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Song L, Yu X, Su B, Geng WK, Lan G, Zhang X. HIV Prevalence and Risk Factors Among Young Men Who Have Sex With Men in Southwest China: Cross-sectional Questionnaire Study. JMIR Form Res 2023; 7:e37344. [PMID: 36630166 PMCID: PMC9893886 DOI: 10.2196/37344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 09/06/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Previous studies showed an increase in HIV prevalence among young men who have sex with men aged 25 years or younger in China. OBJECTIVE This study aimed to assess HIV prevalence and associated factors among young men who have sex with men in the Guangxi Zhuang Autonomous Region. METHODS This study was conducted in 4 cities (Guilin, Liuzhou, Beihai, and Nanning) in the Guangxi Zhuang Autonomous Region between June 2014 and May 2016. Participants were reached through web-based and site recruitment approaches. Laboratory tests were performed to detect HIV and syphilis infections. A self-administered questionnaire was used to collect data from 632 eligible young men who have sex with men. RESULTS The prevalence of HIV and syphilis was 9.3% (59/632) and 11.4% (72/632), respectively. Multivariable logistic analysis showed that ethnic minority (adjusted odds ratio [AOR] for Han Chinese vs other minorities 0.28, 95% CI 0.11-0.71, P=.007), receptive sexual positioning in the past 6 months (AOR 2.94, 95% CI 1.32-6.53, P=.008), current syphilis infection (AOR for individuals without vs those with infection 0.38, 95% CI 0.19-0.75, P=.005), inconsistent condom use in the past 6 months (AOR 1.91, 95% CI 1.06-3.45, P=.03), and psychotropic drug use before last anal intercourse (AOR 16.70, 95% CI 2.34-119.18, P=.005) were independently associated with HIV infection. CONCLUSIONS There is an urgent need to scale up HIV and syphilis interventions in young men who have sex with men. Some subgroups might need specific attention for HIV prevention, including ethnic minority men, individuals with a history of sexually transmitted infections, and individuals who have been engaging in receptive anal sex.
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Affiliation(s)
- Liping Song
- School of Public Health, Guilin Medical University, Guilin, China
| | - Xiangyuan Yu
- School of Public Health, Guilin Medical University, Guilin, China
| | - Bing Su
- Department of Clinical Psychology, Qingdao Mental Health Center, Qingdao, China
| | - Wen Kui Geng
- Guangxi Zhuang Autonomous Region Health and Family Planning Commission, Nanning, China
| | - Guanghua Lan
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Xiangjun Zhang
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States
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Hu H, Chen Y, Shi L, Liu X, Xu Z, Sun L, Zhao X, Zhou Y, Lu J, Zhang Z, Liu X, Fu G. Prevalence of syphilis and chlamydia trachomatis infection among men who have sex with men in Jiangsu province, China: A cross-sectional survey. Front Public Health 2022; 10:1006254. [PMID: 36304236 PMCID: PMC9592808 DOI: 10.3389/fpubh.2022.1006254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/21/2022] [Indexed: 01/27/2023] Open
Abstract
Background Epidemics of sexually transmitted infections (STIs) among men who have sex with men (MSM) are major global public health concerns. This study aimed to examine the prevalence of syphilis and chlamydia trachomatis (CT) infection and associated factors among MSM in Jiangsu province, China, hoping to provide updated data for the formulation of relevant policies. Methods A cross-sectional survey was conducted among MSM from April to July 2021 in four cities in the province. Socio-demographic characteristics and behavioral information were collected through a face-to-face questionnaire interview. Venous blood specimens were collected for HIV, hepatitis C (HCV), and syphilis testing using serological testing methods. First-void urine specimens were collected for CT and Neisseria gonorrhoeae (NG) testing using nucleic acid amplification testing (NAAT) methods. Chi-square tests were used to compare differences in syphilis and CT infection between subgroups of variables. Multivariate logistic regression analysis was used to identify factors associated with syphilis and CT infection. Results A total of 1,087 participants were enrolled. The prevalence of HIV, HCV, syphilis, CT and NG infection were 6.6, 0.4, 6.3, 4.2, and 0.4%, respectively. MSM recruited online [adjusted odds ratio (aOR) = 2.189, P = 0.020], diagnosed with an STI in the past 12 months (aOR = 3.304, P < 0.001), and living with HIV (aOR = 4.721, P < 0.001) were more likely to have syphilis infection. MSM who were younger than 25 years (aOR = 4.286, P = 0.020), had senior high school level education (aOR = 2.521, P = 0.038), and were recruited via VCT clinics (aOR = 3.455, P = 0.001) were more likely to have CT infection. Conclusions Our study showed a high prevalence of syphilis and chlamydia among MSM in Jiangsu province, China. STI screening, diagnosis, and treatment services promotion should be a top priority on the prevention agenda.
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Affiliation(s)
- Haiyang Hu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Yuheng Chen
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Lingen Shi
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xiaoxia Liu
- Zhenjiang Center for Disease Control and Prevention, Zhenjiang, China
| | - Zhuping Xu
- Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Lin Sun
- Yangzhou Center for Disease Control and Prevention, Yangzhou, China
| | - Xiuping Zhao
- Suzhou Center for Disease Control and Prevention, Suzhou, China
| | - Ying Zhou
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jing Lu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Zhi Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xiaoyan Liu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Gengfeng Fu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China,*Correspondence: Gengfeng Fu
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Prediction Model for the Risk of HIV Infection among MSM in China: Validation and Stability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19021010. [PMID: 35055826 PMCID: PMC8776241 DOI: 10.3390/ijerph19021010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 12/04/2022]
Abstract
The impact of psychosocial factors on increasing the risk of HIV infection among men who have sex with men (MSM) has attracted increasing attention. We aimed to develop and validate an integrated prediction model, especially incorporating emerging psychosocial variables, for predicting the risk of HIV infection among MSM. We surveyed and collected sociodemographic, psychosocial, and behavioral information from 547 MSM in China. The participants were split into a training set and a testing set in a 3:1 theoretical ratio. The prediction model was constructed by introducing the important variables selected with the least absolute shrinkage and selection operator (LASSO) regression, applying multivariate logistic regression, and visually assessing the risk of HIV infection through the nomogram. Receiver operating characteristic curves (ROC), Kolmogorov–Smirnov test, calibration plots, Hosmer–Lemeshow test and population stability index (PSI) were performed to test validity and stability of the model. Four of the 15 selected variables—unprotected anal intercourse, multiple sexual partners, involuntary subordination and drug use before sex—were included in the prediction model. The results indicated that the comprehensive prediction model we developed had relatively good predictive performance and stability in identifying MSM at high-risk for HIV infection, thus providing targeted interventions for high-risk MSM.
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4
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Jiang H, Li J, Tan Z, Cheng W, Yang Y. The Moderating Effect of Sexual Sensation Seeking on the Association between Alcohol and Popper Use and Multiple Sexual Partners among Men Who Have Sex with Men in Guangzhou, China. Subst Use Misuse 2022; 57:1497-1503. [PMID: 35869639 DOI: 10.1080/10826084.2022.2079134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Introduction: This cross sectional study was conducted to explore the moderating effect of sexual sensation seeking (SSS) on the association between alcohol/popper use before sex and multiple sexual partners (MSP) among men who have sex with men (MSM) in Guangzhou, China. Methods: From June 2017 to April 2018, MSM were recruited from a community-based HIV service center in Guangzhou, China; data on sociodemographics, sexual behaviors and SSS were collected. A product term of SSS and alcohol/popper use before sex was included in a multivariate logistic regression model to test the potential moderating effect of SSS on the association between alcohol/popper use before sex and MSP. Results: Among the 500 MSM included, individuals who reported alcohol use and popper use before sex, and MSP in the last six months accounted for 33.80%, 33.40%, and 60.40%, respectively. MSM with high SSS traits accounted for 54.80%. The association between popper use before sex and MSP was moderated by SSS (P for interaction = 0.007). A significant association between popper use before sex and MSP among MSM with low SSS traits (odds ratio [OR] = 4.22, 95% confidence interval [CI]: 2.06 ∼ 8.67). But not among MSM with high SSS traits (OR = 1.37, 95%CI: 0.77 ∼ 2.43) were observed. However, no moderating effect of SSS on the association between alcohol use before sex and MSP were observed. Conclusion: The moderated analysis indicated that SSS should be taken into consideration when tailoring interventions to prevent popper use before sex to reduce the risk associated with MSP.
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Affiliation(s)
- Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhimin Tan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Weibin Cheng
- Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
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5
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Hall CDX, Luu M, Nehl EJ, He N, Zheng T, Haardörfer R, Wong FY. Do the same socio-demographic variables predict testing uptake and sero-status? HIV and syphilis among an observational sample of Chinese men who have sex with men in Shanghai, China. Int J STD AIDS 2021; 31:939-949. [PMID: 32772687 DOI: 10.1177/0956462420909733] [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: 11/16/2022]
Abstract
HIV and syphilis are pronounced among men who have sex with men (MSM) in China and often occur as co-infections, while testing remains low. Few studies examine common predictors across these outcomes. This observational venue-based sample of 546 MSM in Shanghai, China used a common set of psychosocial predictors to construct logistic models for the outcomes (HIV non-testing, syphilis non-testing, HIV sero-status, and syphilis sero-status). Fifty-seven (10.7%) participants tested positive for HIV, 126 (23.5%) for syphilis, and 33% of HIV-positive participants had a co-infection. Non-sex working MSM had consistently higher odds of HIV and syphilis non-testing (OR= 2.2, 95% CI 1.4-3.5, p < 0.001; OR = 2.4, 95, 95% CI 1.5-3.8, p < 0.001, respectively) compared to 'money boy' sex workers. Participants with a 0 score on HIV knowledge had 4.1 times (95% CI 1.4-12.5, p = 0.01) the odds of reporting HIV non-testing, 6.0 (95% CI 1.96-18.5, p < 0.01) times the odds of reporting non-testing for syphilis, and 8.44 times (95% CI 1.19-59.7, p = 0.03) the odds of testing positive for HIV, compared to a score of 8. The results highlighted the importance of integrating HIV/syphilis education and promoting testing for both HIV and syphilis among all sub-groups of MSM in China.
