1
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Chen H, Chen Y, Liu S, Yu X, Wang H, Chang R, Wang R, Liu Y, Xu C, Wang Y, Cai Y. Trends in HIV Prevalence, Sexual Behavior, and Pre-Exposure Prophylaxis Willingness Among Transgender Women: An Analysis of Three Cross-Sectional Studies Conducted Mainly in Shenyang, China, 2014-2019. Transgend Health 2024; 9:222-231. [PMID: 39109260 PMCID: PMC11299101 DOI: 10.1089/trgh.2022.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Although transgender women (TGW) bear the highest HIV burden worldwide, routine surveillance of this group is rare. We aimed to evaluate the trends in health characteristics of Chinese TGW. Methods Three cross-sectional studies using snowball sampling were conducted in 2014, 2017, and 2019, primarily in Shenyang, China. A questionnaire and voluntary HIV testing were used to obtain information on background characteristics, sexual behaviors, pre-exposure prophylaxis (PrEP) willingness, and HIV status. Results There were 220 respondents in 2014, 198 in 2017, and 247 in 2019 (average age 31.1±7.6 to 33.5±9.6 years). HIV prevalence significantly decreased from 29.5% (95% confidence interval [CI]: 25.3-38.4%) in 2014 to 19.4% (95% CI: 14.7-24.9%) in 2019 (p<0.05). The proportion of participants reporting condomless anal intercourse (CAI) with any partner fluctuated from 30.8% (95% CI: 25.1-36.1%) to 53.0% (95% CI: 45.8-60.1%). The proportion of participants willing to use PrEP decreased from 86.4% (95% CI: 81.1-90.6%) in 2014 to 62.8% (95% CI: 56.4-68.8%) in 2019. Factors significantly associated with HIV infection were CAI with any partner (multivariate odds ratio [ORm]: 3.58, 95% CI: 1.55-8.29 in 2017; ORm: 3.18, 95% CI: 1.56-6.46 in 2019) and PrEP willingness (ORm: 0.26, 95% CI: 0.12-0.58 in 2017). Conclusion HIV prevalence and associated risk factors remain substantial among Chinese TGW. There is an urgent need to strengthen HIV surveillance in this population, and develop trans-friendly and effective interventions to minimize HIV prevalence and transmission.
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Affiliation(s)
- Hui Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingjie Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shangbin Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyue Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huwen Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Hong Kong, China
| | - Ruijie Chang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongxi Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujie Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Yang X, Yu Y, Song X, He L, Fu Y, Zhang J, Wang X, Zhang H. Prevalence of unprotected anal intercourse and associated factors among male students who have sex with men in Qingdao, China: A cross-sectional study. Medicine (Baltimore) 2023; 102:e33180. [PMID: 36862866 PMCID: PMC9981382 DOI: 10.1097/md.0000000000033180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
The significant rise of human immunodeficiency virus (HIV) epidemic among young students has become a new feature of acquired immune deficiency syndrome in China, and unprotected anal intercourse (UAI) among male students who have sex with men (SMSM) played a central role in this process. The aim of this study was to investigate the prevalence of UAI, as well as analyze the factors associated with UAI among SMSM in Qingdao, China. From May 2021 to April 2022, men who aged 15 to 30, studied in a high school or college in Qingdao and had anal sex with men in the past 6 months were recruited through snowball method relying on the nongovernmental organization. An anonymous electronic questionnaire was administrated to collect information on socio-demographic characteristics, sexual behaviors, substance use before sex, HIV prevention services and self-esteem. Univariate and multivariate logistic regressions were used to assess factors related to UAI. Among the 341 SMSM included in the study, 40.5% engaged in UAI in the past 6 months. Being migrants from other provinces [odds ratios (OR) = 2.04, 95% confidence intervals (CI): 1.10-3.78], failing to use condoms for the first anal intercourse (OR = 3.38, 95% CI: 1.85-6.18), drinking alcohol before sex (OR = 2.31, 95% CI: 1.25-4.28) and being low level self-esteem (OR = 1.77, 95% CI: 1.09-2.87) were positively associated with UAI. SMSM who had homosexual intercourse more than once a week (OR = 1.76, 95% CI: 1.03-3.00) or had multiple male sex partners (OR = 1.99, 95% CI: 1.20-3.30) were more likely to engage in UAI. Received peer education in the past 12 months (OR = 0.48, 95% CI: 0.27-0.86) was associated with lower odds of UAI. The situation of UAI among SMSM in Qingdao was a public health issue of concern. It is necessary to take targeted measures, such as focusing on first-time sex, advancing sexual health education, expanding peer education, implementing alcohol use screening and maintaining the self-esteem of SMSM, so as to reduce the occurrence of high-risk behaviors among SMSM and curb the spread of HIV on campus.
