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Yue T, Zhang P, Hao Y, He J, Zheng J, De Clercq E, Li G, Huang Y, Zheng F. Epidemiology and Clinical Outcomes of HIV Infection in South-Central China: A Retrospective Study From 2003 to 2018. Front Public Health 2022; 10:902537. [PMID: 35757651 PMCID: PMC9218543 DOI: 10.3389/fpubh.2022.902537] [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] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/09/2022] [Indexed: 12/02/2022] Open
Abstract
Objective HIV epidemiology in South-Central China is rarely reported. This study aims to characterize epidemiological and clinical features of HIV-infected patients in Hunan Province, located in South-Central China, for better management of HIV infections. Methods This retrospective study retrieved multi-center records of laboratory-confirmed HIV-infected patients in Hunan province. Information on HIV-associated mortality and antiretroviral therapies was also collected. Results Among 34,297 patients diagnosed with HIV infections from 2003 to 2018, 73.9% were males, 41.3% were older adults (≥50 years), and 71.2% were infected by heterosexual transmission. Despite a slow growth of new HIV infections in the overall population, annual percentages of HIV infections increased in older males (85.3% through heterosexual transmission) and young patients <30 years (39.9% through homosexual transmission). At baseline, serum levels of CD4+ T-cell counts were lower in older adults (191.0 cells/μl) than in young patients (294.6 cells/μl, p-value < 0.0001). A large proportion (47.2%, N = 16,165) of HIV-infected patients had advanced HIV disease (CD4+ T-cell counts < 200 cells/μl) from 2003 to 2018. All-cause mortality (57.0% due to AIDS-related illnesses) was reported among 4411 HIV-infected patients, including 2619 older adults. The 10-year survival rate was significantly lower in elderly males than in other patients (59.0 vs. 78.4%, p-value < 0.05). Conclusions Elderly males are prone to HIV infections with a high risk of HIV-associated fatality. Our findings support early prevention and critical care for elderly populations to control HIV infections.
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Affiliation(s)
- Tingting Yue
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Pan Zhang
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jianmei He
- Hunan Center for Disease Control and Prevention, Changsha, China
| | - Jun Zheng
- Hunan Center for Disease Control and Prevention, Changsha, China
| | - Erik De Clercq
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Guangdi Li
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
- Hunan Children's Hospital, Changsha, China
| | - Yaxiong Huang
- Department of Infectious Disease, The First Hospital of Changsha, Changsha, China
| | - Fang Zheng
- Department of Infectious Disease, The First Hospital of Changsha, Changsha, China
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2
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Cao W, You X, Li J, Peng L, Gu J, Hao C, Hou F, Wei D, Deng Y, Hao Y, Mo PKH. Same-sex behavior disclosure to health care providers associated with greater awareness of pre-exposure prophylaxis. BMC Public Health 2021; 21:2243. [PMID: 34893061 PMCID: PMC8665488 DOI: 10.1186/s12889-021-12317-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This study aimed to determine whether the disclosure of same-sex behavior to health care providers (HCPs) is associated with higher rates of prior human immunodeficiency virus (HIV) testing experience and greater awareness of immediate antiretroviral therapy (ART), Undetectable = Untransmittable (U=U), and pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM). METHODS We conducted a cross-sectional survey among 689 adult males in Chengdu, China who self-reported having had anal intercourse with at least one man in the past 6 months. We measured same-sex behavior disclosure to three types of HCPs (hospital clinicians, community-based organization peer educators, and Center for Disease Control and Prevention public health specialists), and the awareness of immediate ART, U=U, and PrEP. RESULTS Of the 689 enrolled participants, 31.4% had disclosed their same-sex behavior to some or all of the clinicians, 83.9% had done so to the peer educators, and 56.8% had done so to the public health specialists. Approximately four in five (82.1%) of the participants had ever been tested for HIV. The awareness rate was 84.8% for immediate ART, 20.2% for U=U, and 50.7% for PrEP. After controlling for significant background variables, same-sex behavior disclosure to clinicians was associated with greater awareness of PrEP (adjusted odds ratio [AOR] = 1.64; 95% confidence interval [CI]: 1.08-2.48), but similar findings were not reported regarding disclosure to peer educators or public health specialist. Same-sex behavior disclosure to any types of HCPs was not associated with HIV testing experience, and awareness of immediate ART or U=U. CONCLUSIONS The rates of same-sex behavior disclosure varied with different types of HCPs. Disclosure to clinicians was associated with greater awareness of PrEP, but not awareness of immediate ART or U=U.
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Affiliation(s)
- Wangnan Cao
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Xinyi You
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jinghua Li
- School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Liping Peng
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jing Gu
- School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Chun Hao
- School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
| | - Fengsu Hou
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China.,Department of Public Mental Health, Kangning Hospital, Shenzhen, Guangdong, China
| | - Dannuo Wei
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yang Deng
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yuantao Hao
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Phoenix Kit-Han Mo
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Ngan Shing St, Shatin, Hong Kong.
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3
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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: 0.5] [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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4
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Smith MK, Wei C, Liu C, Pan SW, Ong JJ, Tucker JD. Gender Identity and Sexual Orientation in Chinese Men Who Have Sex with Men: A Latent Class Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:721-731. [PMID: 31571020 PMCID: PMC7035172 DOI: 10.1007/s10508-019-01481-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 05/24/2019] [Accepted: 06/01/2019] [Indexed: 06/10/2023]
Abstract
Men who have sex with men (MSM) are a diverse population yet are often treated as a monolithic risk group. In China, MSM have long been characterized as a "bridge population" of closeted men who are married to (or will marry) women due to sociocultural expectations. Latent class models can inform a more nuanced yet empirical characterization of this population. In total, 1424 eligible respondents recruited online provided self-reported behavioral data. Nine items related to constructs including sexual behaviors, sexual orientation, and gender identity informed the latent class model. Logistic regression was used to measure associations between latent class membership and HIV-related sexual and health-seeking behaviors. Model fit indicated a population structure made up of four classes that we characterized as "Gender nonconforming" (4.3%), "Closeted-unmarried" (29.9%), "Closeted-married" (24.6%), and "Out" (41.2%). Members of the "gender nonconforming" class were more likely to report HIV-related risk behaviors, and "Closeted-unmarried" class members were less likely to report health-seeking behaviors, both relative to "Out" members. The largest latent class was made up of members of the "Out" class, an enlightening revision of a population traditionally viewed as largely closeted men. Two types of "closeted" classes emerged, distinguished by divergent tendencies regarding marriage and health seeking. Findings suggest that current understandings of Chinese MSM are simplistic (regarding closeted behaviors) and too narrow (in its definition of MSM as cisgender men). A more nuanced understanding of MSM subgroups and their heterogeneous risk behaviors will be critical for provision of more meaningful prevention services.
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Affiliation(s)
- M Kumi Smith
- Division of Epidemiology and Community Health, University of Minnesota Twin Cities, 1300 South 2nd St., Suite 300, Minneapolis, MN, 55454, USA.
