal and spatial migration characteristics of HIV spread among men who have sex with men (MSM) in China, a total of 1012 HIV-1 partial pol sequences, including five subtypes, were studied. Bayesian analysis were applied for each subtype to infer its dynamic characters including the effective reproductive number (R e ) and migration process. The mean curve of each R e was almost always greater than 1 (even the 95% highest posterior density (HPD) lower value) along with time, which supports the necessity for a comprehensive study about risk behaviors among young MSM group in China. We also should reappraise the free treatment strategy, especially the therapeutic effect during the free treatment policy.
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Affiliation(s)
- Xin Jin
- Department of Mathematics, Shanghai University, 99 Shangda Road, Shanghai, 200444, PR China
| | - Jinjin Cheng
- Department of Mathematics, Shanghai University, 99 Shangda Road, Shanghai, 200444, PR China
| | - Jie Lou
- Department of Mathematics, Shanghai University, 99 Shangda Road, Shanghai, 200444, PR China
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Reza MM, Rana AKMM, Azim T, Chowdhury EI, Gourab G, Imran MSA, Islam MA, Khan SI. Changes in condom use among males who have sex with males (MSM): Measuring the effect of HIV prevention programme in Dhaka city. PLoS One 2020; 15:e0236557. [PMID: 32706840 PMCID: PMC7380615 DOI: 10.1371/journal.pone.0236557] [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: 09/12/2019] [Accepted: 07/08/2020] [Indexed: 11/22/2022] Open
Abstract
Background A systematic assessment was done to examine the effect of HIV interventions among MSM in Dhaka, Bangladesh. MSM were defined as males having sex with males but did not sell sex in the last year. MSM are hidden, marginalized and stigmatized population groups not only in Bangladesh but also globally. In 2010, HIV interventions for MSM were expanded in 40 districts of Bangladesh through 65 drop-in-centres (DICs) and peer outreach workers. Methods Data from two surveys on MSM in Dhaka in 2010 (baseline) and 2013 (midline) were used to analyse the effect of ongoing HIV prevention services. Both surveys used time location sampling to randomly select MSM for risk behaviour interviews. Two outcome variables were considered; condom use in the last anal sex act and consistent condom use during anal sex in the last month. Univariate and multivariate logistic regression methods were used to determine factors associated with condom use. Results Condom use significantly increased at the midline than baseline (p<0.001 for both). Multivariate analysis showed that having comprehensive knowledge of HIV and participation in HIV prevention programme were positively associated with both last time and consistent condom use. MSM who had comprehensive knowledge of HIV were 1.9 times (95% CI: 1.3–2.8, p = 0.002) and 2.1 times (95% CI: 1.4–3.2, p<0.001) more likely to use condoms than those who did not have comprehensive knowledge of HIV. The likelihood of using condoms among MSM was more than double at the midline than the baseline (p<0.01 for both). However, odds of condom use was significantly lower among those who perceived themselves to be at risk or were not able to assess their own risk of HIV. Conclusion To sustain positive changes in HIV risk behaviours, HIV prevention programmes for MSM need to be continued and strengthened.
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Affiliation(s)
- Md. Masud Reza
- Programme for HIV and AIDS, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - AKM Masud Rana
- Programme for HIV and AIDS, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tasnim Azim
- Regional Advisor for Research Policy and Cooperation (RPC), Department of Communicable Diseases, WHO South-East Asia Regional Office, Delhi, India
| | | | - Gorkey Gourab
- Programme for HIV and AIDS, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Sha Al Imran
- Programme for HIV and AIDS, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Aminul Islam
- Programme for HIV and AIDS, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sharful Islam Khan
- Programme for HIV and AIDS, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- * E-mail:
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Yan X, Lu Z, Zhang B, Li Y, Tang W, Zhang L, Jia Z. Protecting Men Who Have Sex With Men From HIV Infection With an mHealth App for Partner Notification: Observational Study. JMIR Mhealth Uhealth 2020; 8:e14457. [PMID: 32130147 PMCID: PMC7057823 DOI: 10.2196/14457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 11/22/2019] [Accepted: 11/29/2019] [Indexed: 12/01/2022] Open
Abstract
Background Traditional partner notification methods have been implemented for HIV-infected patients, as well as HIV treatment, in order to identify people at risk of HIV infection, especially men who have sex with men (MSM), since they are more likely to have casual sex partners. These traditional methods have some limitations. Objective Our study focused on developing an mHealth app to improve partner notification in practice for MSM; the study then focused on evaluating the effects of the app. Methods We developed an mHealth app with different modules using Java and HTML5 and tested it in an MSM community to prevent HIV transmission. The HIV incidence stratified by different follow-up periods were calculated. Poisson regression and social networks were used to estimate the risk ratios and to identify the connection among MSM, respectively. Results In addition to the partner notification module, which is the kernel of the app, we developed a test result self-query module to enable MSM to get their approved test results in a timely manner, a prompt and warning module to alert users to protect themselves from high-risk conditions, and a health education module to teach users more skills regarding HIV/AIDS prevention. Over a 1-year duration, a total of 3186 MSM used the app, of which 678 had at least two HIV test results since becoming app users; they were included in the final analysis. Among 678 users, a total of 6473 self-queries and 623 partner notifications were recorded, which identified 180 social networks of MSM app users. Those who used the partner notification function were more likely to have self-queries (P<.001). The 678 MSM app users covered 296.47 person-years and contributed to 20 HIV seroconversions; the cumulative HIV infection incidence was estimated as 6.75 per 100 person-years (95% CI 4.38-10.01). We found that the longer the app was used, the lower the HIV incidence (>5 months vs ≤5 months: 2.22 per 100 person-years vs 6.99 per 100 person-years; risk ratio 0.32, 95% CI 0.12- 0.87). Conclusions The app developed in this study is consistent with the World Health Organization’s sensitivity and confidentiality recommendations; it has the potential to reduce the risk of HIV infection among MSM.