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Affiliation(s)
- Casey D Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Minh Luu
- Department of Behavioral Sciences and Health Education, Emory University's Rollins School of Public Health, Atlanta, GA, USA
| | - Eric J Nehl
- Department of Behavioral Sciences and Health Education, Emory University's Rollins School of Public Health, Atlanta, GA, USA
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Tony Zheng
- Shanghai Piaoxue Multicultural Medua, Ltd, Shanghai, China
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory University's Rollins School of Public Health, Atlanta, GA, USA
| | - Frank Y Wong
- Department of Behavioral Sciences and Health Education, Emory University's Rollins School of Public Health, Atlanta, GA, USA.,Center for Indigenous Nursing Research for Health Equity, Florida State University, Tallahassee, FL, USA.,Department of Psychology, University of Hawai'i, Mānoa, Honolulu, HI, USA
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6
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Booton RD, Ong JJ, Lee A, Liu A, Huang W, Wei C, Tang W, Ma W, Vickerman P, Tucker JD, Mitchell KM. Modelling the impact of an HIV testing intervention on HIV transmission among men who have sex with men in China. HIV Med 2021; 22:467-477. [PMID: 33511687 DOI: 10.1111/hiv.13063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES An intervention developed through participatory crowdsourcing methods increased HIV self-testing among men who have sex with men [MSM; relative risk (RR) = 1.89]. We estimated the long-term impact of this intervention on HIV transmission among MSM in four cities (Guangzhou, Shenzhen, Jinan and Qingdao). METHODS A mathematical model of HIV transmission, testing and treatment among MSM in China was parameterized using city-level demographic and sexual behaviour data and calibrated to HIV prevalence, diagnosis and antiretroviral therapy (ART) coverage data. The model was used to project the HIV infections averted over 20 years (2016-2036) from the intervention to increase self-testing, compared with current testing rates. RESULTS Running the intervention once would avert < 2.2% infections over 20 years. Repeating the intervention (RR = 1.89) annually would avert 6.4-10.7% of new infections, while further increases in the self-testing rate (hypothetical RR = 3) would avert 11.7-20.7% of new infections. CONCLUSIONS Repeated annual interventions would give a three- to seven-fold increase in long-term impact compared with a one-off intervention. Other interventions will be needed to more effectively reduce the HIV burden in this population.
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Affiliation(s)
- Ross D Booton
- University of Bristol, Bristol, UK.,MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Jason J Ong
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Amy Lee
- University of North Carolina Project-China, Guangzhou, China
| | - Aifeng Liu
- University of North Carolina Project-China, Guangzhou, China.,Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
| | - Wenting Huang
- University of North Carolina Project-China, Guangzhou, China.,Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China
| | - Chongyi Wei
- Rutgers School of Public Health, Piscataway, NJ, USA
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China.,Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China.,University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wei Ma
- School of Public Health, Shandong University, Jinan, China
| | | | - Joseph D Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.,University of North Carolina Project-China, Guangzhou, China.,Social Entrepreneurship to Spur Health (SESH) Global, Guangzhou, China.,University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kate M Mitchell
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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7
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First Responses to the Symptoms of Sexually Transmitted Infections and Treatment-Seeking Behavior Among Men Who Have Sex With Men in 13 Cities in China. Sex Transm Dis 2020; 47:28-33. [PMID: 31651711 DOI: 10.1097/olq.0000000000001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data are scarce on sexually transmitted infection (STI) treatment-seeking behavior among men who have sex with men (MSM) in China. The purpose of the study was to characterize the first response to STI symptoms, treatment-seeking behavior, and its associated factors among MSM in China. METHODS A cross-sectional study with convenience sampling design was conducted in 13 cities from April to July 2017. Face-to-face interviews were conducted to collect information on demographics, STI symptoms, and treatment-seeking behavior. Logistic regression analysis was conducted to evaluate variables associated with not seeking treatment. RESULTS Among 3925 recruited participants, 628 (16.0%) reported STI symptoms in the past 12 months and were included in the analysis. Upon or after being notified of the symptoms, MSM sought help from various sources or self-tested using rapid testing kits. Only 322(51.3%) went to see a doctor in clinic. In multiple logistic regression analyses, younger age, lower income, less STI knowledge (adjusted odds ratio [AOR], 1.8; 95% confidence interval [CI], 1.2-2.5), not knowing own STI risk (AOR, 1.8; 95% CI, 1.2-2.7), no symptoms of anogenital ulcers (AOR, 2.3; 95% CI, 1.3-3.8) or anogenital warts (AOR, 2.4; 95% CI, 1.6-3.7), no syphilis testing in the past 12 months (AOR, 2.1; 95% CI, 1.5-3.0) were associated with higher probability of not seeking treatment in clinics. CONCLUSIONS We found a high prevalence of STI symptoms among MSM and only half sought treatment. Prevention efforts should promote STI education, testing, and adequate treatment-seeking behavior.
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Miller WM, Miller WC, Barrington C, Weir SS, Chen SY, Emch ME, Pettifor AE, Paz-Bailey G. Sex work, discrimination, drug use and violence: a pattern for HIV risk among transgender sex workers compared to MSM sex workers and other MSM in Guatemala. Glob Public Health 2020; 15:262-274. [PMID: 31599193 PMCID: PMC10885015 DOI: 10.1080/17441692.2019.1671984] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 08/21/2019] [Indexed: 10/25/2022]
Abstract
The risk of HIV infection is higher among transgender women and cisgender men who have sex with men (MSM) compared to the general population due in part to social and contextual factors. This study aimed to determine the prevalence and association of alcohol and drug abuse, discrimination and violence among transgender sex workers compared to cisgender male sex workers and cisgender men who had not received money for sex in Guatemala City. In 2010, transgender women and cisgender men who had had sex with men or transgender women were recruited into a cross-sectional behavioural survey. Among transgender women, 86% received money for sex in the past year. Transgender sex workers were more likely to use drugs and binge drink, three times as likely to be discriminated against and eight times as likely to be forced to have sex compared to non-sex worker men. Male sex workers were twice as likely to use illicit drugs or experience physical violence and six times as likely to experience forced sex compared to non-sex worker men. Transgender and male sex workers would benefit from harm reduction for substance use, violence prevention, response and strategies to mitigate discrimination.
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Affiliation(s)
- William M Miller
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - William C Miller
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sharon S Weir
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sanny Y Chen
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention - Central America Regional Office, Guatemala City, Guatemala
| | - Michael E Emch
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Audrey E Pettifor
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gabriela Paz-Bailey
- Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) Central American office, Guatemala City, Guatemala
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Wang Y, Lu R, Wu G, Lan R, Ou R, Zhang Y, Ye M. Changing Trends of HIV, Syphilis, and Hepatitis C among Male Migrant Workers in Chongqing, China: Nine Consecutive Cross-Sectional Surveys, 2010-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030875. [PMID: 32019250 PMCID: PMC7036957 DOI: 10.3390/ijerph17030875] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 11/23/2022]
Abstract
Background: Male migrant workers (MMWs) have been reported to be vulnerable to human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). Chongqing, China is one of the major migration destinations and hotspots of HIV. This study aims to explore the prevalence of HIV, syphilis, and hepatitis C virus (HCV), as well as HIV-related knowledge and behaviors, among MMWs in Chongqing. Methods: Questionnaire surveys were conducted, and blood samples were collected and examined among MMWs selected by two-stage stratified sampling in Chongqing from 2010 to 2018. The Cochran–Armitage trend test was conducted to observe the trends in the prevalence of HIV, syphilis, and HCV, as well as HIV-related knowledge and behaviors. The Chi-square test and Binary Logistic Regression were conducted to observe the distinctions between different groups. Results: The overall HIV prevalence was 0.6% with an increasing trend (0.2% to 0.9%, p < 0.001), whereas the overall HCV prevalence was 0.5% with a decreasing trend (0.5% to 0.4%, p < 0.001). The overall syphilis prevalence was 1.3% in the ≥50 age group, 1.0% in the 30–49 age group, and higher than 0.3% in the 16–29 group (X2 = 19.527, p < 0.001). An uptrend (80.2%–80.6%, p < 0.001) was observed in correct HIV-related knowledge. The 16–29 ((Odds Ratio) OR: 1.575; 95%CI (Confidence Interval): 1.380–1.798; p < 0.001) and 30–49 (OR: 1.697; 95%CI: 1.495–1.926; p < 0.001) age groups had 1.575 and 1.697 times correct HIV-related knowledge more than the ≥50 age group. The proportion of subjects engaged in commercial sex in the past year (7.7%–13.3%, p < 0.001), consistent condom use during this activity (20.5%–54.0%, p < 0.001), and condom use in the last commercial sex (48.6%–72.1%, p = 0.020) were increasing. The risk of engaging in commercial sex in the past year in the 16–29 age group was 0.768 times (OR: 0.768; 95%CI: 0.643–0.917; p = 0.003) less than that in the ≥50 age group. The risk of engaging in non-regular sex in the past year in the 16–29 (OR: 2.819; 95%CI: 2.317–3.431; p < 0.001) and 30–49 (OR: 1.432; 95%CI: 1.184–1.733; p < 0.001) age groups were 2.819 and 1.432 times more than that in the ≥50 age group. The risk of engaging in anal sex in the past year in the 16–29 age group was 6.333 times (OR: 6.333; 95%CI: 1.468–27.327; p < 0.013) more than that in the ≥50 age group. The proportion of consistent condom use during non-regular sex in the past year (10.9%–47.3%, p < 0.001) and condom use in the last non-regular sex (40.8%–71.1%, p < 0.001) increased remarkably. The possibilities of consistent condom use during commercial sex in the past year in the 16–29 (OR: 2.606; 95%CI: 1.847–3.677; p < 0.001) and 30–49 (OR: 1.632; 95%CI: 1.214–2.195; p = 0.001) age groups were 2.606 and 1.632 times more than that in the ≥50 age group. The possibilities of condom use in the last commercial sex in the 16–29 (OR: 1.805; 95%CI: 1.258–2.589; p = 0.001) and 30–49 (OR: 1.360; 95%CI: 1.016–1.821; p = 0.039) age groups were 1.805 and 1.360 times more than that in the ≥50 age group. The possibilities of consistent condom use during non-regular sex in the past year (OR: 1.628; 95%CI: 1.066–2.484; p = 0.024) and condom use in the last non-regular sex (OR: 1.671; 95%CI: 1.148–2.433; p = 0.007) in the 16–29 age group were 1.628 and 1.671 times more than those in the ≥50 age group, respectively. Conclusion: An upward trend of HIV and a downward trend of HCV were observed among MMWs in Chongqing from 2010 to 2018. We also found an increase in commercial sex and inadequate condom use during high-risk behaviors among this population. The overall syphilis prevalence in the middle-aged and elderly groups was higher than in the young group, and elderly MMWs were more likely to engage in unprotected high-risk behaviors. Thus, targeted STI prevention for MMWs in Chongqing, especially those aged 50 years and above, is urgently needed.
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Affiliation(s)
- Yujun Wang
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China; (Y.W.); (R.L.); (Y.Z.)
| | - Rongrong Lu
- Institute for AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing 400042, China; (R.L.); (G.W.)
| | - Guohui Wu
- Institute for AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing 400042, China; (R.L.); (G.W.)
| | - Rong Lan
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China; (Y.W.); (R.L.); (Y.Z.)
| | - Rong Ou
- Library of Chongqing Medical University, Chongqing 400016, China;
| | - Yangchang Zhang
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China; (Y.W.); (R.L.); (Y.Z.)
| | - Mengliang Ye
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China; (Y.W.); (R.L.); (Y.Z.)