- University of North Carolina Project-China, Guangzhou, China.
| | - Chongyi Wei
- University of North Carolina Project-China, Guangzhou, China
- Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, New Brunswick, NJ, USA
| | - Chuncheng Liu
- University of North Carolina Project-China, Guangzhou, China
- Department of Sociology, University of California San Diego, San Diego, CA, USA
| | - Stephen W Pan
- University of North Carolina Project-China, Guangzhou, China
- Xi'an Jiatong-Liverpool University, Suzhou, China
| | - Jason J Ong
- University of North Carolina Project-China, Guangzhou, China
- London School of Hygiene and Tropical Medicine, London, England, UK
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China
- Department of Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
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5
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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: 1.3] [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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6
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Luo H, Sun M, Du J. Associated factors for progression to AIDS among HIV-infected people who use drugs: a retrospective cohort study in Dongguan, China. BMJ Open 2019; 9:e023841. [PMID: 31272970 PMCID: PMC6615836 DOI: 10.1136/bmjopen-2018-023841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Injection drug use is the most important risk factor for the spread of HIV in China over the past two decades. People who use drugs (PWUD) who were diagnosed at an early stage with HIV have gradually developed AIDS. This study investigated the factors associated with disease progression following HIV diagnosis in PWUD. DESIGN This study used a retrospective cohort study. SETTING This investigation was conducted in Dongguan city, Guangdong Province, China. PARTICIPANTS A total of 2969 PWUD with HIV were recruited from 1 January 1995 to 31 December 2014. PRIMARY AND SECONDARY OUTCOME MEASURES Kaplan-Meier method, Logistic regression and Cox proportional hazards regression model were applied to identify the related factors of progression to AIDS following HIV diagnosis. RESULTS The study revealed that age at diagnosis, marital status, baseline CD4 T-cell counts and highly active antiretroviral therapy (HAART) were statistically significant (p<0.01), either in the patients with HIV or in patients with AIDS. Compared with HIV-infected individuals of 18 years, patients with AIDS who were at least 36 years of age possessed sharply increased HR for developing AIDS (HR=7.016, 95% CI 6.083 to 8.092, p=0.001). The single HIV-positive individuals (HR=0.691, 95% CI 0.588 to 0.811, p=0.001) were less likely to develop AIDS compared with married ones. Increasing baseline CD4 T-cell counts, HAART (HR=0.599, 95% CI 0.517 to 0.693, p=0.001) and condom usage (HR=0.825, 95% CI 0.710 to 0.959, p=0.012) were associated with delayed progression to AIDS. CONCLUSIONS Our study found that increasing baseline CD4 T-cell counts, HAART and condom usage might be associated with delayed the progression of HIV to AIDS, while increasing age at diagnosis, marital status increased hazard for developing AIDS.
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Affiliation(s)
- Hao Luo
- Department of Environmental and Occupational Health, Dongguan Key Laboratory of Environmental Medicine, School of Public Health, Guangdong Medical University, Zhanjiang, China
| | - Mingwei Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical University, Dongguan, China
| | - Jinlin Du
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical University, Dongguan, China
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7
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Tang S, Tang W, Meyers K, Chan P, Chen Z, Tucker JD. HIV epidemiology and responses among men who have sex with men and transgender individuals in China: a scoping review. BMC Infect Dis 2016; 16:588. [PMID: 27765021 PMCID: PMC5073436 DOI: 10.1186/s12879-016-1904-5] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite global efforts to control HIV among key populations, new infections among men who have sex with men (MSM) and transgender (TG) individuals are still increasing. The increasing HIV epidemic among MSM/TG in China indicates that more effective services are urgently needed. However, policymakers and program managers must have a clear understanding of MSM/TG sexual health in China to improve service delivery. To meet this need, we undertook a scoping review to summarize HIV epidemiology and responses among MSM and TG individuals in China. METHODS We searched MEDLINE, EMBASE and the Cochrane Library for recent studies on MSM/TG HIV epidemiology and responses. We also included supplemental articles, grey literature, government reports, policy documents, and best practice guidelines. RESULTS Overall, HIV prevalence among Chinese MSM was approximately 8 % in 2015 with a higher prevalence observed in Southwest China. TG are not captured in national HIV, STD, or other sexual health surveillance systems. There is limited data sharing between the public health authorities and community-based organizations (CBOs). Like other low and middle income countries, China is challenged by low rates of HIV testing, linkage, and retention. Several pilot interventions have been shown to be effective to increase HIV testing among MSM and TG individuals, but have not been widely scaled up. Data from two randomized controlled trials suggests that crowdsourcing contests can increase HIV testing, creating demand for services while engaging communities. CONCLUSION Improving HIV surveillance and expanding HIV interventions for Chinese MSM and TG individuals are essential. Further implementation research is needed to ensure high-quality HIV services for MSM and TG individuals in China.
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Affiliation(s)
- Songyuan Tang
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
- Guangdong Provincial Center for Skin Diseases and STI Control, Guangzhou, China
- SESH Global, Guangzhou, China
- Kunming Medical University, Kunming, China
| | - Weiming Tang
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
- Guangdong Provincial Center for Skin Diseases and STI Control, Guangzhou, China
- SESH Global, Guangzhou, China
| | | | | | | | - Joseph D. Tucker
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
- Guangdong Provincial Center for Skin Diseases and STI Control, Guangzhou, China
- SESH Global, Guangzhou, China
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8
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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: 5.4] [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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9
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Li J, Luo J, Li J, Liu H. Disassortative mixing patterns of drug-using and sex networks on HIV risk behaviour among young drug users in Yunnan, China. Public Health 2015; 129:1237-43. [PMID: 26298584 DOI: 10.1016/j.puhe.2015.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 03/06/2015] [Accepted: 07/13/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The dominant mode of HIV transmission in China has changed from injection drug use to sexual contact. The objectives of this study were to describe the disassortative and assortative mixing patterns of drug-using and sex networks among young drug users in China. STUDY DESIGN Cross-sectional study. METHODS Respondent-driven sampling (RDS) was used to recruit young drug users in an egocentric network study in Yunnan, China. Egos were categorized as having disassortative mixing network patterns if they reported both sex and drug-using networks. Egos who only had a sex network (no drug-using network), or only a drug-using network (no sex network) were categorized as having assortative mixing network patterns. Multiple logistic regression was performed to analyze the relationships between disassortative patterns with risky sexual behaviour and drug-using practices. RESULTS A total of 426 participants were recruited into the study. Two hundred forty-two egos reported disassortative mixing patterns and 139 egos had assortative patterns. The RDS-adjusted proportion of having a disassortative pattern was 53.2%. Participants with disassortative patterns were more likely to engage in HIV risk behaviour compared to those with assortative patterns. Specifically, drug users with disassortative patterns reported more multiple sex partners (31.4% vs 19.6%), concurrent partnerships (52.1% vs 39.0%), non-regular sex partners (12.0% vs 4.3%), and sex partners who were IDUs (24.9% vs 12.5%). Consistent condom use with regular or non-regular partners was low (between 18.9% and 47.2%) regardless of the mixing pattern. However, parenteral risk for HIV transmission was relatively low in both groups. CONCLUSIONS The transition of the HIV epidemic in China from injection drug use to sexual contact may be attributed to disassortative mixing in drug-use and sexual networks. HIV programs should consider disassortative mixing patterns when designing new behavioural interventions.
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Affiliation(s)
- J Li
- School of Public Health, University of Maryland, College Park, MD, USA; National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - J Luo
- Yunnan Institute for Drug Abuse, Kunming, Yunnan, China
| | - J Li
- Yunnan Institute for Drug Abuse, Kunming, Yunnan, China.
| | - H Liu
- School of Public Health, University of Maryland, College Park, MD, USA.
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10
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Liu J, Qu B, Zhu Y, Hu B. The influence of social support on quality of life of men who have sex with men in China: a preliminary study. PLoS One 2015; 10:e0127644. [PMID: 26010133 PMCID: PMC4444086 DOI: 10.1371/journal.pone.0127644] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 04/17/2015] [Indexed: 11/19/2022] Open
Abstract
The quality of life (QOL) of men who have sex with men (MSM) has received increasing attention in recent years. Our study surveyed the QOL and explored the influence of social support on QOL in Chinese MSM. A cross-sectional survey was conducted from September 2013 to March 2014 of 438 MSM in Huludao and Zhengzhou City, China. The results of univariate analysis showed that higher QOL scores were associated with receiving psychosocial counseling, higher health education, younger age and marital status of being single or unmarried p < 0.05). The structural equation model fitted well, with χ2 = 2083.47 (p < 0.05), RMSEA = 0.07, and GFI = 0.88. Among the latent factors, social support, with a factor load of 0.47, had greater impact on QOL than demographic characteristics. Within social support, the item loads for psychosocial counseling and health education were 0.17 and 0.29, respectively. Basic demographic characteristics also influenced social support, with a factor load of -0.65. For demographic characteristics, the greatest item loads were for marital status and age (0.77 and 0.71, respectively). These findings suggest that strengthening social support, especially for older and married individuals, would improve QOL in MSM in China.
