Xiping Huan

Rapidly increasing prevalence of HIV and syphilis and HIV-1 subtype characterization among men who have sex with men in Jiangsu, China.

Objectives: To investigate the prevalence of HIV, hepatitis B (HBV), hepatitis C (HCV), and syphilis among men who have sex with men (MSM) in 2 cities of Jiangsu, China, and to characterize the HIV-1 subtypes prevalent among this population. Methods: During September 2006 and July 2007, 296 and 173 MSM were recruited from Nanjing and Yangzhou, respectively. Sera samples were collected and tested for HIV, HBV, HCV, and syphilis infections. The nucleotide sequences of p17 and C2V3 regions were determined by RT-nested-PCR and sequencing. HIV-1 subtypes were characterized by phylogenetic analysis. Results: The prevalence of HIV, HBV, HCV, and syphilis infections among MSM was 5.8%, 11.1%, 0.7%, and 27.7%, respectively. The prevalence of HIV and syphilis was significantly higher in 2006–2007 than in 2003 (P ≤0.0013) in Jiangsu than in other regions of China (P ≤0.003). In contrast, there was no significant difference in HBV and HCV prevalence between present and 2003 studies (P >0.05). The phylogenetic tree of p17 showed that HIV-1 subtypes B, CRF01_AE, and CRF07_BC accounted for 35.7%, 35.7%, and 28.6%, respectively. The result of C2V3 showed that 45.5%, 36.4%, and 18.2% sequences belonged to HIV-1 subtype B, CRF01_AE, and BC recombinants, respectively. The subtype characterization in Jiangsu was significantly different from those in Beijing (P <0.05). Furthermore, Jiangsu HIV-1 B strains were different from majority of China B′ strains and originated from Beijing. Conclusions: The rapidly increasing prevalence and complex subtypes of HIV-1 suggest that effective prevention and intervention strategies are urgently needed for MSM in Jiangsu.

HIV incidence and associated factors in a cohort of men who have sex with men in Nanjing, China.

Background: Many surveys conducted in recent years reported the increasing trend of HIV infection among men who have sex with men (MSM), but limited data exists on HIV incidence by cohort study in China. Methods: A 6-month prospective cohort study was conducted. A total of 397 MSM found HIV seronegative at baseline study were followed-up for 6 months starting from May 2007 and re-evaluated seroconversions of HIV at 6 months. Questionnaire interviews were conducted to collect information about risk behaviors. Results: Of the 397 MSM who were found seronegative at the baseline study, 286 (72.0%) received the HIV antibody testing at month 6; 7 of them showed HIV seroconversions, yielding an incidence of 5.12 per 100 person-years. Significant predictors of seroconversion (Poisson regression analyses) included duration being MSM >10 years (relative risks [RR] = 3.08, 95% CI: 1.53–6.20), recruiting male sex partner mostly at saunas (RR = 2.35, 95% CI:1.09–5.08), positive syphilis diagnosis made at the baseline study (RR = 2.82, 95% CI: 1.31–6.09), having multiple male sex partners in the last 6 months (RR = 2.54, 95% CI: 1.18–5.49), having at least 1 casual male sex partner in the last 6 months (RR = 2.17, 95% CI: 1.00–4.70), and having unprotected anal sex with a regular male sex partner in the last 6 months (RR = 2.22, 95% CI: 1.10–4.49). Conclusions: The incidence of HIV among MSM is very high; many new infections would hence occur in China. Effective interventions are warranted. The risk factors reported in this study give some insights for designing relevant prevention programs.

Accessing HIV testing and treatment among men who have sex with men in China: A qualitative study

Barriers to HIV testing and HIV care and treatment pose significant challenges to HIV prevention among men who have sex with men (MSM) in China. We carried out a qualitative study to identify barriers and facilitators to HIV testing and treatment among Chinese MSM. In 2012, seven focus group (FG) discussions were conducted with 49 MSM participants in Nanjing, China. Purposive sampling was used to recruit a diverse group of MSM participants. Semi-structured interviews were conducted to collect FG data. Major barriers to testing included gay- and HIV-related stigma and discrimination, relationship type and partner characteristics, low perception of risk or threat, HIV is incurable or equals death, concerns of confidentiality, unaware that testing is offered for free, and name-based testing. Key facilitators of testing included engaging in high-risk sex, sense of responsibility for partner, collectivism, testing as a part of standard/routine medical care, MSM-friendly medical personnel, increased acceptance of gay/bisexual men by the general public, legal recognition and protection of homosexuals, and home self-testing. Barriers to treatment included negative coping, nondisclosure to families, misconceptions of domestically produced antiretroviral drugs (ARVs) and the benefits of treatment, and costs associated with long-term treatment. Facilitators of treatment included sense of hopefulness that a cure would be found, the cultural value of longevity, peer social support and professional psychological counseling, affordable and specialized treatment and care, and reduced HIV-related stigma and discrimination. Finally, for both testing and treatment, more educational and promotional activities within MSM communities and among the general public are needed.