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Affiliation(s)
- Xiangyu Yan
- School of Public Health, Peking University, Beijing, China.,National Institute on Drug Dependence, Peking University, Beijing, China
| | - Zuhong Lu
- Biomedical Engineering, Southeast University, Jiangsu Province, China
| | - Bo Zhang
- School of Public Health, Peking University, Beijing, China.,National Institute on Drug Dependence, Peking University, Beijing, China
| | - Yongjie Li
- School of Public Health, Peking University, Beijing, China.,National Institute on Drug Dependence, Peking University, Beijing, China
| | - Wenjun Tang
- School of Public Health, Peking University, Beijing, China.,National Institute on Drug Dependence, Peking University, Beijing, China
| | - Lingling Zhang
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
| | - Zhongwei Jia
- National Institute on Drug Dependence, Peking University, Beijing, China
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Li H, Tucker JD, Ma W, Kim ES, Marley G, Wang J, Kang D, Liao M, Tang W, Jiang B. Mediation Analysis of Peer Norms, Self-Efficacy, and Condom Use Among Chinese Men Who Have Sex with Men: A Parallel Process Latent Growth Curve Model. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:287-297. [PMID: 31535244 PMCID: PMC8187081 DOI: 10.1007/s10508-019-1459-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 03/30/2019] [Accepted: 04/17/2019] [Indexed: 06/10/2023]
Abstract
The objective of this study was to examine direct and indirect relationships among peer norms, self-efficacy, and condom use among Chinese men who have sex with men (MSM). A longitudinal study determined the effectiveness of a condom use video promotion among Chinese MSM in 2015. In this analysis, 804 Chinese MSM were recruited at baseline and then followed at 3 weeks and 3 months after the intervention. Parallel process latent growth curve modeling (LGM) with multiple indicators and bootstrapping was conducted using Mplus 7.4. The LGM model fit indexes were good with RMSEA = 0.046, 90% CI (0.044, 0.048), CFI = 0.956, TLI = 0.955. Our results showed that the initial measure of peer norms affected the initial measure of condom use indirectly through the initial measure of self-efficacy (αβ = 0.414, 95% CI 0.260-0.759). The rate of change in peer norms over time also significantly affected the rate of change in condom use through the rate of change in self-efficacy (αβ = 0.101, 95% CI 0.014-0.262). Self-efficacy mediated the association between peer norms and condom use, indicating a strong potential of causal relationship between peer norms and self-efficacy among Chinese MSM.
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Affiliation(s)
- Haochu Li
- Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, 250012, Shandong Province, China.
| | - Joseph D Tucker
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- SESH Global, Guangzhou, China
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, 250012, Shandong Province, China
| | - Eun Sook Kim
- Department of Educational and Psychological Studies, University of South Florida, Tampa, FL, USA
| | - Gifty Marley
- Department of Epidemiology and Health Statistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jichuan Wang
- Children's National Health System, The George Washington University, Washington, DC, USA
| | - Dianmin Kang
- Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Meizhen Liao
- Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Weiming Tang
- UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- SESH Global, Guangzhou, China
- Guangdong Provincial Center for Skin Diseases and STI Control, Guangzhou, China
| | - Baofa Jiang
- Department of Epidemiology, School of Public Health, Shandong University, 44 West Wenhua Road, Jinan, 250012, Shandong Province, China
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Yang J, Xu H, Li S, Cheng W, Gu Y, Xu P, Yu Q, Lv F. The characteristics of mixing patterns of sexual dyads and factors correlated with condomless anal intercourse among men who have sex with men in Guangzhou, China. BMC Public Health 2019; 19:722. [PMID: 31182070 PMCID: PMC6558892 DOI: 10.1186/s12889-019-7082-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 05/31/2019] [Indexed: 11/19/2022] Open
Abstract
Background The HIV prevalence among men who have sex with men (MSM) in China has increased yearly. This study aimed to explore the association between the characteristics of social communication and condomless anal intercourse (CAI) among MSM and the implications for prevention and control of HIV among MSM in China using an egocentric network framework. Methods The data were collected in Guangzhou between November 2016 and May 2017 through standardized face-to-face interviews. The participants were recruited among MSM who received voluntary counselling and testing services (VCT) provided by nongovernmental organizations (NGOs) and the local Centers for Disease Control and Prevention (CDC). We used the framework of the egocentric network analysis, the odd ratios of CAI were analyzed using generalized estimating equations (GEE). Results In total, 1073 MSM who nominated 2667 sexual partners were sampled. MSM who were approximately 30 years old and chose sexual partners of different age category were more likely to engage in CAI. Participants with high level education who were in partnerships with individuals with lower education levels had a higher risk of CAI. Participants who reported having a strong relationship with their sexual partners(AOR = 1.31) were associated with a higher probability of experiencing CAI during sex; while having sexual partners who were unmarried (OR = 0.56), and participants who reported meeting sexual partners online (AOR = 0.74) or, having sex with an occasional partner (AOR = 0.44)were less likely to engage in CAI. Conclusion Our study indicates that the strength of sexual dyadic relational ties and different social communication mixing patterns across ages, educational categories, and marital status were associated with CAI. Electronic supplementary material The online version of this article (10.1186/s12889-019-7082-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juan Yang
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155th Changbai Road, Changping District, Beijing, China
| | - Huifang Xu
- Department of HIV/AIDS Control and Prevention, Center for Disease Control and Prevention, Guangzhou, China
| | - Shuo Li
- United Nations Entity for Gender Equality and the Empowerment of Woman, China Office, Beijing, China
| | - Weibin Cheng
- Department of HIV/AIDS Control and Prevention, Center for Disease Control and Prevention, Guangzhou, China
| | - Yuzhou Gu
- Department of HIV/AIDS Control and Prevention, Center for Disease Control and Prevention, Guangzhou, China
| | - Peng Xu
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155th Changbai Road, Changping District, Beijing, China
| | - Qiuyan Yu
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155th Changbai Road, Changping District, Beijing, China
| | - Fan Lv
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155th Changbai Road, Changping District, Beijing, China.
