The epidemic of HIV and syphilis and the correlation with substance abuse among men who have sex with men in China: A systematic review and meta-analysis

Prediction of new HIV infection in men who have sex with men based on machine learning: secondary analysis of a prospective cohort study from Western China

OBJECTIVE

This study aimed to construct a model based on machine learning to predict new HIV infections in HIV-negative men who have sex with men (MSM).

METHODS

This is a secondary analysis of a previous random clinical trial aiming to evaluate the preventive effects of PrEP on new HIV infection in MSM. During 2013-2015, 1455 HIV-negative MSM were enrolled. Participants were divided into treatment group and control group and regularly followed up until they seroconverted to HIV positive or until the 2-year endpoint reached. Five machine-learning approaches were applied to predict the risk of HIV infection. Model performance was evaluated using Harrel's C-index and area under the receiver operator characteristic curve (AUC) and validated in an external validation cohort. To explain this model, shapley additive explanation (SHAP) values were calculated and visualized.

RESULTS

During the observation period, 102 MSM developed HIV infection. Thirteen parameters are selected to construct the model. The random survival forest model showed the best performance in the validation cohort, with a C-index of 0.7013, and could significantly categorize MSM into three groups. Our model indicated that MSM with younger age, receptive anal intercourse, and multiple male sexual partners had an increased risk of HIV infection, and those with higher AIDS knowledge scores had a lower risk.

CONCLUSION

We presented a machine learning-based model to predict their risk of developing HIV infection. This model could be applied to recognize MSM who are at a higher risk of developing HIV infection.

Impact pathways of adverse childhood experiences on infectious diseases among substance abusers in border regions: structural equation modeling

Background

Injection of drug abuse could result in infectious disease, and adverse childhood experiences (ACEs) possibly are associated with infectious disease. However, there is a paucity of literature on a direct or indirect relationship between ACEs, injection of drug use and infectious disease. We thus identified the pathway of influence of ACEs in adulthoods and injection of drug use on infectious disease by structural equation models (SEM).

Methods

A cross-sectional study was conducted by respondent driving sampling and consecutive sampling among people who use drugs in southwest of China in 2021. R software 4.2.1 was used to conduct descriptive, univariate, and SEM analysis.

Results

There were 404 participants in total, with an average age of 34 and most males (98.3%) and minorities (79.6%). 95.5% of respondents experienced ACEs with 46.6% of reporting 4 or more ACEs. Correlations in SEM showed that infectious disease might be directly positively affected by injection of drug use (β = 0.184), and directly negatively affected by ACEs (β = -0.188). Age (β = 0.029), Ethnic (β = -0.021), Education (β = 0.019), Gender (β = 0.022), Sex partners (β = -0.017), and ACEs (β = -0.029) might have indirect effects on infectious disease.

Conclusion

ACEs might be a direct or indirect predictor for infectious disease in adulthood, injection of drug use might be a risk factor and moderate other factors of infection of infectious disease. Strategies for creating a positive home environment, minimizing traumatic or stressful childhood experiences, and increasing awareness of the risks associated with drug injection use are all ways to lower the chances of contracting infectious diseases.

Prevalence and factors associated with syphilis among men who have sex with men in Brazil

Purpose

This study aimed to analyze the prevalence of syphilis and assess the factors associated with its diagnosis throughout life.

Methods

Cross-sectional study conducted from January to April 2022 with 812 MSM users of dating apps in Brazil. Sociodemographic, behavioral, and sexual aspects, health issues, and the use of dating apps variables were analyzed.

Results

Multivariate logistic regression estimated the predictors of syphilis at a 95% confidence interval. The prevalence of syphilis diagnoses was 34.23% (95% CI = 30.94-37.46), and the factors associated with the diagnosis throughout life were age ≥ 30 years (adjusted prevalence ratio [aPR] = 1.49; adjusted 95% confidence interval [a95%CI] = 1.15-1.92), more than three sexual relations with Cis men (aPR = 1.40; a95%CI = 1.03-1.90), sex simultaneously with two people or more during social distancing (aPR = 1.31; a95%CI = 1.00-1.73), use of a licit (or illicit) substance in the last 3 months (aPR = 1.35; a95%CI = 1.05-1.74), using condom less than half of the time in anal sex in the last 3 months (aPR = 1.42, a95%CI = 1.07-1.89), being a PrEP user (aPR = 1.10; a95%CI = 0.81-1.51) and having used the Grindr® app in the last 3 months (aPR = 1.38; a95%CI = 1.04-1.83).

