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      HIV prevalence, incidence and risk behaviours among men who have sex with men in Yangzhou and Guangzhou, China: a cohort study

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          Abstract

          Introduction

          In China, the prevalence and incidence of HIV among men who have sex with men (MSM) in large-sized cities have drawn much attention. In contrast, there has been a paucity of research focussing on the sexual health of MSM of medium-sized cities. This study fills this important gap in the knowledge by investigating the sexual health of MSM in a medium-sized city (Yangzhou) and a large-sized city (Guangzhou).

          Methods

          A baseline survey and a prospective cohort study were conducted among MSM in Yangzhou and Guangzhou from July 2009 to September 2010. A total of 622 MSM (317 from Yangzhou and 305 from Guangzhou) were screened for eligibility. Prevalence and incidence of HIV infection, as well as its risk factors, were investigated.

          Results

          Baseline HIV prevalence was 14.5%, and overall HIV incidence density was 6.78 per 100 person-years (PY) among Yangzhou MSM. Risk factors for HIV prevalence that were significant in multivariate models were older age, married status, unprotected sex with female partners, sexually transmitted disease (STD)-associated symptoms and syphilis positivity. Risk factors for HIV incidence that were significant in multivariate models were STD-associated symptom and syphilis positivity. Compared to Yangzhou MSM, Guangzhou MSM had a lower HIV prevalence (6.2%; p<0.05) and lower overall HIV incidence density (5.77 per 100 PY). Risk factors for HIV prevalence that were significant in multivariate models were married status, unprotected anal sex with men and syphilis positivity. The single risk factor for HIV incidence that was significant in multivariate models was unprotected anal sex with men.

          Conclusions

          This study showed a high prevalence and incidence of HIV among Yangzhou MSM, which suggest a more serious HIV epidemic than that in large-sized cities. Further investigation targeting MSM in medium-sized cites is urgently needed to prevent the spread of the HIV epidemic in China.

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          HIV prevalence in China: integration of surveillance data and a systematic review.

          Lei Zhang, Eric Chow, Jun Jing … (2013)
          Asian HIV epidemics are concentrated among particular behavioural groups, but large variations exist in epidemic types, timing, and geographical spread between countries and within countries, especially in China. We aimed to understand the complexity of HIV epidemics in China by systematically analysing prevalence trends by data source, region, population group, and time period. We collected HIV prevalence data from official national sentinel surveillance sites at the provincial level from Jan 1, 1995, to Dec 31, 2010. We also searched PubMed, VIP Chinese Journal Database (VIP), China National Knowledge Infrastructure, and Wanfang Data from Jan 1, 1990, to Dec 31, 2012, for independent studies of HIV prevalence. We integrated both sets of data, and used an intraclass correlation coefficient test to assess the similarity of geographical pattern of HIV disease burden across 31 Chinese provinces in 2010. We investigated prevalence trends (and 95% CIs) to infer corresponding incidence by region, population group, and year. Of 6850 articles identified by the search strategy, 821 studies (384,583 drug users, 52,356 injecting drug users, 186,288 female sex workers, and 87,834 men who have sex with men) met the inclusion criteria. Official surveillance data and findings from independent studies showed a very similar geographical distribution and magnitude of HIV epidemics across China. We noted that HIV epidemics among injecting drug users are decreasing in all regions outside southwest China and have stabilised at a high level in northwest China. Compared with injecting drug users, HIV prevalence in female sex workers is much lower and has stabilised at low levels in all regions except in the southwest. In 2010, national HIV prevalence was 9·08% (95% CI 8·04-10·52) in injecting drug users and 0·36% (0·12-0·71) in female sex workers, whereas incidence in both populations stabilised at rates of 0·57 (0·43-0·72) and 0·02 (0·01-0·04) per 100 person-years, respectively. By comparison, HIV prevalence in men who have sex with men increased from 1·77% (1·26-2·57) in 2000, to 5·98% (4·43-8·18) in 2010, with a national incidence of 0·98 (0·70-1·25) per 100 person-years in 2010. We recorded strong associations between HIV prevalence among at-risk populations in each province, supporting the existence of overlap in risk behaviours and mixing among these populations. HIV epidemics in China remain concentrated in injecting drug users, female sex workers, and men who have sex with men. HIV prevalence is especially high in southwest China. Sex between men has clearly become the main route of HIV transmission. Copyright © 2013 Elsevier Ltd. All rights reserved.
          Article 0 comments Cited 131 times – based on 0 reviews     Review now
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            Syphilis and HIV seroconversion among a 12-month prospective cohort of men who have sex with men in Shenyang, China.