- Correspondence: ; Tel.: +86-153-1093-9053
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10
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Dong MJ, Peng B, Liu ZF, Ye QN, Liu H, Lu XL, Zhang B, Chen JJ. The prevalence of HIV among MSM in China: a large-scale systematic analysis. BMC Infect Dis 2019; 19:1000. [PMID: 31775654 PMCID: PMC6880607 DOI: 10.1186/s12879-019-4559-1] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 10/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of HIV among men who have sex with men (MSM) has become a significant public health challenge. The aim was to comprehensively estimate the national prevalence of HIV among MSM and its time trends through a large-scale systematic analysis. METHODS Systematic search of Cochrane Library, PubMed, EMBASE, CNKI, VIP, and Wanfang Data databases without language restriction for studies on the prevalence of HIV among MSM published before Dec.31, 2018. Studies were eligible for inclusion if they were published in the peer-reviewed literature and used validated assessment methods to assess the prevalence of HIV among MSM. Estimates were pooled using random-effects analysis. RESULTS Data were extracted from 355 cross-sectional studies (571,328 individuals) covered 59 cities from 30 provinces and municipalities of China. The overall national prevalence of HIV among MSM from 2001 to 2018 was estimated to be 5.7% (95% CI: 5.4-6.1%), with high between-study heterogeneity (I2 = 98.0%, P < 0.001). Our study showed an increased tendency in the HIV prevalence as time progressed by meta-regression analysis (I2 = 95.9%, P < 0.0001). HIV prevalence was the highest in those aged 50 years and older with HIV prevalence of 19.3% (95%CI: 13.1-27.4%, N = 13). HIV was more prevalent in the illiterate population (16.8%), than in those who had received an education. Although the internet was a major venue for Chinese MSM seeking male sex partners (35.6, 95%CI: 32.3-39.9%, N = 101), seeking MSM in bathhouses/saunas had the highest associated prevalence of HIV (13.4, 95%CI: 10.3-17.1%, N = 22). The HIV prevalence among MSM varied by location: compared with other regions in China, HIV was highly prevalent among MSM in the southwest (10.7, 95%CI: 9.3-12.2%, N = 91). Compared to participants who sometimes or always used condoms, participants who had never used a condom in the past 6 months had a higher risk of HIV infection, with odds ratios of 0.1 (95%CI: 0.08-0.14). CONCLUSIONS Our analysis provided reliable estimates of China's HIV burden among MSM, which appears to present an increasing national public health challenge. Effective government responses are needed to address this challenge and include the implementation of HIV prevention.
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Affiliation(s)
- Meng-Jie Dong
- The Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, 310003 People’s Republic of China
| | - Bin Peng
- Department of Medical Statistics, Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Zhen-Feng Liu
- The Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, 310003 People’s Republic of China
| | - Qian-ni Ye
- The Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, 310003 People’s Republic of China
| | - Hao Liu
- The Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, 310003 People’s Republic of China
| | - Xi-Li Lu
- The Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, 310003 People’s Republic of China
| | - Bo Zhang
- The Department of Nuclear Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, 310003 People’s Republic of China
| | - Jia-Jia Chen
- Infectious Disease Department, College of Medicine, Zhejiang University, Zhejiang, 310003 People’s Republic of China
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11
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Wang L, Santella AJ, Wei X, Zhuang G, Li H, Zhang H, Huang X, Zhang Y, Zheng H, Zhou A. Prevalence and protective factors of HIV and syphilis infection among men who have sex with men in Northwest China. J Med Virol 2019; 92:1141-1147. [PMID: 31696951 DOI: 10.1002/jmv.25622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 10/29/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) continue to be disproportionately impacted by human immunodeficiency virus (HIV) and syphilis in China. Little is known about HIV and syphilis infections among MSM in Xi'an, a developing city in Northwest China. A cross-sectional study with recruitment via snowball sampling was conducted to collect HIV and syphilis infection status and risk factors among MSM in Xi'an between April 2013 to December 2016. Among the 5000 participants, the mean age was 29.0 years (SD 7.7) and the prevalence of HIV, syphilis, and coinfection was 6.5%, 2.2%, and 0.4%, respectively. There was no significant change in HIV prevalence from 2013 to 2016, while the prevalence of syphilis and coinfection showed a downward trend. Multiple logistic regression analyses found that being over 25 years old (OR = 1.647), junior high school/middle school education and below (OR = 3.085), with a sexual role of passive or versatile (OR = 3.300; OR = 2.337), rush poppers use during the last 6 months (OR = 1.660) and syphilis infection (OR = 2.235) were more likely to acquire HIV infection, whereas used condoms in the last episode of anal sex (OR = 0.572) and tested HIV antibody previously (OR = 0.252) were protective factors for HIV infection. HIV prevalence among MSM in Xi'an was stable, whereas the prevalence of syphilis and coinfection showed a downward trend. Interventions to promote HIV and sexually transmitted disease testing and condom use should be strengthened, especially for MSM with low education.
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Affiliation(s)
- Lirong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Anthony J Santella
- Department of Health Professions, Hofstra University, Hempstead, New York
| | - Xiaoli Wei
- Department of Sexually Transmitted Disease Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Guihua Zhuang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Hengxin Li
- Department of Sexually Transmitted Disease Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Hailan Zhang
- Department of Sexually Transmitted Disease Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Xiaodan Huang
- Department of Sexually Transmitted Disease Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Yalan Zhang
- Department of Sexually Transmitted Disease Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Haichao Zheng
- Department of Sexually Transmitted Disease Prevention and Control, Xi'an Centers for Disease Control and Prevention, Xi'an, China
| | - Anqin Zhou
- Department of HIV Testing Mobilization, Xi'an Center for Marie Stopes International, Xi'an, China
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12
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Cheng W, Xu H, Tang W, Zhong F, Meng G, Han Z, Zhao J. Online HIV prevention intervention on condomless sex among men who have sex with men: a web-based randomized controlled trial. BMC Infect Dis 2019; 19:644. [PMID: 31324233 PMCID: PMC6642590 DOI: 10.1186/s12879-019-4251-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 07/03/2019] [Indexed: 11/13/2022] Open
Abstract
Background Given the widespread use of the Internet among men who have sex with men (MSM) and high risk of Internet-facilitated sexual behaviors, Internet-based interventions to reduce sexual risk are urgently needed. Methods We recruited 1,100 participants from online and randomly assigned to two groups. One group received online HIV intervention services. Online HIV intervention was developed through mix-method formative research, measures included scenarios experiencing intervention and HIV information dissemination. Self-reported condomless anal sex with a male in the past three months was measured to evaluate the intervention effect. Result Of the 1,100 participants, the majority were aged between 21 and 30 years old (62%), had a college degree or higher (80%), were single (88%), and self-identified as homosexual (78%). The estimated risk difference of condomless sex with a male in the past three months between groups was 9.3% (95% confidence interval (CI): 1.1, 17.5%). Using multiple imputations intention-to-treat, the estimated risk difference was 8.9% (95%CI: 1.2, 16.6%). Modification effects were found between intervention and characteristics including: educational attainment (p = 0.012), marital status (p = 0.005) and awareness of AIDS-related knowledge (p = 0.010). Conclusion Internet appears to be a promising approach to disseminate HIV prevention amongst MSM. Interactive online intervention appeals to MSM and poses a great potential for reducing HIV risky behavior. Trial registration ChiCTR1800014260 (retrospectively registered 2 Jan, 2018). Electronic supplementary material The online version of this article (10.1186/s12879-019-4251-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Weibin Cheng
- Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Baiyun District, Guangzhou, 510440, Guangdong, China. .,Dermatology Hospital of Southern Medical University, No.2 Lujing Road, Yuexiu District, Guangzhou, 510095, Guangdong, China.
| | - Huifang Xu
- Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Baiyun District, Guangzhou, 510440, Guangdong, China.
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, No.2 Lujing Road, Yuexiu District, Guangzhou, 510095, Guangdong, China.,University of North Carolina Project-China, No.2 Lujing Road, Yuexiu District, Guangzhou, 510095, Guangdong, China
| | - Fei Zhong
- Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Baiyun District, Guangzhou, 510440, Guangdong, China
| | - Gang Meng
- Lingnan Partners Community Support Center A2-Tianwenyuan, Tiyuxi road, Guangzhou, 510000, Guangdong, China
| | - Zhigang Han
- Department of HIV/AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Baiyun District, Guangzhou, 510440, Guangdong, China
| | - Jinkou Zhao
- The Global Fund to fight AIDS, Tuberculosis and Malaria, Chemin de Blandonnet 8
- 1214 Vernier, Geneva, Switzerland
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13
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Guo C, Yu M, Deng X, Gong H, Li Y, Li C, Liu Y, Guo M, Gong X, Feng S, Xu J, Li Z, Gao Y, Yang J, Cui Z, Ma J. The characteristics of internet-based venue sex-seeking and mobility among money boys in Tianjin, China. HIV Med 2019; 20:473-484. [PMID: 31006956 DOI: 10.1111/hiv.12746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Internet-based venue sex-seeking is prevalent among money boys (MBs), as is a high degree of mobility, which is crucial for HIV transmission in key populations with high risks of HIV infection. However, correlation studies in MBs are scarce because of the secretive nature of this hard-to-reach subpopulation. We conducted this project to explore the characteristics of MBs. METHODS This survey was conducted from December 2014 to June 2015 in Tianjin; a total of 330 MBs were recruited by convenience sampling. Demographic and behavioural data were collected for analysis. RESULTS Among the investigated MBs, 38 (11.52%) were HIV positive, 147 (44.55%) reported using internet-based venues to seek sexual partners and 257 (77.88%) had travelled to two or more destinations in the past 6 months. Compared with non-internet-based venue-using MBs, internet-based venue-using MBs were more likely to have part-time employment as MBs, to have a longer duration of working in the sex trade, to engage in finger intercourse and to present a history of substance abuse and sexually transmitted infections. However, internet-based venue-using MBs were less likely to exhibit consistent condom usage and undergo HIV testing. Origin of residence data showed that most MBs were from northern China, with Tianjin, Beijing and Shanghai as the main travel destinations. Mobile MBs were characterized as a group who were fully engaged in the sex trade and frequently took part in sexual activities but had a weak sense of self-protection. CONCLUSIONS Internet-based venue sex-seeking and mobility are prevalent in MBs. Renewed efforts in internet-based health promotion and school-based primary health examination programmes may benefit more mobile and/or internet-based venue sex-seeking MBs.