The incidence of syphilis, HIV and HCV and associated factors in a cohort of men who have sex with men in Nanjing, China

Objective This study investigated the incidence of syphilis, HIV and hepatitis C virus (HCV), as well as factors associated with syphilis seroconversion among men who have sex with men (MSM) in Nanjing, China. Methods A cohort of MSM was recruited by respondent-driven sampling methods. Those who were syphilis-, HIV- and HCV-seronegative at the baseline were invited to be retested at month 6. A Poisson regression analysis was performed. Results Of the 416 participants in the study, 348 participants were HIV-, syphilis- and HCV-negative at the baseline, 250 (71.84%) of whom returned for retesting at month 6. Nine of these 250 participants had seroconverted to syphilis-positive (incidence=7.58 per 100 person-years (PY); 95% CI 2.63 to 12.53 per 100 PY), and five had seroconverted to HIV-positive (incidence=4.17 per 100 PY; 95% CI=0.52 to 7.83 per 100 PY). No HIV and syphilis coinfection and no HCV seroconversion were found. Multivariate analysis identified four statistically significant factors predicting syphilis seroconversion, including currently single marital status (RR=0.32, 95% CI 0.16 to 0.65, p<0.01), monthly income >US

First detection of a novel HIV type 1 CRF01_AE/07_BC recombinant among an epidemiologically linked cohort of IDUs in Jiangsu, China.

300 (RR=2.68, 95% CI 1.28 to 5.61, p<0.01), self-reported homosexual orientation (RR=0.48, 95% CI 0.24 to 0.96, p<0.05) and recruitment of male sex partners mostly from gay saunas (RR=6.72, 95% CI 2.88 to 15.68, p<0.01). Conclusions The high incidence of syphilis and HIV reflects the seriousness and urgency of the HIV and sexually transmitted diseases (STD) epidemics among MSM in China. Effective interventions of syphilis treatment and prevention should target MSM with characteristics reflecting the aforementioned risk factors.

Worsening Epidemic of HIV and Syphilis Among Men Who Have Sex With Men in Jiangsu Province, China

Our recent study showed that almost equal proportions of B, CRFs_BC, and CRF01_AE were circulating among MSM in Jiangsu, suggesting that there is a very high likelihood of generating new intersubtypes/CRFs recombinants. Here, we report an epidemiologically linked cohort including 22 HIV-1-positive IDUs in Jiangsu. Fifteen blood samples were collected to investigate HIV-1 subtype characterization. The analyses of gag-RT regions showed that 14 of these samples belonged to CRF07_BC. Importantly, we detected, for the first time, a novel second-generation HIV-1 recombinant (07JSNJ001) between CRF01_AE and CRF07_BC. The analyses of the near full-length genomic sequence of 07JSNJ001 (GenBank accession number FJ238521) showed that 07JSNJ001 is composed of at least 10 interlaced CRF07_BC and CRF01_AE segments, quite distinct from any previously identified CRF and URF around the world. The detection of the CRF01_AE/CRF07_BC recombinant may be a harbinger of more new intersubtypes/CRFs recombinants occurring in Jiangsu Province.

Worsening epidemic of HIV and Syphilis among Men who have Sex with Men in Jiangsu, China

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.

High Prevalence of HIV and Syphilis Among Men Who Have Sex With Men Recruited by Respondent-Driven Sampling in a City in Eastern China

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.

Acceptability of circumcision as a means of HIV prevention among men who have sex with men in China

Increasing prevalence of sexually transmitted diseases (STD) was reported among men who have sex with men (MSM) in China. A total of 407 MSMs were recruited by respondent-driven sampling (RDS) from May to July 2008 in Nanjing, China. Face-to-face interviews were conducted to collect information on demographic and risk behaviors; blood samples were collected for HIV and syphilis antibodies testing. The adjusted HIV and syphilis prevalence were, respectively, 7.3% (confidence interval [CI] = 2.6%-10.2%) and 14.4% (95% CI = 9.3%-21.1%). Recruiting male sex partners mostly from saunas and receptive anal intercourse with men in the last 6 months were independently associated with positive HIV status. Risk factors for positive syphilis status included being older than 28 years, low level of HIV-related knowledge, having been a male sex worker, and having unprotected anal sex with casual male sex partners in the past 6 months. High HIV/STD prevalence was detected. HIV/STD prevention strategies are urgently warranted.

The Increased Effectiveness of HIV Preventive Intervention among Men Who Have Sex with Men and of Follow-Up Care for People Living with HIV after ‘Task-Shifting’ to Community-Based Organizations: A ‘Cash on Service Delivery’ Model in China

Abstract Conclusive evidence-based research has shown that circumcision reduces the risk of HIV transmission via heterosexual intercourse, whilst ongoing studies are investigating similar effects via homosexual transmissions and the results are equivocal. Few acceptability studies regarding circumcision were conducted among men who have sex with men (MSM). In this cross-sectional study, a total of 307 MSM were recruited by snowball sampling and were interviewed anonymously by some peer field workers in Yangzhou, China. Amongst all uncircumcised participants (93.4% of all participants were uncircumcised), the willingness to be circumcised increased from 8.1% to 30.7%, before and after the participants were briefed about a hypothetical potential benefit of a 50% risk reduction of circumcision in preventing HIV transmission among MSM. In the multivariate analysis, perception of overly long foreskin (odds ratio [OR] = 6.04), unprotected sexual intercourse with male regular sex partners in the last six months (OR = 2.04), and seeing no chance for contracting HIV in the next 12 months (OR = 0.54) were significantly associated with conditional willingness for circumcision. Adjusting for these variables, other significant factors were identified by multiple logistic regression analysis, including number of perceived disadvantages for having overly long foreskin (adjusted OR = 2.60), variables that were derived from the Theory of Planned Behaviors (TPB), and having some circumcised MSM peers (adjusted OR = 0.45–4.38). Some risk compensation behaviors however, may be practiced by 15.9% of the MSM who were willing to undergo circumcision. The acceptability would increase slightly with the effect size of circumcision in protecting MSM from HIV transmission via homosexual intercourse. However, it was only around 30%, even if circumcision could result in a large (50%) risk reduction in HIV transmission among MSM. If future studies can establish efficacy of circumcision, relevant promotion programs need to guard against risk compensation, though the magnitude of risk compensation may be moderate.