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Affiliation(s)
- Xuebin Yang
- School of Public Health, Qingdao University, Qingdao, China
| | - Yingying Yu
- School of Public Health, Qingdao University, Qingdao, China
| | - Xin Song
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Lili He
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Yong Fu
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Jianwen Zhang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Xiaojun Wang
- School of Public Health, Shandong First Medical University, Tai An, China
| | - Huaqiang Zhang
- School of Public Health, Qingdao University, Qingdao, China
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
- * Correspondence: Huaqiang Zhang, School of Public Health, Qingdao University, Qingdao 266071, China (e-mail: )
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3
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Zhang H, Wang M, Zhang Y, Tan S, Huang H, Zhu J, Tian W, Mo J, Mo J, Cen P, Ning C. Usability of dual HIV/syphilis self-testing among men who have sex with men in China: study protocol for a three-arm randomised controlled trial. BMJ Open 2022; 12:e059034. [PMID: 36216414 PMCID: PMC9558798 DOI: 10.1136/bmjopen-2021-059034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION HIV self-testing (HIVST) provides a key measure for the early detection of HIV infection in men who have sex with men (MSM). However, dual HIV/syphilis self-testing in the MSM population has not been studied. We describe a randomised controlled trial to evaluate the effect of dual HIV/syphilis self-testing on the testing frequency among MSM in China. METHODS AND ANALYSIS This randomised controlled trial will be implemented in Guangxi, China. 330 MSM, including 255 frequent testers and 75 less frequent testers, will be recruited and randomly assigned in a 1:1:1 ratio into one of three arms: a site-based testing arm, a single HIVST arm and a dual HIV/syphilis self-testing arm. Participants in the single HIVST arm and dual HIV/syphilis self-testing arm will receive two free finger-prick-based HIVST or HIV/syphilis self-testing kits at enrolment. The data will be collected at five separate times: baseline, 3 months, 6 months, 9 months and 12 months. The primary outcome is the mean frequency of HIV testing used by MSM after intervention comparing each group during the study period. The secondary outcome includes changes in sex behaviours (eg, number of male sex partners and the proportion of consistent condom use) and the mean number of HIV tests used by the social network members over the study period. ETHICS AND DISSEMINATION The study protocol was reviewed and approved by the Medical Ethics Committee of Guangxi Medical University, China (20210173). The study results will be disseminated through conferences and academic journals. TRIAL REGISTRATION NUMBER ChiCTR2100050898.
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Affiliation(s)
- Hong Zhang
- Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
| | - Min Wang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Yun Zhang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Sumin Tan
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Haimei Huang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Jiawen Zhu
- The Second Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Weiyi Tian
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Jinli Mo
- The Second Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Jieling Mo
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Ping Cen
- AIDS/STD Control and Prevention, Nanning Municipal Center for Disease Prevention and Control, Nanning, Guangxi, China
| | - Chuanyi Ning
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
- Key Lab of AIDS Prevention and Treatment, Life Sciences Institute, Guangxi Medical University, Nanning, Guangxi, China
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4
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Zhang J, Tucker J, Tang W, Wang H, Chu Z, Hu Q, Huang X, Chen Y, Wang H, He X, Li Y, Zhang L, Hu Z, Bao R, Li S, Li H, Ding H, Jiang Y, Geng W, Xu J, Shang H. Internet-Based HIV Self-Testing Among Men Who Have Sex With Men Through Pre-exposure Prophylaxis: 3-Month Prospective Cohort Analysis From China. J Med Internet Res 2021; 23:e23978. [PMID: 34448709 PMCID: PMC8459755 DOI: 10.2196/23978] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/03/2021] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Routine HIV testing accompanied with pre-exposure prophylaxis (PrEP) requires innovative support in a real-world setting. OBJECTIVE This study aimed to determine the usage of HIV self-testing (HIVST) kits and their secondary distribution to partners among men who have sex with men (MSM) in China, who use PrEP, in an observational study between 2018 and 2019. METHODS In 4 major cities in China, we prospectively followed-up MSM from the China Real-world oral PrEP demonstration study, which provides daily or on-demand PrEP for 12 months, to assess the usage and secondary distribution of HIVST on quarterly follow-ups. Half of the PrEP users were randomized to receive 2 HIVSTs per month in addition to quarterly facility-based HIV testing. We evaluated the feasibility of providing HIVST to PrEP users. RESULTS We recruited 939 MSM and randomized 471 to receive HIVST, among whom 235 (49.9%) were daily and 236 (50.1%) were on-demand PrEP users. At baseline, the median age was 29 years, 390 (82.0%) men had at least college-level education, and 119 (25.3%) had never undergone facility-based HIV testing before. Three months after PrEP initiation, 341 (74.5%) men had used the HIVST provided to them and found it very easy to use. Among them, 180 of 341 (52.8%) men had distributed the HIVST kits it to other MSM, and 132 (51.6%) among the 256 men who returned HIVST results reported that used it with their sexual partners at the onset of intercourse. Participants on daily PrEP were more likely to use HIVST (adjusted hazard ratio=1.3, 95% CI 1.0-1.6) and distribute HIVST kits (adjusted hazard ratio=1.3, 95% CI 1.1-1.7) than those using on-demand PrEP. CONCLUSIONS MSM who used PrEP had a high rate of usage and secondary distribution of HIVST kits, especially among those on daily PrEP, which suggested high feasibility and necessity for HIVST after PrEP initiation. Assuming that fourth-generation HIVST kits are available, HIVST may be able to replace facility-based HIV testing to a certain extent. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1800020374; https://www.chictr.org.cn/showprojen.aspx?proj=32481. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2019-036231.
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Affiliation(s)
- Jing Zhang
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Joseph Tucker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.,University of North Carolina at Chapel Hill Project-China, Guangzhou, China
| | - Weiming Tang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China.,Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Hongyi Wang
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Zhenxing Chu
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Qinghai Hu
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Xiaojie Huang
- Center for Infectious Diseases, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Yaokai Chen
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Hui Wang
- Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, China
| | - Xiaoqing He
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Yao Li
- Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China
| | - Lukun Zhang
- Department of Infectious Diseases, Shenzhen Third People's Hospital, Shenzhen, China
| | - Zhili Hu
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Rantong Bao
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Shangcao Li
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Hang Li
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Haibo Ding
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Yongjun Jiang
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Wenqing Geng
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Junjie Xu
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Hong Shang
- NHC Key Laboratory of AIDS Immunology, National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.,Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.,Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
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