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Affiliation(s)
- Jie Liu
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, Liaoning Province, China
| | - Bo Qu
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, Liaoning Province, China
- * E-mail:
| | - Yaxin Zhu
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, Liaoning Province, China
| | - Bingxue Hu
- Department of Health Statistics, School of Public Health, China Medical University, Shenyang, Liaoning Province, China
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Huang S, Tang W, Zhu Z, Lu H, Tan X, Zhang B, Best J, Yang L, Zheng H, Jiang N, Yin Y, Yang B, Chen X. Higher prevalence of sexual transmitted diseases and correlates of genital warts among heterosexual males attending sexually transmitted infection clinics (MSCs) in Jiangmen, China: implication for the up-taking of STD related service. PLoS One 2015; 10:e0121814. [PMID: 25811185 PMCID: PMC4374714 DOI: 10.1371/journal.pone.0121814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/04/2015] [Indexed: 01/28/2023] Open
Abstract
Background Increasing burden of STDs is one of China’s major public health concerns. However, only a limited number of studies have ever investigated the prevalence of these STDs, particular for genital warts and its correlates among heterosexual males attending STD clinics in China. In order to fill this gap, we conducted a cross-sectional study among MSCs in Jiangmen, China, between the years of 2009 and 2010. Method The eligible participants were recruited from several STD-clinics in public hospitals. We collected demographic information and behaviors of the participants. After HIV and syphilis testing, we further checked whether the participants had genital warts and genital herpes. In addition, urine samples were collected from part of the participants for CT and NG testing. Results Of the 533 eligible participants, over three-fifths were aged 35 or below, nearly three quarters had no college degree, over three-fifths were residence of Jiangmen. The prevalence of HIV, syphilis, genital warts, genital herpes, CT and NG were 0.19%, 7.50%, 7.32%, 5.25%, 9.73% and 6.19%, respectively. Living with family members (versus living alone), no STD-related service in past year, experiencing STDs related symptoms in past year, and sex with FSWs in last three months were positively associated with genital warts, with adjusted ORs of 5.54 (95% CI 1.94–15.81), 2.26 (95% CI 1.08–4.74), 1.99 (95% CI 1.00–3.99) and 2.01 (95% CI 1.00–4.04), respectively. Conclusion Our study indicates that the prevalence of STDs among MSCs in Jiangmen was high, which may further spread HIV among MSCs. Targeted interventions that focused on STDs related services uptake should be implemented urgently.
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Affiliation(s)
- Shujie Huang
- Guangdong Provincial Center for Skin Diseases and STI Control, No. 2 Lujing Road, Guangzhou, 510095, China
| | - Weiming Tang
- Guangdong Provincial Center for Skin Diseases and STI Control, No. 2 Lujing Road, Guangzhou, 510095, China
- University of North Carolina Project-China, No. 2 Lujing Road, Guangzhou, 510095, China
| | - Zhengjun Zhu
- Jiangmen Dermatology Hospital, No. 62 Yuejin Road, Jiangmen, 529000, China
| | - Hekun Lu
- Jiangmen Dermatology Hospital, No. 62 Yuejin Road, Jiangmen, 529000, China
| | - Xueling Tan
- Jiangmen Dermatology Hospital, No. 62 Yuejin Road, Jiangmen, 529000, China
| | - Baoyuan Zhang
- Jiangmen Dermatology Hospital, No. 62 Yuejin Road, Jiangmen, 529000, China
| | - John Best
- Department of Medicine, Medical School, University of California San Francisco, San Francisco, CA, 94143, United States of America
| | - Ligang Yang
- Guangdong Provincial Center for Skin Diseases and STI Control, No. 2 Lujing Road, Guangzhou, 510095, China
| | - Heping Zheng
- Guangdong Provincial Center for Skin Diseases and STI Control, No. 2 Lujing Road, Guangzhou, 510095, China
| | - Ning Jiang
- National Center for STD Control, China CDC. No. 12, Jiangwangmiao, Nanjing, Jiangsu, 210000, China
| | - Yueping Yin
- National Center for STD Control, China CDC. No. 12, Jiangwangmiao, Nanjing, Jiangsu, 210000, China
| | - Bin Yang
- Guangdong Provincial Center for Skin Diseases and STI Control, No. 2 Lujing Road, Guangzhou, 510095, China
- * E-mail: (BY); (XC)
| | - Xiangsheng Chen
- National Center for STD Control, China CDC. No. 12, Jiangwangmiao, Nanjing, Jiangsu, 210000, China
- * E-mail: (BY); (XC)
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12
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Fu GF, Jiang N, Hu HY, Mahapatra T, Yin YP, Mahapatra S, Wang XL, Chen XS, Babu GR, Xu XQ, Ding P, Qiu T, Liu XY, Guo H, Huan XP, Tang W. The epidemic of HIV, syphilis, chlamydia and gonorrhea and the correlates of sexual transmitted infections among men who have sex with men in Jiangsu, China, 2009. PLoS One 2015; 10:e0118863. [PMID: 25775451 PMCID: PMC4361608 DOI: 10.1371/journal.pone.0118863] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 01/07/2015] [Indexed: 12/18/2022] Open
Abstract
Background In China, the HIV/AIDS epidemic is expanding among men who have sex with men (MSM). As independent risk factors of HIV infection, the epidemics of Chlamydia (CT) and Gonorrhea (NG) in MSM were not well studied, particular for the risk factors of these infectious. The objectives of current reported study were to understand the dynamics of HIV and other sexual transmitted infections (STIs) among MSM in Jiangsu, China, and to measure factors that correlated with STIs. Methods In order to gain more participants, a multisite cross-sectional study design was used in our study, by using convenience-sampling to recruit MSM in two Changzhou and Yangzhou, Jiangsu, China, between the July and October of 2009. Results In this comprehensive survey involving MSM in two cities of Jiangsu province of China, the prevalence of STIs of CT (6.54%), NG (3.63%), syphilis (20.34%) and HIV (11.62%) were measured. Overall, the STIs prevalence (CT, NG or syphilis) for the participants in our study was 26.39%, meanwhile, 3.4% (14 out of the 413) participants had at least two kinds of STIs. Meeting casual partners at parks, public restrooms or other public areas, having had anal sex with men in the past six months, having had STI symptoms in the past year were positively correlated with STIs positive, with adjusted ORs of 4.61(95%CI 1.03–20.75), 1.91(95%CI 1.14–3.21) and 2.36(95%CI 1.07,5.24). Conclusion Our study findings reiterate the fact that Chinese MSM are highly susceptible to acquiring syphilis, CT, NG and HIV, and there is an urgent need for intervention targeted towards this population. Behavioral measures should constitute an important part of the targeted intervention. Furthermore, the already implemented preventive and diagnostic services for HIV should be expanded to include syphilis CT and NG, too.
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Affiliation(s)
- Geng-Feng Fu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Ning Jiang
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Hai-Yang Hu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Tanmay Mahapatra
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Yue-Ping Yin
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Sanchita Mahapatra
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Xiao-Liang Wang
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Xiang-Sheng Chen
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, China
| | - Giridhar R. Babu
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Xiao-Qin Xu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Ping Ding
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Tao Qiu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Xiao-Yan Liu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Hongxiong Guo
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Xi-Ping Huan
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
- * E-mail: (XPH); (WT)
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
- * E-mail: (XPH); (WT)
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Yang X, Yuan Y, Pang Y, Wang B, Bai Y, Wang Y, Yu B, Zhang Z, Fan M, Zhao Y. The burden of MDR/XDR tuberculosis in coastal plains population of China. PLoS One 2015; 10:e0117361. [PMID: 25689373 PMCID: PMC4331508 DOI: 10.1371/journal.pone.0117361] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 12/22/2014] [Indexed: 11/18/2022] Open
Abstract
Background We conducted a first baseline survey in Jilin Province of China to determine the proportion of drug-resistant tuberculosis (TB), and to analyze risk factors associated with the emergence of drug-resistance. Methodology/Principal Findings Thirty counties in Jilin Province were randomly selected as survey sites using a stratified cluster sampling method. People enrolled in the survey were new and re-treated, smear-positive pulmonary TB patients newly enrolled in local TB control and prevention institutions during the survey period. Sputum samples were collected, and the susceptibility of bacterial strains to anti-TB drugs was analyzed by proportion method. Based on the survey results, we estimated the number of drug-resistant TB patients and analyzed the risk factors associated with the emergence of drug resistance. Of 1,174 new TB patients and 597 re-treated TB patients, 8.6% and 23.2% were multi-drug resistant (MDR)-TB patients, respectively. Approximately 12% of MDR-TB patients were extensively drug-resistant. We estimate that approximately 1,290 new MDR-TB cases develop in Jilin Province every year. Of these, 810 cases would be new patients, and 480 cases would involve re-treated patients. Risk factors associated with MDR-TB include employment status, educational background, and income level. Conclusions/Significance Jilin Province remains one of the highest-burden areas in China for drug-resistant TB. The higher number of MDR-TB among new cases suggested that the transmission of drug-resistant strains in Jilin is an urgent problem in the MDR-TB control and prevention system of Jilin Province. Improving the treatment compliance of TB patients and the quality of medical care in public health institutions is urgently needed.