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Flowers P, Wu O, Lorimer K, Ahmed B, Hesselgreaves H, MacDonald J, Cayless S, Hutchinson S, Elliott L, Sullivan A, Clutterbuck D, Rayment M, McDaid L. The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development. Health Technol Assess 2018; 21:1-164. [PMID: 28145220 DOI: 10.3310/hta21050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited. OBJECTIVES To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention. DATA SOURCES All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014. REVIEW METHODS A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation. RESULTS Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from 'goals and planning' and 'identity' groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation. LIMITATIONS There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity. CONCLUSIONS Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention. FUTURE WORK There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity. STUDY REGISTRATION The study is registered as PROSPERO CRD42014009500. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Paul Flowers
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Karen Lorimer
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Bipasha Ahmed
- GCU London, Glasgow Caledonian University, London, UK
| | - Hannah Hesselgreaves
- Health Economics and Health Technology Assessment and National Institute for Health Research Complex Reviews Support Unit, University of Glasgow, Glasgow, UK
| | - Jennifer MacDonald
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Sandi Cayless
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sharon Hutchinson
- Department of Psychology, Social Work and Allied Health Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Lawrie Elliott
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Lisa McDaid
- Chief Scientist Office/Medical Research Council Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Transmission network characteristics based on env and gag sequences from MSM during acute HIV-1 infection in Beijing, China. Arch Virol 2017; 162:3329-3338. [PMID: 28726130 DOI: 10.1007/s00705-017-3485-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/29/2017] [Indexed: 10/19/2022]
Abstract
Molecular epidemiology can be used to identify human immunodeficiency virus (HIV) transmission clusters, usually using pol sequence for analysis. In the present study, we explored appropriate parameters to construct a simple network using HIV env and gag sequences instead of pol sequences for constructing a phylogenetic tree and a genetic transmission subnetwork, which were used to identify individuals with many potential transmission links and to explore the evolutionary dynamics of the virus among men who have sex with men (MSM) in Beijing. We investigated 70 acute HIV-1 infections, which consisted of HIV-1 subtype B (15.71%), the circulating recombinant forms CRF01_AE (47.14%), CRF07_BC (21.43%), CRF55_01B (1.43%), and CRF65_cpx (4.29%), and an unknown subtype (10.00%). By exploring the similarities and differences among HIV env, gag and pol sequences in describing the dynamics of the HIV-1 CRF01_AE transmission subnetwork among Beijing MSM, we found that four key points of the env sequences (strains E-2011_BJ.CY_16014, E-2011_BJ.FT_16017, E-2011_BJ.TZ_16064, and E-2011_BJ.XW_16035) contained more transmission information than gag sequences (three key points: strains G-2011_BJ.CY_16014, G-2011_BJ.FT_16017, and G-2011_BJ.XW_16035) and pol sequences (two key points: strains P-2011_BJ.CY_16014 and P-2011_BJ.XW_16035). Although the env and gag sequence results were similar to pol sequences in describing the dynamics of the HIV-1 CRF01_AE transmission subnetwork, we were able to obtain more precise information, allowing identification of key points of subnetwork expansion, based on HIV env and gag sequences instead of pol sequences. Taken together, the key points we found will improve our current understanding of how HIV spreads between MSM populations in Beijing and help to better target preventative interventions for promoting public health.