Conclusion

The prevalence of syphilis among MSM users of dating apps is at worrying levels. Thus, frequent testing (less than 3 months for MSM using PrEP and semi-annual for everyone, regardless of the risk), access to DoxiPEP for this population, consistent use of condoms, and the use of apps as a strategic intervention and educommunication platforms are essential to prevent the spread of syphilis.

Prevalence of HIV/syphilis co-infection among men who have sex with men in China: a systematic review and meta-analysis

BACKGROUND

Men who have sex with men (MSM) are key populations for HIV and syphilis infection, and co-infection with both diseases significantly increases health risks. However, the co-infection of HIV/syphilis among this population in China has not been systematically evaluated. We aimed to conduct a meta-analysis to ascertain the prevalence of HIV/syphilis co-infection among MSM in China.

METHODS

We conducted a systematic literature search involving PubMed, Web of Science, CNKI and Wanfang to identify publications reporting HIV/syphilis co-infection among MSM in China. Our search encompassed articles available from the establishment of these databases up to December 31, 2022. Additionally, we examined the references of retrieved articles to identify additional relevant records. The random-effects model fitting Freeman-Tukey double arcsine transformation was employed to estimate the prevalence of HIV/syphilis co-infection and its 95% confidence interval (CI). Heterogeneity was assessed utilizing the I2 statistics and Cochran's Q test. To explore the potential sources of heterogeneity, we conducted subgroup and meta-regression analyses.

RESULTS

A total of 46 studies were included, with a total sample size of 50,187 MSM, including1,459 co-infected individuals. The pooled prevalence of HIV/syphilis co-infection among MSM in China was 2.7% (95% CI: 2.2-3.4%), with significant heterogeneity (I2 = 90.5%, Q = 474.65, P < 0.01). Across China's four regions, the Central region exhibited the highest co-infection prevalence (4.5%, 95% CI: 0.0-17.7%), followed by the Eastern region (3.1%, 95% CI: 2.4-3.9%) and Western region (2.4%, 95% CI: 1.8-3.1%). In contrast, the Northeast region reported the lowest co-infection prevalence (0.6%, 95% CI: 0.3-1.0%). Studies utilizing multiple sampling methods (4.7%, 95% CI: 3.6-6.0%) and recruiting MSM from sexually transmitted disease (STD) clinics (9.1%, 95% CI: 3.2-17.6%) showed higher prevalence of co-infection. Furthermore, the co-infection prevalence among MSM in China demonstrated a progressive increase with age.

CONCLUSION

The prevalence of HIV/syphilis co-infection among MSM in China was elevated, with certain regional disparities. Notably, the STD clinics attendees and older MSM were more likely to be co-infected. Urgent and targeted measures are needed to enhance interventions for these vulnerable populations to control HIV/syphilis co-infection.

A Comparison of Mobile Social Media Promotion and Volunteer-Driven Strategies for Community Organizations Recruiting Men Who Have Sex with Men for HIV Testing in Zhejiang Province, China: Cross-Sectional Study Based on a Large-Scale Survey

BACKGROUND

China has recently implemented a strategy to promote and facilitate community organization involvement in HIV prevention among men who have sex with men (MSM). Although community-based strategies have been shown to increase HIV testing uptake, the relative effectiveness of mobile social media promotion compared with volunteer-driven recruitment remains underexplored. Limited research has investigated how these strategies differentially affect MSM who have not undergone previous HIV testing.

OBJECTIVE

This study aimed to compare the differences between a mobile social media promotion strategy and a volunteer-driven strategy for community organizations to recruit MSM for HIV testing.

METHODS

A cross-sectional study was conducted from July to December 2023 among MSM in Zhejiang Province, China. Participants aged 16 years with an HIV-negative or unknown status were recruited either through a mobile social media promotion strategy or through a volunteer-driven strategy by a community organization. They completed a questionnaire that collected information on demographics, sexual behavior, and HIV testing history. All participants were tested for HIV after completing the questionnaire. A multivariate logistic regression model was used to identify factors associated with recruitment through mobile social media promotion.