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Affiliation(s)
- Xiujun Yang
- Jilin Province Center for Disease Control and Prevention, Changchun, China
| | - Yanli Yuan
- Jilin Province Center for Disease Control and Prevention, Changchun, China
| | - Yu Pang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bo Wang
- Jilin Province Center for Disease Control and Prevention, Changchun, China
| | - Yunlong Bai
- Jilin Province Center for Disease Control and Prevention, Changchun, China
| | - Yanhua Wang
- Jilin Province Center for Disease Control and Prevention, Changchun, China
| | - Baozhu Yu
- Jilin Province Center for Disease Control and Prevention, Changchun, China
| | | | - Ming Fan
- Jilin Province Center for Disease Control and Prevention, Changchun, China
- * E-mail: (YZ); (MF)
| | - Yanlin Zhao
- Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (YZ); (MF)
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Huang ZJ, Hu D, Chang R, Zaccaro H, Iguchi M, Zheng H, He N. Female streetwalkers' perspectives on migration and HIV/STI risks in a changing economic and social environment: a qualitative study in Shanghai, China. CULTURE, HEALTH & SEXUALITY 2015; 17:763-776. [PMID: 25587711 PMCID: PMC4382416 DOI: 10.1080/13691058.2014.990518] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
China's 30-year economic boom has created a unique social and economic market for commercial sex, as well as for a workforce of migrant women from rural China. This qualitative study explores the impact of the rapidly changing social and economic environment on migration patterns, knowledge of sexually transmitted infections (STIs), STI risk behaviours and health beliefs among female streetwalkers in Shanghai. Qualitative data were collected in 2010 through semi-structured in-depth interviews with 16 streetwalkers to characterise their migration passages, sexual health and behaviours, and peer networks. Many streetwalkers reported histories of childhood impoverishment, of family or partner violence or trauma, of migration consistent with the timeline and routes of economic development and of a scarcity in health, social or economic support. Their knowledge of the prevention and treatment of HIV and STIs was limited. They had little bargaining power on condom use and the majority resorted to vaginal douching and self-management with antibiotics as preventative measures. The study identifies streetwalkers' perspectives on the changing environment, their options and actions and, finally, HIV/STI risks that were unique to this hidden population.
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Affiliation(s)
- Z. Jennifer Huang
- Department of International Health, Georgetown University, Washington, DC, USA
| | - Dier Hu
- Department of International Health, Georgetown University, Washington, DC, USA
| | - Ruth Chang
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Heather Zaccaro
- Department of International Health, Georgetown University, Washington, DC, USA
| | - Martin Iguchi
- Department of Psychology, Georgetown University, Georgetown University, Washington, DC, USA
| | | | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
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15
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Li L, Assanangkornchai S, Duo L, McNeil E, Li J. Risk behaviors, prevalence of HIV and hepatitis C virus infection and population size of current injection drug users in a China-Myanmar border city: results from a Respondent-Driven Sampling Survey in 2012. PLoS One 2014; 9:e106899. [PMID: 25203256 PMCID: PMC4159231 DOI: 10.1371/journal.pone.0106899] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 08/10/2014] [Indexed: 02/06/2023] Open
Abstract
Background Injection drug use has been the major cause of HIV/AIDS in China in the past two decades. We measured the prevalences of HIV and hepatitis C virus (HCV) prevalence and their associated risk factors among current injection drug users (IDUs) in Ruili city, a border region connecting China with Myanmar that has been undergoing serious drug use and HIV spread problems. An estimate of the number of current IDUs is also presented. Methods In 2012, Chinese IDUs who had injected within the past six months and aged ≥18 years were recruited using a respondent-driven sampling (RDS) technique. Participants underwent interviews and serological testing for HIV, HBV, HCV and syphilis. Logistic regression indentified factors associated with HIV and HCV infections. Multiplier method was used to obtain an estimate of the size of the current IDU population via combining available service data and findings from our survey. Results Among 370 IDUs recruited, the prevalence of HIV and HCV was 18.3% and 41.5%, respectively. 27.1% of participants had shared a needle/syringe in their lifetime. Consistent condom use rates were low among both regular (6.8%) and non-regular (30.4%) partners. Factors independently associated with being HIV positive included HCV infection, having a longer history of injection drug use and experience of needle/syringe sharing. Participants with HCV infection were more likely to be HIV positive, have injected more types of drugs, have shared other injection equipments and have unprotected sex with regular sex partners. The estimated number of current IDUs in Ruili city was 2,714 (95% CI: 1,617–5,846). Conclusions IDUs may continue to be a critical subpopulation for transmission of HIV and other infections in this region because of the increasing population and persistent high risk of injection and sexual behaviours. Developing innovative strategies that can improve accessibility of current harm reduction services and incorporate more comprehensive contents is urgently needed.
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Affiliation(s)
- Lei Li
- Yunnan Institute of Drug Abuse, Kunming, Yunnan, P.R. China
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
- * E-mail:
| | - Lin Duo
- HIV/AIDS Asia Regional Program Yunnan Management Office, Kunming, Yunnan, P.R. China
| | - Edward McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Jianhua Li
- Yunnan Institute of Drug Abuse, Kunming, Yunnan, P.R. China
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Wang L, Tang W, Wang L, Qian S, Li YG, Xing J, Li D, Ding Z, Babu GR, Wang N. The HIV, syphilis, and HCV epidemics among female sex workers in china: results from a serial cross-sectional study between 2008 and 2012. Clin Infect Dis 2014; 59:e1-9. [PMID: 24723287 PMCID: PMC4305149 DOI: 10.1093/cid/ciu245] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies on the transmission of human immunodeficiency virus (HIV) and sexually transmitted diseases in female sex workers (FSWs) have been limited primarily to inferences drawn by focusing on defined geographical areas. METHODS AND FINDINGS This serial cross-sectional study was conducted in mainland China from 2008 through 2012. Data for 827 079 participants was analyzed. We classified venues such as karaoke bars and hotels as high tier and venues such as hair salons and barbershops, massage parlors, and other public outdoor venues as low tier based on the participants' socioeconomic status. FSWs who worked at the venues and those who were present on the days of the survey were recruited. The prevalence of HIV decreased from 0.6% in 2008 to 0.3% in 2012, the syphilis prevalence ranged from 2.4% to 3.2% between 2008 and 2012, and hepatitis C virus (HCV) prevalence decreased from 0.9% in 2008 to 0.8% in 2012. Further, we found that HIV, syphilis, and HCV prevalence proportions were high in FSWs from low tiers. CONCLUSIONS HIV, syphilis, and HCV prevalence among FSWs in our study decreased during the study period. Comprehensive intervention strategies, particularly those that focus on low-tier and older FSWs, are needed in order to decrease the disease burden in this population.
