Yueping Yin

Sexually Transmitted Disease Prevalence and Characteristics of Market Vendors in Eastern China

Background and Objectives Sexually transmitted diseases (STDs) have soared in China. To address the impact, we studied market stall vendors in eastern China. Goal The goal was to determine STD prevalence and predictors. Study Design A total of 1536 randomly selected market stall vendors were interviewed and tested for STDs. Results The prevalence of any STD was 20.1% among those reporting sexual intercourse and 5.5% among those reporting never having sexual intercourse. Among those reporting sexual intercourse, chlamydia was most common (9.4%), followed by herpes (9.3%). A total of 4.5% of those reporting never having sexual intercourse had herpes infection, but none had chlamydia. Prevalence of all STDs was higher among females, and those with low education and multiple partners. The pharmacy was the major source of health care (48.8%). Conclusion Generalizing from the results, targeting only STD clinic patients and persons reporting multiple partners for intervention will exclude a high proportion of those with STDs. More effective, less stigmatized sources of STD treatment should be developed.

Stigma, delayed treatment, and spousal notification among male patients with sexually transmitted disease in China.

Background Stigmatization may prevent effective control of sexually transmitted diseases (STDs) in China. Thus, its impact needs to be studied. Goal The goal of the study was to explore the effect of perceived stigmatization on control of STDs. Study Design A cross-sectional study was conducted among males attending four STD clinics for the first time for a current STD. Results Among 406 patients, 80% felt stigmatized, 28% sought treatment only after suffering symptoms for at least 1 week, and 40% reported continuing to have sex while having symptoms. No association was observed between feelings of stigmatization and delay in seeking treatment. Among those married, 77% expressed unwillingness to notify their spouses. Patients who felt stigmatized were less likely to agree to notify their spouses (odds ratio, 0.42; 95% CI, 0.21–0.85). Conclusion Policies are needed to reduce stigmatization, reduce time to treatment, and promote disclosure to sex partners.

Correlates of HIV infection among former blood/plasma donors in rural China.

Background:In 1995, when the first cases of HIV infection were reported among former plasma donors (FPDs), the Chinese government closed all commercial plasma collection stations. Objective:To determine the prevalence of HIV among FPDs and non-donors in affected villages in Anhui, China. Methods:A cross-sectional survey was conducted among residents, aged 25–55 years, in 40 villages randomly selected from villages with many former blood/plasma donors, using a two-stage clustered sampling method. A questionnaire was administered face-to-face to 1997 villagers without collecting any identifying information, and venous blood specimens were collected for HIV testing with two enzyme-linked immunosorbent assays and western blotting. EpiData was used for data entry, and STATA was used for data analysis. Results:Overall HIV prevalence was 10.8%, with values of 15.1% among FPDs and 4.8% among non-donors. Among FPDs, factors associated with HIV infection included: donating plasma more than 10 times [odds ratio (OR) 4.09; P < 0.001] compared with subjects who donated 1–3 times; spouse being HIV-positive (OR, 4.06; P = 0.001); and being male (OR, 2.04; P = 0.011). Condom use was rare, and was not associated with HIV infection (OR, 1.09; P = 0.872). Among non-plasma donors, spouse being HIV-positive (OR, 11.07, P < 0.001) and having multiple sexual partners (OR, 7.04; P = 0.006) were associated with HIV infection. Conclusions:The prevalence of HIV infection is high among rural residents in villages with former commercial plasma businesses. Plasma but not blood donations were associated with HIV infection. The HIV/AIDS epidemic has spread to non-donors primarily through sexual transmission. HIV/AIDS education, testing, and condoms should be promoted urgently to prevent further transmission.