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Affiliation(s)
- C Guo
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - M Yu
- STD & AIDS Control and Prevention Section, Tianjin Center for Disease Control and Prevention, Tianjin, China
| | - X Deng
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - H Gong
- STD & AIDS Control and Prevention Section, Tianjin Center for Disease Control and Prevention, Tianjin, China
| | - Y Li
- STD & AIDS Control and Prevention Section, Tianjin Nankai District Center for Disease Control and Prevention, Tianjin, China
| | - C Li
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Y Liu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - M Guo
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - X Gong
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - S Feng
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - J Xu
- National Center for AIDS/STD Control and Prevention, Beijing, China
| | - Z Li
- GAP Program Office of US CDC, Atlanta, GA, USA
| | - Y Gao
- STD & AIDS Control and Prevention Section, Tianjin HongQiao District Center for Disease Prevention and Control, Tianjin, China
| | - J Yang
- Tianjin ShenLan Public Health Counseling Service Center, Tianjin, China
| | - Z Cui
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - J Ma
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
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14
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Jiang H, Chen X, Li J, Tan Z, Cheng W, Yang Y. Predictors of condom use behavior among men who have sex with men in China using a modified information-motivation-behavioral skills (IMB) model. BMC Public Health 2019; 19:261. [PMID: 30832640 PMCID: PMC6399930 DOI: 10.1186/s12889-019-6593-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/25/2019] [Indexed: 01/11/2023] Open
Abstract
Background Men who have sex with men (MSM) are at high risk for human immunodeficiency virus (HIV) infection in China. Correct and consistent condom use is one of the most effective strategies for preventing the spread of HIV. This study developed a modified Information-Motivation-Behavioral Skills (IMB) model to predict condom use behavior among Chinese MSM. Methods A cross-sectional study was conducted to collect data using self-administered electronic questionnaire. Participants were recruited from HIV Voluntary Counseling and Testing clinics in six district Centers for Disease Control and Prevention in Guangzhou and two community-based HIV service centers (Lingnan Partners and Zhitong Charity) from May to September 2017. Structural equation modeling was performed to develop the modified IMB model with extended multilevel factors. Results Among the 976 MSM included, 52.05% had engaged in anal intercourse with a condom every time. The final modified IMB model fitted the data more ideally than the conventional model. The final modified IMB model revealed that behavioral skills positively contributed directly to condom use (β = 0.385, p < 0.001) and partially mediated the associations between information (β = 0.106, p = 0.005) and motivation (β = 0.390, p < 0.001) and condom use. Regarding the extended multilevel factors, education, income, receiving HIV prevention services, sexual partner seeking behavior, depression, intimate partner violence, and child sexual abuse had indirect impacts on condom use that were mediated by information, motivation, and/or behavioral skills (p < 0.05). All paths from the latent variable to the corresponding observed variables were statistically significant (p < 0.001). Conclusion The modified IMB model with extended multilevel factors could serve as a theoretical framework for behavioral interventions for condom use among Chinese MSM. Further prospective studies are needed to examine the predictive power of the modified IMB model. Electronic supplementary material The online version of this article (10.1186/s12889-019-6593-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Xiaobin Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Zhimin Tan
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Weibin Cheng
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No. 1 Qide Road, Baiyun District, Guangzhou, China.
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China.
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15
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Zhu Z, Yan H, Wu S, Xu Y, Xu W, Liu L, Li X, Xu F, Detels R. Trends in HIV prevalence and risk behaviours among men who have sex with men from 2013 to 2017 in Nanjing, China: a consecutive cross-sectional survey. BMJ Open 2019; 9:e021955. [PMID: 30705234 PMCID: PMC6359734 DOI: 10.1136/bmjopen-2018-021955] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine the trends of HIV prevalence, risk behaviours and HIV testing among men who have sex with men (MSM) in Nanjing. DESIGN Five consecutive cross-sectional surveys. SETTING Nanjing, China. PRIMARY AND SECONDARY OUTCOME MEASURES HIV and syphilis prevalence, HIV testing rate and factors associated with HIV infection; demographic characteristics and behaviours. RESULTS 649, 669, 577, 633, 503 MSM were recruited from 2013 to 2017. HIV prevalence was 9.9%, 12.3%, 12.5%, 9.8% and 10.1%, respectively. Syphilis prevalence decreased with a range from 10.6% to 5.6%. Risk behaviours like unprotected anal intercourse (UAI) and unprotected virginal sex in the past 6 months decreased, but multiple sex partners and ever used rush popper rose significantly. MSM tested for HIV in the previous year remained stable from 57.0% to 64.1% (P=0.633). Multivariate analysis showed that tested for HIV in the past year was protective factor against HIV infection. MSM who had UAI in the past 6 months, sex role as receptive and dual, diagnosed with sexually transmitted diseases (STDs) in the past year and currently syphilis infected were risk factors for HIV infection. CONCLUSIONS We observed stable high HIV prevalence, a steady HIV testing rate, decreasing syphilis prevalence and UAI among MSM in Nanjing. However, rush popper use rose dramatically. The HIV preventive strategies for MSM including condom promotion, HIV testing expansion and reduction of rush popper use, STDs screening and standardised treatment should be strengthened.
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Affiliation(s)
- Zhengping Zhu
- Section of AIDS Control and Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Hongjing Yan
- Section of AIDS Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, China
| | - Sushu Wu
- Section of AIDS Control and Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Yuanyuan Xu
- Section of AIDS Control and Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Wenjiong Xu
- Section of AIDS Control and Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Li Liu
- Section of AIDS Control and Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Xin Li
- Section of AIDS Control and Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Fei Xu
- Section of AIDS Control and Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Roger Detels
- Department of Epidemiology, School of Public Health, University of California, Los Angeles, California, USA
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16
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Yang LG, Zhang XH, Zhao PZ, Chen ZY, Ke WJ, Ren XQ, Wang LY, Chen WY, Tucker JD. Gonorrhea and chlamydia prevalence in different anatomical sites among men who have sex with men: a cross-sectional study in Guangzhou, China. BMC Infect Dis 2018; 18:675. [PMID: 30563478 PMCID: PMC6299533 DOI: 10.1186/s12879-018-3579-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 12/03/2018] [Indexed: 12/02/2022] Open
Abstract
Background A high rectal and oropharyngeal sexually transmitted infection (STI) burden has been reported among men who have sex with men (MSM) in many regions, but little data exists on rectal and oropharyngeal STIs among MSM in China. The purpose of this study was to determine the prevalence of gonorrhea and chlamydia at different anatomic sites among MSM in Guangzhou, China. Methods We recruited a cross-sectional sample of MSM in one Chinese city and collected detailed information about socio-demographic characteristics and sexual behaviors. Men had urine, rectal, and pharyngeal swab samples tested for gonorrhea and chlamydia using nucleic acid amplification tests (NAAT). Univariate and multivariate logistic regressions were used to evaluate factors associated with gonorrhea and chlamydia. Among men without any STI symptoms, we also examined the prevalence of gonorrhea and chlamydia by anatomical site. Results We enrolled 463 men between January 2015 and March 2017. A total of 58/463 (12.5%) of men had gonorrhea and 84/463 (18.1%) had chlamydia. MSM with gonorrhea were more likely to have been recruited from the STI clinic (OR 3.41, 95% CI 1.94–5.99), living with HIV (OR 2.41, 95% CI 1.18–4.92), diagnosed had STI co-infection (OR 2.55, 95% CI 1.39–4.69). MSM with chlamydia were more likely to be students (OR 1.8, 95% CI 0.99–3.39). Most gonorrhea (34/58, 59%) and chlamydia (64/84, 76%) infections were not associated with STI symptoms. Conclusion Asymptomatic gonorrhea and chlamydia infection were common in this sample of Chinese MSM. Further research is necessary to determine optimal STI screening programs.
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Affiliation(s)
- Li-Gang Yang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China. .,Guangdong Provincial Dermatology Hospital, Guangzhou, 510091, China.
| | - Xiao-Hui Zhang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China.,Guangdong Provincial Dermatology Hospital, Guangzhou, 510091, China
| | - Pei-Zhen Zhao
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China.,Guangdong Provincial Dermatology Hospital, Guangzhou, 510091, China
| | - Zheng-Yu Chen
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China.,Guangdong Provincial Dermatology Hospital, Guangzhou, 510091, China
| | - Wu-Jian Ke
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China.,Guangdong Provincial Dermatology Hospital, Guangzhou, 510091, China
| | - Xu-Qi Ren
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China.,Guangdong Provincial Dermatology Hospital, Guangzhou, 510091, China
| | - Liu-Yuan Wang
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China.,Guangdong Provincial Dermatology Hospital, Guangzhou, 510091, China
| | - Wei-Ying Chen
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China.,Guangdong Provincial Dermatology Hospital, Guangzhou, 510091, China
| | - Joseph D Tucker
- Department of Sexually Transmitted Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China.,Guangdong Provincial Dermatology Hospital, Guangzhou, 510091, China.,Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Raleigh, USA.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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17
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Fu R, Zhao J, Wu D, Zhang X, Tucker JD, Zhang M, Tang W. A spatiotemporal meta-analysis of HIV/syphilis epidemic among men who have sex with men living in mainland China. BMC Infect Dis 2018; 18:652. [PMID: 30541463 PMCID: PMC6292157 DOI: 10.1186/s12879-018-3532-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/20/2018] [Indexed: 11/25/2022] Open
Abstract
Background Geographic differences in HIV, syphilis and condomless sex among men who have sex with men in China remained unknown. We aimed to elucidate these spatiotemporal changing patterns in China. Methods We conducted a spatiotemporal meta-analysis. We searched four databases for studies conducted between 2001 and 2015. We included studies that reported original data of HIV/syphilis prevalence in China, the study’s area/province, and period of data collection. We grouped studies into six regions and four time periods. We examined the changing patterns of national and regional prevalence of HIV, syphilis and condomless sex. Results Search results yielded 2119 papers, and 272 were included in the meta-analysis. The sample sizes of the studies ranged from 19 to 47,231. National HIV prevalence increased from 3.8% (95% CI 3.0–4.8) in 2001–07 to 6.6% (5.6–7.7) in 2013–15. In most regions, the rise occurred before 2010 and the HIV prevalence remained relatively stable afterwards, except for the Northwest which showed a considerable increase since 2008. National syphilis prevalence decreased from 12.3% (10.2–14.9) in 2001–07 to 7.1% (5.6–8.9) in 2013–15. Conclusions The trends of HIV and syphilis infections have been effectively curbed in MSM in most regions of China. Continuous efforts, particularly promotion of condom use, are needed to further reduce these infections. Electronic supplementary material The online version of this article (10.1186/s12879-018-3532-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rong Fu
- Dermatology Hospital, Southern Medical University, Guangzhou, 510095, Guangdong, China.,University of North Carolina Project-China, Guangzhou, China.,SESH (Social Entrepreneurship to Spur Health) study group, Guangzhou, China
| | - Jinkou Zhao
- Technical Advice and Partnership Department, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Dan Wu
- Dermatology Hospital, Southern Medical University, Guangzhou, 510095, Guangdong, China.,University of North Carolina Project-China, Guangzhou, China.,SESH (Social Entrepreneurship to Spur Health) study group, Guangzhou, China
| | - Xiayan Zhang
- Shijingshan District Center for Disease Control and Prevention, Beijing, China
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China.,SESH (Social Entrepreneurship to Spur Health) study group, Guangzhou, China
| | - Meiwen Zhang
- Claremont Graduate University, Claremont, CA, USA
| | - Weiming Tang
- Dermatology Hospital, Southern Medical University, Guangzhou, 510095, Guangdong, China. .,University of North Carolina Project-China, Guangzhou, China. .,SESH (Social Entrepreneurship to Spur Health) study group, Guangzhou, China.