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Affiliation(s)
- Lu Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - Lan Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shasha Qian
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yin-Ge Li
- School of Public Health, Harvard School of Public Health
| | - Jiannan Xing
- 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
| | - Zhengwei Ding
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Giridhara R Babu
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Ning Wang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Li J, Zhang H, Shen Z, Zhou Y, Fang N, Wang L, Wang B, Wang J, Tang Z. Screening for acute HIV infections and estimating HIV incidence among female sex workers from low-grade venues in Guangxi, China. PLoS One 2014; 9:e99522. [PMID: 24918933 PMCID: PMC4053442 DOI: 10.1371/journal.pone.0099522] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 05/15/2014] [Indexed: 12/05/2022] Open
Abstract
Background Guangxi has become one of the provinces with the most severe HIV-1 epidemic in China, where heterosexual contact is the dominant transmission route. However, data of acute HIV infections and HIV incidence among female sex workers (FSWs) from low-grade venues are scant. Methods A cross-sectional survey was performed among FSWs from low-grade venues in Guangxi. HIV antibody screening was performed by rapid testing (RT). HIV antibody–negative specimens were screened by pooled nucleic acid amplification testing (NAAT) for acute HIV infections. HIV antibody-positive specimens were further analyzed by Western blot (WB), followed by an HIV-1 BED capture enzyme immunoassay (BED-CEIA) to identify the recent infections. HIV-1 incidence was estimated by the data of pooled NAAT and BED-CEIA, respectively. Results A total of 7936 FSWs were recruited and answered the questionnaires. We successfully collected the blood samples from 6469 (81.5%) participants, of which 139 (2.1%) were HIV antibody–positive and 6330 (97.9%) were HIV antibody-negative by RT. With pooled NAAT, 7 cases were found to be HIV RNA positive, representing an additional 5.0% of HIV-infected persons and an estimated HIV incidence of 1.45 (95% CI: 1.17–1.76) per 100 person years. There were 137 positive and 2 indeterminate by WB, of which 124 (90.5%) positive specimens were subjected to BED-CEIA testing identifying 28 recent infections. The HIV incidence determined by BED-CEIA testing was 1.04 (95% CI: 0.65–1.43) per 100 person years. The overall prevalence of HIV among FSWs from low-grade venues in Guangxi was 2.2% (95% CI: 1.9–2.6). Conclusions We found that the addition of HIV RNA screening to routine HIV antibody testing significantly improved the detection of HIV infection among FSWs from low-grade venues in Guangxi. Our findings also provided the useful baseline data of HIV incidence among this population for targeting local HIV prevention, intervention, monitoring and treatment.
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Affiliation(s)
- Jianjun Li
- Guangxi Central Laboratory of HIV/AIDS Confirmation, Institute of HIV/AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Hongman Zhang
- Guangxi Central Laboratory of HIV/AIDS Confirmation, Institute of HIV/AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Zhiyong Shen
- Institute of HIV/AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Yuejiao Zhou
- Institute of HIV/AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Ningye Fang
- Guangxi Central Laboratory of HIV/AIDS Confirmation, Institute of HIV/AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Lu Wang
- Guangxi Central Laboratory of HIV/AIDS Confirmation, Institute of HIV/AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Bin Wang
- Guangxi Central Laboratory of HIV/AIDS Confirmation, Institute of HIV/AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Jiangwei Wang
- Guangxi Central Laboratory of HIV/AIDS Confirmation, Institute of HIV/AIDS Prevention and Control, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Zhenzhu Tang
- Guangxi Center for Disease Control and Prevention, Nanning, China
- * E-mail:
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Prevalence of HIV and syphilis infection among men who have sex with men in China: a meta-analysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:620431. [PMID: 24868533 PMCID: PMC4017804 DOI: 10.1155/2014/620431] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 01/06/2014] [Indexed: 12/02/2022]
Abstract
Objectives. To figure out the most current prevalence of HIV and syphilis in MSM in China. Methods. A meta-analysis was conducted on the studies searched through PubMed, CNKI, and Wanfang published between 1 January 2009 and 11 April 2013. Results. Eighty-four eligible studies, either in Chinese or in English, were included in this review. The pooled prevalence of HIV and syphilis infection in MSM in China was 6.5% and 11.2%, respectively. The subgroup analyses indicated that the prevalence of HIV infection was higher in the economically less developed cities than that in the developed cities (7.5% versus 6.1%, P < 0.05). In contrast, the prevalence of syphilis infection was lower in less developed cities than in developed cities (8.6% versus 15.1%). Studies with a sample size smaller than 500 had a lower prevalence of HIV and syphilis infection than those with a sample size greater than 500 (5.9% versus 7.2% for HIV; 11.0% versus 11.5% for syphilis, respectively). Conclusions. HIV and syphilis infection are prevalent in MSM in China. The different prevalence of HIV and syphilis infection between developing and developed cities underscores the need to target prevention strategies based on economic conditions.
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Liu XY, Hao C, Jiang H, Sun L, Zhou JB, Yin YP, Tang W, Jiang N, Mahapatra T, Mahapatra S, Chen XS, Yang HT, Fu GF, Huan XP. Syphilis and its correlates among heterosexual males attending sexually transmitted infection clinics - observation from a multicity cohort in Jiangsu Province, China. PLoS One 2014; 9:e95289. [PMID: 24743839 PMCID: PMC3990697 DOI: 10.1371/journal.pone.0095289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 03/25/2014] [Indexed: 11/23/2022] Open
Abstract
Objectives To estimate the prevalence of HIV and syphilis, incidence of syphilis and to identify the correlates of syphilis infection among heterosexual male attendees of sexually transmitted infection (STI) clinics (MSC). Methods A cohort study of one-year duration was conducted in Yangzhou and Changzhou cities in Jiangsu province of China. The baseline survey commenced in June 2009, recruited 1225 consenting adult MSCs (609 in Yangzhou and 617 in Changzhou) through STI-clinic based convenience sampling. Results Baseline HIV and syphilis prevalence were 0.49% and 17.29% respectively. Syphilis incidence rate was 7.22 per 100 person-years (6.53 in Yangzhou and 7.76 in Changzhou) during the 6-month follow-up with retention fractions of 27.38% and 35.15% for Yangzhou and Changzhou respectively. Majority of the participants were middle-aged, high school educated, married, living with partners and non-migrants. Very few subjects reported recent and consistent condom-use with regular partners. Although considerable number of MSCs reported recent sexual exposure with female sex workers (FSW) and non-FSW casual partners, the proportion of reported condom use was very low during those exposures. In multivariate analyses higher age, having recent sex with FSWs and being HIV-positive were associated with higher syphilis sero-positivity while higher education was protective. In bivariate analyses, being married, divorced/widowed, official residency of the study cities and non-use of condom with regular partners predicted higher risk. Conclusions Considering the potential bridging role of MSCs between high and low-risk populations, effective intervention strategies among them targeting the correlates of syphilis infection are urgently called for in Jiangsu province of China.
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Affiliation(s)
- Xiao-Yan Liu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Chao Hao
- Changzhou Center for Disease Prevention and Control, Nanjing, China
| | - Hui Jiang
- Yangzhou Center for Disease Prevention and Control, Nanjing, China
| | - Lin Sun
- Yangzhou Center for Disease Prevention and Control, Nanjing, China
| | - Jian-Bo Zhou
- Changzhou Center for Disease Prevention and Control, Nanjing, China
| | - Yue-Ping Yin
- National Center for STDs Control, China CDC, Nanjing, China
| | - Weiming Tang
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Ning Jiang
- National Center for STDs Control, China CDC, Nanjing, China
| | - Tanmay Mahapatra
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Sanchita Mahapatra
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | | | - Hai-Tao Yang
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Geng-Feng Fu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Xi-Ping Huan
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
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Yang HT, Tang W, Xiao ZP, Jiang N, Mahapatra T, Huan XP, Yin YP, Wang XL, Chen XS, Fu GF. Worsening epidemic of HIV and syphilis among men who have sex with men in Jiangsu Province, China. Clin Infect Dis 2014; 58:1753-9. [PMID: 24647017 DOI: 10.1093/cid/ciu175] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Epidemics of human immunodeficiency virus (HIV) and syphilis among men who have sex with men (MSM) are major public health concerns in most parts of China. A dearth of information regarding the current trend of HIV in this hard-to-reach population in several regions including Jiangsu, coupled with the reemergence of syphilis, calls for an effort to understand the dynamics of the dual epidemic in this province. METHODS To estimate the occurrence and burden of these 2 sexually transmitted diseases and the distribution of their potential sociobehavioral correlates among MSM in Jiangsu, 2 cohort studies were conducted in Yangzhou and Changzhou cities. RESULTS Among 839 participants, 48% were married, 51.7% had sex with women in the last 6 months, and 25.5% did not use condoms during their last anal intercourse. The observed incidence of HIV was 13.59 and 12.62 and that of syphilis was 7.33 and 13.25 per 100 person-years among the participants of Yangzhou and Changzhou, respectively. The baseline prevalence of HIV and syphilis was 16.0% and 29.9% in Yangzhou and 13.6% and 14.9% in Changzhou, respectively. CONCLUSIONS Considerably high incidence and prevalence of HIV and syphilis among participants and their potential bridging role in transmitting these infections to the general population in Yangzhou and Changzhou cities calls for urgent effective intervention strategies.
