Xiong He

Trends in prevalence of HIV syphilis hepatitis C hepatitis B and sexual risk behavior among men who have sex with men. Results of 3 consecutive respondent-driven sampling surveys in Beijing 2004 through 2006.

Background:Studies tracking trends in HIV prevalence and risk behavior among men who have sex with men (MSM) in China are rare. We report on 3 consecutive cross-sectional surveys measuring the prevalence of HIV, other infectious diseases, and related risk behavior among MSM in Beijing in 2004, 2005, and 2006. Methods:We applied respondent-driven sampling (RDS) to recruit MSM for a structured face-to-face interview on demographic characteristics and HIV risk-related behavior. Blood specimens were drawn for HIV, syphilis, hepatitis B virus, and hepatitis C virus (HCV) testing. Results:A total of 325 MSM participated in 2004, 427 in 2005, and 540 in 2006. HIV prevalence was 0.4% (95% confidence interval [CI]: 0.1 to 0.8) in 2004, 4.6% (95% CI: 2.2 to 7.6) in 2005, and 5.8% (95% CI: 3.4 to 8.5) in 2006. This apparent rise was accompanied by an increase in syphilis and self-reported history of sexually transmitted diseases (STDs), high prevalence of multiple sex partners, and low consistent condom use. HCV prevalence also increased, from 0.4% (95% CI: 0.1 to 0.8) in 2004 to 5.2% (95% CI: 2.3 to 8.2) in 2006. Conclusions:We detected a possible rising prevalence of HIV and related risk behavior among MSM in Beijing using RDS in each of 3 consecutive years. Practical measures, including MSM-friendly HIV testing, STD services, and health provider education, are urgently needed to stop the further spread of HIV in this population.

Untested and undiagnosed: barriers to HIV testing among men who have sex with men Beijing China.

Objectives Undiagnosed HIV presents great potential for the spread of infection. The authors identify the prevalence and correlates of never testing and being unaware of HIV infection in Beijing men who have sex with men (MSM). Methods Cross-sectional biological and behavioural survey using respondent-driven sampling; 500 MSM were included. Results HIV prevalence was 7.2% with 86.1% unaware of their infection; 33.2% had never tested. Never testing was associated with lower educational (adjusted odds ratio (AOR) 1.6, 95% CI (CI) 1.1 to 2.5), living in Beijing for ≤3 years (AOR 1.5, 95% CI 1.0 to 2.3), unprotected anal intercourse with most recent male partner (AOR 1.6, 95% CI 1.0 to 2.4), being unaware of the most recent male partners HIV status (AOR 3.6, 95% CI 2.1 to 6.1) and holding stigmatised attitudes towards persons with HIV (AOR 1.1 per scale point, 95% CI 1.0 to 1.1). Predictors of having undiagnosed HIV infection were being married (AOR 2.4, 95% CI 1.0 to 5.4), living in Beijing for ≤3 years (AOR 3.6, 95% CI 1.5 to 8.4), being unaware of the most recent male partners HIV status (AOR 6.8, 95% CI 0.9 to 51.6) and holding negative attitudes towards safe sex (AOR 1.1 per scale point, 95% CI 1.0 to 1.1). Conclusions Recent attention has focused on HIV prevention interventions that depend upon knowing ones serostatus, including viral load suppression, prevention with positives, pre-exposure prophylaxis and seroadaptation. Until the low level of testing and resulting high level of undiagnosed HIV infection are addressed, these tools are not likely to be effective for MSM in China.

HIV/AIDS-Related Stigmatizing and Discriminatory Attitudes and Recent HIV Testing Among Men Who Have Sex With Men in Beijing