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Expanded antiretroviral treatment, sexual networks, and condom use: Treatment as prevention unlikely to succeed without partner reduction among men who have sex with men in China. PLoS One 2017; 12:e0171295. [PMID: 28406992 PMCID: PMC5390964 DOI: 10.1371/journal.pone.0171295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 01/19/2017] [Indexed: 12/26/2022] Open
Abstract
Background To project the impact of partner reduction on preventing new HIV infections among men who have sex with men (MSM) under varying conditions of enhanced HIV testing and treatment (T&T) and condom use in Beijing, China. Methods and findings A complex network model was fitted to predict the number of new HIV infections averted from 2014 to 2023 under four scenarios of sexual behavior risk reduction (S)—S1: Male sexual partners decrease (reduced by a random value m from 1–50) while condom use increases (risk constant p is a random value between 0.2 and 1]); S2: Both sexual partners and condom use decrease (m 1, 50; p 1, 1.8); S3: Sexual partners reduce (m 1, 10) while condom use increases or decreases (p 0.2, 1.8); S4: Only MSM with ≥100 male sexual partners reduce their partners (m 1, 50) while condom use increases (p 0.2, 1). HIV prevalence will reach 23.2% by 2023 among Beijing MSM if T&T remains at the 2013 level. The three most influential factors are: T&T coverage; partner reduction (m); and the background risk (p). Under scenarios 1–4 of sexual behavioral changes with enhanced T&T interventions, the cumulative HIV new infections prevented over the 10 years will be 46.8% for S1 (interquartile range [IQR] 32.4%, 60.1%); 29.7% for S2 (IQR 18.0%, 41.4%), 23.2% for S3 (IQR 12.2%, 37.0%) and 11.6% for S4 (IQR 4.0%, 26.6%), respectively. The reproduction number R0 could drop below 1 if there were a substantial reduction of male sexual partners and/or expanded condom use. Conclusion Partner reduction is a vital factor within HIV combination interventions to reduce HIV incidence among Beijing MSM, with substantial additional benefits derived from condom use. T&T without substantial partner reduction and increased condom use is less promising unless its implementation were extremely (and improbably) efficient.
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He H, Lv F, Zhang NN, Wu Z, Liao Q, Chang Z, Li Y, Xu H, OuYang L, Huan X, Yang J. Look into the HIV Epidemic of Gay Community with a Socio-Cultural Perspective: A Qualitative Study in China, 2015-2016. PLoS One 2017; 12:e0170457. [PMID: 28107523 PMCID: PMC5249147 DOI: 10.1371/journal.pone.0170457] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/05/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Current Chinese studies continue to view male homosexuality through a disease focused lens which pays limited attention to socio-cultural aspects of sexual behavior and HIV transmission. This qualitative study aimed to investigate how socio-cultural factors influence gay men's sexual beliefs and behaviors in contemporary China, and their implications for HIV epidemic. METHODS AND FINDINGS Qualitative methodology was used in this study. During 2015-2016, in-depth interviews were conducted with 61 self identified gay men in Jiangxi, Henan, Heilongjiang, Guangdong, Jiangsu provinces and Chongqing municipality of China. Our study revealed that: 1) influenced by Chinese traditional culture, gay men have conflicts on self-identity, which led to low self-acceptance and negative attitude on sex, and huge socio-psychological stress; 2) a generational differences within gay community was observed, reflected in varied sexual attitudes and practices as well as way for approaching new friends, both of which have implications and challenges on HIV control and prevention; 3) socio-cultural barriers, including open minds towards casual sex and nonmonogamous relationship, and low priority of health demands were widely observed and led to negative coping with AIDS among gay community. CONCLUSIONS It is essential to take a holistic view into gay men's HIV epidemic in China. Socio-cultural barriers for HIV control and prevention found in this study call for serious and imperative consideration on integrated measures, including targeted efforts towards effective sex education and further inclusion of socio-cultural perspectives in HIV/AIDS interventions for gay men.
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Affiliation(s)
- Huijing He
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fan Lv
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail:
| | - Nanci Nanyi Zhang
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zunyou Wu
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qinghua Liao
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Zhanjun Chang
- Zhengzhou Center for Disease Control and Prevention, Zhengzhou, Henan Province, China
| | - Yi Li
- Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, Heilongjiang Province, China
| | - Huifang Xu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong Province, China
| | - Lin OuYang
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Xiping Huan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China
| | - Juan Yang
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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12
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Zhang C, Qian HZ, Yin L, Liu Y, Strauss SM, Ruan Y, Shao Y, Lu H, Vermund SH. Sexual Behaviors Linked to Drug and Alcohol Use Among Men Who Have Sex With Men in China. Subst Use Misuse 2016; 51:1821-30. [PMID: 27608264 PMCID: PMC5423713 DOI: 10.1080/10826084.2016.1197264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND High-risk sexual behaviors drive the HIV epidemic among men who have sex with men (MSM). Alcohol consumption and use of club drugs may increase sexual risk behaviors. We evaluated effects of drug and alcohol use on sexual behaviors with both their male and female partners as well as on HIV and syphilis infections among MSM in China. METHODS As the part of a community randomized clinical trial that conducted among MSM in Beijing from 2013 to 2015, we recruited a total of 3,680 participants cross-sectionally. A self-administered questionnaire was employed to collect information regarding demographics, sexual behaviors, and a history of alcohol and drug use. Blood sample was collected for HIV and syphilis testing. RESULTS A total of 3,588 MSM completed the survey and were included in the data analysis. The mean age was 29.9 with 97.3% of Han-ethnicity and 85.0% unmarried. The HIV and syphilis prevalence was 12.7% and 7.4%, respectively. Drug use was significantly associated with higher odds of HIV infection (aOR = 1.3, 95% Confidence Interval [CI] = 1.0,1.6), but not associated with syphilis. A higher level of alcohol consumption was similarly associated with higher odds of HIV risks with both male (e.g., condomless sex acts) and female partners (e.g., numbers of sexual partners). CONCLUSION The association between drug and alcohol use and high-risk behaviors is notable among MSM in China. Integrated HIV interventions that target substance use among MSM may be more effective than programs that only target HIV alone.