            Jun-Jie Xu, Min Zhang, Katherine Brown … (2010)
            Cross-sectional studies have found a high prevalence of syphilis and HIV infection among men who have sex with men (MSM) in China. A total of 218 HIV-negative MSM participated in this prospective cohort study. Interviewer-administered questionnaires were completed, and blood samples were obtained for HIV and syphilis testing, both upon enrollment and at 12-month follow-up. Of enrolled participants, 56% (122) were retained for the full 12-month follow-up period. The cohort had an HIV incidence density of 5.4 (95% CI: 2.0-11.3)/100 person-year (PY) and a syphilis incidence density of 38.5(95% CI: 27.7-50.2)/100 PY. Having syphilis (odds ratio [OR]: 11.4, 95% CI: 1.2-104.7) and more than 5 male sexual partners within the past 12 months (OR: 6.5, 95% CI: 1.1-39.8) were independent risk factors for HIV seroconversion (each P or =30 (OR 2.1, 95% CI 0.7-9.5) and having recently engaged in unprotected receptive anal sex (OR: 2.4, 95% CI: 0.7-13.1) were marginally associated with syphilis seroconversion. The high incidence rates of HIV and syphilis in the Shenyang MSM community are significant cause for concern. The seroconversion rate for syphilis, in particular, indicates the high prevalence of high-risk sexual behaviors and the potential for increased HIV transmission. Appropriate interventions that address MSM-specific issues, including stigma, pressures from traditional society, and bisexual behavior, need to be tailored to inform and empower MSM in order to prevent HIV and syphilis in this community.
            Article 0 comments Cited 57 times – based on 0 reviews     Review now
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              China's floating population and the potential for HIV transmission: a social-behavioural perspective.

              B Jianfeng, Susan Hua, Garry Anderson … (2003)
              Historical, geo-economic and behavioural perspectives are used in an exploratory analysis of China's migrant or 'floating' population as a factor in the spread of HIV on the mainland. Participants in the interview format survey (N = 506) included in-transit individuals in Beijing, and peddlers, restaurant workers, and employment seekers in Shanghai. When viewed in light of various social dynamics, the convenience survey data suggest that elements within this migrant population, as well as their rurally located partners and spouses, may be at increased risk of acquiring the virus. Given the sheer size and broad movement of this population, it is contended that it may well be a 'tipping point' factor in AIDS prevention and control in China.
              Article 0 comments Cited 35 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Int AIDS Soc
                Journal ID (iso-abbrev): J Int AIDS Soc
                Journal ID (publisher-id): JIAS
                Title: Journal of the International AIDS Society
                Publisher: International AIDS Society
                ISSN (Electronic): 1758-2652
                Publication date (Electronic): 06 August 2014
                Publication date Collection: 2014
                Volume: 17
                Issue: 1
                Electronic Location Identifier: 18849
                Affiliations
                [1 ]National Center for STD Control and Prevention, China Centers for Diseases Control and Prevention, Institute of Dermatology, Chinese Academy of Medical Sciences, Nanjing, China
                [2 ]Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, China
                [3 ]Guangdong Provincial Center for Skin Diseases and STD Control, Guangzhou, China
                [4 ]Hainan Provincial Center for Skin Diseases and STD Control, Haikou, China
                [5 ]Guangxi Centers for Disease Control and Prevention, Nanning, China
                Author notes
                [§ ] Corresponding author: Qian-Qiu Wang, National Center for STD Control and Prevention, China Centers for Diseases Control and Prevention, Institute of Dermatology, Chinese Academy of Medical Sciences, 12 Jiangwangmiao Road, Nanjing 210042, China. Tel: +86 025 85478940. ( doctorwqq@ 123456163.com )
                Article
                Publisher ID: 18849
                DOI: 10.7448/IAS.17.1.18849
                PMC ID: 4188039
                PubMed ID: 25103308
                SO-VID: f904d169-106c-4a05-9111-9d7b0e5f7cca
                Copyright © © 2014 Wang Q-Q et al; licensee International AIDS Society
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 29 August 2013
                Date revision received : 25 June 2014
                Date accepted : 01 July 2014
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: hiv,prevalence,incidence,risk behaviours,men who have sex with men,yangzhou,guangzhou
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: hiv, prevalence, incidence, risk behaviours, men who have sex with men, yangzhou, guangzhou

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