Syndromic and laboratory diagnosis of sexually transmitted infection: a comparative study in China

Summary: The rate of sexually transmitted infections (STIs) has soared in China. Yet, there is no universal consensus about the accuracy of the syndromic approach to STI management. This study aims to compare the syndromic approach with laboratory tests. A randomly selected sample of market vendors in eastern China (n = 4510) was recruited and assessed for the five most common STIs (Chlamydia trachomatis infection, gonorrhoea, genital herpes [herpes simplex type 2, HSV-2] syphilis and trichomoniasis [female only]). Symptom-based assessments made by physicians were compared with laboratory tests. Laboratory test results were used as the gold standard for the comparisons. The overall sensitivity of physician symptom-based assessment was about 10%; sensitivity was lower for males (1.6%) than for females (17.2%). The sensitivity of physician assessments for those who reported STI symptoms was relatively higher (36.7%) than for those who reported no symptoms (5.1%). More than half (54.37%) of the participants were diagnosed with STI of trichomoniasis. For the other four types of STIs, physicians correctly identified only <10% of the positive cases. The study detected a low sensitivity of STI diagnosis made by physicians in an Eastern city of China. The failure in the detection of asymptomatic patients remains one of the limitations of the syndromic approach.

Reductions in sexually transmitted infections associated with popular opinion leaders in China in a randomised controlled trial

Objectives A community level randomised controlled trial of a Community Popular Opinion Leader (C-POL) intervention to reduce bacterial and viral sexually transmitted infections (STIs) and unprotected extramarital sex was carried out over 2 years in five countries. The main study results did not find significant intervention effects. This paper presents a sub-analysis examining the differential intervention impacts among high-risk and low-risk participants in the China site. Methods From 2002 –2006, 3912 migrant market vendors aged 18 and 49 years were recruited at an urban site in China. Markets were randomly assigned to the C-POL intervention (N=20 markets; n=1979) or standard-care control condition (N=20; n=1933). Both study condition venues received HIV/STI education, free condoms, STI testing and treatment, and training for pharmacists in antibiotic treatments. In intervention markets, C-POLs were identified and trained to diffuse messages regarding safer sex, STI treatment and partner discussions of sex. The primary biological outcome was incidence of new STIs (chlamydia, gonorrhoea, syphilis, trichomonas, herpes or HIV). The primary sexual behaviour risk outcome was any unprotected extramarital sex in the prior 3 months. Results In unadjusted analyses, women had significantly lower rates of STI infection at 24 months in the C-POL intervention (5.7%) compared to controls (8.3%; p=0.043). In mixed-effects regression models, intervention participants with STIs at previous assessments were about half as likely to have STIs at 24 months (OR 0.47, 95% CI 0.25 to 0.90) compared to controls. Conclusions The C-POL intervention lowers HIV risk among those at highest risk (ie, with a STI or engaging in high-risk sexual activities) rather than the general population. Trial registration http://Clinicaltrials.gov/ identifier NCT 00710060.

Is syndromic management better than the current approach for treatment of STDs in China? Evaluation of the cost-effectiveness of syndromic management for male STD patients

Background The syndromic treatment approach has not been evaluated in sexually transmitted disease (STD) clinics in China. Goal The goal was to evaluate and compare the validity and cost-effectiveness of syndromic management with current STD management for men in clinics in Hefei, China. Study Design Diagnostic accuracy, treatment appropriateness, costs, and effectiveness of current clinical procedures and syndromic management were compared for 406 men attending four STD clinics. Results A modified World Health Organization (WHO) syndromic algorithm for urethral discharge yielded 100% sensitivity and a 69% positive predictive value (PPV). A syndromic algorithm for genital ulcers correctly treated all syphilis patients, with a 25% PPV. The average cost (in

Sexually transmitted diseases and risk behaviors among market vendors in China.

US) per correct treatment by the current approach was

Risk of sexual HIV transmission in a rural area of China

323.48 for urethritis and

S2.3 Screening high-risk populations using rapid syphilis tests: the importance of social and cultural contexts

85.65 for syphilis. For the syndromic approach, the average cost per correct treatment was

P1-S2.36 Prevalence and risk factors of HSV-2 infection among men who have sex with men in China

3.15 for urethritis and