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Affiliation(s)
- Chen Zhang
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Han-Zhu Qian
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA.,b Division of Epidemiology , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Lu Yin
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Yu Liu
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
| | - Shiela M Strauss
- c College of Nursing , New York University , New York , New York , USA
| | - Yuhua Ruan
- d State Key Laboratory of Infectious Disease Prevention and Control (SKLID) , Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Beijing , China
| | - Yiming Shao
- d State Key Laboratory of Infectious Disease Prevention and Control (SKLID) , Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases , Beijing , China
| | - Hongyan Lu
- e Beijing Center for Disease Control and Prevention , Beijing , China
| | - Sten H Vermund
- a Vanderbilt Institute for Global Health , Vanderbilt University School of Medicine , Nashville , Tennessee , USA.,f Department of Pediatrics , Vanderbilt University School of Medicine , Nashville , Tennessee , USA
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13
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Geng GZ, Gao G, Ruan YH, Yu MR, Zhou YH. Behavioral Risk Profile of Men Who Have Sex with Men in Beijing, China: Results from a Cross-sectional Survey with Randomized Response Techniques. Chin Med J (Engl) 2016; 129:523-9. [PMID: 26904985 PMCID: PMC4804432 DOI: 10.4103/0366-6999.177003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Human immunodeficiency virus (HIV) is spreading rapidly among men who have sex with men (MSM) in China. Anonymous questionnaires or direct interviews have been frequently used to study their behavior. The aim of the study was to describe the behavioral risk profile of the MSM in Beijing using the randomized response techniques (RRTs). Methods: A cross-sectional survey of sexual behavior among a sample of MSM was conducted in two HIV counseling and testing clinics in Beijing. The survey was carried out with an anonymous questionnaire containing sensitive questions on sexual behavior. To obtain the honest responses to the sensitive questions, three distinctive RRTs were used in the questionnaire: (1) Additive randomized response model for quantitative questions, (2) randomized response model for multiple choice questions, and (3) Simmons randomized response model for binomial questions. Formulae for the point estimate, variance, and confidence interval (CI) were provided for each specific model. Results: Using RRTs in a sample of 659 participants, the mean age at first homosexual encounter was estimated to be 21.7 years (95% CI: 21.2–22.2), and each had sex with about three (2.9, 95% CI: 2.4–3.4) male partners on average in the past month. The estimated rate for consistent condom use was 56.4% (95% CI: 50.1–62.8%). In addition, condom was estimated to be used among 80.0% (95% CI: 74.1–85.9%) of the population during last anal sex with a male partner. Conclusions: Our study employed RRTs in a survey containing questions on sexual behavior among MSM, and the results showed that RRT might be a useful tool to obtain truthful feedback on sensitive information such as sexual behavior from the respondents, especially in traditional Chinese cultural settings.
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Affiliation(s)
| | - Ge Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu 215123, China
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14
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Phanuphak N, Lo YR, Shao Y, Solomon SS, O'Connell RJ, Tovanabutra S, Chang D, Kim JH, Excler JL. HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials. AIDS Res Hum Retroviruses 2015; 31:1060-76. [PMID: 26107771 DOI: 10.1089/aid.2015.0049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process.
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Affiliation(s)
| | - Ying-Ru Lo
- HIV, Hepatitis, and STI Unit, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Yiming Shao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sunil Suhas Solomon
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), Chennai, India
| | - Robert J. O'Connell
- Department of Retrovirology, U.S. Army Medical Component, Armed Forces Institute of Medical Sciences (AFRIMS), Bangkok, Thailand
| | - Sodsai Tovanabutra
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - David Chang
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jerome H. Kim
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jean Louis Excler
- U.S. Military HIV Research Program, Bethesda, Maryland
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
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15
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Zhao Y, Zhang L, Zhang H, Xia D, Pan SW, Yue H, Lu H, Xing H, He X, Shao Y, Ruan Y. HIV testing and preventive services accessibility among men who have sex with men at high risk of HIV infection in Beijing, China. Medicine (Baltimore) 2015; 94:e534. [PMID: 25674755 PMCID: PMC4602732 DOI: 10.1097/md.0000000000000534] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The HIV epidemic among men who have sex with men (MSM) has been increasing at an alarming rate in most areas of China in recent years. Many Chinese MSM still lack sufficient access to HIV prevention services, despite ongoing scale-up of comprehensive HIV testing and intervention services. The purpose of this study was to investigate utilization of HIV testing and prevention services, and related factors that influence the MSM people to access HIV test or other services to prevent HIV among MSM in Beijing, China.Three successive cross-sectional surveys of MSM were conducted in Beijing from September 2009 to January 2010, September 2010 to January 2011, and September 2011 to January 2012. Demographic and behavioral data were collected and analyzed. Blood samples were tested for HIV and syphilis. Three models were established to analyze factors associated with HIV testing and preventive services.Of the 1312 participants, prevalence of HIV and syphilis was 7.9% and 15.4%, respectively. Sixty-nine percent ever had an HIV test, 56.2%, 78.7%, and 46.1% received HIV test, free condom/lubricants, and sexually transmitted infection services in the past 12 months (P12M), respectively. MSM with larger social networks and who knew someone infected with HIV were more likely to receive HIV testing and preventive services; lower degrees of stigma and discriminatory attitudes toward HIV/AIDS were positively associated with having an HIV test, whereas unprotected anal intercourse in the past 6 months (P6M) was associated with less preventive services participation. The most reported barriers to HIV testing were fear of testing HIV positive (79.3%) and perceiving no risk for HIV (75.4%). Almost all participants felt that ensuring confidentiality would encourage more MSM to have an HIV test. The two main reasons for not seeking HIV test was not knowing where to go for a test (63.2%) and perceiving low risk of HIV infection (55.1%).Given a high prevalence of HIV, syphilis, and risky behaviors and a relatively low HIV testing rate among MSM in Beijing, more efforts are urgently needed to address barriers to HIV testing and improve accessibility of prevention services.