This study assessed the correlates of recent HIV testing and HIV/AIDS-related stigmatizing and discriminatory attitudes among men who have sex with men (MSM) in Beijing, China. A cross-sectional study probed demographics, sexual and drug use behaviors, HIV testing, and prevention services. Of 500 participants, 39.3% recently received a test for HIV. Recent testing was independently associated with expressing lower levels of HIV/AIDS-related stigmatizing and discriminatory attitudes, more male sex partners, no female sexual partners and knowing HIV status of their last male partner. Expressing lower levels of HIV/AIDS-related stigmatizing and discriminatory attitudes was independently associated with recent testing, younger age, and knowing HIV status of their last male partner. This study revealed that HIV/AIDS-related stigmatizing and discriminatory attitudes were common and inversely associated with recent HIV testing. Low levels of testing highlighted the urgent needs to reduce HIV/AIDS-related stigma and discrimination and expand HIV testing among MSM in Beijing.ResumenEl estudio fue evaluar la correlación de los últimos la prueba del VIH y el VIH/SIDA relacionados con las actitudes estigmatizantes y discriminatorias entre hombres que tienen sexo con hombres (HSH) en Beijing, China. Un estudio transversal investigado los datos demográficos, las conductas sexuales y de uso de drogas, pruebas de VIH y servicios de prevención. De 500 participantes, el 39,3% ha recibido recientemente una prueba de VIH. Pruebas recientes se asoció independientemente con la expresión de los niveles más bajos de VIH/SIDA relacionados con las actitudes estigmatizantes y discriminatorias, más parejas sexuales masculinas, no las parejas sexuales femeninas y conocer el estado de VIH de su pareja masculina pasado. Expresar niveles más bajos de VIH/SIDA actitudes estigmatizantes y discriminatorias se asoció independientemente con las pruebas recientes, una edad más joven, y conocer el estado de VIH de su pareja masculina pasado. Este estudio reveló que el VIH/SIDA relacionados con las actitudes estigmatizantes y discriminatorias eran comunes e inversamente asociada con las recientes pruebas de VIH. Los bajos niveles de las pruebas destacó la necesidad urgente de reducir el VIH/SIDA, el estigma y la discriminación y ampliar las pruebas del VIH entre los HSH Beijing.

Behavioral and Serologic Survey of Men Who Have Sex with Men in Beijing, China: Implication for HIV Intervention

We assessed HIV prevalence and associated behaviors and risk factors among men who have sex with men (MSM) in Beijing, China. Five hundred MSM were recruited for a biological and behavioral survey using respondent-driven sampling (RDS) in 2009. Serologic specimens were tested for markers of HIV and syphilis infection. A computer-assisted personal interview (CAPI) administered questionnaire gathered information including demographic characteristics, sexual behaviors, HIV testing, and social norms concerning condom use. The adjusted HIV prevalence was 8.0%, syphilis 22.0%. HIV testing and disclosure was low; only 39.3% had HIV tested in the past 12 months, 49.7% knew their own HIV status and 22.8% knew their last male partners HIV status. HIV infection was associated with syphilis, ever having sex with a woman, not knowing the HIV status of the most recent male partner, and never buying condoms in the past 12 months. Stronger endorsement of positive social norms around condom use strongly and predicted lower prevalence of HIV infection. Compared to surveys of similar design in the recent past, HIV continues to spread rapidly among Beijings MSM. Our results identify points of intervention that, if addressed in time, may still alter the course of the epidemic including the promotion of HIV testing and partner disclosure, syphilis control and particularly changing social norms around condom use.

Alcohol use and HIV risk taking among Chinese MSM in Beijing

BACKGROUND Few studies have used standardized alcohol use measures among men who have sex with men in China. METHODS A cross-sectional study was conducted among MSM in Beijing. A computer-assisted self-administered questionnaire was used to collect demographics, risk behaviors the Alcohol Use Disorders Identification Test (AUDIT). AUDIT uses a cutoff score of ≥ 8 while AUDIT C uses a score of ≥ 4 to classify respondents as problem drinkers. Both include a binge drinking measure. RESULTS A total of 500 participants were recruited using respondent-driven sampling. HIV and prevalence is estimated to be 6.1% (95% CI 3.7, 9.2). Almost half of MSM (42.1%, 95% CI 35.8, 49.0) never had a drink containing alcohol in the past year. 5.0% (95% CI 3.1, 7.0) and 8.8% (95% CI 6.1, 11.6) had AUDIT score ≥ 8 and AUDIT-C score ≥ 4, respectively. Binge drinking was at 11.8% (95% CI 7.9, 16.0). In multivariate models all measures were associated with alcohol during sex, while AUDIT was associated with high level of attitudes and perceptions on safe sex (AOR 0.9, 95% CI 0.9,1.0), AUDIT-C with being older (AOR 3.5, 95%CI 1.4, 8.8), and HIV status (AOR 2.2, 95% CI 1.4, 10.9), and binge drinking with number of male partners (AOR 2.0, 95% CI 1.0, 3.9) and ever having had an HIV test (AOR 1.0, 95%CI 0.9, 1.0). Compared to AUDIT ≥ 8, AUDIT-C ≥ 4 and binge drinking were more suitable in identifying HIV risks related to problem drinking. CONCLUSIONS Findings suggest AUDIT is appropriate for use among MSM in China and reinforces the need for incorporating problem drinking as part of approaches to prevent HIV infection among Chinese MSM.