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Affiliation(s)
- Hai-Tao Yang
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, Jiangsu, China
| | - Weiming Tang
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - Zhan-Pei Xiao
- Henan Provincial Center for Disease Prevention and Control, Zhengzhou, Henan
| | - Ning Jiang
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Tanmay Mahapatra
- Department of Epidemiology, School of Public Health, University of California, Los Angeles
| | - Xi-Ping Huan
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, Jiangsu, China
| | - Yue-Ping Yin
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Xiao-Liang Wang
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, Jiangsu, China
| | - Xiang-Sheng Chen
- National Center for STD Control, Chinese Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Geng-Feng Fu
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, Jiangsu, China
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Shao B, Li Y, Yu L, Wang K, Chang M, Wang B, Wang F. The HIV/AIDS epidemic characteristics in a northeast province of China—Men who have sex with men have made a tremendous contribution to the growth of the HIV epidemic. J Infect 2014; 68:273-80. [DOI: 10.1016/j.jinf.2013.10.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 09/22/2013] [Accepted: 10/17/2013] [Indexed: 10/26/2022]
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HIV risk-reduction counseling and testing on behavior change of MSM. PLoS One 2013; 8:e69740. [PMID: 23922787 PMCID: PMC3726787 DOI: 10.1371/journal.pone.0069740] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 06/11/2013] [Indexed: 12/02/2022] Open
Abstract
HIV and AIDS incidence in China is high among men who have sex with men (MSM) and ours was one of few studies in China to evaluate the role of HIV risk reduction counseling and testing. Respondent-driven sampling (RDS) was used to recruit 430 MSM. Participants were followed up at 6, 12 and 18 months to evaluate behavioral changes after counseling to reduce risk behaviors. At baseline, HIV prevalence was 4.7%, whereas HIV incidence was 5.2 per 100 person-years. The incidence was 3.8 during six to 12 months, and 1.1 during 12 to 18 months. During the study period, the reported unprotected anal intercourse (UAI) significantly decreased from 60.9% to 42.9%. The proportion of participants who had one or no partner significantly increased from 40.9% to 48.0%. The study also found that some risk behaviors decreased between baseline and 12 months, followed by a slight increase between 12 and 18 months. Reductions in UAI can be achieved through counseling and testing, but may wane over time. Future programs should consider HIV risk-reduction counseling and testing for interventions in MSM in China.
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Li Y, Xu J, Reilly KH, Zhang J, Wei H, Jiang Y, Geng W, Tang W, Shang H. Prevalence of HIV and syphilis infection among high school and college student MSM in China: a systematic review and meta-analysis. PLoS One 2013; 8:e69137. [PMID: 23874891 PMCID: PMC3712943 DOI: 10.1371/journal.pone.0069137] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 06/04/2013] [Indexed: 11/19/2022] Open
Abstract
Objectives The aim of this study is to systematically review the published studies and summarize the estimates of HIV and syphilis prevalences among high school and college student MSM in China in order to provide information for conducting targeted interventions. Methods Pubmed, Chinese National Knowledge Infrastructure, Wanfang and Google Scholar databases were searched in January 2013 to identify relevant articles. Data of eligible citations were extracted by two reviewers. All analyses were performed using Comprehensive Meta-Analysis V2.0 and SPSS V17.0. Results Twenty-four eligible studies (6 in English and 18 in Chinese), published between 2006 and 2012, with a total of 3083 student MSM participants, were included. The meta-analyses showed that the prevalences of HIV and syphilis among studied student MSM were 4.4% (95% CI: 3.0%, 6.4%) and 5.7% (95% CI: 4.8%, 6.7%), respectively. HIV prevalence increased over the study period (3.0% in 2003–2006; 4.5% in 2007–2008, and 6.8% in 2009–2010, trend test chi-square = 11.3, p = 0.001). Conclusions Student MSM have become high-risk populations for HIV infection in China. The high prevalence of syphilis and the increasing HIV prevalence trend indicate the potential for a more severe HIV epidemic. Comprehensive intervention strategies that address condom promotion, syphilis detection and treatment, and health education need to be tailored to this vulnerable population to prevent HIV and syphilis infections.
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Affiliation(s)
- Yongze Li
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Junjie Xu
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Kathleen H. Reilly
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianming Zhang
- Department of Clinical Epidemiology and Evidence-based Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongyi Wei
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yongjun Jiang
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wenqing Geng
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
| | - Weiming Tang
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Hong Shang
- Key Laboratory of AIDS Immunology of Ministry of Health, Department of Laboratory Medicine, No 1 Hospital of China Medical University, Shenyang, Liaoning, China
- * E-mail:
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Lin H, Ding Y, Liu X, Zhu W, Gao M, He N. Changes in sexual behaviors among HIV-infected individuals after their HIV diagnosis in a rural prefecture of Eastern China. PLoS One 2013; 8:e59575. [PMID: 23527221 PMCID: PMC3601103 DOI: 10.1371/journal.pone.0059575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 02/15/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To describe changes in sexual behaviors among HIV-infected individuals after their HIV diagnosis. METHODS All HIV-infected individuals diagnosed by the end of 2009 in Taizhou Prefecture were invited to participate in this 12-month prospective study. Assessments including the total number and types of sexual contacts, and condom use details for up to their most familiar eight sexual contacts were collected both at enrollment and 12-month follow-up. RESULTS 262 HIV-infected individuals were eligible for analysis. The total number of sexual contacts reported by participants was 4,017, 1,496 and 356 during the 12- month period prior to HIV diagnosis (T1), the 12-month period prior to the baseline survey (T2), and the 12-month follow-up period (T3), respectively. The difference in the number of sexual contacts between T2 and T1 was -5 in median (IQR -1, -14), and the difference between T3 and T2 was 0 in median (IQR: 0, -6). A larger proportion of spousal or long-term heterosexual contact was reported from T1(27.7%) to T2(42.5%) to T3(76.1%), whereas a smaller proportion of commercial heterosexual contacts was reported from T1 (48.6%) to T2 (33.2%) to T3 (7.0%) as well as a smaller proportion of non-commercial casual homosexual contacts was reported from T2 (8.4%) to T3 (3.8%).The proportion of consistent condom use increased significantly from T1 (9.3%) to T2 (35.3%) to T3 (91.5%). CONCLUSION Sexual behaviors did not change in a uniform manner for the participants in our study. Sexual behaviors and sexual networks vis-à-vis HIV diagnosis and follow-up were associated with the participant's characteristics and HIV infection and treatment status. The overall lesson is that individuals who are unaware of their HIV infection are the main drivers of secondary transmission. Early identification of HIV infection and access to antiretroviral therapy (ART) are both key strategies to the control and prevention.