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Affiliation(s)
- Yuejuan Zhao
- From the Beijing Center for Disease Control and Prevention (YZ, LZ, DX, HY, HL, XH); State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China (HZ, HX, YS, YR); The School of Population and Public Health University of British Columbia, Vancouver, BC, Canada (SWP)
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16
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Yan H, Ding Y, Wong FY, Ning Z, Zheng T, Nehl EJ, He N. Epidemiological and molecular characteristics of HIV infection among money boys and general men who have sex with men in Shanghai, China. INFECTION GENETICS AND EVOLUTION 2015; 31:135-41. [PMID: 25653132 DOI: 10.1016/j.meegid.2015.01.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/19/2015] [Accepted: 01/25/2015] [Indexed: 11/26/2022]
Abstract
To examine and compare the epidemiological and molecular characteristics of HIV infection between money boys (MBs) and general men who have sex with men (MSM) in Shanghai, China. Using a venue-based sampling strategy, a total of 535 MSM including 226 MBs and 309 general MSM were recruited to participate in a cross-sectional survey including a face-to-face questionnaire interview and HIV testing. Genotyping of HIV-1 pol gene was performed for HIV-positive participants. Compared with general MSM, MBs reported more sexual partners, more alcohol and drug use and more sex after alcohol or drug use. HIV prevalence was 10.7% overall, 14.6% for MBs and 7.8% for general MSM (p=0.011). Two independent multiple logistic regression analyses indicated that HIV infection was positively associated with non-Han ethnicity (Odds Ratio [OR]=4.79, 95% Confidence Interval [CI]: 1.08-21.28) and sex after drug use in the past 6months (OR=3.59, 95% CI: 1.50-8.61) among MBs, and with sex after drug use in the past 6months (OR=3.38, 95% CI: 1.10-10.34) among general MSM as well. HIV-1 pol gene was successfully amplified and sequenced for 52 (91.2%) of HIV-positive participants. Of them, 53.8% were genotyped as CRF01_AE, 36.5% as CRF07_BC and 9.6% as subtype B. Two CRF01_AE subtype-infected participants (3.8%), a 50years old MB and a 24years old general MSM, harbored viruses with a M46L mutation conferring resistance to protease inhibitors (PI). MSM particularly MBs in Shanghai, China were at high risk of HIV infection, underscoring an urgent need for joint intervention efforts for drug use and sexual behaviors. HIV drug resistance surveillance is also warranted although the relatively low prevalence of HIV drug resistance implies the effectiveness of current antiretroviral treatment regimen.
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Affiliation(s)
- Huamei Yan
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Frank Y Wong
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA; The Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Zhen Ning
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China; Shanghai Center for Disease Control and Prevention, Shanghai, China
| | - Tony Zheng
- Shanghai Piaoxue Cultural Media Limited, Shanghai, China
| | - Eric J Nehl
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China; Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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17
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Mitchell KM, Foss AM, Ramesh BM, Washington R, Isac S, Prudden HJ, Deering KN, Blanchard JF, Moses S, Lowndes CM, Boily MC, Alary M, Vickerman P. Relationship between exposure to the Avahan intervention and levels of reported condom use among men who have sex with men in southern India. BMC Public Health 2014; 14:1245. [PMID: 25476231 PMCID: PMC4289401 DOI: 10.1186/1471-2458-14-1245] [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: 04/01/2014] [Accepted: 11/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Avahan intervention promotes consistent (100%) condom use amongst men who have sex with men in southern India. We assessed how condom use varies with intervention exposure for men who have sex with men in Bangalore. METHODS Self-reported condom use and intervention exposure data were derived from a cross-sectional survey. Consistent condom use and condom use at last sex act with all, main, and casual male sex partners were assessed. Binary and continuous variables reflecting intervention exposure (including contact(s) with intervention staff, receiving condoms and seeing condom demonstrations) were used. Multivariable logistic regression was employed to assess the relationship between condom use with each type of partner and each exposure variable independently, controlling for socio-demographic and behavioural factors associated with condom use or intervention exposure. RESULTS Condom use with all partners was higher among those who had ever been contacted by, received condoms from, or seen a condom demonstration by intervention staff (adjusted odds ratio >2, p < 0.02 for all). Consistent condom use with all types of partner increased with the number of condom demonstrations seen in the last month (adjusted odds ratio = 2.1 per demonstration, p < 0.025), while condom use at last sex act with a casual (but not main) partner increased with the number of condoms received from the intervention (adjusted odds ratio = 1.4 per condom, p = 0.04). CONCLUSIONS Direct contact with Avahan program staff is associated with increased reported condom use among men who have sex with men in Bangalore. Reported consistent condom use and condom use at last sex act are associated with contacts involving demonstrations of correct condom use, and with receiving condoms, respectively.