Modeling the Impact on HIV Incidence of Combination Prevention Strategies among Men Who Have Sex with Men in Beijing, China

Objective To project the HIV/AIDS epidemics among men who have sex with men (MSM) under different combinations of HIV testing and linkage to care (TLC) interventions including antiretroviral therapy (ART) in Beijing, China. Design Mathematical modeling. Methods Using a mathematical model to fit prevalence estimates from 2000–2010, we projected trends in HIV prevalence and incidence during 2011–2020 under five scenarios: (S1) current intervention levels by averaging 2000–2010 coverage; (S2) increased ART coverage with current TLC; (S3) increased TLC/ART coverage; (S4) increased condom use; and (S5) increased TLC/ART plus increased condom use. Results The basic reproduction number based upon the current level of interventions is significantly higher than 1 ( confidence interval (CI), 1.83–2.35), suggesting that the HIV epidemic will continue to increase to 2020. Compared to the 2010 prevalence of 7.8%, the projected HIV prevalence in 2020 for the five prevention scenarios will be: (S1) Current coverage: 21.4% (95% CI, 9.9–31.7%); (S2) Increased ART: 19.9% (95% CI, 9.9–28.4%); (S3) Increased TLC/ART: 14.5% (95% CI, 7.0–23.8%); (S4) Increased condom use: 13.0% (95% CI, 9.8–28.4%); and (S5) Increased TLC/ART and condom use: 8.7% (95% CI, 5.4–11.5%). HIV epidemic will continue to rise () for S1–S4 even with hyperbolic coverage in the sensitivity analysis, and is expected to decline () for S5. Conclusion Our transmission model suggests that Beijing MSM will have a rapidly rising HIV epidemic. Even enhanced levels of TLC/ART will not interrupt epidemic expansion, despite optimistic assumptions for coverage. Promoting condom use is a crucial component of combination interventions.

HIV Testing and Preventive Services Accessibility Among Men Who Have Sex With Men at High Risk of HIV Infection in Beijing, China

AbstractThe HIV epidemic among men who have sex with men (MSM) has been increasing at an alarming rate in most areas of China in recent years. Many Chinese MSM still lack sufficient access to HIV prevention services, despite ongoing scale-up of comprehensive HIV testing and intervention services. The purpose of this study was to investigate utilization of HIV testing and prevention services, and related factors that influence the MSM people to access HIV test or other services to prevent HIV among MSM in Beijing, China.Three successive cross-sectional surveys of MSM were conducted in Beijing from September 2009 to January 2010, September 2010 to January 2011, and September 2011 to January 2012. Demographic and behavioral data were collected and analyzed. Blood samples were tested for HIV and syphilis. Three models were established to analyze factors associated with HIV testing and preventive services.Of the 1312 participants, prevalence of HIV and syphilis was 7.9% and 15.4%, respectively. Sixty-nine percent ever had an HIV test, 56.2%, 78.7%, and 46.1% received HIV test, free condom/lubricants, and sexually transmitted infection services in the past 12 months (P12M), respectively. MSM with larger social networks and who knew someone infected with HIV were more likely to receive HIV testing and preventive services; lower degrees of stigma and discriminatory attitudes toward HIV/AIDS were positively associated with having an HIV test, whereas unprotected anal intercourse in the past 6 months (P6M) was associated with less preventive services participation. The most reported barriers to HIV testing were fear of testing HIV positive (79.3%) and perceiving no risk for HIV (75.4%). Almost all participants felt that ensuring confidentiality would encourage more MSM to have an HIV test. The two main reasons for not seeking HIV test was not knowing where to go for a test (63.2%) and perceiving low risk of HIV infection (55.1%).Given a high prevalence of HIV, syphilis, and risky behaviors and a relatively low HIV testing rate among MSM in Beijing, more efforts are urgently needed to address barriers to HIV testing and improve accessibility of prevention services.