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18
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Cheng W, Xu H, Zhong F, Pan S, Tucker JD, Weir S, Zhao J, Tang W. Can HIV service data be used for surveillance purposes?: a case study in Guangzhou, China. BMC Public Health 2018; 18:1268. [PMID: 30453934 PMCID: PMC6245699 DOI: 10.1186/s12889-018-6128-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timely monitoring HIV epidemic among key populations is a formidable challenge. This study aimed to evaluate the agreement between data collected from an enhanced HIV sentinel surveillance (HSS+) and an HIV service, and to discuss whether testing service data can be used for surveillance purposes. METHODS The HSS+ data were collected from HIV sentinel surveillance conducted annually among men who have sex with men (MSM) between 2009 and 2013 in Guangzhou, China. The HIV service data were obtained from the China-Bill & Melinda Gates Foundation Cooperation Program on HIV Prevention and Care (China-Gates HIV Program) in Guangzhou during the same period. The China-Gates HIV Program aimed to increase HIV counseling and testing among MSM. We compared demographic characteristics, condom use, HIV testing history, and the HIV status among individuals in these two datasets. The Armitage-trend test was used to evaluate the HIV epidemic and behaviors of the participants in the two datasets over the study period. RESULTS Overall, a total of 2224 and 5311 MSM were included in the surveillance and service datasets, respectively. The majority of participants in the two datasets were between 20 and 29 years old, at least attended college, and had never been married. However, socio-demographic characteristics varied slightly between the two datasets. Similar trends were observed for the HIV epidemic in these two datasets. The surveillance dataset indicated that HIV prevalence increased from 3.9% in 2009 to 11.4% in 2013 (P-value for trend < 0.001), while data from the HIV service dataset indicated that MSM HIV prevalence during this same period increased from 6.2 to 8.9% (P-value for trend = 0.025). The rates of condom use were similar between the two datasets and remained consistent throughout the study period. CONCLUSION HIV service data can complement existing HIV surveillance systems for MSM in China, though it may underestimate the HIV prevalence (HSS+ data contains people whose status is already know, while service data contains people who were initially negative or people of unknown status). HIV service data can be used for surveillance purposes, when prerequisite variables are collected from a large number people, if the quality assessment is conducted.
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Affiliation(s)
- Weibin Cheng
- Dermatology Hospital of Southern Medical University, Guangzhou, China.,Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Huifang Xu
- Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Fei Zhong
- Department of AIDS Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Stephen Pan
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, China
| | - Joseph D Tucker
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, China
| | - Sharon Weir
- School of Medicine of University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jinkou Zhao
- Technical Advice and Partnership Department, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Chemin de Blandonnet 8, CH 1214, Geneva, Switzerland.
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China. .,University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, China.
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Impact of worker emigration on HIV epidemics in labour export areas: a molecular epidemiology investigation in Guangyuan, China. Sci Rep 2018; 8:16046. [PMID: 30375405 PMCID: PMC6207672 DOI: 10.1038/s41598-018-33996-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/10/2018] [Indexed: 11/14/2022] Open
Abstract
We aimed to investigate the molecular epidemic characteristics and viral transmission patterns of HIV-1 in a typical labor export area, Guangyuan city, China. Based on conducting phylogenetic trees and molecular transmission networks, a phylogenetic analysis was performed on HIV-1 pol sequences obtained from 211 migrant-history workers, 83 non-migrant-history individuals, and 21 migrant-history unknown individuals between January, 2012 and February, 2017 in Guangyuan city. Phylogenetic analysis revealed that CRF07_BC (48.3%, n = 152) and CRF01_AE (33.3%, n = 105) were the dominant strains in Guangyuan city, and circulated by multiple lineages with various epidemic characteristics. Geographic network analysis showed that Guangyuan city-related sequences with 20.3% CRF07_BC and 28.3% CRF01_AE were linked to that of other provinces, compared to that with 1.7% CRF07_BC and 5.0% CRF01_AE in cities of Sichuan. Molecular transmission network analysis further illustrated that migrant-history workers linked more sequences from other provinces than non-migrant-history individuals in both CRF07_BC (29.3% versus 0.0%, P = 0.013) and CRF01_AE (40.5% versus 10.0%, P = 0.001) networks. Our results highlighted that migrant-history workers in recent year played a vital role in fueling HIV-1 epidemic in Guangyuan city. Molecular transmission network analysis could be a useful approach for disclosing the transmission mechanism of HIV, which should be used in prevention and intervention efforts.
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20
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Chen Q, Sun Y, Sun W, Hao M, Li G, Su X, Xin R, Lu H. Trends of HIV incidence and prevalence among men who have sex with men in Beijing, China: Nine consecutive cross-sectional surveys, 2008-2016. PLoS One 2018; 13:e0201953. [PMID: 30092072 PMCID: PMC6084969 DOI: 10.1371/journal.pone.0201953] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 07/13/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sexual transmission of HIV among men who have sex with men (MSM) increased markedly in China during the past decade. HIV incidence is a critical indicator in HIV surveillance and we use a HIV-1 BED-capture-enzyme immunoassay (BED-CEIA) to examine the incidence among MSM in Beijing from 2008 to 2016. Risk factors related to recent HIV infection were also assessed. METHODS Consecutive cross-sectional surveys on MSM were conducted yearly from 2008 through 2016. Demographic and behaviors data were collected. HIV status was determined and HIV positive specimens were tested for recent infection using BED-CEIA. Specimens with ODn values≤0.8 were considered recently infected, HIV incidence rates and prevalence were then calculated. Risk factors associated with recent HIV infection were assessed by univariate and multivariable logistic regression. RESULTS From 2008 to 2016, the numbers of eligible participants in the nine consecutive years ranged from 472 to 616. All the 261 eligible HIV-positive specimens were subjected to recent HIV infection testing. HIV prevalence ranged from 5.0% (3.3%-6.8%) to 10.2% (7.8%-12.7%), and incidence ranged from 1.57% (0.19%-2.95%) to 6.63% (3.65%-9.61%). MSM who never or sometimes used condoms during anal sex with men in the past 6 months (aOR = 1.515, 95%CI: 1.016-2.257, p = 0.041), or having syphilis infection (aOR = 1.561, 95%CI: 0.946-2.575, p = 0.081) were more likely to be recently infected with HIV. Being a Beijing resident (aOR = 0.409, 95%CI: 0.212-0.790, p = 0.008), or having only one male anal sex partner in the past 6 months (aOR = 0.467, 95%CI: 0.220-0.994, p = 0.048) were associated with a lower risk for recent HIV infection. CONCLUSIONS The HIV incidence fluctuated among MSM in Beijing. Unprotected anal sex, having multiple sex partners, being a non-registered Beijing resident and having a syphilis infection play important roles in the recent HIV infection. Effective intervention measures for HIV and syphilis control and prevention should be continuously strengthened.
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Affiliation(s)
- Qiang Chen
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing Center for Preventive Medical Research, Beijing, China
| | - Yanming Sun
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing Center for Preventive Medical Research, Beijing, China
| | - Weidong Sun
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing Center for Preventive Medical Research, Beijing, China
| | - Mingqiang Hao
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing Center for Preventive Medical Research, Beijing, China
| | - Guiying Li
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing Center for Preventive Medical Research, Beijing, China
| | - Xueli Su
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing Center for Preventive Medical Research, Beijing, China
| | - Ruolei Xin
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing Center for Preventive Medical Research, Beijing, China
| | - Hongyan Lu
- Institute for AIDS/STD Control and Prevention, Beijing Center for Disease Control and Prevention, Beijing Center for Preventive Medical Research, Beijing, China
- * E-mail:
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21
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Li J, Lau JTF, Ma YL, Lau MMC. Trend and Factors Associated with Condom Use Among Male Clients of Female Sex Workers in Hong Kong: Findings of 13 Serial Behavioural Surveillance Surveys. AIDS Behav 2018; 22:2235-2247. [PMID: 29946808 DOI: 10.1007/s10461-018-2148-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study investigated the trend and associated factors of condom use among male clients of female sex workers (CFSW) in Hong Kong. A total of 25,443 males of the general population were screened to identify 2,330 CFSW via 13 rounds of population-based serial cross-sectional telephone surveys during 1998 through 2015. Over time, there were no significant changes in condom use with various types of female sex partners (p ranged 0. 219-0.837) and prevalence of self-reported STI (p = 0.975) in the past 6 months. Decrease in the prevalence of non-regular sex partners (p < 0.001) and increase in perceived efficacy of condom use for HIV prevention (p = 0.028) were observed. Perceived efficacy of condom use for HIV prevention and self-reported STI experience were significantly associated with condom use with various types of female sex partners in the past 6 months. No evident improvement for condom use was found. Tailored intervention programs are warranted.
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Affiliation(s)
- Jinghua Li
- The School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Joseph T F Lau
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Yee Ling Ma
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Mason M C Lau
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Wong NS, Mao J, Cheng W, Tang W, Cohen MS, Tucker JD, Xu H. HIV Linkage to Care and Retention in Care Rate Among MSM in Guangzhou, China. AIDS Behav 2018; 22:701-710. [PMID: 28849284 DOI: 10.1007/s10461-017-1893-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Quantifying HIV service provision along the HIV care continuum is increasingly important for monitoring and evaluating HIV interventions. We examined factors associated with linkage and retention in care longitudinally among MSM (n = 1974, 4933 person-years) diagnosed and living in Guangzhou, China, in 2008-2014. We measured longitudinal change of retention in care (≥2 CD4 tests per year) from linkage and antiretroviral therapy initiation (ART). We examined factors associated with linkage using logistic regression and with retention using generalized estimating equations. The rate of linkage to care was 89% in 2014. ART retention rate dropped from 71% (year 1) to 46% (year 2), suggesting that first-year retention measures likely overestimate retention over longer periods. Lower CD4 levels and older age predicted retention in ART care. These data can inform interventions to improve retention about some subgroups.
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Affiliation(s)
- Ngai Sze Wong
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- University of North Carolina Project-China, Guangzhou, Guangdong, China
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Jessica Mao
- David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Weibin Cheng
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1 Qide Road, Jiahe Street, Baiyun District, Guangzhou, 510440, Guangdong, China
| | - Weiming Tang
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- University of North Carolina Project-China, Guangzhou, Guangdong, China
| | - Myron S Cohen
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph D Tucker
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- University of North Carolina Project-China, Guangzhou, Guangdong, China
| | - Huifang Xu
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1 Qide Road, Jiahe Street, Baiyun District, Guangzhou, 510440, Guangdong, China.