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Affiliation(s)
- Kate M Mitchell
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
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18
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Firestone R, Rivas J, Lungo S, Cabrera A, Ruether S, Wheeler J, Vu L. Effectiveness of a combination prevention strategy for HIV risk reduction with men who have sex with men in Central America: a mid-term evaluation. BMC Public Health 2014; 14:1244. [PMID: 25471459 PMCID: PMC4289249 DOI: 10.1186/1471-2458-14-1244] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite over a decade of research and programming, little evidence is available on effective strategies to reduce HIV risks among Central American men who have sex with men (MSM). The Pan-American Social Marketing Organization (PASMO) and partners are implementing a HIV Combination Prevention Program to provide key populations with an essential package of prevention interventions and services: 1) behavioral, including interpersonal communications, and online outreach; 2) biomedical services including HIV testing and counseling and screening for STIs; and 3) complementary support, including legal support and treatment for substance abuse. Two years into implementation, we evaluated this program's effectiveness for MSM by testing whether exposure to any or a combination of program components could reduce HIV risks. METHODS PASMO surveyed MSM in 10 cities across Guatemala, El Salvador, Nicaragua, Costa Rica, and Panama in 2012 using respondent-driven sampling. We used coarsened exact matching to create statistically equivalent groups of men exposed and non-exposed to the program, matching on education, measures of social interaction, and exposure to other HIV prevention programs. We estimated average treatment effects of each component and all combined to assess HIV testing and condom use outcomes, using multivariable logistic regression. We also linked survey data to routine service data to assess program coverage. RESULTS Exposure to any program component was 32% in the study area (n = 3531). Only 2.8% of men received all components. Men exposed to both behavioral and biomedical components were more likely to use condoms and lubricant at last sex (AOR 3.05, 95% CI 1.08, 8.64), and those exposed to behavioral interventions were more likely to have tested for HIV in the past year (AOR 1.76, 95% CI 1.01, 3.10). CONCLUSIONS PASMO's strategies to reach MSM with HIV prevention programming are still achieving low levels of population coverage, and few men are receiving the complete essential package. However, those reached are able to practice HIV prevention. Combination prevention is a promising approach in Central America, requiring expansion in coverage and intensity.
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Affiliation(s)
- Rebecca Firestone
- Population Services International, 1120 19th Street, NW, Suite 600, Washington, DC 20036, USA.
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19
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Xu JJ, Zhang C, Hu QH, Chu ZX, Zhang J, Li YZ, Lu L, Wang Z, Fu JH, Chen X, Yan HJ, Zhuang MH, Jiang YJ, Geng WQ, Vermund SH, Shang H, Qian HZ. Recreational drug use and risks of HIV and sexually transmitted infections among Chinese men who have sex with men: Mediation through multiple sexual partnerships. BMC Infect Dis 2014; 14:642. [PMID: 25443542 PMCID: PMC4272794 DOI: 10.1186/s12879-014-0642-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/19/2014] [Indexed: 12/04/2022] Open
Abstract
Background Recreational drug use (RDU) may result in sexual disinhibition and higher risk for HIV and other sexually transmitted infections (STIs) among men who have sex with men (MSM) in China. We assessed whether RDU was associated with HIV, syphilis, and herpes simplex virus type 2 (HSV-2) within the context of multiple sexual partnerships and unprotected sex. Methods We conducted a cross-sectional study among sexually-active MSM in six Chinese cities (Kunming, Jinan, Changsha, Zhengzhou, Nanjing, and Shanghai) in 2012–2013. We interviewed participants regarding RDU and sexual activity and drew blood for HIV, syphilis, and HSV-2. We fit multiple logistic regression models to assess associations of drug use and HIV, syphilis and HSV-2 infections, controlling for number of sexual partners and unprotected sex. Results Of 3830 participants, 28% reported ever using ≥1 of these drugs in the past 6 months: popper (alkyl nitrites), ecstasy, ice (methamphetamine), amphetamine, tramadol, and ketamine. In the past six months, 62% of MSM reported ≥2 sexual partners and 76% did not use condoms at last sexual encounter. HIV, syphilis and HSV-2 prevalences were 9.2%, 12.2%, and 10.3%, respectively.RDU was associated with HIV infection (aOR = 1.67; 95% CI, 1.31-2.13). Men with RDU were more likely to report multiple sexual partners (OR = 1.69; 95% CI, 1.44-1.98) and unprotected sex (aOR = 1.25; 95% CI, 1.05-1.49). The RDU-HIV association persisted (aOR = 1.58; 95% CI = 1.23-2.02) after adjusting for numbers of partners. Conclusions RDU was associated with multiple sexual partnerships, unprotected sex, and HIV among Chinese MSM. It is plausible that RDU is a driver of increased sexual/HIV risk and/or may be an associated behavior with sexually risky lifestyles. Community engagement is needed. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0642-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jun-Jie Xu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Chen Zhang
- Vanderbilt Institute for Global Health and Departments of Pediatrics and Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 750, Nashville, TN, 37203, USA.
| | - Qing-Hai Hu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Zhen-Xing Chu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Jing Zhang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Yong-Ze Li
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Lin Lu
- Yunnan Provincial Centers for Disease Control and Prevention (CDC), Kunming, China.
| | - Zhe Wang
- Henan Provincial CDC, Zhengzhou, China.
| | - Ji-Hua Fu
- Shandong Provincial CDC, Jinan, China.
| | - Xi Chen
- Hunan Provincial CDC, Changsha, China.
| | | | | | - Yong-Jun Jiang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Wen-Qing Geng
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Sten H Vermund
- Vanderbilt Institute for Global Health and Departments of Pediatrics and Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 750, Nashville, TN, 37203, USA.
| | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of The First Affiliated Hospital, China Medical University, 92 North Second Road, Heping District, Shenyang, 110001, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health and Departments of Pediatrics and Medicine, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 750, Nashville, TN, 37203, USA.