Changing the Landscape of the HIV Epidemic among MSM in China: Results from Three Consecutive Respondent-Driven Sampling Surveys from 2009 to 2011

This study assessed the changes of HIV incidence and its predictors among Beijings men who have sex with men (MSM). Three consecutive cross-sectional surveys were carried out using a consistent respondent-driven sampling (RDS) approach in 2009, 2010, and 2011, respectively. Structured-questionnaire based interviews were completed with computer-assisted self-administration. Incident infection was examined with BED capture enzyme immunoassay (BED-CEIA). The overall rate of HIV prevalence was 8.0% in the three years (95% confidence interval [CI]: 4.9%–11.2%). The overall rate of BED-CEIA incidence was 7.8/100 person years (PY) (95% CI: 5.5–10.1) with 6.8/100PY (95% CI: 3.4–10.2) in 2009, 11.2/100PY (95% CI: 6.2–16.3) in 2010, and 5.8/100PY (95% CI: 2.4–9.3) in 2011, respectively. Multivariable logistic regression analysis revealed that, compared with HIV-negative MSM, recently infected MSM were more likely to be bisexual (adjusted odds ratio [AOR] = 2.1, 95% CI: 1.1–4.1), live in Beijing ≤3 years (AOR = 2.1, 95% CI: 1.2–4.0), and have a negative attitude towards safe sex (AOR = 1.1 per scale point, 95% CI: 1.0–1.1). This study demonstrated a disturbing rise of HIV infections among Beijings MSM. These findings underscored the urgency of scaling up effective and better-targeted intervention services to stop the rapid spread of the virus.

Poppers use and risky sexual behaviors among men who have sex with men in Beijing, China.

BACKGROUND Although poppers are increasingly popular among MSM in China, little is known about the patterns of poppers use. The objectives of this study were to describe the patterns of poppers use and examine its association with sexual behaviors and HIV infection among MSM in Beijing, China. METHODS As part of a multi-component HIV intervention trial, 3588 MSM were surveyed between March 2013 and March 2014 in Beijing, China. Blood samples were collected and tested for HIV and syphilis. The questionnaire collected information about socio-demographic and behavioral characteristics. Univariate and multivariable logistic regression analyses were performed to evaluate the correlates of poppers use. RESULTS Over a quarter of men (27.5%) reported having used at least one type of drugs in the past three months. Poppers were the most popular one (26.8%). Poppers use was correlated with a higher HIV prevalence [odds ratio (OR): 1.38, 95% confidence interval (CI): 1.11-1.70]. Demographic and sexual behavioral factors associated with poppers use included: younger age [adjusted OR (AOR): 1.56, 95% CI: 1.25-1.94], higher education (AOR: 1.61, 95% CI: 1.33-1.96), alcohol use (AOR: 1.32, 95% CI: 1.10-1.60), seeking male partners mainly via the internet (AOR: 1.60, 95% CI: 1.28-2.00), multiple male sex partnership (AOR: 2.22, 95% CI: 1.90-2.60), and unprotected receptive anal intercourse (AOR: 1.52, 95% CI: 1.28-1.81). CONCLUSIONS In this study, poppers use was positively associated with HIV infection and unprotected anal intercourse. Intervention efforts should be devoted to promote safer sex and HIV testing and counseling among MSM who use poppers.

Measures of condom and safer sex social norms and stigma towards HIV/AIDS among Beijing MSM.

Social norms around condom use and safe sex as well as HIV/AIDS stigma are used to identify persons at higher risk for HIV. These measures have been developed and tested in a variety of settings and populations. While efforts have been undertaken to develop context specific measures of these domains among Chinese MSM, the feasibility of using existing measures is unknown. A survey of MSM, based on respondent-driven sampling, was conducted in Beijing. Existing measures of condom social norms, attitudes towards safer sex and HIV/AIDS stigma were piloted. Internal consistency of all measures was high. As expected higher levels of condom social norms and positive attitudes towards safer sex were associated with condom use. HIV/AIDS stigma and discrimination had a significant relationship with never having an HIV test and lack of discussion of HIV/AIDS with male partners. Correlates of low condom social norms were age, education, employment and resident status. Existing measures of condom social norms, attitudes towards safer sex and HIV/AIDS stigma appear to be appropriate for use among Chinese MSM. Using existing measures as opposed to developing new measures has the potential to expedite investigations into psychosocial correlates of HIV risk behavior.