RESULTS

The study included 4600 MSM, of whom 3035 (66%) were recruited through the mobile social media strategy. Overall, 1.4% (66/4600) of participants tested positive for HIV, and 18.8% (865/4600) underwent HIV testing for the first time. Recruitment via the mobile social media promotion strategy was significantly associated with several factors: having only gay sexual partners (adjusted OR [aOR] 1.23, 95% CI 1.05-1.45), having more than 2 sexual partners in the past 3 months (aOR 1.74, 95% CI 1.42-2.11), frequently using rush poppers during sex (aOR 1.39, 95% CI 1.14-1.99), having a history of sexually transmitted infections (aOR 1.56, 95% CI 1.02-2.39), having awareness of pre-exposure prophylaxis (aOR 1.42, 95% CI 1.19-1.71), having awareness of postexposure prophylaxis (PEP; aOR 1.49, 95% CI 1.24-1.79), using mail-in HIV self-testing kits (aOR 2.02, 95% CI 1.77-2.31), testing HIV-positive (aOR 2.02, 95% CI 1.10-3.72), and first-time HIV testing (aOR 1.28, 95% CI 1.09-1.52).

CONCLUSIONS

Community organizations play a critical role in expanding HIV testing and identifying undiagnosed individuals infected with HIV. Compared to the volunteer-driven outreach, mobile social media promotion strategies had a higher proportion of first-time testers and a higher rate of HIV positivity. We recommend prioritizing mobile social media strategies in regions with limited LGBTQ+ organizations or HIV health services to increase HIV testing coverage and interventions among MSM.

HIV risk and influence factors among MSM who had sought sexual partners in core venues: a continuous sentinel surveillance in 2010-2022

Background

Seeking sexual partners in men who have sex with men (MSM) venues has been regarded as a high-risk behavior for HIV among MSM. Nevertheless, with the implementation of venue-based interventions and the change in the way MSM seek sexual partners, the continued status of MSM venues as the HIV risk factor remains inconclusive. This study endeavors to delve into this ambiguity by examining the MSM sexual contact network (SCN) as a foundation.

Methods

A series of cross-sectional surveys were conducted in Shenzhen in the period 2010-2022. MSM sexual contact network and venue network were acquired, and network metrics were employed to identify core MSM and core venues. We compared the risk of HIV and risk behaviors between MSM who sought sexual partners in core venues and those who did not, with subgroup analyses based on different time periods.

Results

The overall HIV prevalence among the 4,408 MSM surveyed in this study was 14.6%. Notably, 17 core venues were identified out of the 68 reported MSM venues, with 1,486 MSM who had sought sexual partners in core venues. These MSM had significantly higher risk of HIV and were more likely to take HIV testing and receive intervention services. Subgroup analyses showed that the heightened HIV risk associated with seeking partners in core venues was specific to the period 2010-2014, while HIV testing and service access remained consistently higher across all-period subgroups. Multiple sexual partners, seeking partners in core venues, receptive or both sexual roles, drug abuse, absence of HIV test, unprotected anal intercourse (UAI), and lower education levels were associated with elevated HIV risk among MSM.

Conclusion

Following the implementation of differentiated venue-based interventions, the risk of HIV among MSM who had sought sexual partners in core venues decreased to a level comparable to that of MSM who had not. The accessibility of HIV testing and intervention services remains uneven between MSM who had sought sexual partners in core venues and those who had not. As the Internet sex-seeking behavior gains prevalence among MSM, strategic adjustments of public health resource allocation may be necessary to address this imbalance.

HIV incidence and recreational drug use among men who have sex with men aged 18-24 years in Tianjin, China: a retrospective cohort study

BACKGROUND

Recreational drug use has been identified as a significant risk factor for the transmission of human immunodeficiency virus (HIV). This behavior is particularly prevalent among young men who have sex with men (YMSM). However, limited research has been conducted to investigate the correlation between recreational drug use and HIV incidence within this population.

OBJECTIVE

To examine HIV incidence and explore the association between recreational drug use and HIV incidence among YMSM.

METHODS

A retrospective cohort study was conducted by a local non-governmental organization (NGO) among MSM aged 18-24 years from October 2017 to December 2023 in Tianjin, China. Participants were included if they had at least two HIV test records during this period. HIV incidence density and its 95% confidence interval (CI) were calculated using person-years (PYs) with a Poisson distribution. Risk factors for HIV incidence were identified using univariable and multivariable Cox proportional hazards regression models.