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Lou J, Blevins M, Ruan Y, Vermund SH, Tang S, Webb GF, Shepherd BE, He X, Lu H, Shao Y, Qian HZ. Modeling the impact on HIV incidence of combination prevention strategies among men who have sex with men in Beijing, China. PLoS One 2014; 9:e90985. [PMID: 24626165 PMCID: PMC3953201 DOI: 10.1371/journal.pone.0090985] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 02/05/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To project the HIV/AIDS epidemics among men who have sex with men (MSM) under different combinations of HIV testing and linkage to care (TLC) interventions including antiretroviral therapy (ART) in Beijing, China. DESIGN Mathematical modeling. METHODS Using a mathematical model to fit prevalence estimates from 2000-2010, we projected trends in HIV prevalence and incidence during 2011-2020 under five scenarios: (S1) current intervention levels by averaging 2000-2010 coverage; (S2) increased ART coverage with current TLC; (S3) increased TLC/ART coverage; (S4) increased condom use; and (S5) increased TLC/ART plus increased condom use. RESULTS The basic reproduction number based upon the current level of interventions is significantly higher than 1 (R0 = 2.09; 95% confidence interval (CI), 1.83-2.35), suggesting that the HIV epidemic will continue to increase to 2020. Compared to the 2010 prevalence of 7.8%, the projected HIV prevalence in 2020 for the five prevention scenarios will be: (S1) Current coverage: 21.4% (95% CI, 9.9-31.7%); (S2) Increased ART: 19.9% (95% CI, 9.9-28.4%); (S3) Increased TLC/ART: 14.5% (95% CI, 7.0-23.8%); (S4) Increased condom use: 13.0% (95% CI, 9.8-28.4%); and (S5) Increased TLC/ART and condom use: 8.7% (95% CI, 5.4-11.5%). HIV epidemic will continue to rise (R0 > 1) for S1-S4 even with hyperbolic coverage in the sensitivity analysis, and is expected to decline (R0 = 0.93) for S5. CONCLUSION Our transmission model suggests that Beijing MSM will have a rapidly rising HIV epidemic. Even enhanced levels of TLC/ART will not interrupt epidemic expansion, despite optimistic assumptions for coverage. Promoting condom use is a crucial component of combination interventions.
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Affiliation(s)
- Jie Lou
- Department of Mathematics, Shanghai University, Shanghai, China
| | - Meridith Blevins
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Sten H. Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Sanyi Tang
- College of Mathematics and Information Science, Shaanxi Normal University, Xi'an, Shaanxi Province, China
| | - Glenn F. Webb
- Department of Mathematics, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Bryan E. Shepherd
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Xiong He
- Institute for AIDS/STD Prevention & Control, Beijing Municipal Center for Disease Control and Prevention, Beijing, China
| | - Hongyan Lu
- Institute for AIDS/STD Prevention & Control, Beijing Municipal Center for Disease Control and Prevention, Beijing, China
| | - Yiming Shao
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, Tennessee, United States of America
- Division of Epidemiology, Department of Medicine, Vanderbilt University, Nashville, Tennessee, United States of America
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Lu H, Liu Y, Dahiya K, Qian HZ, Fan W, Zhang L, Ma J, Ruan Y, Shao Y, Vermund SH, Yin L. Effectiveness of HIV risk reduction interventions among men who have sex with men in China: a systematic review and meta-analysis. PLoS One 2013; 8:e72747. [PMID: 24137497 PMCID: PMC3796948 DOI: 10.1371/journal.pone.0072747] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 07/11/2013] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the effect of risk reduction interventions on HIV knowledge, attitudes and behaviors among men who have sex with men (MSM) in China. Methods We performed a systematic review and meta-analysis of HIV risk reduction intervention studies among Chinese MSM. The summary difference of standardized mean differences (SMD) between both study arms or between pre- and post-intervention assessments were defined as the effect size (ES); ES was calculated using standard meta-analysis in random effects models. Results Thirty-four eligible studies were included in the analysis, including two randomized clinical trials (RCT), six quasi-experimental studies, six pre-and-post intervention studies, and twenty serial cross-sectional intervention studies. These studies showed an increase in consistent condom use with any male sexual partners (mean ES, 0.46; 95% confidence interval [CI], 0.35–0.56), with regular sexual partners (mean ES, 0.41; 95% CI, 0.18–0.63), and casual sexual partners (mean ES, 0.52; 95% CI, 0.24–0.79). The analysis of ten studies that measured the impact on uptake of HIV testing also showed a positive result (mean ES, 0.55; 95% CI, 0.38–0.71). The risk reduction interventions also improved HIV/AIDS-related knowledge (mean ES, 0.77; 95% CI, 0.60–0.94) and attitudes (mean ES, 1.35; 95% CI, 0.91–1.79), but did not reduce prevalence of HIV (mean ES, 0.23; 95% CI, 0.02–0.45) and syphilis infections (mean ES, −0.01; 95% CI, −0.19–0.17). There was significant heterogeneity among these studies. Conclusions On aggregate, HIV risk reduction interventions were effective in reducing risky behaviors and improving knowledge and attitudes among Chinese MSM, but were not associated with a change in the prevalence of HIV and syphilis. Future studies should use incidence as definitive study outcome.
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Affiliation(s)
- Hongyan Lu
- Institute for AIDS/STD Prevention & Control, Beijing Center for Disease Prevention and Control, Beijing, China
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