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23
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Qin Q, Guo W, Tang W, Mahapatra T, Wang L, Zhang N, Ding Z, Cai C, Cui Y, Sun J. Spatial Analysis of the Human Immunodeficiency Virus Epidemic among Men Who Have Sex with Men in China, 2006-2015. Clin Infect Dis 2017; 64:956-963. [PMID: 28362948 PMCID: PMC5439342 DOI: 10.1093/cid/cix031] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 01/16/2017] [Indexed: 01/01/2023] Open
Abstract
Background Studies have shown a recent upsurge in human immunodeficiency virus (HIV) burden among men who have sex with men (MSM) in China, especially in urban areas. For intervention planning and resource allocation, spatial analyses of HIV/AIDS case-clusters were required to identify epidemic foci and trends among MSM in China. Methods Information regarding MSM recorded as HIV/AIDS cases during 2006-2015 were extracted from the National Case Reporting System. Demographic trends were determined through Cochran-Armitage trend tests. Distribution of case-clusters was examined using spatial autocorrelation. Spatial-temporal scan was used to detect disease clustering. Spatial correlations between cases and socioenvironmental factors were determined by spatial regression. Results Between 2006 and 2015, in China, 120 371 HIV/AIDS cases were identified among MSM. Newly identified HIV/AIDS cases among self-reported MSM increased from 487 cases in 2006 to >30 000 cases in 2015. Among those HIV/AIDS cases recorded during 2006-2015, 47.0% were 20-29 years old and 24.9% were aged 30-39 years. Based on clusters of HIV/AIDS cases identified through spatial analysis, the epidemic was concentrated among MSM in large cities. Spatial-temporal clusters contained municipalities, provincial capitals, and main cities such as Beijing, Shanghai, Chongqing, Chengdu, and Guangzhou. Spatial regression analysis showed that sociodemographic indicators such as population density, per capita gross domestic product, and number of county-level medical institutions had statistically significant positive correlations with HIV/AIDS among MSM. Conclusions Assorted spatial analyses revealed an increasingly concentrated HIV epidemic among young MSM in Chinese cities, calling for targeted health education and intensive interventions at an early age.
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Affiliation(s)
- Qianqian Qin
- National Center for AIDS/Sexually Transmitted Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, and
| | - Wei Guo
- National Center for AIDS/Sexually Transmitted Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, and
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou.,School of Medicine, University of North Carolina at Chapel Hill; and
| | - Tanmay Mahapatra
- Mission Arogya Health and Information Technology Research Foundation, Kolkata, India
| | - Liyan Wang
- National Center for AIDS/Sexually Transmitted Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, and
| | - Nanci Zhang
- National Center for AIDS/Sexually Transmitted Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, and
| | - Zhengwei Ding
- National Center for AIDS/Sexually Transmitted Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, and
| | - Chang Cai
- National Center for AIDS/Sexually Transmitted Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, and
| | - Yan Cui
- National Center for AIDS/Sexually Transmitted Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, and
| | - Jiangping Sun
- National Center for AIDS/Sexually Transmitted Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, and
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24
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Zhong F, Tang W, Cheng W, Lin P, Wu Q, Cai Y, Tang S, Fan L, Zhao Y, Chen X, Mao J, Meng G, Tucker JD, Xu H. Acceptability and feasibility of a social entrepreneurship testing model to promote HIV self-testing and linkage to care among men who have sex with men. HIV Med 2017; 18:376-382. [PMID: 27601301 PMCID: PMC5340630 DOI: 10.1111/hiv.12437] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES HIV self-testing (HIVST) offers an opportunity to increase HIV testing among people not reached by facility-based services. However, the promotion of HIVST is limited as a consequence of insufficient community engagement. We built a social entrepreneurship testing (SET) model to promote HIVST linkage to care among Chinese men who have sex with men (MSM) in Guangzhou. METHODS The SET model includes a few key steps. Each participant first completed an online survey, and paid a US$23 (refundable) deposit to receive an HIVST kit and a syphilis self-testing (SST) kit. After the testing, the results were sent to the platform by the participants and interpreted by Center for Disease Control and Prevention (CDC) staff. Meanwhile, the deposit was returned to each participant. Finally, the Community based organizations (CBO) contacted the participants to provide counselling services, confirmation testing and linkage to care. RESULTS During April-June 2015, a total of 198 MSM completed a preliminary survey and purchased self-testing kits. The majority were aged < 34 years (84.4%) and met partners online (93.1%). In addition, 68.9% of participants had ever been tested for HIV, and 19.5% had ever performed HIVST. Overall, feedback was received from 192 participants (97.0%). Of these participants, 14 people did not use the kits; among those who did use the kits, the HIV and syphilis prevalences were 4.5% (eight of 178) and 3.7% (six of 178), respectively. All of the screened HIV-positive individuals sought further confirmation testing and were linked to care. CONCLUSIONS Using an online SET model to promote HIV and syphilis self-testing among Chinese MSM is acceptable and feasible, and this model adds a new testing platform to the current testing service system.
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Affiliation(s)
- Fei Zhong
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Weiming Tang
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Weibin Cheng
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Peng Lin
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Qiongmiao Wu
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Yanshan Cai
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Songyuan Tang
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Lirui Fan
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Yuteng Zhao
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Xi Chen
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Jessica Mao
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Gang Meng
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Joseph D. Tucker
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
| | - Huifang Xu
- Guangzhou Center for Disease Prevention and Control: FZ, WC, YC, LF, YZ, XC and HX; University of North Carolina Chapel Hill Project-China: WT, ST, JM and JT; Guangdong Center for Disease Prevention and Control: QW and PL; Lingnan Partners Community Support Center (Guangzhou Tongzhi): GM
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Prevalence of condomless anal intercourse and recent HIV testing and their associated factors among men who have sex with men in Hangzhou, China: A respondent-driven sampling survey. PLoS One 2017; 12:e0167730. [PMID: 28273077 PMCID: PMC5342181 DOI: 10.1371/journal.pone.0167730] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 11/18/2016] [Indexed: 11/19/2022] Open
Abstract
Men who have sex with men (MSM) are a large high-risk population for HIV infection in recent years in China. A cross-sectional survey was conducted in Hangzhou, China, to determine rates of condomless anal intercourse (CAI), recent HIV testing (in the recent year) and associated factors using respondent-driven sampling. Questionnaires using face-to-face interviews were employed to collect data on sexual risk behaviors and HIV testing. Five hundred eleven MSM were recruited, of which 459 (89.8%) had anal intercourse in the past 6 months. Of these 459 participants, 457 (99.6%) answered whether they had taken an HIV test in the recent year, so only their data were analyzed. Weighted data were analyzed using bivariate and multivariate logistic regression analysis. The CAI rate with male partners in the past 6 months was 43.7% (95% confidence interval [CI], 34.0-51.5%), while the rate of condomless vaginal intercourse (CVI) was 21.6% (95% CI, 15.6-32.3%). The prevalence of recent HIV testing was 56.8% (95% CI, 48.7-66.5%), while the prevalence of HIV and syphilis were 8.8% and 6.5%, respectively. Multivariate analysis indicated that CAI was associated with earlier homosexual debut, suicidal inclinations, childhood sexual abuse, HIV testing in the recent year, and lower estimate of HIV prevalence. Recent HIV testing was associated with homosexual debut age, engaging in CAI with male partners in the past 6 months, having oral sex in the past 6 months, self-perceived higher likelihood of HIV infection, knowing about antiretroviral therapy for HIV/AIDS, receiving AIDS/sexually transmitted infection (STI) interventions in the past year, and syphilis infection. Given high prevalence of HIV and syphilis, high levels of CAI and CVI, and low HIV testing rate, the results indicated high risk of HIV infection and transmission among MSM. HIV prevention interventions should target MSM with early homosexual debut and psychosocial health problems, while HIV/AIDS education among MSM should focus on increasing knowledge of HIV risk, estimated HIV prevalence and antiretroviral therapy, and improving risk perception of HIV acquisition.
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Xu JJ, Yu YQ, Hu QH, Yan HJ, Wang Z, Lu L, Zhuang MH, Chen X, Fu JH, Tang WM, Geng WQ, Jiang YJ, Shang H. Treatment-seeking behaviour and barriers to service access for sexually transmitted diseases among men who have sex with men in China: a multicentre cross-sectional survey. Infect Dis Poverty 2017; 6:15. [PMID: 28095879 PMCID: PMC5242014 DOI: 10.1186/s40249-016-0219-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 12/07/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Delayed or inappropriate treatment for sexually transmitted diseases (STDs) increases the risk of HIV acquisition and may cause other harmful outcomes. However, studies on STD treatment-seeking behaviour and correlated factors in men who have sex with men (MSM) are scarce. This information is crucial for the promotion of STD treatment-seeking behaviour and reduction of HIV transmission among Chinese MSM. METHODS During 2012-2013, a multicentre cross-sectional study was conducted in 7 Chinese cities. Participants completed an interview-questionnaire and gave venous blood samples, which were then tested for antibodies to HIV, syphilis, and herpes simplex virus-2 (HSV-2). MSM who tested positive for syphilis/HSV-2 or had obvious STD-related symptoms within the last 12 months were defined as suspected STD-infected MSM. RESULTS Of the 4 496 eligible MSM who completed this survey, 24.4% (1 096/4 496) were categorized as suspected STD-infected MSM. 35.7% (391/1 096) of these MSM with suspected STD infections sought STD treatment in clinics within the last 12 months. Among MSM who did not attend STD clinics for treatment, the prevalence of syphilis and HSV-2 was significantly higher; the HIV prevalence and incidence within this subpopulation reached as high as 14.5% and 12.2/100 person-years, respectively. Multivariate logistic regression analysis indicated that having 7-12 years of education (vs. ≤6 years; aOR, 2.5; 95%CI, 1.0-6.1), ≥13 years of education (vs. ≤6 years: aOR, 2.8; 95%CI, 1.2-7.0), monthly income >500 USD (vs. ≤500 USD: aOR, 1.5; 95%CI, 1.1-2.1), obvious STD-related symptoms within last 12 months (aOR, 5.3; 95%CI, 3.7-7.5), being HIV infected (aOR, 1.7; 95%CI, 1.1-2.6), currently syphilis infected (aOR, 0.6; 95%CI, 0.4-0.9) and HSV-2 infected (aOR, 0.6; 95%CI, 0.5-0.9) were independent correlates with seeking STD treatment in clinics among Chinese MSM. CONCLUSIONS The high prevalence of STD infection coupled with a low proportion of individuals who exhibit appropriate treatment-seeking behaviour create a high risk of a growing HIV epidemic among Chinese MSM. Models that prioritize better screening for and education about STDs should be urgently implemented, especially among low-income MSM.