RESULTS

A total of 56 HIV seroconversions were reported with 2901.9 PYs, resulting in an overall incidence density of 1.9/100 PYs (95% CI: 1.4-2.4). Among YMSM who do not use recreational drugs (YMSM-URD), the incidence density was 1.1/100 PYs (95% CI: 0.5-1.6), while it was 2.8/100 PYs (95% CI: 1.9-3.7) among those who do use recreational drugs (YMSM-RD). Adjusted for confounders, factors associated with HIV infection included recreational drug use (adjusted hazard ratio = 2.6, 95% CI = 1.4-4.7) and unprotected anal intercourse in the past six months (adjusted hazard ratio = 2.3, 95% CI = 1.2-4.4).

CONCLUSIONS

Recreational drug use and unprotected anal intercourse significantly increase the risk of HIV infection. To effectively mitigate the spread of HIV, interventions should focus on these risk factors by employing HIV counseling and testing clinics, collaborating with NGOs focused on MSM, and establishing peer education programs aimed at YMSM.

Translating and validating the gay affirmative practice scale for nurses in mainland China

Background

The gay affirmative practice (GAP) scale is an effective tool for evaluating the beliefs and behaviors of health care professionals toward gay and lesbian clients.

Aim

This study aimed to examine the reliability and validity of the GAP scale among Chinese nurses.

Methods

A quantitative cross-sectional study was conducted to evaluate the Chinese version of the GAP (C-GAP) scale after translation and cross-cultural adaptation and to examine its psychometric characteristics. The reliability and validity of the C-GAP scale were determined by item analysis, factor analysis, internal consistency, test-retest reliability, and discriminant construct validity.

Outcomes

The GAP scale was translated and adapted specifically for China. A total of 1440 participants completed the C-GAP scale, sociodemographic questionnaire, and Marlowe-Crowne social desirability scale.

Results

The C-GAP scale exhibited a Cronbach α of 0.95, with a high test-retest reliability coefficient of 0.92. Exploratory factor analysis identified 2 factors that accounted for 59.91% of the total variance. The results of the confirmatory factor analysis were as follows: χ2/df = 1.09, goodness-of-fit index = 0.98, adjusted goodness-of-fit index = 0.97, root mean square error of approximation = 0.01, Tucker-Lewis index = 1.00, comparative fit index = 1.00, incremental fit index = 1.00, parsimony goodness-of-fit index = 0.85, and parsimony normed fit index = 0.91. These findings confirm that all goodness-of-fit indices were satisfactory.

Clinical Implications

The C-GAP scale can be an effective tool for health care professionals and managers and for education and research; it can also identify the beliefs and behaviors of health care professionals toward gay and lesbian clients, facilitating cultural competence development and enhancing care quality awareness and skills.

Strengths and Limitations

The C-GAP scale demonstrates reliability and validity; however, because the sample consisted only of nurses, the findings may not be generalizable to other professional groups, such as counselors and therapists. Therefore, the occupational focus of the sample limited the broader applicability of the results.

Conclusion

The C-GAP scale is a reliable and valid tool suitable for assessing the practice attitudes and behaviors of Chinese nurses toward gay and lesbian clients.

Homoprejudiced Violence Experiences and High-Risk Sexual Behaviors among Chinese Men Who Have Sex with Men: Depression Severity and Recreational Drug Usage as Potential Mediators

Homoprejudiced violence is a type of aggression against an individual or a community based on their actual or perceived sexual orientation. It may be linked to risks of acquiring HIV/STI via psychosocial variables. This study explored the association between homoprejudiced violence experiences and high-risk sexual behaviors, and potential psychosocial mediators. Using cross-sectional survey data collected in China through Blued among men who have sex with men (MSM) in January 2021, this study conducted multiple mediation analyses. Standard instruments were used to collect data on depressive symptoms in the last two weeks (PHQ-9), recreational drug usage in the last three months, and ever experiencing homoprejudiced violence (12-item survey instrument). Dependent variables were having condomless anal sex and having three or more sexual partners in the last three months. Among 1828 MSM, nearly half (847, 46%) had experienced homoprejudiced violence. Twenty-three percent (427) reached a score that suggested moderate or severe depression and 35% (644) had used recreational drugs. In the last three months, 40% (731) had condomless anal sex and 34% (626) had three or more sexual partners. The indirect mediational coefficients through depression on condomless anal sex and multiple sexual partners were 0.04 (95% CI: [0.02, 0.07]) and 0.02 (95% CI: [0.001, 0.05]), respectively. The indirect mediational coefficient of homoprejudiced violence experience on multiple sexual partners through recreational drug use was 0.05 (95% CI: [0.03, 0.08]). These findings suggest that more comprehensive interventions are needed to address the syndemic of homoprejudiced violence, mental health issues, and HIV/STI-related risks.