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Affiliation(s)
- Haijiang Lin
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Taizhou City Center for Disease Control and Prevention, Taizhou City of Zhejiang Province, China
- The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Yingying Ding
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Xing Liu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
- The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Weiming Zhu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Department of Epidemiology, School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
- The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Meiyang Gao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
| | - Na He
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- The Key Laboratory of Public Health Safety of Ministry of Education, Shanghai, China
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Lin H, He N, Zhou S, Ding Y, Qiu D, Zhang T, Wong FY. Behavioral and molecular tracing of risky sexual contacts in a sample of Chinese HIV-infected men who have sex with men. Am J Epidemiol 2013; 177:343-50. [PMID: 23348006 PMCID: PMC3566707 DOI: 10.1093/aje/kws256] [Citation(s) in RCA: 17] [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: 12/16/2011] [Accepted: 05/07/2012] [Indexed: 11/14/2022] Open
Abstract
Contact tracing, coupled with molecular epidemiologic investigation, is especially useful for identifying an infection with few cases in the population, such as human immunodeficiency virus (HIV) infection in China. No such research is available on Chinese men who have sex with men (MSM). From 2008 to 2010 in Taizhou Prefecture in China, every newly diagnosed HIV-infected MSM was invited to participate as an "index case" in a contact tracing survey by providing contact information for up to 8 sexual contacts, who themselves were approached to receive voluntary HIV counseling and testing. Those who tested HIV-positive were then subjected to another contact tracing survey. This process was repeated until no more sexual contacts were reported or tested positive. A total of 100 HIV-infected MSM served as "index cases," including the initial 49 cases identified through routine surveillance programs and 51 cases from the present survey. Traced MSM exhibited little willingness to receive voluntary counseling and testing. CRF01_AE (HIV type 1) was the dominant subtype. Seven of 49 independent sexual networks were deemed HIV transmission clusters. Fear of stigma or discrimination may deter Chinese MSM from receiving voluntary counseling and testing. Nonetheless, the integration of behavioral network analysis and HIV phylogenetic analysis provides enhanced evidence for developing tailored prevention strategies for HIV-infected MSM.
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Affiliation(s)
| | - Na He
- Correspondence to Dr. Na He, Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China (e-mail: )
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Lin H, He N, Ding Y, Qiu D, Zhu W, Liu X, Zhang T, Detels R. Tracing sexual contacts of HIV-infected individuals in a rural prefecture, Eastern China. BMC Public Health 2012; 12:533. [PMID: 22818298 PMCID: PMC3413611 DOI: 10.1186/1471-2458-12-533] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 06/30/2012] [Indexed: 11/10/2022] Open
Abstract
Background Contact tracing is especially useful for identifying an infection with few cases in the population, such as HIV in China. Little such research is available in China. Methods Every newly diagnosed HIV case from 2008–2010 in Taizhou Prefecture, Zhejiang Province in China, was invited to participate as an “index case” in a contact tracing survey by providing contact information for up to eight sexual contacts who themselves were approached for voluntary HIV counseling and testing (VCT). Those who tested HIV-positive were then subjected to another contact tracing survey. This process was repeated until no more sexual contacts were reported or tested positive. Results A total of 463 HIV-infected individuals were newly identified during the study period, including 338 cases who were identified from routine surveillance programs and 125 cases who were identified from the present contact tracing survey. Among these 463 cases, 398 (86.0%) served as ‘index cases’ in the survey, including 290 (85.8%) out of the 338 cases identified from routine surveillance programs and 108 (86.4%) out of the 125 cases identified from the present survey. These 398 ‘index cases’ reported a total of 1,403 contactable sexual contacts, of whom 320 (22.8%) received HIV testing and 125 (39.1%) tested positive for HIV. Willingness to receive HIV testing was high among spouses and long term heterosexual or homosexual partners but extremely low among casual and commercial sex partners of ‘index cases’. Consistent condom use was rare for all participants. A total of 290 independent sexual network components were constructed, with high complexity. Conclusion Contact tracing is useful for identifying new HIV infections from spouses or long term sexual partners of HIV-infected individuals. The complicated sexual networks existing between and beyond HIV-infected persons provide opportunities for rapid spread of HIV in such areas.
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Affiliation(s)
- Haijiang Lin
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
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Huang ZJ, He N, Nehl EJ, Zheng T, Smith BD, Zhang J, McNabb S, Wong FY. Social network and other correlates of HIV testing: findings from male sex workers and other MSM in Shanghai, China. AIDS Behav 2012; 16:858-71. [PMID: 22223298 PMCID: PMC8080277 DOI: 10.1007/s10461-011-0119-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Although the Chinese government provides free-of-charge voluntary HIV counseling and testing, HIV testing rates among men who have sex with men (MSM) are reported to be extremely low. This study examines the association of structural and psychosocial factors and social network characteristics with HIV testing behaviors among "money boys" and general MSM in Shanghai. Overall, 28.5% of "money boys" and 50.5% of general MSM had never tested for HIV despite high rates of reported HIV risk behaviors. Factors associated with not testing for HIV included: not knowing of a testing site, limited HIV knowledge, low perceived HIV risk, concern about HIV testing confidentiality, being a closeted gay, not using the Internet, and having a small social network or network with few members who had tested for HIV. Future efforts to promote HIV testing should focus on outreach to general MSM, confidentiality protection, decreasing the stigma of homosexuality, and encouraging peer education and support through the Internet and social networks.
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Affiliation(s)
- Z Jennifer Huang
- Department of International Health, Georgetown University School of Nursing and Health Studies, Washington, DC 20057, USA.
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Role of sexual transmission of HIV among young noninjection and injection opiate users: a respondent-driven sampling study. Sex Transm Dis 2012; 38:1161-6. [PMID: 22082729 DOI: 10.1097/olq.0b013e3182315772] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sexual transmissibility of HIV among young drug users in China has been investigated in few studies. The objective of this study was to examine the role of sexual transmission on HIV infection among injection drug users (IDUs) and noninjection drug users (NIDUs). METHODS Respondent-driven sampling (RDS) was used to recruit 426 young heroin/opium drug users in Yunnan, China. Logistic regression modeling was performed to examine interrelationships among risky sexual behaviors, drug-use modes, and drug-use practices. RESULTS Substantial proportions of NIDUs and IDUs reported engagement in risky sexual behaviors including: (1) multiple sexual partners (42% of NIDUs vs. 37% of IDUs), (2) concurrent sexual partnerships (48% vs. 46%), (3) commercial sex partners (23% vs. 24%), and sex partners who were NIDUs (14% vs. 17%). Both NIDUs and IDUs reported low levels of condom use with nonregular partners (48% vs. 42%) and regular partner (24% vs. 27%), and having a history of recent methamphetamine use (21% vs. 18%). Compared to IDUs, NIDUs reported having had fewer sex partners who were IDUs, fewer IDU network peers, more NIDU network peers, and having lower levels of HIV knowledge and self-perceived HIV risk. CONCLUSIONS Generalization of the HIV epidemic from high-risk groups to the general population may be driven by risky sexual behavior among drug users. Reducing sexual transmission of HIV among both IDUs and NIDUs is the next major challenge for HIV intervention among drug users in China.
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Li J, Liu H, Li J, Luo J, Koram N, Detels R. Sexual transmissibility of HIV among opiate users with concurrent sexual partnerships: an egocentric network study in Yunnan, China. Addiction 2011; 106:1780-7; discussion 1788-9. [PMID: 21457169 PMCID: PMC3142291 DOI: 10.1111/j.1360-0443.2011.03459.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To investigate the patterns of concurrent sexual partnerships among young opiate users and sexual transmissibility of human immunodeficiency virus (HIV) in concurrent sexual partnerships in drug-use and sexual networks. DESIGN Cross-sectional design. PARTICIPANTS A total of 426 young opiate users in Yunnan, China. SETTING Young opiate users recruited from their network ties. MEASUREMENT Respondent-driven sampling (RDS) was used to recruit participants. Multiple logistic regressions were performed to analyze the relationships of concurrent sexual partnerships with egocentric social network components, risky sexual behavior for HIV and drug-use practices. FINDINGS The RDS-adjusted prevalence of concurrent sexual partners was 42.9% among opiate users. Opiate users with concurrent sexual partnerships were more likely to engage in risky HIV-related sexual behavior, compared to those without. Specifically, they were more likely to report having had four or more sexual partners (26.3% versus 2.0%), having had a spouse or boy/girlfriends who also had concurrent sexual partnerships (28.1% versus 8.2%), having exchanged drug for sex (12.4% versus 3.8%), having had sexual partners who were non-injection drug users (22.6% versus 10.1%), having had sexual partners who were injection drug users (25.3% versus 13.5%) and having used club drugs (26.3% versus 13.5%). There were no significant differences in consistent condom use between opiate users with sexual concurrency and those without. The same proportion (25.8%) of opiate users in the two groups reported having consistently used condoms when having sex with regular partners, and 46.3% of opiate users with sexual concurrency and 36.4% of those without such concurrency consistently used condoms with non-regular partners. CONCLUSION The expansion of the human immunodeficiency virus epidemic from high-risk populations to the general population in China may be driven by concurrent sexual partnerships. Behavioral interventions targeting safer sex should be integrated into harm reduction programmes.