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Affiliation(s)
- Jun-Jie Xu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yan-Qiu Yu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Qing-Hai Hu
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong-Jing Yan
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, China
| | - Zhe Wang
- He’nan Provincial Centers for Disease Control and Prevention, Zhengzhou, China
| | - Lin Lu
- Yunnan Provincial Centers for Disease Control and Prevention, Kunming, China
| | - Ming-Hua Zhuang
- Shanghai Municipal Centers for Disease Control and Prevention, Shanghai, China
| | - Xi Chen
- Hu’nan Provincial Centers for Disease Control and Prevention, Changsha, China
| | - Ji-Hua Fu
- Shandong Provincial Centers for Disease Control and Prevention, Jinan, China
| | - Wei-Ming Tang
- University of North Carolina Project-China, Guangzhou, China
| | - Wen-Qing Geng
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yong-Jun Jiang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong Shang
- Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, Department of Laboratory Medicine, The First Affiliated Hospital, China Medical University, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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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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28
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Ahn JY, Boettiger D, Kiertiburanakul S, Merati TP, Huy BV, Wong WW, Ditangco R, Lee MP, Oka S, Durier N, Choi JY. Incidence of syphilis seroconversion among HIV-infected persons in Asia: results from the TREAT Asia HIV Observational Database. J Int AIDS Soc 2016; 19:20965. [PMID: 27774955 PMCID: PMC5075717 DOI: 10.7448/ias.19.1.20965] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 06/29/2016] [Accepted: 09/14/2016] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Outbreaks of syphilis have been described among HIV-infected men who have sex with men (MSM) in Western communities, whereas reports in Asian countries are limited. We aimed to characterize the incidence and temporal trends of syphilis among HIV-infected MSM compared with HIV-infected non-MSM in Asian countries. METHODS Patients enrolled in the TREAT Asia HIV Observational Database cohort and with a negative non-treponemal test since enrolment were analyzed. Incidence of syphilis seroconversion, defined as a positive non-treponemal test after previously testing negative, was evaluated among patients at sites performing non-treponemal tests at least annually. Factors associated with syphilis seroconversion were investigated at sites doing non-treponemal testing in all new patients and subsequently testing routinely or when patients were suspected of having syphilis. RESULTS We included 1010 patients from five sites that performed non-treponemal tests in all new patients; those included had negative non-treponemal test results during enrolment and subsequent follow-ups. Among them, 657 patients were from three sites conducting regular non-treponemal testing. The incidence of syphilis seroconversion was 5.38/100 person-years (PY). Incidence was higher in MSM than non-MSM (7.64/100 PY vs. 2.44/100 PY, p<0.001). Among MSM, the incidence rate ratio (IRR) for every additional year from 2009 was 1.19 (p=0.051). MSM status (IRR 3.48, 95% confidence interval (CI) 1.88-6.47), past syphilis diagnosis (IRR 5.15, 95% CI 3.69-7.17) and younger age (IRR 0.84 for every additional 10 years, 95% CI 0.706-0.997) were significantly associated with syphilis seroconversion. CONCLUSIONS We observed a higher incidence of syphilis seroconversion among HIV-infected MSM and a trend to increasing annual incidence. Regular screening for syphilis and targeted interventions to limit transmission are needed in this population.
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Affiliation(s)
- Jin Young Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | | | | | - Tuti Parwati Merati
- Faculty of Medicine, Udayana University and Sanglah Hospital, Bali, Indonesia
| | - Bui Vu Huy
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | | | | | - Man Po Lee
- Queen Elizabeth Hospital, Hong Kong, China
| | - Shinichi Oka
- National Center for Global Health and Medicine, Tokyo, Japan
| | - Nicolas Durier
- TREAT Asia, Foundation for AIDS Research, Bangkok, Thailand
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- AIDS Research Institute, Yonsei University College of Medicine, Seoul, Korea;
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29
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Liu Y, Wang J, Qian HZ, Liu H, Yin L, Lu H, Zhang C, Ruan Y, Shao Y, Vermund SH. Seeking Male Sexual Partners via Internet and Traditional Venues among Chinese Men Who Have Sex with Men: Implications for HIV Risk Reduction Interventions. AIDS Behav 2016; 20:2222-2230. [PMID: 27000143 DOI: 10.1007/s10461-016-1371-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The dynamic nature of finding male sexual partners (sex-finding) among Chinese men who have sex with men (MSM) may play a substantial role in the HIV epidemic. We compared characteristics and behaviors of MSM who mostly sought sex via the Internet versus traditional venues in a cross-sectional survey among 3588 Chinese MSM. We assessed the sociodemographic predictors and compared high-risk behaviors of using Internet versus traditional venues for sex-finding. Compared to non-Internet MSM, Internet-user MSM were more likely to have been: younger, currently single, better educated, health-insured, with higher income, with Beijing residency ('Hukou'), living longer in the city, HIV-positive, ever using drug and engaging in condomless receptive anal sex. Internet sex-finding users were less likely to be sexually active for longer duration, drink alcohol, drink alcohol before sex, or ever have sex with women. Knowledge of differential characteristics of various sex-finding MSM can help design targeted interventions.
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Affiliation(s)
- Yu Liu
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Suite 725, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Juan Wang
- Beijing Municipal Center for Disease Control and Prevention, Beijing, China
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Suite 725, 2525 West End Avenue, Nashville, TN, 37203, USA
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Hongjie Liu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | - Lu Yin
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Suite 725, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Hongyan Lu
- Beijing Municipal Center for Disease Control and Prevention, Beijing, China
| | - Chen Zhang
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Suite 725, 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Suite 725, 2525 West End Avenue, Nashville, TN, 37203, USA.
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA.
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30
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Abstract
Syphilis is on the increase globally. While recognized more frequently in patients with, HIV/AIDS, it is not unusual among immune competent individuals sometimes presenting with unusual manifestations and/or behaviour. This paper reviews the history and clinical features of syphilis and draws attention to the oral manifestations. CPD/Clinical Relevance: Syphilis should be in the differential diagnosis of oral ulcers or unusual oral lesions.
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31
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Qin Q, Tang W, Ge L, Li D, Mahapatra T, Wang L, Guo W, Cui Y, Sun J. Changing trend of HIV, Syphilis and Hepatitis C among Men Who Have Sex with Men in China. Sci Rep 2016; 6:31081. [PMID: 27535092 PMCID: PMC4989164 DOI: 10.1038/srep31081] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 07/13/2016] [Indexed: 11/21/2022] Open
Abstract
Dearth of information regarding the trend and correlates of HIV, syphilis and Hepatitis C (HCV) in a country-wide sample of understudied though high-risk Chinese men who have sex with men (MSM) called for a comprehensive serial cross-sectional study. Using a multistage mixed-method strategy, 171,311 MSM from 107 selected cities/counties in 30 provinces of mainland China, were interviewed and tested. Descriptive, bivariate, multivariate and Cochran-Armitage trend analyses were conducted using SAS 9.2. During 2009-13, recent (71.5% to 78.6%, p < 0.001) and consistent (40.4% to 48.8%, p < 0.001) condom use as well as condom use during commercial anal sex (46.5% to 55.0%, p < 0.001) were increasing. In contrast, commercial anal sex with male (11.9% to 7.1%, p < 0.001) and drug use (1.9% to 0.8%, p < 0.001) were decreasing over time. HIV prevalence increased gradually (5.5% to 7.3%, p < 0.001), while syphilis (9.0% to 6.3%, p < 0.001) and HCV prevalence (1.5% to 0.7%, p < 0.001) decreased over time. A positive correlation was observed between HIV and syphilis prevalence (r = 0.38). HIV infection was associated with HIV-related knowledge, services and injecting drug use. An increasing trend of HIV prevalence was observed during 2009–13 among MSM in China. While gradual reduction of risk behaviors along with syphilis and HCV prevalence supported expansion of testing and prevention services, increasing HIV burden called for deeper thematic investigations.
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Affiliation(s)
- Qianqian Qin
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Weiming Tang
- University of North Carolina at Chapel Hill, Project-China. No. 2 Lujing Road, Guangzhou, 510095, China.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27514, USA
| | - Lin Ge
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dongmin Li
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tanmay Mahapatra
- National Institute of Cholera and Enteric Diseases, Kolkata, 700010, India
| | - Liyan Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wei Guo
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan Cui
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiangping Sun
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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32
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Decreasing age at first anal intercourse among men who have sex with men in China: a multicentre cross-sectional survey. J Int AIDS Soc 2016; 19:20792. [PMID: 27515018 PMCID: PMC4981647 DOI: 10.7448/ias.19.1.20792] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 06/20/2016] [Accepted: 07/03/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction Literature on the age at first anal intercourse (AFAI) among men who have sex with men (MSM) is limited. We aimed to elucidate the evolution of AFAI and the factors associated with early AFAI, based on a large sample of MSM in China. Methods We collected information on the demographics and sexual behaviours of MSM from seven large cities in China from 2012 to 2013. Blood samples were collected for HIV serology. AFAI was calculated for MSM born in different time periods. Linear regression models were used to explore factors associated with younger AFAI. Results A total of 4491 MSM (median age: 27 years, median AFAI: 21 years) were recruited. Median AFAI decreased steadily from 33 years of age among MSM born from 1940 to 1959 to 18 years of age among MSM born from 1990 to 1996. Factors significantly associated with younger AFAI included more recent birth cohort, being unmarried or living with a male partner, being a student or industry worker, the gender of the first partner being male, and using Rush or Ecstasy in the past six months (p for all <0.05). Conclusions AFAI among MSM in China has considerably decreased over the past few decades. The decreasing AFAI and factors associated with younger AFAI point to the necessity of early sex education and control of recreational drug use among MSM in China.
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33
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Hu H, Liu X, Zhang Z, Xu X, Shi L, Fu G, Huan X, Zhou Y. Increasing HIV Incidence among Men Who Have Sex with Men in Jiangsu Province, China: Results from Five Consecutive Surveys, 2011-2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13080795. [PMID: 27509513 PMCID: PMC4997481 DOI: 10.3390/ijerph13080795] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/27/2016] [Accepted: 08/02/2016] [Indexed: 12/04/2022]
Abstract
Epidemics of HIV among men who have sex with men (MSM) are major public health concerns in most parts of China. This study examined the trends in HIV incidence and associated factors among MSM in Jiangsu Province. Five consecutive cross-sectional surveys were conducted among MSM from 2011 to 2015 in eight cities throughout Jiangsu Province. Participants were recruited from MSM venues or via the internet. Demographic and behavioral data were collected through HIV bio-behavioral surveys. Blood specimens were collected to test for HIV and syphilis. HIV incidence was estimated by the IgG-capture BED-EIA (BED) method and a chi-square trend test was used to compare differences over the years. Multivariate logistic regression analysis was used to identify factors associated with recent infection. A total of 2433, 2678, 2591, 2610 and 2541 participants were enrolled in 2011, 2012, 2013, 2014 and 2015, respectively. HIV incidence increased from 5.10% in 2011 to 6.62% in 2015 (p = 0.025). MSM who had an education level of junior high school or less (aOR = 1.472, p = 0.018), engaged in condomless anal sex in the past 6 months (aOR = 2.389, p < 0.001), did not have an HIV test in the past 12 months (aOR = 3.215, p < 0.001), and were currently infected with syphilis (aOR = 2.025, p = 0.001) were likely to be recently infected with HIV. HIV incidence is increasing among MSM in Jiangsu Province, China. Condom usage and HIV testing promotion should be prioritized when attempting to reduce HIV transmission among MSM in China.
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Affiliation(s)
- Haiyang Hu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China.
| | - Xiaoyan Liu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China.
| | - Zhi Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China.
| | - Xiaoqin Xu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China.
| | - Lingen Shi
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China.
| | - Gengfeng Fu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China.
| | - Xiping Huan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China.
| | - Ying Zhou
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China.
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34
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Zhao J, Chen L, Chaillon A, Zheng C, Cai W, Yang Z, Li G, Gan Y, Wang X, Hu Y, Zhong P, Zhang C, Smith DM. The dynamics of the HIV epidemic among men who have sex with men (MSM) from 2005 to 2012 in Shenzhen, China. Sci Rep 2016; 6:28703. [PMID: 27352965 PMCID: PMC4926087 DOI: 10.1038/srep28703] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/06/2016] [Indexed: 11/24/2022] Open
Abstract
HIV-1 epidemics among MSM are a major public health concern in China, especially in large cities. This study sought to better understand the dynamics of HIV molecular epidemiology among MSM in Shenzhen, a rapidly developing city with over 13.8 million people. HIV-1 pol sequences were obtained from 996 (53.5%) of 1862 HIV-infected MSM and 403(9.0%) of 4498 heterosexuals and injection drug users in Shenzhen, China from 2005-2012. Eight HIV-1 subtypes and some inter-subtype recombinants were identified among sampled MSM with CRF07_BC (39.1%) and CRF01_AE (35.1%) being the most predominant. From 2006 to 2012, the prevalence of CRF07_BC and CRF55_01B rapidly increased, while the prevalence of subtypes B and CRF01_AE gradually decreased. The genetic distances within CRF07_BC and CRF55_01B groups were significantly lower than within CRF01_AE and B groups. The vast majority (90.3%) of HIV-1 infected MSM in Shenzhen were migrants who came from 31 of the 34 provinces of China, and these migrants had significantly different HIV-1 subtype distributions from the local MSM. This study highlighted the importance of CRF07_BC and migrants in the changing HIV epidemic among MSM in China, and provides a molecular epidemiology framework for understanding how HIV-1 epidemics can change in large cities with diverse risk groups.
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Affiliation(s)
- Jin Zhao
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Lin Chen
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Antoine Chaillon
- University of California San Diego, La Jolla, California, USA.,Veterans Affairs Healthcare System San Diego, San Diego, California, USA
| | - Chenli Zheng
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Wende Cai
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Zhengrong Yang
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Guilian Li
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Yongxia Gan
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Xiaohui Wang
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Yihong Hu
- Pathogen Diagnostic Center, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
| | - Ping Zhong
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Chiyu Zhang
- University of California San Diego, La Jolla, California, USA.,Veterans Affairs Healthcare System San Diego, San Diego, California, USA.,Pathogen Diagnostic Center, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
| | - Davey M Smith
- Veterans Affairs Healthcare System San Diego, San Diego, California, USA.,Pathogen Diagnostic Center, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, China
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35
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Cheng W, Cai Y, Tang W, Zhong F, Meng G, Gu J, Hao C, Han Z, Li J, Das A, Zhao J, Xu H, Tucker JD, Wang M. Providing HIV-related services in China for men who have sex with men. Bull World Health Organ 2016; 94:222-7. [PMID: 26966334 PMCID: PMC4773928 DOI: 10.2471/blt.15.156406] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 09/28/2015] [Accepted: 11/16/2015] [Indexed: 11/27/2022] Open
Abstract
Problem In China, human immunodeficiency virus (HIV) care provided by community-based organizations and the public sector are not well integrated. Approach A community-based organization and experts from the Guangzhou Center for Disease Control and Prevention developed internet-based services for men who have sex with men, in Guangzhou, China. The internet services were linked to clinical services offering HIV testing and care. Local setting The expanding HIV epidemic among men who have sex with men is a public health problem in China. HIV control and prevention measures are implemented primarily through the public system. Only a limited number of community organizations are involved in providing HIV services. Relevant changes The programme integrated community and public sector HIV services including health education, online HIV risk assessment, on-site HIV counselling and testing, partner notification, psychosocial care and support, counting of CD4+ T-lymphocytes and treatment guidance. Lessons learnt The internet can facilitate HIV prevention among a subset of men who have sex with men by enhancing awareness, service uptake, retention in care and adherence to treatment. Collaboration between the public sector and the community group promoted acceptance by the target population. Task sharing by community groups can increase access of this high-risk group to available HIV-related services.
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Affiliation(s)
- Weibin Cheng
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No. 1 Qide Road, Jiahe, Guangzhou, Guangdong,510440, China
| | - Yanshan Cai
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No. 1 Qide Road, Jiahe, Guangzhou, Guangdong,510440, China
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
| | - Fei Zhong
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No. 1 Qide Road, Jiahe, Guangzhou, Guangdong,510440, China
| | - Gang Meng
- Lingnan Partners Community Support Center (GZTZ.ORG), Guangzhou, China
| | - Jing Gu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chun Hao
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhigang Han
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No. 1 Qide Road, Jiahe, Guangzhou, Guangdong,510440, China
| | - Jingyan Li
- Lingnan Partners Community Support Center (GZTZ.ORG), Guangzhou, China
| | - Aritra Das
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, United States of America
| | - Jinkou Zhao
- Global Fund to fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Huifang Xu
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No. 1 Qide Road, Jiahe, Guangzhou, Guangdong,510440, China
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China
| | - Ming Wang
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No. 1 Qide Road, Jiahe, Guangzhou, Guangdong,510440, China
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36
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Risky sexual networks and concentrated HIV epidemics among men who have sex with men in Wenzhou, China: a respondent-driven sampling study. BMC Public Health 2015; 15:1246. [PMID: 26673429 PMCID: PMC4682249 DOI: 10.1186/s12889-015-2591-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 12/09/2015] [Indexed: 11/21/2022] Open
Abstract
Background The high and continually increasing prevalence of human immunodeficiency virus (HIV) and other sexually transmitted diseases among men who have sex with men (MSM) in China underscores the critical importance of examining the exact sexual networks that result in HIV transmission, as well as HIV infection, using powerful sampling methods, such as respondent-driven sampling (RDS), to improve the sexual health of this population. Methods Using RDS, a cross-sectional study was conducted among MSM in Wenzhou, Zhejiang province, China from December 2013 to June 2014. The type of sex, numbers of anal sex partners, male oral sex partners and vaginal sex partners, condom use during each type of sex over the previous 6 months, prevention behaviors, risk perception, and the burdens of HIV and syphilis were investigated and analyzed. Results Of 424 MSM, a great number of them did anal sex, male oral sex, and vaginal sex during the previous 6 months, and weighted estimates for the prevalence that MSM did not conduct these sexual behaviors were 11.2 % (95 % confidence interval [CI] =6.7–16.50 %), 20.3 % (95 % CI = 15.2–27.1 %), and 58.9 % (95 % CI = 52.1–65.8 %), respectively. Multiple sexual partners, engaging in regular, casual and commercial sex, and lack of condom use during all types of sex were common among MSM. The estimated HIV and syphilis prevalences were 22.8 % (95 % CI = 16.9–28.5 %) and 9.7 % (95 % CI = 6.4–13.6 %), respectively. Of the participants, 53.5 % (95 % CI = 45.3–60.2 %) received HIV-related interventions during the previous year, 48.1 % (95 % CI = 39.7–55.1 %) had never been tested for HIV, and only 14.1 % (95 % CI =10.1–19.2 %) perceived a risk of contracting HIV. Multiple logistic regression analysis revealed that age over 44 years (adjusted odds ratio [AOR] = 3.60, 95 % CI = 1.34–9.64), a monthly income of 3001–4000 yuan (approximately 470–630 US$) (AOR = 1.96, 95 % CI = 1.67–3.60), multiple anal sex partners (AOR = 1.93, 95 % CI = 1.15–3.24), awareness of the possibility of contracting HIV (AOR = 3.18, 95 % CI = 1.56–6.48), and current syphilis infection (AOR = 3.01, 95 % CI = 1.44–6.29) were predictors of HIV infection. Conclusions HIV transmission has become highly prevalent and will likely become more prevalent among MSM and their female partners if these risky sexual networks persist. Our findings call for urgent and effective interventions to prevent the rapid transmission of HIV among MSM in Wenzhou. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2591-7) contains supplementary material, which is available to authorized users.
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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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Cheng W, Tang W, Zhong F, Babu GR, Han Z, Qin F, Gao K, Mai H, Zhao Y, Liang C, Fan L, Wu H, Xu H, Wang M. Consistently high unprotected anal intercourse (UAI) and factors correlated with UAI among men who have sex with men: implication of a serial cross-sectional study in Guangzhou, China. BMC Infect Dis 2014; 14:696. [PMID: 25519034 PMCID: PMC4279965 DOI: 10.1186/s12879-014-0696-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 12/11/2014] [Indexed: 12/22/2022] Open
Abstract
Background China experiencing an increasing HIV epidemic among men who have sex with men (MSM), and unprotected anal intercourse (UAI) has played a key role in this process. The aims of this study were to examine the trend of UAI and to explore the factors correlated with UAI among MSM in Guangzhou, China. Methods Data from 2008 to 2013 were retrieved from the annual serological and behavioral surveys system. We collected information on demographic, HIV related sexual behavior with men and women, access to HIV prevention services, and symptoms of sexually transmitted infections. Chi-square test was used to examine the similarity of the participants during the study period. Univariate and multivariate logistic regression were conducted to test the factors associated with UAI. Trend test was used to check the change of UAI in different characteristic stratums during the study period. Results In total, 58.4% (range from 54.5% to 62.0%) of the participants reported that they engaged in UAI in the past six months. Participants who aged less than 20 [Adjusted Odds Ratio (AOR): 2.22, 95% Confidential Interval (CI): 1.07-4.61], only attended elementary school (or less) (AOR: 1.41, 95% CI: 1.04-1.90), cohabiting with male partner (AOR: 2.15, 95% CI: 1.66-2.79), divorced or widowed (AOR: 2.80, 95% CI: 1.54-5.07), did not test for HIV in the past year (AOR: 1.36, 95% CI: 1.12-1.65), and had 10 or more partners in the past six months (AOR: 1.85, 95% CI: 1.18-2.91) had higher odds of UAI. However, the proportions of UAI were stable in different stratums during the study period. Conclusions The proportion of MSM engaged in UAI was consistently high during the study period. Effective intervention strategies, which include but not limit to risk reduction counseling and testing services, are urgently needed to bring down the risk behaviors of the MSM in Guangzhou, in order to control HIV/STIs epidemic in this specific population.
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Affiliation(s)
- Weibin Cheng
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Weiming Tang
- University of North Carolina Project-China, No.2 Lujing Road, Yuexiu District, Guangzhou, Guangdong Province, 510095, China.
| | - Fei Zhong
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China. .,School of Public Health, Sun Yat-Sen University, No.74 2nd Yat-Sen Road, Yuexiu District, Guangzhou, Guangdong, Province, 510080, China.
| | - Giridhar R Babu
- Department of Epidemiology, Public Health Foundation of India, IIPH H, Bangalore Campus, SIHFW Premises, 1st cross, Magadi road, Bangalore, Karnataka, 560023, India.
| | - Zhigang Han
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Faju Qin
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Kai Gao
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Huixia Mai
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Yuteng Zhao
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Caiyun Liang
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Lirui Fan
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Hao Wu
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Huifang Xu
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
| | - Ming Wang
- Department of AIDS/STD Control and Prevention, Guangzhou Center for Disease Control and Prevention, No.1, Qide Road, Jiahe, Baiyun District, Guangzhou, Guangdong Province, 510440, China.
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