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Affiliation(s)
- Jian Li
- Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Hongjie Liu
- Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jianhua Li
- Yunnan Institute for Drug Abuse, Kunming, Yunnan, China
| | - Jian Luo
- Yunnan Institute for Drug Abuse, Kunming, Yunnan, China
| | - Nana Koram
- Department of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Roger Detels
- Department of Epidemiology, University of California, Los Angeles, California, USA
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Koram N, Liu H, Li J, Li J, Luo J, Nield J. Role of social network dimensions in the transition to injection drug use: actions speak louder than words. AIDS Behav 2011; 15:1579-88. [PMID: 21431412 PMCID: PMC3145823 DOI: 10.1007/s10461-011-9930-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective of this study was to examine the influences of social network factors, particularly social support and norms, in the transition from non-injection heroin and/or opiate use to heroin-injection, which is one of the leading causes of the spread of HIV/AIDS in China. Respondent-driven sampling was used to recruit young heroin and/or opiate users in an egocentric network study in Yunnan, China. Multivariate logistic regression using hierarchical combinations of candidate variables was used to analyze network factors for the injection transition. A total of 3,121 social network alters were reported by 403 egos with an average network size of eight. Fifty-eight percent of egos transitioned to heroin-injection from non-injection. This transition was associated with having a larger sex network size, a larger number of heroin injectors in one's network, and a higher network density. The findings enhance our understanding of the influence of social network dimensions on the transition to injection drug use. Accordingly, the development of interventions for heroin and/or opiate users in China should consider social network characteristics.
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Affiliation(s)
- Nana Koram
- Department of Epidemiology and Community Health, Virginia Commonwealth University, 830 E. Main Street, Suite 5034, 980212, Richmond, VA 23298, USA
| | - Hongjie Liu
- Department of Epidemiology and Community Health, Virginia Commonwealth University, 830 E. Main Street, Suite 5034, 980212, Richmond, VA 23298, USA
| | - Jianhua Li
- Department of Epidemiology and Community Health, Virginia Commonwealth University, 830 E. Main Street, Suite 5034, 980212, Richmond, VA 23298, USA
| | - Jian Li
- Yunnan Institute for Drug Abuse, Kunming, Yunnan, China
| | - Jian Luo
- Yunnan Institute for Drug Abuse, Kunming, Yunnan, China
| | - Jennifer Nield
- Department of Epidemiology and Community Health, Virginia Commonwealth University, 830 E. Main Street, Suite 5034, 980212, Richmond, VA 23298, USA
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Bai H, Huan X, Tang W, Chen X, Yan H, Liu X, Yang H, Peng Z, Zhao X, Yu R, Yu H, Chen F. A survey of HIV infection and related high-risk factors among men who have sex with men in Suzhou, Jiangsu, China. J Biomed Res 2011; 25:17-24. [PMID: 23554667 PMCID: PMC3596672 DOI: 10.1016/s1674-8301(11)60002-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 12/20/2010] [Accepted: 01/11/2011] [Indexed: 11/28/2022] Open
Abstract
A cross-sectional study using the snowball sampling method was conducted in May 2008 to investigate human immunodeficiency virus (HIV) infection status and related high risk factors among men who have sex with men (MSM) in Suzhou city of Jiangsu province. The researchers carried out a face-to-face questionnaire interview among MSM, and collected their blood samples to test for HIV and other sexually transmitted diseases (STDs). Among the 280 respondents, 91.1% had homosexual acts in the past 6 months and 87.5% had multiple homosexual partners; 46.4% had heterosexual sex in the past 6 months and 33.1% had multiple heterosexual partners. The rate of continued condom use was 44.3% in homosexual sex in the past 6 months, while the rate in heterosexual sex was 33.9%. Laboratory test results showed that the prevalences of HIV and syphilis were 7.1% (20/280) and 15.0% (42/280), respectively, but no HCV-positive person was found. In the multivariate logistic regression model, subjects with a monthly income of more than RMB ¥ 1,000 (OR=4.83,95% CI=1.44-16.22), subjects who often went to bars for sexual partners (OR=2.25, 95%CI=1.21-4.20), and subjects who had more than one sexual partner in the past 6 months (OR=0.49, 95%CI=0.25-0.97) and had sex with fixed sexual partners in the past 6 months (OR=0.42, 95%CI=0.25-0.75) were significantly associated with the rate of continued condom use in homosexual sex in the past 6 months. Unprotected sex and multiple sexual partners were more common among MSM in Suzhou city; furthermore, the prevalences of HIV infection and syphilis were relatively high. HIV preventive measures should be designed to address these risk factors and control the spread of HIV among MSM.
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Affiliation(s)
- Hongling Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 210029, China;
| | - Xiping Huan
- Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu 210009, China;
| | - Weiming Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 210029, China;
| | - Xin Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 210029, China;
| | - Hongjing Yan
- Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu 210009, China;
| | - Xiaoyan Liu
- Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu 210009, China;
| | - Haitao Yang
- Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu 210009, China;
| | - Zhihang Peng
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 210029, China;
| | - Xiuping Zhao
- Suzhou Center for Disease Prevention and Control, Suzhou, Jiangsu 215004, China.
| | - Rongbin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 210029, China;
| | - Hao Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 210029, China;
| | - Feng Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 210029, China;
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García Calleja JM, Jacobson J, Garg R, Thuy N, Stengaard A, Alonso M, Ziady HO, Mukenge L, Ntabangana S, Chamla D, Alisalad A, Gouws E, Sabin K, Souteyrand Y. Has the quality of serosurveillance in low- and middle-income countries improved since the last HIV estimates round in 2007? Status and trends through 2009. Sex Transm Infect 2010; 86 Suppl 2:ii35-42. [PMID: 21106513 PMCID: PMC3173824 DOI: 10.1136/sti.2010.043653] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND HIV surveillance systems aim to monitor trends of HIV infection, the geographical distribution and its magnitude, and the impact of HIV. The quality of HIV surveillance is a key element in determining the uncertainty ranges around HIV estimates. This paper aims to assess the quality of HIV surveillance systems in low- and middle-income countries in 2009 compared with 2007. METHODS Four dimensions related to the quality of surveillance systems are assessed: frequency and timeliness of data; appropriateness of populations; consistency of locations and groups; and representativeness of the groups. An algorithm for scoring the quality of surveillance systems was used separately for low and concentrated epidemics and for generalised epidemics. RESULTS The number of countries categorised as fully functioning in 2009 was 35, down from 40 in 2007. 47 countries were identified as partially functioning, while 56 were categorised as poorly functioning. When compared with 2007, the quality of HIV surveillance remains similar. The number of ANC sites in sub-Saharan Africa has increased over time. The number of countries with low and concentrated epidemics that do not have functioning HIV surveillance systems has increased from 53 to 56 between 2007 and 2009. CONCLUSION Overall, the quality of surveillance in low- and middle-income countries has remained stable. Still too many countries have poorly functioning surveillance systems. Several countries with generalised epidemics have conducted more than one population-based survey which can be used to confirm trends. In countries with concentrated or low-level epidemics, the lack of data on high-risk populations remains a challenge.
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